1
|
Wong CS, Chidgey A, Lee KL, Mo PKH, Wong T, Banerjee S, Ho V, Leow Y, Gowindah R, Yew YJ, Fung R, Lau A. Empowering people living with HIV (PLHIV): unveiling care gaps and identifying opportunities for improving care for PLHIV in Singapore and Hong Kong. J Int AIDS Soc 2024; 27:e26250. [PMID: 38726655 PMCID: PMC11082721 DOI: 10.1002/jia2.26250] [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: 05/29/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION This study explored the behaviours of people living with HIV in Singapore and Hong Kong in terms of achieving and maintaining their physical and psychological wellbeing in relation to HIV, to identify the challenges and support needed in HIV care. METHODS This qualitative study involved 90-minute interviews among Singapore and Hong Kong people living with HIV aged ≥18 years to explore health-related quality of life perceptions and gaps in patient empowerment in HIV care during February-May 2022. The COM-B (C: Capability; O: Opportunity; M: Motivation; B: Behaviour) framework was used during data analysis to identify behaviour facilitators and barriers for people living with HIV to achieve and maintain their wellbeing. Detailed accounts of respondents' experience of living with and managing HIV, that is what worked well, unmet needs and perceived significance of wellbeing indicators, were analysed qualitatively via a combination of inductive content and deductive frameworks. RESULTS A total of 30 and 28 respondents were recruited from Singapore (SG) and Hong Kong (HK), respectively. Most respondents were aged 20-49 years (SG: 83.3%; HK: 64.3%), males (SG: 96.7%; HK: 92.9%), men who have sex with men (SG: 93.3%; HK: 71.4%), had university or higher education (SG: 73.3%; HK: 50.0%) and were fully employed (SG: 73.3%; HK: 57.1%). In both Singapore and Hong Kong, physical health was considered a key focus of overall wellbeing, albeit attention to long-term health associated with cardiovascular and renal health was less salient. The impact of symptoms, side effects of treatment, mood and sleep were among the top wellbeing indicators of importance. Respondents felt that insufficient information was provided by physicians, citing consultation time and resource constraints impeding further expression of concerns to their physicians during consultation. Respondents prioritized functional wellness and delegated psychosocial health to supportive care professionals, patient groups, families and/or friends. CONCLUSIONS There is a need in Singapore and Hong Kong to empower people living with HIV to establish better communications with their physicians and be more involved in their treatment journey and equally prioritize their psychosocial wellbeing.
Collapse
Affiliation(s)
- Chen Seong Wong
- National Centre for Infectious DiseasesSingaporeSingapore
- Department of Infectious DiseasesTan Tock Seng HospitalSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | | | | | - Phoenix K. H. Mo
- Centre for Health Behaviours ResearchThe School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong SARHong Kong SAR
- Hong Kong Coalition of AIDS Service OrganisationsHong Kong SARHong Kong SAR
| | - Timothy Wong
- Hong Kong AIDS FoundationHong Kong SARHong Kong SAR
| | | | | | | | | | | | - Ricky Fung
- Gilead SciencesHong Kong SARHong Kong SAR
| | - Agnes Lau
- Gilead SciencesHong Kong SARHong Kong SAR
| |
Collapse
|
2
|
Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, Divatia JV, Kumar A, Iyer SK, Deodhar J, Bhat RS, Salins N, Thota RS, Mathur R, Iyer RK, Gupta S, Kulkarni P, Murugan S, Nasa P, Myatra SN. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024; 28:200-250. [PMID: 38477011 PMCID: PMC10926026 DOI: 10.5005/jp-journals-10071-24661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine-Indian Association of Palliative Care (ISCCM-IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200-250.
