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MacRae H. Older Men, The Patient-Physician Relationship, and Patient Involvement. Can J Aging 2024; 43:142-152. [PMID: 37737232 DOI: 10.1017/s0714980823000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Despite the fact that older adults interact frequently with physicians, there is little research examining their preferences, and perceptions of the patient-physician relationship. Research on this topic is particularly sparse when it comes to older men. This study investigates older men's experiences with physicians, their perceptions of the patient-physician relationship, and the extent to which they wished to be involved in their health care. In-depth, face-to-face interviews were conducted with 23 men 55-96 years of age. Findings reveal that older men want to participate in the medical encounter and be involved in their care, contradicting earlier work suggesting that older adults prefer to be passive patients. Preferred involvement, however, varied along a continuum ranging from "quasi-involvement" to "taking charge", with most participants being in the middle, preferring a "partnership" patient-physician relationship. Factors influencing patient involvement and potential to negotiate the patient-physician relationship are discussed.
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Affiliation(s)
- Hazel MacRae
- Department of Sociology and Anthropology, Mount Saint Vincent University, Halifax, NS, Canada
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2
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Sun K, Zheng X, Liu W. Increasing clinical medical service satisfaction: An investigation into the impacts of Physicians' use of clinical decision-making support AI on patients' service satisfaction. Int J Med Inform 2023; 176:105107. [PMID: 37257235 DOI: 10.1016/j.ijmedinf.2023.105107] [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: 09/23/2022] [Revised: 04/12/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The medical industry is one of the key industries for the application of artificial intelligence (AI). Although it is believed that the combination of CDSS and physicians could improve the medical service, there are still many concerns about the usage of CDSS. Based on these concerns, limited studies have answered the question that when a physician makes decision independently or with AI's help, will there be any differences in patients' satisfaction with the medical service? METHODS This study uses the service fairness theory as a theoretical lens and employs three vignette experiments to address this research gap. There are totally 740 subjects recruited to participate into the three experiments. Group comparison methods and structural equation model are used to verify the hypotheses. RESULTS The experimental results reveal that: (1) physicians using AI can reduce patients' service satisfaction (Mdifference=0.404,p=0.004); (2) the negative relationship between AI usage and service satisfaction can partially be mediated through distributive fairness and procedural fairness; (3) physicians actively informing their patients about the usage of AI can help mitigate the reduction in service satisfaction (Mdifference=0.400,p=0.003) and three types of fairness Mdifferencedistributive=0.307,p=0.042;Mdifferenceprocedural=0.483,p<0.001;Mdifferenceinteractional=0.253,p=0.027. CONCLUSION This study investigates the effect of physicians using decision-making support AI on their patients' service satisfaction. These results contribute to the existing literature pertaining to AI and fairness theory, and also help in formulating some practical suggestions for medical staff and AI development companies.
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Affiliation(s)
- Kai Sun
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, China.
| | - Xiangwei Zheng
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Weilong Liu
- School of Management Science and Engineering, Shandong University of Finance and Economics, Jinan, China
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3
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Supporting care engagement in primary care; the development of a maturity matrix. PLoS One 2023; 18:e0279542. [PMID: 36602972 PMCID: PMC9815637 DOI: 10.1371/journal.pone.0279542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Care engagement or active patient involvement in healthcare contributes to the quality of primary care, but organisational preconditions in routine practice need to be aligned. A Maturity Matrix for Care Engagement to assess and discuss these preconditions in the general practice team was developed and tested on feasibility and acceptability in general practice. METHODS AND FINDINGS A systematic user-centred approach was applied, starting with a scoping literature search to describe the domains on the horizontal axis of the maturity matrix. The domains and growing steps (vertical axis) were refined by patients (n = 16) and general practice staff (n = 11) in three focus group discussions and reviewed by six experts (local facilitators and scientists). Seven domains could be distinguished: Personalised Care, Shared Decision Making, Self-Management, Patient as Partner, Supportive Means, Patient Environment, and Teamwork among Healthcare Professionals. The growing steps described three to six activities per domain (n = 32 in total) that contribute to care engagement. Local facilitators implemented the tool in two general practice teams according to a user guide, starting with a two-hour kick-off meeting on care engagement. In the next step, practitioners, nurses and assistants in each practice indicated their score on the domains individually. The scores were discussed in the facilitated practice meeting which was aimed at SMART improvement plans. Feasibility and acceptability were assessed in interviews showing that the tool was well received by the pilot practices, although the practice assistants had difficulties scoring some of the activities as they did not always relate to their daily work. An assessment after three months showed changes in practice organisation towards increased care engagement. CONCLUSIONS The maturity matrix on care engagement is a tool to identify the organisational practice maturity for care engagement. Suggested adaptations must be implemented before large-scale testing.
