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Chen TT, Su WC, Liu MI. Patient-centered care in diabetes care-concepts, relationships and practice. World J Diabetes 2024; 15:1417-1429. [DOI: 10.4239/wjd.v15.i7.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 07/08/2024] Open
Abstract
We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Wei-Chih Su
- Department of Gastroenterology, Taipei Tzu-Chi Hospital, New Taipei 23142, Taiwan
| | - Mei-I Liu
- Department of Pediatric Endocrinology, Mackay Children's Hospital, Taipei 10449, Taiwan
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2
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Primeau C, Chau M, Turner MR, Paterson C. Patient Experiences of Patient-Clinician Communication Among Cancer Multidisciplinary Healthcare Professionals During "Breaking Bad News": A Qualitative Systematic Review. Semin Oncol Nurs 2024:151680. [PMID: 38918149 DOI: 10.1016/j.soncn.2024.151680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To explore patient experiences of patient-clinician communication during the critical moments of "breaking bad news" in cancer care. METHODS A qualitative systematic review followed the Joanna Briggs Institute methodology and has been reported according to PRISMA guidelines. Databases, including APA PsycINFO, CINAHL, MEDLINE, and Scopus, were searched from the beginning of their date range coverage to April 2023. Data extraction and quality assessment were performed, and a meta-aggregation approach was used for data synthesis. RESULTS Twenty-eight studies were included and represented 976 patients. Key themes included (1) sensing something is wrong (prior to diagnosis), (2) reaction to the diagnosis, (3) information (during breaking bad news), (4) communication with health care professionals, (5) specialist versus nonspecialist centers, (6) decision-making, and (7) feeling supported. The review underscores the need for health care professionals to adeptly navigate and respond to individual patient needs during confronting and distressing times. CONCLUSIONS The complexity and individuality of patient-clinician communication suggest that further education is needed among the cancer multidisciplinary team to develop personalized, empathetic communication strategies in clinical practice, catering to diverse patient preferences. The findings call for more inclusive research across different cultures and languages, and a need to understand evolving communication needs, especially in the context of increasing digital communication modalities in health care. IMPLICATIONS FOR CANCER SURVIVORSHIP This review provides valuable new insights into developing effective communication strategies that are responsive to the diverse needs of patients undergoing cancer treatment. Its findings emphasize the importance of empathy, flexibility, and a personalized approach in delivering bad news and supporting patients throughout survivorship.
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Affiliation(s)
- Charlotte Primeau
- Warwick Manufacturing Group, University of Warwick Coventry, Coventry, UK
| | - Minh Chau
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia; School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Murray R Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia; Flinders University, Caring Futures Institute, Adelaide, Australia; Central Adelaide Local Health Network, Adelaide, Australia.
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Popa M, Young B, Rousseau N, Cherry MG, Jenkins I, Cloke J, Pettitt A, Jenkinson MD, Ahmed S, Pemberton AR, Sherratt FC. Consultations about randomised controlled trials are shorter and less in-depth for socioeconomically disadvantaged patients compared to socioeconomically advantaged patients: qualitative analysis across three trials. Trials 2024; 25:382. [PMID: 38872208 DOI: 10.1186/s13063-024-08216-4] [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] [Received: 08/04/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Patients from socioeconomically disadvantaged backgrounds are underserved in randomised controlled trials, yet they experience a much greater burden of disease compared with patients from socioeconomically advantaged areas. It is crucial to make trials more inclusive to ensure that treatments and interventions are safe and effective in real-world contexts. Improving how information about trials is verbally communicated is an unexplored strategy to make trials more inclusive. This study examined how trials are communicated verbally, comparing consultations involving patients from the most and least socioeconomically disadvantaged areas. METHODS Secondary qualitative analysis of 55 trial consultation transcripts from 41 patients, sampled from 3 qualitative studies embedded in their respective UK multi-site, cancer-related randomised controlled trials. Patients living in the most and least socioeconomically disadvantaged areas, defined using English Indices of Multiple Deprivation decile scores, were purposively sampled. Analysis was largely thematic and drew on the constant comparison method. RESULTS Recruiters communicated clinical uncertainty in a similar way for patients living in different socioeconomic areas. Consultations with disadvantaged patients were, on average, half the duration of those with advantaged patients, and tended to involve recruiters providing less in-depth explanations of trial concepts, used phrasing that softened trial arm risks, and described trial processes (e.g. randomisation) using informal or metaphorical phrasing. Disadvantaged and advantaged patients differed in the concerns they expressed; disadvantaged patients voiced fewer concerns and asked fewer questions but were also less likely to be invited to do so by recruiters. CONCLUSION Interactions about trials unfolded in different ways between patients living in different socioeconomic areas, likely due to both patient- and recruiter-related factors. We present considerations for recruiters when discussing trials with patients from socioeconomically disadvantaged backgrounds, aimed at enhancing trial communication. Future research should examine disadvantaged patients' and recruiters' experiences of verbal trial communication to inform guidance that addresses the needs and preferences of underserved groups.
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Affiliation(s)
- Mariana Popa
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Nikki Rousseau
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mary G Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Isobel Jenkins
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jane Cloke
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Andrew Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Saiqa Ahmed
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Allan R Pemberton
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Frances C Sherratt
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Elkefi S, Asan O. Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients. JMIR Hum Factors 2024; 11:e53053. [PMID: 38656776 PMCID: PMC11079762 DOI: 10.2196/53053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. OBJECTIVE This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. METHODS This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. RESULTS We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). CONCLUSIONS Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.
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Affiliation(s)
- Safa Elkefi
- School of Nursing, Columbia University, New York, NY, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
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Çakmak C, Uğurluoğlu Ö. The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control 2024; 31:10732748241236327. [PMID: 38411086 PMCID: PMC10901059 DOI: 10.1177/10732748241236327] [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] [Received: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Patient-centered communication is a type of communication that takes place between the provider and the patient. OBJECTIVES It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction. METHOD The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye. RESULTS More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction. CONCLUSION Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.
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Affiliation(s)
- Cuma Çakmak
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Dicle University, Diyarbakır, Türkiye
| | - Özgür Uğurluoğlu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Türkiye
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Shabanian J, Capaldi JM, Luna-Lupercio B, Finster LJ, Noskoff K, Gan H, Davies S, Whiteway SL, Shirazipour CH. Healthcare providers' promotion of physical activity among child and adolescent cancer survivors: strategies and challenges. J Cancer Surviv 2023; 17:1546-1560. [PMID: 35759086 PMCID: PMC9244136 DOI: 10.1007/s11764-022-01218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE This study aims to investigate how healthcare providers (HCPs) promote physical activity (PA) to child and adolescent cancer survivors. METHODS Semi-structured interviews were conducted with HCPs (n = 16; women n = 12; men n = 4) who provide care for cancer survivor youth (age 3 to 18). Participants represented 7 professions, including child life specialists, oncologists, nurse practitioners, physical therapists, and social workers. A reflexive thematic analysis was conducted to explore the techniques that HCPs use to promote PA for this patient population and ways PA promotion can improve. RESULTS HCPs use five strategies to promote PA to cancer survivor youth: (1) broadening the definition of PA, (2) tailoring PA recommendations, (3) including families, (4) connecting patients to programming, and (5) promoting patient motivation. CONCLUSIONS This research highlights techniques that HCPs use to promote PA to young cancer survivors and reveals the need for additional ways to support HCPs to improve PA promotion for child and adolescent cancer survivors. While HCPs emphasized the importance of PA for this patient population, they navigate barriers that limit the quality of PA discussions. IMPLICATIONS FOR CANCER SURVIVORS Further research should explore interventions to improve PA promotion and PA participation among child and adolescent cancer survivors. By understanding the perspectives of HCPs, patients, and their families, PA promotion strategies can be improved, and more programs that support both patients and practitioners may be developed.
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Affiliation(s)
- Julia Shabanian
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Jessica M Capaldi
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Bianca Luna-Lupercio
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | - Laurel J Finster
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA
| | | | - Hilary Gan
- Teen Cancer America, Los Angeles, CA, USA
| | | | - Susan L Whiteway
- Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University Health Sciences, Bethesda, MD, USA
| | - Celina H Shirazipour
- Cedars-Sinai Medical Center, Cancer Research Center for Health Equity, 700 N San Vicente Blvd, 5th Floor, West Hollywood, CA, 90069, USA.
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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de Vries S, Verhoef MJ, Vervoort SCJM, van der Linden YM, Teunissen SCCM, de Graaf E. Barriers and facilitators that hospital clinicians perceive to discuss the personal values, wishes, and needs of patients in palliative care: a mixed-methods systematic review. Palliat Care Soc Pract 2023; 17:26323524231212510. [PMID: 38044932 PMCID: PMC10693227 DOI: 10.1177/26323524231212510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Background The exploration and monitoring of the personal values, wishes, and needs (VWN) of patients in the palliative phase by hospital clinicians is essential for guiding appropriate palliative care. Objective To explore the barriers and facilitators concerning communication with patients in the palliative phase about their VWN as perceived by hospital clinicians. Design A mixed-methods systematic review following the Joanna Briggs Institute guidelines for mixed-method systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted (PROSPERO ID: CRD42021216693). Data sources and methods Eight databases, including PubMed, Embase, and CINAHL, were searched without time restrictions. The search string was built using the search Palliative cAre Literature rEview iTeraTive mEthod (PALETTE) framework. Eligible studies focused on (1) hospital clinicians and (2) perceived barriers and facilitators regarding the exploration and monitoring of the VWN of adult patients in the palliative phase. Two researchers independently selected articles and evaluated the quality. Findings were synthesized using a convergent integrated approach. Results In total, 29 studies were included: 14 quantitative, 13 qualitative, and 2 mixed methods. Five synthesized findings were identified: (1) the clinician's professional manners, (2) the image formed of the patient and loved ones, (3) the human aspect of being a clinician, (4) the multidisciplinary collaboration, and (5) the contextual preconditions. Most studies seemed focused on communication about treatment decision making. Conclusion A patient-centered approach seems lacking when clinicians discuss the patient's VWN, since most studies focused on treatment decision making rather than on the exploration and monitoring of the multidimensional well-being of patients. This review emphasizes the need for the development and integration of a systematic approach to explore and monitor the patients' VWN to improve appropriate palliative care in hospitals.