Collapse
Affiliation(s)
- Raj K Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Kaushambi, Uttar Pradesh, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Butola
- Department of Palliative Care, Border Security Force Sector Hospital, Panisagar, Tripura, India
| | - Roop Gursahani
- Department of Neurology, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Dhvani Mehta
- Division of Health, Vidhi Centre for Legal Policy, New Delhi, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care, and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arun Kumar
- Department of Intensive Care, Medical Intensive Care Unit, Fortis Healthcare Ltd, Mohali, Punjab, India
| | - Shiva K Iyer
- Department of Critical Care, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Jayita Deodhar
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajani S Bhat
- Department of Interventional Pulmonology and Palliative Medicine, SPARSH Hospitals, Bengaluru, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghu S Thota
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Roli Mathur
- Department of Bioethics, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Rajam K Iyer
- Department of Palliative Care, Bhatia Hospital; P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sangeetha Murugan
- Department of Education and Research, Karunashraya, Bengaluru, Karnataka, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Neprash HT, Everhart A, McAlpine D, Smith LB, Sheridan B, Cross DA. Measuring Primary Care Exam Length Using Electronic Health Record Data. Med Care 2021; 59:62-66. [PMID: 33301282 DOI: 10.1097/mlr.0000000000001450] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physicians' time with patients is a critical input to care, but is typically measured retrospectively through survey instruments. Data collected through the use of electronic health records (EHRs) offer an alternative way to measure visit length. OBJECTIVE To measure how much time primary care physicians spend with their patients, during each visit. RESEARCH DESIGN We used a national source of EHR data for primary care practices, from a large health information technology company. We calculated exam length and schedule deviations based on timestamps recorded by the EHR, after implementing sequential data refinements to account for non-real-time EHR use and clinical multitasking. Observational analyses calculated and plotted the mean, median, and interquartile range of exam length and exam length relative to scheduled visit length. SUBJECTS A total of 21,010,780 primary care visits in 2017. MEASURES We identified primary care visits based on physician specialty. For these visits, we extracted timestamps for EHR activity during the exam. We also extracted scheduled visit length from the EHR's practice management functionality. RESULTS After data refinements, the average primary care exam was 18.0 minutes long (SD=13.5 min). On average, exams ran later than their scheduled duration by 1.2 minutes (SD=13.5 min). Visits scheduled for 10 or 15 minutes were more likely to exceed their allotted time than visits scheduled for 20 or 30 minutes. CONCLUSIONS Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time.
Collapse
Affiliation(s)
- Hannah T Neprash
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Alexander Everhart
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Donna McAlpine
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | | | - Dori A Cross
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN
| |
Collapse
|
5
|
Ibilibor C, Moses KA. Putting nonverbal communication under a lens: An examination of the dynamic interplay of patient-provider interactions between Black patients and non-Black physicians. Cancer 2020; 127:1008-1009. [PMID: 33290591 DOI: 10.1002/cncr.33353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Christine Ibilibor
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
6
|
Hajebrahimi S, Janati A, Arab-Zozani M, Sokhanvar M, Haghgoshayie E, Siraneh Y, Bahadori M, Hasanpoor E. Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-05-2019-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeVisit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.Design/methodology/approachMEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.FindingsOf 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8,I2=81.27,p=0.891) and patients’ gender (Q=55.98, df=11,I2=80.35,p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5,I2=87.88,p=0.170).Originality/valueIn this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.