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Residents' autonomy in long-term care facilities: the case of shared decision-making in medication management - when, for whom, and how important is it? Int Psychogeriatr 2022; 34:871-874. [PMID: 35570694 DOI: 10.1017/s1041610222000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tarbi EC, Pirl WF. Sharing Decisions About Systemic Therapy for Advanced Cancers. JCO Oncol Pract 2022; 18:543-544. [PMID: 34986004 DOI: 10.1200/op.21.00804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elise C Tarbi
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - William F Pirl
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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‘I've never given it a thought’: older men's experiences with and perceptions of ageism during interactions with physicians. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe subjective experience of ageism among older men has received little research attention. This study examines older Canadian men's experiences with and perceptions of ageism during interactions with physicians. In-depth, face-to-face interviews were conducted with 21 men aged 55 years and over. The findings indicate a seeming lack of awareness of ageism among many, and many did not believe ageism was likely to occur during patient–physician interaction. Negative stereotyping of older patients was common. A large majority of the participants reported that they had not personally experienced ageism during a medical encounter, nor were they concerned about it. Numerous rationales were proffered as explanations of why a particular participant had not experienced ageism and who was more likely to be a target.
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Christiansen R, Emiliussen J. Manipulation and free will in shared decision making. J Eval Clin Pract 2020; 26:403-408. [PMID: 31529578 DOI: 10.1111/jep.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
In recent years, there has been an increased focus on patient involvement in treatment planning in the health care system. To reduce the risk of the clinician moving towards paternalism, various methods have been introduced-shared decision making, among others. The goal of shared decision making is for the clinician and patient to share available evidence on the best treatment and to raise awareness on the needs and preferences of the patient as to make a genuinely informed choice. However, in the present article, we discuss to which degree paternalism can be avoided in light of the clinician's role as an authority with certain knowledge and expertise. Through the philosophical theory of reasons-responsiveness, we discuss to which extend free will and control applies to the patient. Through theoretical analysis, we come to suggest that the clinician has a role as an ally rather than manipulator.
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Affiliation(s)
- Regina Christiansen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark.,Unit for Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Emiliussen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark.,Unit for Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
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Aysola J, Schapira MM, Huo H, Werner RM. Organizational Processes and Patient Experiences in the Patient-centered Medical Home. Med Care 2018; 56:497-504. [PMID: 29629923 PMCID: PMC5945304 DOI: 10.1097/mlr.0000000000000910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is increasing emphasis on the use of patient-reported experience data to assess practice performance, particularly in the setting of patient-centered medical homes. Yet we lack understanding of what organizational processes relate to patient experiences. OBJECTIVE Examine associations between organizational processes practices adopt to become PCMH and patient experiences with care. RESEARCH DESIGN We analyzed visit data from patients (n=8356) at adult primary care practices (n=22) in a large health system. We evaluated the associations between practice organizational processes and patient experience using generalized estimating equations (GEE) with an exchangeable correlation structure to account for patient clustering by practice in multivariate models, adjusting for several practice-level and patient-level characteristics. We evaluated if these associations varied by race/ethnicity, insurance type, and the degree of patient comorbidity MEASURES:: Predictors include overall PCMH adoption and adoption of six organizational processes: access and communications, patient tracking and registry, care management, test referral tracking, quality improvement and external coordination. Primary outcome was overall patient experience. RESULTS In our full sample, overall PCMH adoption score was not significantly associated with patient experience outcomes. However, among subpopulations with higher comorbidities, the overall PCMH adoption score was positively associated with overall patient experience measures [0.2 (0.06, 0.4); P=0.006]. Differences by race/ethnicity and insurance type in associations between specific organizational processes and patient experience were noted. CONCLUSION Although some organizational processes relate to patients' experiences with care irrespective of the background of the patient, further efforts are needed to align practice efforts with patient experience.