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Affiliation(s)
- Sita de Vries
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
| | - Mary-Joanne Verhoef
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sigrid Cornelia Johanna Maria Vervoort
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvette Milene van der Linden
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Contreras Sánchez SE, Doubova SV, Grajales Álvarez R, Dip Borunda AK, Martínez Pineda WJ, Nuñez Cerrillo JG, Silva Bravo F, Zalapa Velázquez R, Gutiérrez De la Barrera M, Leslie HH. Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial. BMJ Open 2023; 13:e077322. [PMID: 37931967 PMCID: PMC10632859 DOI: 10.1136/bmjopen-2023-077322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses. METHODS AND ANALYSIS We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico's largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months. ETHICS AND DISSEMINATION The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT05925257.
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Affiliation(s)
- Saúl Eduardo Contreras Sánchez
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | | | | | | | | | - Fernando Silva Bravo
- Oncology Department, Speciality Hospital CMN Manuel Ávila Camacho, IMSS, Puebla, Puebla, Mexico
| | - Rita Zalapa Velázquez
- Oncology Department, Speciality Hospital CMN Manuel Ávila Camacho, IMSS, Puebla, Puebla, Mexico
| | | | - Hannah H Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
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Torres TK, Hamann HA, Shen M, Stone J. Empathic Communication and Implicit Bias in the Context of Cancer Among a Medical Student Sample. HEALTH COMMUNICATION 2023:1-12. [PMID: 37906434 PMCID: PMC11058116 DOI: 10.1080/10410236.2023.2272359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters (M = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student (OR = 3.24, p = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.
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Affiliation(s)
- Tara K. Torres
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ
- University of Arizona Cancer Center, Tucson, AZ
| | - Megan Shen
- Fred Hutchinson Cancer Research Institute, Seattle, WA
| | - Jeff Stone
- Department of Psychology, University of Arizona, Tucson, AZ
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Rahaman RR, Motilal MS, Khan R, Maharaj RG. Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases. BMC PRIMARY CARE 2023; 24:215. [PMID: 37865738 PMCID: PMC10589933 DOI: 10.1186/s12875-023-02149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/03/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement. METHOD A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12. RESULTS There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025). CONCLUSION Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.
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Affiliation(s)
- Reisa R Rahaman
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - M Shastri Motilal
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Raveed Khan
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Rohan G Maharaj
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.
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Elkefi S, Asan O. Perceived Patient Workload and Its Impact on Outcomes During New Cancer Patient Visits: Analysis of a Convenience Sample. JMIR Hum Factors 2023; 10:e49490. [PMID: 37594798 PMCID: PMC10474510 DOI: 10.2196/49490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Studies exploring the workload in health care focus on the doctors' perspectives. The ecology of the health care environment is critical and different for doctors and patients. OBJECTIVE In this study, we explore the patient workload among newly diagnosed patients with cancer during their first visit and its impact on the patient's perceptions of the quality of care (their trust in their doctors, their satisfaction with the care visits, their perception of technology use). METHODS We collected data from the Hackensack Meridian Health, John Theurer Cancer Center between February 2021 and May 2022. The technology use considered during the visit is related to doctors' use of electronic health records. A total of 135 participants were included in the study. Most participants were 50-64 years old (n=91, 67.41%). A majority (n=81, 60%) of them were White, and only (n=16, 11.85%) went to graduate schools. RESULTS The findings captured the significant effect of overall workload on trust in doctors and perception of health IT use within the visits. On the other hand, the overall workload did not impact patients' satisfaction during the visit. A total of 80% (n=108) of patients experienced an overall high level of workload. Despite almost 55% (n=75) of them experiencing a high mental load, 71.1% (n=96) reported low levels of effort, 89% (n=120) experienced low time pressure, 85.2% (n=115) experienced low frustration levels, and 69.6% (n=94) experienced low physical activity. The more overall workload patients felt, the less they trusted their doctors (odds ratio [OR] 0.059, 95% CI 0.001-2.34; P=.007). Low trust was also associated with the demanding mental tasks in the visits (OR 0.055, 95% CI 0.002-2.64; P<.001), the physical load (OR 0.194, 95% CI 0.004-4.23; P<.001), the time load (OR 0.183, 95% CI 0.02-2.35; P=.046) the effort needed to cope with the environment (OR 0.163, 95% CI 0.05-1.69; P<.001), and the frustration levels (OR 0.323, 95% CI 0.04-2.55; P=.03). The patients' perceptions of electronic health record use during the visit were negatively impacted by the overall workload experienced by the patients (OR 0.315, 95% CI 0.08-6.35; P=.01) and the high frustration level experienced (OR 0.111, 95% CI 0.015-3.75; P<.001). CONCLUSIONS The study's findings established pathways for future research and have implications for cancer patients' workload. Better technology design and use can minimize perceived workload, which might contribute to the trust relationship between doctors and patients in this critical environment. Future human factors work needs to explore the workload and driving factors in longitudinal studies and assess whether these workloads might contribute to unintended patient outcomes and medical errors.
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Affiliation(s)
- Safa Elkefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
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Marino F, Alby F, Zucchermaglio C, Fatigante M. Digital technology in medical visits: a critical review of its impact on doctor-patient communication. Front Psychiatry 2023; 14:1226225. [PMID: 37575567 PMCID: PMC10412815 DOI: 10.3389/fpsyt.2023.1226225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
With the rapid advances of digital technology, computer-mediated medical practices are becoming increasingly dominant in medical visits. However, the question of how to ensure effective, patient-centered communication in this transition remains crucial. In this mini-review, we explore this topic by reviewing quantitative and survey-based studies, as well as discursive-interactional studies that focus on the visit as a communicative event. The review is organized into four sections: the introductory section provides a brief synthesis of the two main models used in medical practice and describes the effects of patient-centered communication practices on patients' health and well-being. The second section presents and discusses qualitative and quantitative studies that assess the effect of technology on medical interaction and its impact on patient-centered communication. The third section focuses on whether and how the digital medical record represents a "potential communication risk" during doctor-patient interactions and explores how certain pen-and-paper literacy practices could help mitigate these challenges. In the concluding section, we outline and analyze three key considerations for utilizing technologies to foster and enhance patient-centered communication during medical visits.
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Affiliation(s)
- Filomena Marino
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
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13
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Gåsvær JI, Jepsen R, Heldal I, Sudmann T. Supporting Collaboration in Rehabilitation Trajectories With Information and Communication Technologies: Scoping Review. JMIR Rehabil Assist Technol 2023; 10:e46408. [PMID: 37432715 PMCID: PMC10369310 DOI: 10.2196/46408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/14/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Despite a surge in health information and communication technology (ICT), there is little evidence of lowered cost or increased quality of care. ICT may support patients, health care providers, and other stakeholders through complex rehabilitation trajectories by offering digital platforms for collaboration, shared decision-making, and safe storage of data. Yet, the questions on how ICT can become a useful tool and how the complex intersection between producers and users of ICT should be solved are challenging. OBJECTIVE This study aims to review the literature on how ICTs are used to foster collaboration among the patient, the provider, and other stakeholders. METHODS This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were identified by searching MEDLINE (OVID), Embase (OVID), CINAHL (EBSCOhost), AMED (EBSCOhost), and Scopus. Unpublished studies were extracted from OAIster, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, NARIC, and Google Scholar. Eligible papers addressed or described a remote dialogue between stakeholders using ICT to address goals and means, provide decision support, or evaluate certain treatment modalities within a rehabilitation context. Due to the rapid development of ICTs, searches included studies published in the period of 2018-2022. RESULTS In total, 3206 papers (excluding duplicates) were screened. Three papers met all inclusion criteria. The papers varied in design, key findings, and key challenges. These 3 studies reported outcomes such as improvements in activity performance, participation, frequency of leaving the house, improved self-efficacy, change in patients' perspective on possibilities, and change in professionals' understanding of patients' priorities. However, a misfit between the participants' needs and the technology offered, complexity and lack of availability of the technology, difficulties with implementation and uptake, and lack of flexibility in setup and maintenance reduced the value of ICT for those involved in the studies. The low number of included papers is probably due to the complexity of remote collaboration with ICT. CONCLUSIONS ICT has the potential to facilitate communication among stakeholders in the complex and collaborative context of rehabilitation trajectories. This scoping review indicates that there is a paucity of research considering remote ICT-supported collaboration in health care and rehabilitation trajectories. Furthermore, current ICT builds on eHealth literacy, which may differ among stakeholders, and the lack of sufficient eHealth literacy and ICT knowledge creates barriers for access to health care and rehabilitation. Lastly, the aim and results of this review are probably most relevant in high-income countries.
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Affiliation(s)
- Jo Inge Gåsvær
- Faculty of Health and Social Sciences, Department of Health and Function, Western Norway University of Applies Sciences, Bergen, Norway
- Carasent Norge AS, Dale i Sunnfjord, Norway
| | - Randi Jepsen
- Red Cross Haugland Rehabilitation Center, Flekke, Norway
- Center for Epidemiological Research, Nykøbing F Hospital, Nykøbing Falster, Denmark
| | - Ilona Heldal
- Department of Computer Science, Electrical Engineering and Mathematical Sciences, Faculty of Engineering and Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tobba Sudmann
- Faculty of Health and Social Sciences, Department of Health and Function, Western Norway University of Applies Sciences, Bergen, Norway
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Marino F, Alby F, Zucchermaglio C, Scalisi TG, Lauriola M. Navigating Intercultural Medical Encounters: An Examination of Patient-Centered Communication Practices with Italian and Foreign Cancer Patients Living in Italy. Cancers (Basel) 2023; 15:cancers15113008. [PMID: 37296970 DOI: 10.3390/cancers15113008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Effective communication is crucial in cancer care due to the sensitive nature of the information and the psychosocial impact on patients and their families. Patient-centered communication (PCC) is the gold standard for providing quality cancer care, as it improves patient satisfaction, treatment adherence, clinical outcomes, and overall quality of life. However, doctor-patient communication can be complicated by ethnic, linguistic, and cultural differences. This study employed the ONCode coding system to investigate PCC practices in oncological visits (doctor's communicative behavior, patient's initiatives, misalignments, interruptions, accountability, and expressions of trust in participants' talk, Markers of uncertainty in doctor's talk, markers of emotions in doctor's talk). Forty-two video-recorded patient-oncologist encounters (with 22 Italian and 20 foreign patients), including both first and follow-up visits, were analyzed. Three discriminant analyses were conducted to assess differences in PCC between patient groups (Italian or foreign patients) according to the type of encounter (first visit or follow-up) and the presence or absence of companions during the encounters. Multiple regression analyses were performed to evaluate the PCC differences by oncologist age, patient age, and patient sex, controlling for the type of encounter, the presence of a companion during the visit, and patient group on ONCode dimensions. No differences were found in PCC by patient group in discriminant analyses and regressions. Doctor communication behavior, interruptions, accountability, and expressions of trust were higher in first visits than in follow-ups. The disparities in PCC were primarily linked to the type of visit and the age of the oncologist. However, a qualitative analysis showed notable differences in the types of interruptions during visits with foreign patients compared to Italian patients. It is essential to minimize interruptions during intercultural encounters to foster a more respectful and conducive environment for patients. Furthermore, even when foreign patients demonstrate sufficient linguistic competence, healthcare providers should not solely rely on this factor to ensure effective communication and quality care.