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Affiliation(s)
- Jaya Aysola
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- Crescenz VA Medical Center, Philadelphia PA
| | - Hairong Huo
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Rachel M. Werner
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- Crescenz VA Medical Center, Philadelphia PA
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Son HK, Song HB, Kim DH. Effects of the Mother-Medical Staff Partnership on Mothers’ Condition Management Ability for Children with Chronic Allergic Diseases. CHILD HEALTH NURSING RESEARCH 2018. [DOI: 10.4094/chnr.2018.24.1.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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10
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Brand PLP, van Dulmen S. Can we trust what parents tell us? A systematic review. Paediatr Respir Rev 2017; 24:65-71. [PMID: 28283301 DOI: 10.1016/j.prrv.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/11/2022]
Abstract
Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations.
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Affiliation(s)
- Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Abstract
ABSTRACTThis study examines older women's views about and subjective experience of ageism during interactions with physicians. Views about and experience of sexism are also examined. Data were obtained from in-depth, face-to-face interviews conducted with 36 Canadian women 55 years and older. The findings indicate that older women believe ageism is likely to occur during medical encounters and are concerned about it. Few, however, claim to have personally experienced it. Contradicting the stereotype of the passive older patient, many participants were employing strategies to avoid becoming targets of ageism. Although there was some concern about sexism during medical encounters, in general, the women appeared to be less conscious of sexism than ageism.
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Wright MM, Medved M, Woodgate RL, Roger K, Sullivan D. Narratives of acquired brain injury patients: Their experience of healthcare relationships and medical decision-making. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17538068.2016.1186337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
RÉSUMÉ Les femmes plus âgées interagissent avec les médecins plus souvent que les hommes âgés et les personnes plus jeunes; pourtant, la connaissance et la compréhension de leurs expériences avec les médecins sont limitées. Le but de cette étude était d'étudier les perceptions des femmes âgées de leurs interactions avec les médecins et d'identifier ce que les femmes veulent de leurs médecins. Les entrevues en profondeur avec 30 femmes âgées montrent que la majorité veulent être impliquée activement dans leurs propres soins de santé. Dans la relation patient-médecin, les femmes donnent généralement la priorité aux qualités personnelles de médecins et leur comportement à l'égard du patient. Pour de nombreuses femmes, l'âge et le sexe du médecin ont aussi leur importance.
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Hafskjold L, Sundler AJ, Holmström IK, Sundling V, van Dulmen S, Eide H. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol. BMJ Open 2015; 5:e007864. [PMID: 25877282 PMCID: PMC4401848 DOI: 10.1136/bmjopen-2015-007864] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. METHODS AND ANALYSIS This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. ETHICS AND DISSEMINATION Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.