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Affiliation(s)
- Filomena Marino
- Department of Social and Developmental Psychology, Sapienza Università di Roma, 00185 Roma, Italy
| | - Francesca Alby
- Department of Social and Developmental Psychology, Sapienza Università di Roma, 00185 Roma, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, Sapienza Università di Roma, 00185 Roma, Italy
| | - Teresa Gloria Scalisi
- Department of Social and Developmental Psychology, Sapienza Università di Roma, 00185 Roma, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza Università di Roma, 00185 Roma, Italy
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15
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Kobayashi M, Katayama M, Hayashi T, Hashiyama T, Iyanagi T, Une S, Honda M. Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study. BMJ Open 2023; 13:e065477. [PMID: 36868602 PMCID: PMC9990644 DOI: 10.1136/bmjopen-2022-065477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES To quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and to qualitatively explore the educational benefits of this training programme. DESIGN A convergent mixed-methods study, including an intervention trial with a quasi-experimental design, was conducted to quantitatively analyse the communication skills of physicians. Qualitative data were collected via physicians' responses to an open-ended questionnaire administered after the training. SETTING An acute care hospital. PARTICIPANTS A total of 23 physicians. INTERVENTIONS In a 4-week multimodal comprehensive care communication skills training programme, including video lectures and bedside instruction, from May to October 2021, all the participants examined a simulated patient in the same scenario before and after their training. These examinations were video recorded by an eye-tracking camera and two fixed cameras. Then, the videos were analysed for communication skills by AI. MAIN OUTCOME MEASURES The primary outcomes were the physicians' eye contact, verbal expression, physical touch and multimodal communication skills with a simulated patient. The secondary outcomes were the physicians' empathy and burnout scores. RESULTS The proportion of the duration of the participants' single and multimodal types of communication significantly increased (p<0.001). The mean empathy scores and the personal accomplishment burnout scores also significantly increased after training. We developed a learning cycle model based on the six categories that changed after training from the physicians' perspective: multimodal comprehensive care communication skills training; increasing awareness of and sensitivity to changes to geriatric patients' condition; changes in clinical management; professionalism; team building and personal accomplishments. CONCLUSIONS Our study showed that multimodal comprehensive care communication skills training for physicians increased the proportions of time spent performing single and multimodal communication skills by video analysis through AI. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000044288; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050586).
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Affiliation(s)
- Masaki Kobayashi
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Division of Geriatric Medicine, Rochester Regional Health System, Rochester, New York, USA
| | - Mitsuya Katayama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Tomofumi Hayashi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Takuhiro Hashiyama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Toshinori Iyanagi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Saki Une
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
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Alves-Nogueira AC, Melo D, Carona C, Figueiredo-Dias M. The Psychosocial Impact of the Decision to Undergo Risk-Reducing Salpingo-Oophorectomy Surgery in BRCA Mutation Carriers and the Role of Physician-Patient Communication. Curr Oncol 2023; 30:2429-2440. [PMID: 36826146 PMCID: PMC9955232 DOI: 10.3390/curroncol30020185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy (RRSO) is an effective prophylactic surgery provided to premenopausal women carrying BRCA1 or BRCA2 mutations and presenting an increased risk of developing breast or ovarian cancer. This procedure is related to physiological, sexual, and psychosocial distress, which altogether increase uncertainty and complexity in the clinical decision-making process and post-surgery adaptation. Physician-patient communication (PPC) has been pointed out as a determinant factor in the decision-making to undergo RRSO, and the subsequent adjustment of women. However, studies examining the psychosocial impact of the decision-making process have been scarce and often lack clear theoretical frameworks. While the role of PPC in such processes has been highlighted in a few qualitative studies, there is a paucity of quantitative research addressing this question. Therefore, this narrative review, conducted using a multidisciplinary approach, was planned to: (1) present an updated medical background for RRSO; (2) analyze the psychosocial impact of the decision-making process within a theoretical framework of the Health Belief Model; and (3) discuss the role of PPC in such a decision-making process and in post-surgery. The collected research also enabled the recommendation of some additions to the existing clinical guidelines and the outlining of future research directions.
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Affiliation(s)
- Ana C. Alves-Nogueira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal
- Correspondence:
| | - Daniela Melo
- Gynecology Clinic, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra University Hospital Centre, 3004-561 Coimbra, Portugal
| | - Carlos Carona
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- Gynecology Clinic, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra University Hospital Centre, 3004-561 Coimbra, Portugal
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17
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Robbel C, Vesel L, Ernst E, He Y, Vesel T. Community Member and Health Care Provider Perspectives on Communication With Chinese American Patients With Cancer: A Qualitative Study. JCO Oncol Pract 2022; 18:e1927-e1934. [PMID: 36265104 PMCID: PMC9750549 DOI: 10.1200/op.22.00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/23/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Effective health care provider-patient discussions of cancer diagnoses and prognoses are essential to enhance health outcomes in oncology. Chinese Americans have been designated an underserved population in oncology by the National Institutes of Health. We explored the perspectives of Boston Chinese American community members and health care providers regarding communication preferences and decision making in oncology care. METHODS In this inductive, qualitative study, we conducted virtual, semi-structured interviews with 21 health care providers with experience in caring for Chinese American patients with cancer and 25 older Boston Chinatown community members who self-identify as Chinese or Chinese American. Thematic analysis was performed. RESULTS Two major themes were identified. First, provider communication should incorporate a gentle but truthful approach, careful word choice, authority-led style, and professionalism. Second, the family plays a large role in medical and nonmedical settings, and a family-centered approach to communication should be used. CONCLUSION Our study builds on and challenges current knowledge regarding oncologic communication with Chinese American patients. A focus on the improvement of provider-patient cancer communication for Chinese Americans will improve care quality and satisfaction among patients and clinicians alike and serve to decrease disparities in care.
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Affiliation(s)
- Courtney Robbel
- Division of Hematology Oncology, Tufts Medical Center, Boston, MA 02111
- Department of Hematology Oncology, Atrius Health, Boston, MA 02215
| | - Linda Vesel
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA
| | - Emma Ernst
- Tufts University School of Medicine, Boston, MA
| | - Yang He
- Greater Boston Chinese Golden Age Center, Boston, MA
| | - Tamara Vesel
- Tufts University School of Medicine, Boston, MA
- Division of Palliative Care, Tufts Medical Center, Boston, MA
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18
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Amanian A, Tran KL, Wang E, Chotwani H, Prisman E. Postoperative patient-centered multimedia education in head and neck cancer patients: A pilot study. Laryngoscope Investig Otolaryngol 2022; 7:1857-1865. [PMID: 36544951 PMCID: PMC9764763 DOI: 10.1002/lio2.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/17/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022] Open
Abstract
Objective It is hypothesized that patients who are actively provided with more treatment-related education may report increased satisfaction and have improved overall outcomes. The aim of this study was to demonstrate the feasibility of an audiovisual education platform in patients undergoing head and neck surgery and to investigate whether patients using this module reported increased satisfaction. Methods This was a prospective pilot study of patients undergoing major head and neck reconstructive surgery who were randomized to either (1) control group or (2) intervention (i.e., in-patient audiovisual educational module). Both study groups then completed a discharge survey. Results Total 35 patients were recruited into the study (N = 16 Intervention; N = 19 Control). Patients in the intervention group reported an increased satisfaction with their overall outcome. Exactly 87.5% (14 of 16) found the intervention to be "Extremely useful," "Quite useful," or "Sometimes useful." Exactly 68.8% (11 of 16) would recommend similar patients to receive the same educational intervention. However, there was no significant difference in patients' perceived level of involvement amongst the two groups. For future improvements to the intervention, patients requested further information such as how to look after themselves, postoperative radiation, course in hospital, and nutrition. Conclusion This pilot study demonstrated the feasibility of an audiovisual education platform in the postoperative setting for patients undergoing major head and neck reconstructive surgery. Although most patients found the module useful, future steps will incorporate patient feedback to further improve the educational platform and confirm the current preliminary impressions in prospective studies. Level of Evidence 1b.
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Affiliation(s)
- Ameen Amanian
- Division of Otolaryngology – Head and Neck SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Khanh Linh Tran
- Division of Otolaryngology – Head and Neck SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Edward Wang
- Division of Otolaryngology – Head and Neck SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Himanshu Chotwani
- Division of Otolaryngology – Head and Neck SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Eitan Prisman
- Division of Otolaryngology – Head and Neck SurgeryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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19
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Alpert JM, Hampton CN, Raisa A, Markham MJ, Bylund CL. Integrating patient-centeredness into online patient-clinician communication: a qualitative analysis of clinicians' secure messaging usage. Support Care Cancer 2022; 30:9851-9857. [PMID: 36260178 PMCID: PMC9580446 DOI: 10.1007/s00520-022-07408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
Purpose Patient-centered communication (PCC) in cancer care is helpful to nurture the patient-clinician relationship and respond to patients’ emotions. However, it is unknown how PCC is incorporated into electronic patient-clinician communication. Methods In-depth, semi-structured qualitative interviews with clinicians were conducted to understand how PCC was integrated into asynchronous communication between patients and clinicians; otherwise, known as secure messaging. The constant comparative method was used to develop a codebook and formulate themes. Results Twenty clinicians in medical and radiation oncology participated in audio-recorded interviews. Three main themes addressed how clinicians incorporate PCC within messages: (1) being mindful of the patient-clinician relationship, (2) encouraging participation and partnership, and (3) responding promptly suggests accessibility and approachability. Clinicians recommended that patients could craft more effective messages by being specific, expressing concern, needs, and directness, summarized by the acronym S.E.N.D. Conclusions Clinicians value secure messaging to connect with patients and demonstrate their accessibility. They acknowledge that secure messaging can influence the patient-clinician relationship and make efforts to include considerate and supportive language. As secure messaging is increasingly relied upon for patient-clinician communication, patients’ message quality must improve to assist clinicians in being able to provide prompt responses inclusive of PCC.
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Affiliation(s)
- Jordan M Alpert
- Center for Value-Based Care Research, Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA.
| | - Chelsea N Hampton
- College of Journalism and Communications, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA
| | - Aantaki Raisa
- College of Journalism and Communications, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA
| | | | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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20
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Scheel-Sailer A, Eich S, Jelmoni L, Lampart P, Schwitter M, Sigrist-Nix D, Langewitz W. Effect of an interprofessional small-group communication skills training incorporating critical incident approaches in an acute care and rehabilitation clinic specialized for spinal cord injury and disorder. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:883138. [PMID: 36188965 PMCID: PMC9397787 DOI: 10.3389/fresc.2022.883138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
AIM To investigate the impact of site-specific inter-professional small-group communication skills training (CST) that incorporates critical incident approaches to learning on patient satisfaction with communication. SETTING Rehabilitation clinic specialized for spinal cord injury/disorder (SCI/D). METHODS Retrospective observational cohort study design using patient and health-professional self-report data. Data for patient satisfaction with communication were collected in 2014 (existing records) and each year from 2015 to 2021 (post-program; volunteers) using the MECON survey. RESULTS Fifteen basic (n = 161 participants), 16 refresher (n = 84), and five short (n = 17) CST seminars were conducted. Overall, 262 employees (105 physicians, 63 nurses, 36 physio- and occupational therapists, and 58 others) participated; 92 participants (response rate 37.6%) responded to feedback surveys. They rated the seminars positive concerning the alternation between theory, discussion, and practical exercise in 91.3%, and rated the length of the training ideal in 80.2%. Post-program patient satisfaction overall increased from 83.1% (confidence interval (CI) 2.6%) to 90% (CI 0.8%; R2 = 0.776; p= 0.004). It was higher in specific communication-related topics: "receiving information" (81.1%, CI 3.1-90.2%, CI 1.0%; p = 0.003), "being able to bring in concerns" (83%, CI 1.0-90.8%; R2 = 0.707; p = 0.009) and "being treated with respect" (89.4%, CI 2.6-94.4%, CI 0.8%; R2 = 0.708; p = 0.004). PRACTICE IMPLICATIONS Inter-professional CST is feasible and well accepted by professionals from various professional groups. During seven years of continuous training, independent patient ratings of satisfaction with professional communication have improved significantly. Participants attest to the training's high credibility and usefulness in everyday life.
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Affiliation(s)
- Anke Scheel-Sailer
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stephanie Eich
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Luca Jelmoni
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Patricia Lampart
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Diana Sigrist-Nix
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- MECON Measure & Consult GmbH, Zürich, Switzerland
| | - Wolf Langewitz
- Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
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Cao B, Wang D, Wang Y, Hall BJ. Patient Expectation in China: Exploring Patient Satisfaction in Online and Offline Patient-Provider Communication. Front Psychol 2022; 13:888657. [PMID: 35756275 PMCID: PMC9226754 DOI: 10.3389/fpsyg.2022.888657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Online patient-provider communication (OPPC) has become an alternative approach to seek medical advice and contact health professionals. However, its penetration rate remains low, and the underlying mechanisms of patient satisfaction with OPPC are underexamined. This study investigates the role of patient expectancy and the expectancy violation of patient-centered communication (PCC) in patient satisfaction in emerging OPPC scenarios by integrating the concepts of PCC and expectancy violation theory (EVT). Method An online survey was conducted in October 2019 among Chinese respondents who experienced OPPC and offline medical services. Results The 471 qualified participants reported high satisfaction with OPPC (mean [M] = 3.63, standard deviation [SD] = 0.81). However, patient satisfaction with OPPC was lower than that in offline medical encounters (M = 3.75, SD = 0.80), and patients suffered a higher expectancy violation of PCC in OPPC scenarios (M = 0.45, SD = 0.76) than in offline medical encounters (M = 0.27, SD = 0.69). Nevertheless, patients' satisfaction with OPPC significantly increased as the frequency of OPPC usage increased (β = 0.209, p < 0.001). This positive relationship was partially mediated by the decrease in the expectancy violation of PCC in OPPC scenarios. Discussion The study can contribute to increasing the adoption of OPPC and reducing the burden of offline medical resources.
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Affiliation(s)
- Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Dongya Wang
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Yifan Wang
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Brian J. Hall
- Center for Global Health Equity, New York University Shanghai, Shanghai, China
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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22
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Waters AR, Zamora ER, Fluchel M, Warner EL, Rosen S, Gwilliam V, Tovar GE, Morales JP, Kirchhoff AC. A qualitative inquiry of communication based barriers to the diagnosis of pediatric cancer: Perceptions of primarily Spanish-speaking caregivers. PATIENT EDUCATION AND COUNSELING 2022; 105:1503-1509. [PMID: 34598802 DOI: 10.1016/j.pec.2021.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Primarily Spanish-speaking cancer patients and caregivers often experience non-congruence with healthcare providers about beliefs, values, and knowledge of cancer. Our goal was to describe how communication related to the diagnosis of cancer was influenced by culture and language among primarily Spanish-speaking caregivers of pediatric cancer patients. METHODS Caregivers participated in three focus groups about their experiences with their child's diagnosis, communication issues, and understanding of their child's diagnosis and treatment plan. Focus groups were audio recorded, transcribed, and qualitatively analyzed using interpretive description. RESULTS Three themes emerged: 1) Negative experiences and barriers during the cancer diagnosis and treatment, 2) Miscommunication and system complexity, and 3) Language barriers throughout the diagnostic process. Due to barriers and negative experiences, some caregivers reported that their child's diagnosis was delayed, that providers sometimes used dehumanizing language, and that they were confused about diagnostic testing and treatment. CONCLUSION Cultural and linguistic disparities in pediatric oncology must be systematically addressed at the provider, clinic, and system level. PRACTICE IMPLICATIONS High-quality cancer care delivered by oncologists and cancer care teams should include cultural humility when discussing the cancer diagnosis and prognosis.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
| | - Eduardo R Zamora
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mark Fluchel
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Echo L Warner
- University of Arizona Cancer Center, Tucson, Arizona, USA; College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Stephanie Rosen
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Vannina Gwilliam
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Guadalupe E Tovar
- Patient and Public Education Department, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jennyffer P Morales
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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23
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Communicating is analogous to caring: A systematic review and thematic synthesis of the patient-clinician communication experiences of individuals with ovarian cancer. Palliat Support Care 2022; 21:515-533. [PMID: 35582975 DOI: 10.1017/s1478951522000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To systematically review and synthesize the patient-clinician communication experiences of individuals with ovarian cancer. METHODS The CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases were reviewed for articles that described (a) original qualitative or mixed methods research, (b) the experiences of individuals with ovarian cancer, and (c) findings related to patient-clinician communication. Relevant data were extracted from study results sections, then coded for descriptive and analytical themes in accordance with Thomas and Harden's approach to thematic synthesis. Data were coded by two authors and discrepancies were resolved through discussion. RESULTS Of 1,390 unique articles, 65 met criteria for inclusion. Four descriptive themes captured participants' experiences communicating with clinicians: respecting me, seeing me, supporting me, and advocating for myself. Findings were synthesized into three analytical themes: communication is analogous to caring, communication is essential to personalized care, and communication may mitigate or exacerbate the burden of illness. SIGNIFICANCE OF RESULTS Patient-clinician communication is a process by which individuals with ovarian cancer may engage in self-advocacy and appraise the extent to which they are seen, respected, and supported by clinicians. Strategies to enhance patient-clinician communication in the ovarian cancer care setting may promote patient perceptions of patient-centered care.
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24
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Jain G, Walter L, Reed C, O’Donnell P, Troy J. How do patients and physicians communicate about hereditary angioedema in the United States? PLoS One 2021; 16:e0260805. [PMID: 34855883 PMCID: PMC8638958 DOI: 10.1371/journal.pone.0260805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hereditary angioedema (HAE) is a rare disease that manifests as recurrent and debilitating angioedema attacks, significantly impacting patients’ quality of life. Objective To assess communication dynamics between patients with HAE and treating physicians and the impact this has on the treatment of HAE in the United States. Methods This observational study used an institutional review board–approved protocol to collect four sources of patient–physician communication data from the period between January 2015 and May 2017: in-office conversations between patients aged ≥18 years with HAE and physicians, follow-up dictations with physicians, telephone interviews with patients and physicians, and publicly available social media posts from patients. Participant language was qualitatively assessed and key communication elements and communication gaps identified. Results Twenty-five in-office conversations, 14 follow-up physician dictations, and 17 telephone interviews were conducted with a total of 29 unique patients, 4 caregivers, and 14 physicians. In-office conversations were generally physician-driven and focused primarily on symptom frequency, location, and severity; lexicon from both parties centered on “episodes” and “swelling.” During visits, impact on quality of life was not routinely assessed by physicians nor discussed proactively by patients; however, during telephone interviews and online, patients frequently described the multifaceted burden of HAE. Patients highlighted the difficulties they experience by using repetition, emphasis, and metaphors; they also varied the descriptors used for attacks depending on the communication goal. Physicians used intensifiers to emphasize the necessity of rescue medication access, whereas prophylactic treatments were positioned as an option for frequent or laryngeal attacks. Conclusion Vocabulary differences suggest that the full impact of HAE is not consistently communicated by patients to physicians during clinical visits, indicating the potential for misaligned understanding of disease burden. A patient-driven, rather than physician-driven approach to the discussions may elicit valuable information that could help to optimize treatment approaches.