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Affiliation(s)
- Linda Hafskjold
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Annelie J Sundler
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Vibeke Sundling
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Sandra van Dulmen
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Eide
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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Van Damme-Ostapowicz K, Krajewska-Kułak E, Nwosu PJC, Kułak W, Sobolewski M, Olszański R. Acceptance of illness and satisfaction with life among malaria patients in rivers state, Nigeria. BMC Health Serv Res 2014; 14:202. [PMID: 24885562 PMCID: PMC4045946 DOI: 10.1186/1472-6963-14-202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health condition is one of the basic factors affecting satisfaction with life, and the level of illness acceptance. The purpose of the study was to analyse the level of illness acceptance, the level of satisfaction with life among malaria patients, and the level of trust placed in the physician and the nurse. METHODS The study employs the method of diagnostic survey based on standardised AIS and SWLS scales, as well as Anderson and Dedrick's PPTS and PNTS scales. RESULTS The average AIS level was 12 points, while the average level of SwL at the SWLS scale was 16.5 points. The average level of trust in the physician and the nurse amounted to 50.6 points and 51.4 points, respectively. The correlation between the level of illness acceptance and self-evaluated satisfaction with life was statistically significant, with R = 0.56. The marital status influenced the level of illness acceptance with p < 0.05 and the level of satisfaction with life with p < 0.05. The employment status affected the level of satisfaction with life with p < 0.05 and the level of illness acceptance with p < 0.05. CONCLUSIONS The majority of malaria patients did not accept their illness, while the level of satisfaction with life was low. The majority of respondents trusted their physician and nurse. There is a statistically significant correlation between the level of illness acceptance and the self-evaluated satisfaction with life. The marital status had a statistically significant effect on the acceptance of illness and the satisfaction with life. The individuals who had a job demonstrated higher levels of quality of life and illness acceptance.
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New insight into the role of patients during medical appointments: a synthesis of three qualitative studies. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:313-8. [PMID: 24664461 PMCID: PMC4141969 DOI: 10.1007/s40271-014-0056-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The complexity of the doctor-patient relationship requires in-depth research to enable a better understanding of the nature of the doctor's appointment. OBJECTIVE To explore how patients can facilitate their medical appointments, and how they can be responsible for their relationship with their doctors. METHODS A synthesis of our previous three qualitative studies of doctor-patient relationships focussed on the consultations. The analysis involved three qualitative studies based on in-depth interviews with 94 patients of family doctors in Poland. RESULTS A detailed analysis of these data allowed us to distinguish several different ways in which patients participate in medical consultation, namely: 1. facilitating the visit; 2. having an impact on both patient and doctor perception of satisfaction with the visit; and 3. showing concern for the doctor, understanding the doctor's situation and having empathy. CONCLUSION This study concerning patient-doctor interactions shows that each participant can explicitly provide emotional support for the other, despite the evident asymmetry in the roles of doctor and patient. Patients can substantially contribute to the personalisation of their relationship with the doctor, which is often facilitated by the repetition and regularity of the interaction.
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Chhabra KR, Pollak KI, Lee SJ, Back AL, Goldman RE, Tulsky JA. Physician communication styles in initial consultations for hematological cancer. PATIENT EDUCATION AND COUNSELING 2013; 93:573-8. [PMID: 24035463 PMCID: PMC3852201 DOI: 10.1016/j.pec.2013.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations. METHODS Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists. RESULTS Physicians frequently "broadcasted" information about the disease, treatment options, relevant research, and prognostic information in extended, often-uninterrupted monologs. Their communicative styles had one of two implications: conveying options without offering specific recommendations, or recommending one without incorporating patients' goals and values into the decision. Some physicians, however, used techniques that encouraged patient participation. CONCLUSIONS Broadcasting may be a suboptimal method of conveying complex treatment information in order to support shared decision-making. Interventions could teach techniques that encourage patient participation. PRACTICE IMPLICATIONS Techniques such as open-ended questions, affirmations of patients' expressions, and pauses to check for patient understanding can mitigate the effects of broadcasting and could be used to promote shared decision-making in information-dense subspecialist consultations.
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Affiliation(s)
- Karan R Chhabra
- Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
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Trudel JG, Leduc N, Dumont S. Perceived communication between physicians and breast cancer patients as a predicting factor of patients' health-related quality of life: a longitudinal analysis. Psychooncology 2013; 23:531-8. [DOI: 10.1002/pon.3442] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/08/2013] [Accepted: 10/04/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Julie G. Trudel
- Behavioural Sciences and Health Research Division; University Health Network, Toronto General Hospital; Toronto Ontario Canada
- Lawrence S. Bloomberg, Faculty of Nursing; University of Toronto; Toronto Ontario Canada
| | - Nicole Leduc
- Département d'Administration de la santé, Faculté de médecine; Université de Montréal; Montréal Québec Canada
| | - Serge Dumont
- École de service social, Pavillon Charles De-Koninck; Université Laval; Québec Canada
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Kuis EE, Hesselink G, Goossensen A. Can quality from a care ethical perspective be assessed? A review. Nurs Ethics 2013; 21:774-93. [DOI: 10.1177/0969733013500163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.