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Affiliation(s)
- Gagan Jain
- Takeda Pharmaceutical Company Limited, Lexington, Massachusetts, United States of America
- * E-mail:
| | - Lauren Walter
- Verilogue, Philadelphia, Pennsylvania, United States of America
| | - Carolyn Reed
- Verilogue, Philadelphia, Pennsylvania, United States of America
| | | | - Jeffrey Troy
- Verilogue, Philadelphia, Pennsylvania, United States of America
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25
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Westendorp J, Evers AWM, Stouthard JML, Budding J, van der Wall E, Plum NMF, Velting M, Francke AL, van Dulmen S, Olde Hartman TC, Van Vliet LM. Mind your words: Oncologists' communication that potentially harms patients with advanced cancer: A survey on patient perspectives. Cancer 2021; 128:1133-1140. [PMID: 34762305 PMCID: PMC9298810 DOI: 10.1002/cncr.34018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives. METHODS An online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered "yes," they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis). RESULTS Communication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication. CONCLUSIONS This article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm.
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Affiliation(s)
- Janine Westendorp
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Andrea W M Evers
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | | | | | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicole M F Plum
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mirjam Velting
- Dutch Breast Cancer Association (BVN), Utrecht, the Netherlands
| | - Anneke L Francke
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Liesbeth M Van Vliet
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
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26
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Iversen ED, Wolderslund M, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S, Ammentorp J. Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice. J Patient Cent Res Rev 2021; 8:307-314. [PMID: 34722798 DOI: 10.17294/2330-0698.1782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. Methods This study was part of the large-scale implementation of a communication skills training program called "Clear-Cut Communication With Patients" at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers' participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. Results Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35-2.3; P=0.01) for the overall score. The consultations did not last longer after the training. Conclusions Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations.
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Affiliation(s)
- Else Dalsgaard Iversen
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Helle Poulsen
- Department of Gastrointestinal Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
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27
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Park J, Jindal A, Kuo P, Tanana M, Lafata JE, Tai-Seale M, Atkins DC, Imel ZE, Smyth P. Automated rating of patient and physician emotion in primary care visits. PATIENT EDUCATION AND COUNSELING 2021; 104:2098-2105. [PMID: 33468364 DOI: 10.1016/j.pec.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Train machine learning models that automatically predict emotional valence of patient and physician in primary care visits. METHODS Using transcripts from 353 primary care office visits with 350 patients and 84 physicians (Cook, 2002 [1], Tai-Seale et al., 2015 [2]), we developed two machine learning models (a recurrent neural network with a hierarchical structure and a logistic regression classifier) to recognize the emotional valence (positive, negative, neutral) (Posner et al., 2005 [3]) of each utterance. We examined the agreement of human-generated ratings of emotional valence with machine learning model ratings of emotion. RESULTS The agreement of emotion ratings from the recurrent neural network model with human ratings was comparable to that of human-human inter-rater agreement. The weighted-average of the correlation coefficients for the recurrent neural network model with human raters was 0.60, and the human rater agreement was also 0.60. CONCLUSIONS The recurrent neural network model predicted the emotional valence of patients and physicians in primary care visits with similar reliability as human raters. PRACTICE IMPLICATIONS As the first machine learning-based evaluation of emotion recognition in primary care visit conversations, our work provides valuable baselines for future applications that might help monitor patient emotional signals, supporting physicians in empathic communication, or examining the role of emotion in patient-centered care.
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Affiliation(s)
- Jihyun Park
- Department of Computer Science, University of California, Irvine, USA; Apple Inc., Cupertino, USA.
| | - Abhishek Jindal
- Department of Computer Science, University of California, Irvine, USA; Hewlett Packard Enterprise, San Jose, USA
| | - Patty Kuo
- Department of Educational Psychology, University of Utah, Salt Lake City, USA
| | - Michael Tanana
- Social Research Institute, University of Utah, Salt Lake City, USA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, USA; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, USA
| | - Zac E Imel
- Department of Educational Psychology, University of Utah, Salt Lake City, USA.
| | - Padhraic Smyth
- Department of Computer Science, University of California, Irvine, USA.
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28
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Ochoa CY, Toledo G, Iyawe-Parsons A, Navarro S, Farias AJ. Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis. JCO Oncol Pract 2021; 17:e645-e653. [PMID: 33974829 DOI: 10.1200/op.21.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.
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Affiliation(s)
- Carol Y Ochoa
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Aisa Iyawe-Parsons
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Stephanie Navarro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA
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29
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Niu Z, Bhurosy T, Heckman C. Cancer Survivors' Emotional Well-being: Roles of Internet Information Seeking, Patient-centered Communication, and Social Support. JOURNAL OF HEALTH COMMUNICATION 2021; 26:514-522. [PMID: 34435927 DOI: 10.1080/10810730.2021.1966685] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cancer survivors' emotional well-being is an integral part of their overall health and may influence their recovery and survival. The current study used the 2018 Health Information National Trends Survey (HINTS) 5 Cycle 2 (N = 593) to evaluate the determinants of cancer survivors' emotional well-being. Internet cancer information seeking, social support, patient-centered communication, cancer beliefs, and self-efficacy to take care of one's health were examined as factors to be associated with cancer survivors' emotional well-being using structural equation modeling. Social support, cancer beliefs, and self-efficacy to take care of one's health were found to be significantly associated with emotional well-being among cancer survivors. Cancer beliefs mediated the associations of cancer information seeking using the Internet, social support, and patient-centered communication with cancer survivors' emotional well-being while health self-efficacy mediated the associations of social support and patient-centered communication with cancer survivors' emotional well-being. It is important for health practitioners to focus on improving social support, self-efficacy for managing health, and cancer-related beliefs in order to enhance the emotional well-being of cancer survivors.
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Affiliation(s)
- Zhaomeng Niu
- Population Science, Rutgers Cancer Institute Of New Jersey, New Brunswick, New Jersey, USA
| | - Trishnee Bhurosy
- Population Science, Rutgers Cancer Institute Of New Jersey, New Brunswick, New Jersey, USA
| | - Carolyn Heckman
- Population Science, Rutgers Cancer Institute Of New Jersey, New Brunswick, New Jersey, USA
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30
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Rossi AA, Marconi M, Taccini F, Verusio C, Mannarini S. From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19. Behav Sci (Basel) 2021; 11:bs11060087. [PMID: 34198572 PMCID: PMC8231896 DOI: 10.3390/bs11060087] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Maria Marconi
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Claudio Verusio
- Department of Medical Oncology, Presidio Ospedaliero di Saronno, ASST Valle Olona, 21047 Saronno, Italy; (M.M.); (C.V.)
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35131 Padova, Italy; (F.T.); (S.M.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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31
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Alpert JM, Wang S, Bylund CL, Markham MJ, Bjarnadottir RI, Lee JH, Lafata JE, Salloum RG. Improving secure messaging: A framework for support, partnership & information-giving communicating electronically (SPICE). PATIENT EDUCATION AND COUNSELING 2021; 104:1380-1386. [PMID: 33280967 DOI: 10.1016/j.pec.2020.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/19/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers. PURPOSE Given the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging. METHODS A 26 balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets. RESULTS 210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored. CONCLUSIONS Similar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies. PRACTICE IMPLICATIONS Patient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, USA.
| | - Shu Wang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Carma L Bylund
- Department of Public Relations, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | | | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Jennifer Elston Lafata
- UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
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32
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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33
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Hall A, Bryant J, Sanson-Fisher R, Grady A, Proietto A, Doran CM. Top Priorities for Health Service Improvements Among Australian Oncology Patients. PATIENT-RELATED OUTCOME MEASURES 2021; 12:83-95. [PMID: 33994819 PMCID: PMC8114575 DOI: 10.2147/prom.s291794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Objective To determine among a sample of Australian cancer patients receiving outpatient oncology care: 1) the most frequently endorsed general health service improvements selected by patients; 2) for the three most endorsed general health service improvements, the proportion of participants endorsing specific health service changes; and 3) sociodemographic, disease and treatment characteristics associated with the most frequently endorsed general health service improvements. Methods A cross-sectional survey was conducted across six outpatient oncology treatment units located in New South Wales, Australia. Patients receiving chemotherapy for any cancer diagnosis at any of six oncology services were recruited. Participants completed an online survey which included the Consumer Preferences Survey. Logistic regression analyses were conducted to identify sociodemographic, disease and treatment characteristics associated with frequently endorsed health service improvements. Results A total of 879 eligible patients initiated the survey (72% consent rate). Participants selected a median of two health service improvements. The three most wanted improvements were car parking (56%), up-to-date information about treatment or condition progress (19%), and hospital catering (17%). Age was the only characteristic significantly associated with identifying car parking as a needed improvement. Conclusion Achieving high quality cancer care requires understanding of the views and experiences of patients about the quality of care they receive. Car parking and access to information were the two most frequently endorsed general health service changes desired by this sample of participants. Practice Implication Future studies could examine whether enacting changes as per patient feedback improves patient perceptions of quality of care, and health outcomes.
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Affiliation(s)
- Alix Hall
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alice Grady
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - Anthony Proietto
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher M Doran
- Centre for Indigenous Health Equity Research, Central Queensland University, Rockhampton, QLD, Australia
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Hinding B, Brünahl CA, Buggenhagen H, Gronewold N, Hollinderbäumer A, Reschke K, Schultz JH, Jünger J. Pilot implementation of the national longitudinal communication curriculum: experiences from four German faculties. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc52. [PMID: 33824888 PMCID: PMC7994880 DOI: 10.3205/zma001448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/17/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Abstract
Background: The German national longitudinal communication curriculum provides medical faculties with orientation for the content of their communication teaching. But its implementation also requires changes in the organization of teaching. However, due to a lack of reports and studies on experiences with the development and implementation of communication curricula, recommendations on the procedure and the use of suitable instruments cannot be provided. Consequently, as part of this exploratory study the implementation process of the communication curricula was observed at four faculties. Methods: A comparative case study was conducted against the background of a change management concept. The four participating faculties were selected in such a way that they differed significantly in their initial conditions, particularly the development stage of the communication curriculum. Group interviews were conducted with the project teams at each faculty concerning the conditions and experiences with the implementation process. The evaluation took the form of a qualitative content analysis with a focus on identifying supporting and inhibiting factors and useful activities. Results: Different faculty approaches, support structures, core skills, the scope of study and examination regulations, teaching organization and available resources can have a major impact on the implementation processes. It became clear that, depending on the status of the implementation process, other barriers and supporting conditions gain in importance. Strategically, it proved to be a particular success factor to implement the communication curriculum together with other innovations in the course of the conversion to a model study program. This enabled a particularly quick and efficient implementation. The implementation into an existing curriculum proved to be much more protracted. In addition, a change management concept was used to illustrate which measures were found to be effective for which task areas. This includes, for example, curricular mapping, the development of skills in communication teaching or the integration of communication into exams. Conclusions: Thus a concept with strategies and measures for the implementation of the National Longitudinal Communication Curriculum is available. It already contains numerous suggestions for planning one's own approach in line with the conditions and resources of other locations. However, it needs to be supplemented and further validated.
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Affiliation(s)
- Barbara Hinding
- Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
| | - Christian A. Brünahl
- Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Hamburg, Germany
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Urologie, Hamburg, Germany
| | - Holger Buggenhagen
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rudolf Frey Lernklinik – Zentrale Lehrplattform, Mainz, Germany
| | - Nadine Gronewold
- Universitätsklinik Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
| | - Anke Hollinderbäumer
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Rudolf Frey Lernklinik – Zentrale Lehrplattform, Mainz, Germany
| | - Kirsten Reschke
- Otto-von-Guericke-Universität Magdeburg, Klinik für Nieren- und Hochdruckkrankheiten, Diabetologie und Endokrinologie, Magdeburg, Germany
| | - Jobst-Hendrik Schultz
- Universitätsklinik Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik, Heidelberg, Germany
| | - Jana Jünger
- Institut für Medizinische und Pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
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Otto AK, Reblin M, Harper FWK, Hamel LM, Moore TF, Ellington L, Eggly S. Impact of Patients' Companions on Clinical Encounters Between Black Patients and Their Non-Black Oncologists. JCO Oncol Pract 2021; 17:e676-e685. [PMID: 33411574 DOI: 10.1200/op.20.00820] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists. METHODS This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other. RESULTS Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication. DISCUSSION Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.
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Affiliation(s)
- Amy K Otto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Public Health Sciences at the University of Miami, Miami, FL
| | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Felicity W K Harper
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Lauren M Hamel
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Tanina F Moore
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI.,Karmanos Cancer Institute, Detroit, MI
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Doubova SV, Pérez-Cuevas R. Association of supportive care needs and quality of patient-centered cancer care with depression in women with breast and cervical cancer in Mexico. Psychooncology 2020; 30:591-601. [PMID: 33247968 DOI: 10.1002/pon.5608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the prevalence of depression, supportive care needs (SC-needs), and quality of patient-centered cancer care (PCC-quality) between women with breast cancer and women with cervical cancer and to assess the association of SC-needs and PCC-quality with depression. METHODS We conducted a cross-sectional survey in a public oncology hospital in Mexico City with 247 breast cancer and 165 cervical cancer ambulatory patients aged ≥18 years with at least one hospitalization and ≤5 years since diagnosis. Participants completed the short-form Supportive Care Needs Survey, the Patient-Centered Quality of Cancer Care Questionnaire, and the Hospital Anxiety and Depression Scale. We performed multiple logistic regression analyses to evaluate the association between SC-needs, PCC-quality, and probable presence of depression. RESULTS Nearly all women reported SC-needs-mainly health system and information needs, followed by physical and psychological needs. PCC-quality was substandard in both groups. PCC-quality was lowest when addressing biopsychosocial needs, followed by information for treatment decision-making needs. Cervical cancer patients had probable depression more often (41.2%) than those with breast cancer (29.5%). Having unmet psychological and care needs was associated with increased odds of probable depression, while high-quality timely care was associated with reduced odds of probable depression. CONCLUSION In Mexico, women with cervical and breast cancer face unmet SC-needs, probable depression, and substandard PCC-quality, pointing to priority areas for improvements in cancer care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Interamerican Development Bank, Jamaica
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Toro J, Martiny K. New perspectives on person-centered care: an affordance-based account. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:631-644. [PMID: 32886295 DOI: 10.1007/s11019-020-09977-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.
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Affiliation(s)
- Juan Toro
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark.
- The Enactlab, Copenhagen, Denmark.
| | - Kristian Martiny
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
- The Enactlab, Copenhagen, Denmark
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Ghaffari F, Ghahramanian A, Zamanzadeh V, Onyeka TC, Davoodi A, Mazaheri E, Asghari-Jafarabadi M. Patient-centred communication for women with breast cancer: Relation to body image perception. J Clin Nurs 2020; 29:4674-4684. [PMID: 32956571 DOI: 10.1111/jocn.15508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/26/2020] [Accepted: 09/06/2020] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to determine the predictive values of patient-centred communication (PCC) and patient's characteristics on the body image (BI) perception in postmastectomy patients. BACKGROUND Patient-centred communication has been touted as a means of addressing BI issues, especially for postmastectomy patients. DESIGN AND METHODS This predictive correlational study was conducted on 275 surgically treated breast cancer patients admitted to the Oncology Departments of two hospitals in Tabriz, Iran. These patients were selected using a convenience sampling method. The Body Image after Breast Cancer Questionnaire (BIBCQ) and patient-centred communication questionnaire (PCCQ) were used for collecting the data. Descriptive and inferential statistics were applied to the data. Reporting was in accordance with the STROBE guideline. RESULTS A multivariable model significantly predicted BI perception in participants using surgery type and time elapsed following surgery. Participants' limitations were significantly affected by surgery type and participants' perception of the nurses' PCC skills. Arm concern was significantly affected by surgery type and nurses' PCC skills. CONCLUSION Patient-centred skills in nurse-patient communication are critical for resolving BI difficulties such as arm concerns and limitations regarding the disease and its treatment. RELEVANCE TO CLINICAL PRACTICE Patient-centred communication skills can be taught nurses in the clinical setting to help alleviate patients' BI problems.
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Affiliation(s)
- Fariba Ghaffari
- Department of Medical Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Medical Surgical Department, Nursing and Midwifery Faculty, Hematology & Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Medical Surgical Department, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tonia C Onyeka
- Department of Anaesthesia/Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Arefeh Davoodi
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Effat Mazaheri
- Department of Medical Surgical, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Howell EP, Fischer J, Valea FA, Davidson BA. Communication Matters: a Survey Study of Communication Didactics in Obstetrics/Gynecology Residency. MEDICAL SCIENCE EDUCATOR 2020; 30:1069-1076. [PMID: 34457769 PMCID: PMC8368866 DOI: 10.1007/s40670-020-01017-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Delivery of excellent patient care hinges on effective communication. Improved communication between physicians, patients, and colleagues can facilitate shared decision-making and foster successful interprofessional teams. Despite the importance of this skill, little is understood about the status or acceptability of dedicated communication training during obstetrics and gynecology (OB/GYN) residency. OBJECTIVE To explore the national landscape of dedicated communication didactics during OB/GYN training. METHODS Residents and program directors (PDs) at ACGME-accredited programs were emailed anonymized surveys. Survey responses pertaining to communication didactics and trainee experiences were evaluated using descriptive statistics and chi-squared tests. RESULTS Of 143 PDs, 45 responded (31.5%). Although the total number of residents receiving our survey is unattainable, our 215 resident respondents can be estimated to represent at least 4.4% of trainees. 98.1% of residents reported challenging clinical communication at least monthly, with many reporting this weekly (47.9%) and daily (30.0%). A majority of PDs (77.8%) and residents (67.0%) endorsed interest in communication training. 62.2% of programs reported formally teaching communication skills. Certain topics were infrequently taught yet cited by residents as particularly challenging-such as "diffusing conflict" and "angry patient or family members." PDs tended to significantly overestimate trainee competence in conducting difficult conversations with both patients (p = 0.0003) and interdisciplinary colleagues (p < 0.0001), as compared with resident self-assessments. CONCLUSIONS Residents encounter frequent challenging communications interactions, and often feel inadequately equipped to navigate them. Dedicated didactics may provide a critical component to optimally educating of the next generation of trainees within OB/GYN and more broadly.
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Affiliation(s)
- Elizabeth P. Howell
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC USA
| | - Jonathan Fischer
- Department of Family Medicine and Community Health, Duke University, Durham, NC USA
| | - Fidel A. Valea
- Department of Obstetrics and Gynecology, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Brittany A. Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC Box 3079, Durham, NC 27710 USA
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Alkan A, Yaşar A, Güç ZG, Gürbüz M, Başoğlu T, Sezgin Göksu S, Buğdaycı Başal F, Türk HM, Özdemir Ö, Yeşil Çınkır H, Güven DC, Kuş T, Türker S, Koral L, Karakaş Y, Ak N, Paydaş S, Karcı E, Demiray AG, Demir A, Alan Ö, Keskin Ö, Nayır E, Tanrıverdi Ö, Yavuzşen T, Yumuk PF, Ateş Ö, Coşkun HŞ, Turhal S, Çay Şenler F. Worse patient-physician relationship is associated with more fear of cancer recurrence (Deimos Study): A study of the Palliative Care Working Committee of the Turkish Oncology Group (TOG). Eur J Cancer Care (Engl) 2020; 29:e13296. [PMID: 32864838 DOI: 10.1111/ecc.13296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/16/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is an important psychological trauma associated with reduction in the quality of life, disruptions in the level of adjustment, emotional distress and anxiety. The purpose of the study was to evaluate the impact of patient-physician relationship on FCR. METHODS The study was designed as a multicentre survey study. The cancer survivors, who were under remission, were evaluated with structured questionnaires. Patient-physician relationship (PPR) scale in which higher scores indicate better relationship and FCR inventory was used. RESULTS Between January and April 2019, 1,580 patients were evaluated. The median age was 57.0 (19-88), and 66% were female. There was high level of FCR scores in 51% of participants. There was a negative correlation between PPR and FCR scores (r = -.134, p < .001). In multivariate analysis, young age, female gender, history of metastasectomy and worse PPR were associated with high levels of FCR. CONCLUSION It is the first data showing the adverse impact of worse PPR on FCR. The strategies to improve the PPR should be practised. In addition, the cancer survivors, who are under the risk of FCR, should be evaluated and managed.