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Affiliation(s)
| | - Gijs Hesselink
- Radboud University Nijmegen Medical Centre, The Netherlands
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Price K, Taylor AW, Dal Grande E, Kralik D. Do trial-and-error practices and the use of the internet influence how medicines are used? Aust J Prim Health 2013; 20:228-35. [PMID: 23562223 DOI: 10.1071/py13007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 03/14/2013] [Indexed: 11/23/2022]
Abstract
The aim of this research was to identify if people understood and used a practice termed 'trial and error' and the association of this practice to: (1) taking medicines as prescribed; and (2) use of the internet to assist their self-care decision-making. A national Computer Assisted Telephone Interview (CATI) was conducted in 2011 of a random sample of 3003 adults aged 18 years and over. Multivariable modelling, in stages, was undertaken adjusting for a range of demographics and associated health variables. There is a very strong relationship between the use of trial-and-error practices and not taking prescription medicines as prescribed. In addition, adults who state that they use trial-and-error practices to assist their health-related decision-making are more likely to have used the internet for information and then as a result, adjusted medicines or treatment. Any health care initiative directed at ensuring people take medicines as prescribed cannot dismiss the use of trial-and-error practices derived from information found on the internet.
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Affiliation(s)
- Kay Price
- School of Nursing and Midwifery, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Anne W Taylor
- Population Research and Outcome Studies, School of Medicine, University of Adelaide, Level 3, 122 Frome Street, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Eleonora Dal Grande
- Population Research and Outcome Studies, School of Medicine, University of Adelaide, Level 3, 122 Frome Street, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia
| | - Debbie Kralik
- Services and Innovation, Silver Chain Group incorporating RDNS SA Ltd, 1 Richmond Road, Keswick, SA 5034, Australia
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Schieber AC, Kelly-Irving M, Delpierre C, Lepage B, Bensafi A, Afrite A, Pascal J, Cases C, Lombrail P, Lang T. Is perceived social distance between the patient and the general practitioner related to their disagreement on patient's health status? PATIENT EDUCATION AND COUNSELING 2013; 91:97-104. [PMID: 23228376 DOI: 10.1016/j.pec.2012.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 10/11/2012] [Accepted: 11/11/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To ascertain whether disagreement between patients and general practitioners (GP) on the patient's health status varies according to their respective perceived social distance (PSD). METHODS The analysis used the Intermede project's quantitative data collected from 585 patients and 27 doctors via mirrored questionnaires. GPs and patients ranked their own perceived social position (PSP) in society, and their patients' and their GP respectively. PSD was calculated as the PSP's subtraction from the patients' and GPs' assessments. RESULTS Disagreement between GPs and patients regarding the patient's health status was associated with PSD by the GP whereas it was not associated with PSD by the patient. In the multilevel analysis, disagreement whereby GPs overestimate patient's health status increased within PSD by the GP: OR:2.9 (95%CI = 1.0-8.6, p = 0.055) for low PSD, OR:3.4 (95%CI = 1.1-10.2, p < 0.05) for moderate PSD and OR:3.8 (95%CI = 1.1-13.1, p < 0.05) for high PSD (reference: no distance). CONCLUSIONS Patients perceived with a lower social position by their GP and who consider themselves to have poor health are less likely to be identified in the primary care system. PRACTICE IMPLICATIONS Physicians need to be conscious that their own perception influences the quality of the interaction with their patients, potentially resulting in unequal health care trajectories.
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Westermann GMA, Verheij F, Winkens B, Verhulst FC, Van Oort FVA. Structured shared decision-making using dialogue and visualization: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2013; 90:74-81. [PMID: 23107362 DOI: 10.1016/j.pec.2012.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 09/04/2012] [Accepted: 09/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate a method, "Counseling in Dialogue" (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making. METHODS 94 children aged 2-12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N=133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N=20). 81 children had follow-up data. RESULTS Compared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: -0.38 (95%CI -0.56; -0.19), p<.001; fathers: -0.22 (95%CI -0.44; -0.01), p=.045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p<0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: -0.03 (95%CI -0.19; 0.14), p=.741). CONCLUSION The counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.