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Affiliation(s)
- Ali Alkan
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Arzu Yaşar
- Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Gülsüm Güç
- Medical Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Mustafa Gürbüz
- Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
| | - Tuğba Başoğlu
- Medical Oncology, Marmara University School of Medicine, İstanbul, Turkey
| | - Sema Sezgin Göksu
- Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Fatma Buğdaycı Başal
- Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Hacı Mehmet Türk
- Medical Oncology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Özlem Özdemir
- Medical Oncology, İzmir Bozyaka Research and Training Hospital, İzmir, Turkey
| | - Havva Yeşil Çınkır
- Medical Oncology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Deniz Can Güven
- Medical Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tülay Kuş
- Medical Oncology, Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Sema Türker
- Medical Oncology, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Lokman Koral
- Medical Oncology, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Yusuf Karakaş
- Medical Oncology, Bodrum Acıbadem Hospital, Muğla, Turkey
| | - Naziye Ak
- Department of Medical Oncology, Institute of Oncology, Istanbul University, İstanbul, Turkey
| | - Semra Paydaş
- Medical Oncology, Çukurova University School of Medicine, Adana, Turkey
| | - Ebru Karcı
- Medical Oncology, Bağcılar Research and Training Hospital, İstanbul, Turkey
| | | | - Atakan Demir
- Medical Oncology, Acıbadem Maslak Hospital, İstanbul, Turkey
| | - Özkan Alan
- Medical Oncology, Tekirdağ Public Hospital, Tekirdağ, Turkey
| | - Özge Keskin
- Medical Oncology, Selçuk University School of Medicine, Konya, Turkey
| | - Erdinç Nayır
- Medical Oncology, VM Medical Park Mersin Hospital, Mersin, Turkey
| | - Özgür Tanrıverdi
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Tuğba Yavuzşen
- Medical Oncology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | | | - Öztürk Ateş
- Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Hasan Şenol Coşkun
- Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Serdar Turhal
- Medical Oncology, Anadolu Medical Center, Kocaeli, Turkey
| | - Filiz Çay Şenler
- Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
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Fatigante M, Heritage J, Alby F, Zucchermaglio C. Presenting treatment options in breast cancer consultations: Advice and consent in Italian medical care. Soc Sci Med 2020; 266:113175. [PMID: 32987310 DOI: 10.1016/j.socscimed.2020.113175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/11/2020] [Accepted: 06/25/2020] [Indexed: 01/05/2023]
Abstract
Variety, complexity and uncertainty in the therapy outcomes of cancer illness make the treatment recommendation (TR) in oncology a "monumentally difficult task". Previous studies have distinguished unilateral and bilateral formats of treatment recommendations, accordingly to whether, or to what extent, the patient's perspective is included in the consideration of therapeutic options. Others have also shown how the oncologists' presentation of therapeutic options varied accordingly to the severity of the diagnosis and the availability of alternatives. Yet, no study has systemically dentified and compared components of treatment recommendation in oncology on a common set of patients and clinicians. This paper analyzes how different options in breast cancer treatments - radiotherapy, hormone therapy and chemotherapy - are presented and discussed in a set of 12 first post-surgical breast cancer visits carried out by two oncologists of high experience and seniority in two Italian hospitals. Treatment recommendation sequences involving these three option types were analyzed using the methods of conversation analysis. They were also coded for the mention of side effects and treatment burden, and for whether consent to the recommendation was invited, or expressed by the patient. Results show that radiotherapy is presented as presupposed as an extension of surgery and is not further discussed, and hormone therapy is delivered as good news and as not implying any health or lifestyle burdens. Treatment burdens were raised in the much more extensive discussions of chemotherapy, which were also accompanied by a higher chance that the patient was asked for consent to therapy. Implications are drawn as regards the extent to which clinical practice meets theory in communication protocols available in oncology, and how to consider the doctor-patient partnership and the concept of shared decision-making in such an encounter.
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Affiliation(s)
- Marilena Fatigante
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy.
| | - John Heritage
- Department of Sociology, University of California, Los Angeles, USA
| | - Francesca Alby
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, University Sapienza of Rome, Rome, Italy
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Doubova SV, Terreros-Muñoz E, Delgado-Lòpez N, Montaño-Figueroa EH, Infante-Castañeda C, Pérez-Cuevas R. Experiences with health care and health-related quality of life of patients with hematologic malignancies in Mexico. BMC Health Serv Res 2020; 20:644. [PMID: 32650770 PMCID: PMC7353677 DOI: 10.1186/s12913-020-05498-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Mexico, patients with hematologic malignancies (HMs) are characterized by being at high risk and advanced stages at diagnosis and by having a low cure rate; yet information on their experiences with health care and health-related quality of life (HRQL) is scarce. We aimed to evaluate experiences with health care and HRQL of patients with HMs and the association between these patient-reported measures. METHODS We conducted a cross-sectional survey in two public oncology hospitals in Mexico City. The study included outpatient cancer patients aged ≥18 years with a diagnosis of leukemia, lymphoma, or multiple myeloma. We used a patient-centered quality of cancer care questionnaire to assess patient experiences with receiving 1) timely care; 2) clear information; 3) information for treatment decision-making; 4) care to address biopsychosocial needs; and 5) respectful and coordinated care. We applied the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) to measure HRQL. We performed a multiple linear regression to evaluate the association between patient-reported experiences (independent variables) and the QLQ-C30 summary score (dependent variable). RESULTS Of the 515 participating HM patients, 46.6% had lymphoma, 34% leukemia, and 19.4% multiple myeloma; 70.9% were at advanced stages or at high risk. Additionally, 15.1% had anxiety and 12.8% had depression. Over one third (35.9%) reported receiving clear information, 28.5% timely care, 20.6% information for treatment decision-making, 23.7% care that addressed their biopsychosocial needs, and 31% respectful and coordinated care. The mean QLQ-C30 summary score was 71.9 points. Timely care, clear information, and care that addresses biopsychosocial needs were associated with higher HRQL. CONCLUSIONS Health care services for HM patients at public oncology hospitals in Mexico need improvement. Notably, providing timely care, clear information, and care that addresses patients' biopsychosocial needs can increase the likelihood of better HRQL. Health care providers should measure and improve the experiences of HM patients with health care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, Del. Cuauhtemoc, CP 06720, Mexico City, Mexico.
| | - Eduardo Terreros-Muñoz
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Nancy Delgado-Lòpez
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Efreen Horacio Montaño-Figueroa
- Departamento de Hematología, Hospital General de México "Dr. Eduardo Liceaga". Secretaría de Salud, Ciudad de México, Mexico
| | - Claudia Infante-Castañeda
- Instituto de Investigaciones Sociales, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica
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Social inequalities in supportive care needs and quality of patient-centered care of cancer patients in Mexico. Support Care Cancer 2020; 29:1355-1367. [PMID: 32651679 DOI: 10.1007/s00520-020-05615-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate educational and health insurance-related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancer patients in Mexico. METHODS We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancer patients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. RESULTS We included 1058 IMSS and 606 MoH cancer patients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. CONCLUSION Uninsured cancer patients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico.
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Hong CS, Moliterno J. The Patient-Centered Approach: A Review of the Literature and Its Application for Acoustic Neuromas. J Neurol Surg B Skull Base 2020; 81:280-286. [PMID: 32500003 DOI: 10.1055/s-0039-1692396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/05/2019] [Indexed: 10/26/2022] Open
Abstract
Patient-centered care is defined as "care that is consistent with and respects the values, needs, and wishes of patients" and is best achieved when clinicians involve patients and their support system in health care discussions and decisions. While this approach has been well established and supported in more general medical specialties, such as primary care, that may encompass a more holistic approach, it has rarely been described in surgical disciplines. Acoustic neuromas (ANs) can be unique among other skull base and intracranial pathologies, in that the management of these tumors can vary from patient to patient depending on various factors. Moreover, typical options, including observation, radiation, and surgery, may often have equipoise for some patients and their tumors. Therefore, a patient-centered approach, strongly guided by the expertise of experienced skull base surgeons, may likely be the most appropriate type of care for patients with ANs. Herein, we review the documented use of patient-centered care in other aspects of medicine, propose the benefits of this approach for patients with ANs, and provide ways this can be better implemented in practice.
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Affiliation(s)
- Christopher S Hong
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States.,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States.,Yale Brain Tumor Center, Smilow Cancer Hospital, New Haven, Connecticut, United States
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Diekmann A, Heuser C, Schellenberger B, Bohmeier B, Holmberg C, Ansmann L, Ernstmann N. Patient participation in multidisciplinary tumor conferences: Providers' perceptions of patients' need satisfaction and emotional experiences. Psychooncology 2020; 29:1263-1271. [PMID: 32419276 DOI: 10.1002/pon.5413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/16/2020] [Accepted: 05/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In some breast and gynecological cancer centers in Germany, patients participate in multidisciplinary tumor conferences (MTCs) during the discussion of their own case. The aim of this study was to explore providers' perceptions concerning patients' emotional experiences during participation in an MTC by comparing the perspectives of providers with and without experience with patient participation. METHODS In this study, semi-structured interviews with n = 30 providers in n = 6 breast and gynecological cancer centers in North Rhine-Westphalia, Germany, were conducted. One half of the providers had no experience and the other half had experience with patient participation in MTCs. The interviews were audiotaped and transcribed, and content analysis was performed. RESULTS The results of this study show a mixed picture of met, unmet and disappointed needs of patients and their emotional reactions, which mainly overlap between both provider groups. Our results show that both provider groups report positive and negative experiences or expectations. CONCLUSION The mixed results regarding expected and perceived patient experiences from the providers' perspective suggest that patient participation in MTCs may not be exclusively of benefit. Further research on advantages and disadvantages for patients and on feasibility from the providers' perspective is necessary and will be conducted within the PINTU project.
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Affiliation(s)
- Annika Diekmann
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Christian Heuser
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Barbara Bohmeier
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology Bonn (CIO), University Hospital Bonn, Bonn, Germany
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Reconsidering the Moralization of Health: Practices Versus Concepts, and What We Can Learn from Evidence-based Research. Camb Q Healthc Ethics 2020; 28:215-224. [PMID: 31113510 DOI: 10.1017/s0963180119000069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article aims to do two things. First, it argues that moralization of health occurs not only at the practical level of individual healthcare choices and health states, but also at the conceptual level of health itself. This is most evident in cases where the concept of health is presumed to possess the property of "overridingness" when compared to competing values and norms, that is, when it is treated as taking precedence over other values and norms it may come into conflict with. Second, the article makes a case for being critically skeptical of specific deployments of the concept of health when it has been moralized in this way. In such cases, what typically results is that some other personal value/norm, or set of values/norms, held by the individual is treated as intrinsically at odds with the concept of health, which is presumed, uncritically, to be superior, often because it is taken to be free-standing and self-justifying. Yet, a growing body of evidence-based research suggests that the role played by dimensions of personal meaningfulness in the quality of individuals' overall health is quite underappreciated. It is useful to think of these dimensions of personal meaning and significance as representing the individual's values. Thus, taking these data more seriously ought to lead to a reevaluation of the moralization of health at the conceptual level. In the first place, it is not obvious that if the concept of health runs afoul of other values/norms held by an individual, the latter should automatically yield. In the second place, they suggest that other values/norms held by an individual are not necessarily intrinsically opposed to the concept of health, but in fact may go a good distance in support of it.
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Tailoring the amount of treatment information to cancer patients' and survivors' preferences: Effects on patient-reported outcomes. PATIENT EDUCATION AND COUNSELING 2020; 103:514-520. [PMID: 31585818 DOI: 10.1016/j.pec.2019.09.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Tailoring medical information to cancer patients' needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here. METHODS A video-vignette experiment was used to systematically vary video patients' information preferences (limited/extensive) and amount of provided information (additional/no additional). N = 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures. RESULTS Tailoring information to video patients' preferences had no effect on APs' evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs' own information preferences: Those preferring extensive information recalled (MΔ = 5.8%) and recognized (MΔ = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information. CONCLUSIONS Tailoring to the amount of video patient's information preferences did not affect APs' evaluation of the consultation (satisfaction, trust), while APs' personal information preferences determined their recall and recognition of medical information. PRACTICE IMPLICATIONS Information preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands.
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Hohmann NS, McDaniel CC, Mason SW, Cheung WY, Williams MS, Salvador C, Graves EK, Camp CN, Chou C. Healthcare providers’ perspectives on care coordination for adults with cancer and multiple chronic conditions: a systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Natalie S. Hohmann
- Department of Pharmacy Practice Harrison School of Pharmacy Auburn University Auburn AlabamaUSA
| | - Cassidi C. McDaniel
- Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University Auburn Alabama USA
| | - S. Walker Mason
- Department of Pharmacy University of North Carolina Medical Center Chapel Hill North Carolina USA
| | - Winson Y. Cheung
- Department of Oncology Tom Baker Cancer Centre Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Michelle S. Williams
- Cancer Institute and Department of Population Health Science University of Mississippi Medical Center Jackson Mississippi USA
| | - Carolina Salvador
- Division of Hematology/Oncology School of Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - Edith K. Graves
- Medical Oncology Cancer Center of East Alabama Medical Center Opelika Alabama USA
| | - Christina N. Camp
- Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University Auburn Alabama USA
| | - Chiahung Chou
- Health Outcomes Research and Policy Harrison School of Pharmacy Auburn University Auburn Alabama USA
- Department of Medical Research China Medical University Hospital Taichung City Taiwan
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Khatib R, Lee GA, Marques-Sule E, Hopstock LA, O'Donnell S, Svavarsdóttir MH, Andreae C, Vellone E, Goossens E, Strömberg A, Kjellström B, Jaarsma T, Stewart C. Evaluating the extent of patient-centred care in a selection of ESC guidelines. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:55-61. [PMID: 31119288 DOI: 10.1093/ehjqcco/qcz025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/26/2019] [Accepted: 05/15/2019] [Indexed: 11/14/2022]
Abstract
AIMS Patient-centred care (PCC) is the cornerstone for healthcare professionals to promote high quality care for patients with cardiovascular conditions. It is defined as 'Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions'. PCC can improve patient outcomes and allow patients and healthcare professionals to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC). METHODS AND RESULTS Using a narrative literature review and expert consensus, the Science Committee within the Association of Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed, with committee members independently evaluating five PCC aspects: patient voice and involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients' needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared. The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the 'multidisciplinary involvement' category. CONCLUSION Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing, or formulating recommendations. Future development of guidelines should ensure better incorporation of patients' perspective, in particular, and other PCC aspects highlighted in this study.
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Affiliation(s)
- Rani Khatib
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9DA, UK
| | - Geraldine A Lee
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London SE1 8WA, UK
| | - Elena Marques-Sule
- Department of Physiotherapy, University of Valencia, Valencia 46010, Spain
| | | | - Sharon O'Donnell
- School of nursing and Midfwifery, 24 D'Olier St, University of Dublin, Trinity College, Dublin 2, Ireland
| | - Margrét Hrönn Svavarsdóttir
- School of Health Science, Department of Nursing, University of Akureyri, Solborg V/Nordurslod, 600 Akureyri, Iceland
| | - Christina Andreae
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden.,Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Eva Goossens
- Academic Center for Nursing and Midwifery, Departement of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 box 7001, 3000 Leuven, Belgium.,Research Foundation Flanders (FWO), Egmontstraat 5, 2000 Brussels, Belgium
| | - Anna Strömberg
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden.,Department of Cardiology, Linköping University, 581 83 Linköping, Sweden
| | - Barbro Kjellström
- Department of Medicine, Cardiology Unit, Karolinska Institute, 171 77 Stockholm, Sweden.,Faculty of Medical and Health Sciences, Department of Nursing, Linköping University, 581 83 Linköping, Sweden
| | - Tiny Jaarsma
- Department of Nursing Science Julius Center, University Medical Center 100, 3584 CG Utrecht, The Netherlands
| | - Chloe Stewart
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
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Hohmann NS, McDaniel CC, Mason SW, Cheung WY, Williams MS, Salvador C, Graves EK, Camp CN, Chou C. Patient perspectives on primary care and oncology care coordination in the context of multiple chronic conditions: A systematic review. Res Social Adm Pharm 2019; 16:1003-1016. [PMID: 31812499 DOI: 10.1016/j.sapharm.2019.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/12/2019] [Accepted: 11/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients' views on the optimal model for care coordination between primary care providers (PCPs) and oncologists in the context of cancer and multiple chronic conditions (MCC) are unclear. Thus, the purpose of this systematic review is to evaluate the perceptions of patients with both cancer and MCC regarding their care coordination needs. METHODS Following PRISMA guidelines, the literature was systematically searched through PubMed, CINAHL, and PsycINFO for articles pertaining to patients' perspectives, experiences, and needs regarding care coordination between PCPs and oncologists during the cancer care continuum, in the context of patients with cancer and MCC. English-language articles were included if they met the following criteria: 1) published between 2008 and 2018; 2) peer-reviewed study; 3) patients aged 18 years or older diagnosed with any type or stage of cancer; 4) patients have one or more chronic comorbid condition; 5) inclusion of patient perceptions, experiences, or needs related to care coordination between PCPs and oncologists; and 6) ability to extract results. Data extraction was performed with a standardized form, and themes were developed through qualitative synthesis. A grounded theory approach was used to qualitatively evaluate data extracted from articles and create a framework for providers to consider when developing patient-centered care coordination strategies for these complex patients. Risk of bias within each study was assessed independently by two authors using the Mixed Methods Appraisal Tool. RESULTS A total of 22 articles were retained, representing the perspectives of 8,114 patients with cancer and MCC. Studies were heterogeneous in the patients' respective phases of cancer care and study design. From qualitative synthesis, four themes emerged regarding patients' needs for cancer care coordination and were included as constructs to develop the Patient-centered Care Coordination among Patients with Multiple Chronic Conditions and Cancer (PCP-MC) framework. Constructs included: 1) Communication; 2) Defining provider care roles; 3) Information access; and 4) Individualized patient care. Care navigators served as a communication bridge between providers and patients. CONCLUSIONS Findings highlight the importance that patients with both cancer and MCC place on communication with and between providers, efficient access to understandable care information, defined provider care roles, and care tailored to their individual needs and circumstances. Providers and policymakers may consider the developed PCP-MC framework when designing, implementing, and evaluating patient-centered care coordination strategies for patients with both cancer and MCC.
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Affiliation(s)
- Natalie S Hohmann
- Auburn University, Harrison School of Pharmacy, Department of Pharmacy Practice, 4201 Walker Building, Auburn University, AL, 36849, USA
| | - Cassidi C McDaniel
- Auburn University, Harrison School of Pharmacy, Health Outcomes Research and Policy, 4306 Walker Building, Auburn University, AL, 36849, USA
| | - S Walker Mason
- University of North Carolina Medical Center, Department of Pharmacy, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Winson Y Cheung
- University of Calgary, Cumming School of Medicine, Department of Oncology: Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, Alberta, T2N 4N2, Canada
| | - Michelle S Williams
- University of Mississippi Medical Center, Cancer Institute and Department of Population Health Science, 2500 North State Street, Jackson, MS, 39216, USA
| | - Carolina Salvador
- University of Alabama at Birmingham, School of Medicine, Division of Hematology/Oncology, 1720 2nd Avenue South, NP2540, Birmingham, AL, 35294, USA
| | - Edith K Graves
- Cancer Center of East Alabama Medical Center, Medical Oncology, 2501 Village Professional Dr, Opelika, AL, 36801, USA
| | - Christina N Camp
- Auburn University, Harrison School of Pharmacy, Health Outcomes Research and Policy, 4306 Walker Building, Auburn University, AL, 36849, USA
| | - Chiahung Chou
- Auburn University, Harrison School of Pharmacy, Health Outcomes Research and Policy, 4306 Walker Building, Auburn University, AL, 36849, USA; China Medical University Hospital, Department of Medical Research, No.2 Yude Road, North District, Taichung City, 40447, Taiwan.
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