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Chung H, Lee H, Chang DS, Kim HS, Lee H, Park HJ, Chae Y. Doctor's attire influences perceived empathy in the patient-doctor relationship. PATIENT EDUCATION AND COUNSELING 2012; 89:387-391. [PMID: 22445730 DOI: 10.1016/j.pec.2012.02.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 02/23/2012] [Accepted: 02/26/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study investigated whether doctors' attire influences the perception of empathy in the patient-doctor relationship during a therapeutic encounter. METHODS A total number of 143 patients were divided into four groups when they were consulting a Traditional Korean Medicine doctor. Depending on the group, the same doctor was wearing four different attires--Casual, Suit, Traditional dress, White coat--when having a clinical consultation with the patients. RESULTS The patients preferred white coat and traditional dress more than other attires, giving highest scores to white coat in competency, trustworthiness and preference of attire and to traditional dress in comfortableness and contentment with the consultation. The "Consultation and Relational Empathy (CARE)" score was significantly higher in the "White coat" and "Traditional" groups, compared to the "Casual" and "Suit" groups. CONCLUSION The strong association between the patients' preference of doctors' attire and the CARE score indicates that the doctor's attire plays not only an important role for establishing confidence and trustworthiness but also for the perception of empathy in the patient-doctor relationship. PRACTICE IMPLICATIONS The doctor's attire can function as an effective tool of non-verbal communication in order to signal confidence, trust and empathy and establish a good patient-doctor relationship.
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Affiliation(s)
- Heesu Chung
- Acupuncture & Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
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Stoddart KM. Social meanings and understandings in patient-nurse interaction in the community practice setting: a grounded theory study. BMC Nurs 2012; 11:14. [PMID: 22950713 PMCID: PMC3496696 DOI: 10.1186/1472-6955-11-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 08/31/2012] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED BACKGROUND The patient-nurse relationship is a traditional concern of healthcare research. However, patient-nurse interaction is under examined from a social perspective. Current research focuses mostly on specific contexts of care delivery and experience related to medical condition or illness, or to nurses' speciality. Consequentially, this paper is about the social meanings and understandings at play within situated patient-nurse interaction in the community practice setting in a transforming healthcare service. METHODS Grounded theory methodology was used and the research process was characterised by principles of theoretical sensitivity and constant comparative analysis. The field of study was four health centres in the community. The participants were patients and nurses representative of those attending or working in the health centres and meeting there by scheduled appointment. Data collection methods were observations, informal interviews and semi-structured interviews. RESULTS Key properties of 'Being a good patient, being a good nurse', 'Institutional experiences' and 'Expectations about healthcare' were associated with the construction of a category entitled 'Experience'. Those key properties captured that in an evolving healthcare environment individuals continually re-constructed their reality of being a patient or nurse as they endeavoured to perform appropriately; articulation of past and present healthcare experiences was important in that process. Modus operandi in role as patient was influenced by past experiences in healthcare and by those in non-healthcare institutions in terms of engagement and involvement (or not) in interaction. Patients' expectations about interaction in healthcare included some uncertainly as they strived to make sense of the changing roles and expertise of nurses and, differentiating between the roles and expertise of nurses and doctors. CONCLUSIONS The importance of social meanings and understandings in patient-nurse interaction is not fully apparent to nurses, but important in the patient experience. Seeking understanding from a social perspective makes a contribution to enhancing knowledge about patient-nurse interaction with subsequent impact on practice, in particular the development of the patient-nurse relationship. The implications are that the meanings and understandings patients and nurses generate from experiences beyond and within their situated interaction are pivotal to the development of their relationship in the transforming community healthcare environment.
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Affiliation(s)
- Kathleen M Stoddart
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, FK9 4LA, Scotland.
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