Collapse
|
7
|
Tampi RP, Tembo T, Mukumba-Mwenechanya M, Sharma A, Dowdy DW, Holmes CB, Bolton-Moore C, Sikazwe I, Tucker A, Sohn H. Operational characteristics of antiretroviral therapy clinics in Zambia: a time and motion analysis. BMC Health Serv Res 2019; 19:244. [PMID: 31018846 PMCID: PMC6480736 DOI: 10.1186/s12913-019-4096-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The mass scale-up of antiretroviral therapy (ART) in Zambia has taken place in the context of limited infrastructure and human resources resulting in many operational side-effects. In this study, we aimed to empirically measure current workload of ART clinic staff and patient wait times and service utilization. METHODS We conducted time and motion (TAM) studies from both the healthcare worker (HCW) and patient perspectives at 10 ART clinics throughout Zambia. Trained personnel recorded times for consecutive discrete activities based on direct observation of clinical and non-clinical activities performed by counselors, clinical officers, nurses, and pharmacy technicians. For patient TAM, we recruited consenting patients and recorded times of arrival and departure and major ART services utilized. Data from 10 clinics were pooled to evaluate median time per patient spent for each activity and patient duration of stay in the clinic. RESULTS The percentage of observed clinical time for direct patient interaction (median time per patient encounter) was 43.1% for ART counselors (4 min, interquartile range [IQR] 2-7), 46.1% for nurses (3 min, IQR 2-4), 57.2% for pharmacy technicians (2 min, IQR 1-2), and 78.5% for clinical officers (3 min, IQR 2-5). Patient workloads for HCWs were heaviest between 8 AM and 12 PM with few clinical activities observed after 2 PM. The length of patient visits was inversely associated with arrival time - patients arriving prior to 8 AM spent 61% longer at the clinic than those arriving after 8 AM (277 vs. 171 min). Overall, patients spent 219 min on average for non-clinical visits, and 244 min for clinical visits, but this difference was not significant in rural clinics. In comparison, total time patients spent directly with clinic staff were 9 and 12 min on average for non-clinical and clinical visits. CONCLUSION Current Zambian ART clinic operations include substantial inefficiencies for both patients and HCWs, with workloads heavily concentrated in the first few hours of clinic opening, limiting HCW and patient interaction time. Use of a differentiated care model may help to redistribute workloads during operational hours and prevent backlogs of patients waiting for hours before clinic opening, which may substantially improve ART delivery in the Zambian context.
Collapse
Affiliation(s)
- Radhika P. Tampi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Taniya Tembo
- Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia
| | | | - Anjali Sharma
- Centers for Infectious Disease Research (CIDRZ), Lusaka, Zambia
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | | | | | | | - Austin Tucker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Hojoon Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| |
Collapse
|
8
|
Fortuna RJ, Nagel AK, Rocco TA, Legette-Sobers S, Quigley DD. Patient Experience With Care and Its Association With Adherence to Hypertension Medications. Am J Hypertens 2018; 31:340-345. [PMID: 29253071 DOI: 10.1093/ajh/hpx200] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medication adherence is crucial to effective chronic disease management, yet little is known about the influence of the patient-provider interaction on medication adherence to hypertensive regimens. We aimed to examine the association between the patient's experience with care and medication adherence. METHODS We collected 2,128 surveys over 4 years from a convenience sample of hypertensive patients seeking care at three urban safety-net practices in upstate New York. The survey collected adherence measures using the Morisky Medication Adherence Scale (MMAS-8) and patient experience measures. We used regression models to adjust for age, gender, race/ethnicity, self-reported health status, and clustering by patients. The primary outcome was reporting of medium-to-high adherence (MMAS ≥ 6) vs. low adherence. RESULTS A total of 62.5% of respondents reported medium-to-high medication adherence. The concern the provider demonstrated for patient questions or worries (adjusted odds ratio [AOR] 1.4; 95% confidence interval [CI] 1.1-1.7), provider efforts to include the patient in decisions (AOR 1.5; 95% CI 1.8-1.9), information given (AOR 1.3; 95% CI 1.0-1.6), and the overall rating of care received (AOR 1.4; 95% CI 1.1-1.8) were associated with higher medication adherence. The amount of time the provider spent was not associated with medication adherence (AOR 1.2; 95% CI 0.9-1.4). Medium-to-high medication adherence was in turn associated with increased hypertension control rates. CONCLUSIONS Overall, better experiences with care were associated with higher adherence to hypertension regimens. However, the amount of time the provider spent with the patient was not statistically associated with medication adherence, suggesting that the quality of communication may be more important than the absolute quantity of time.
Collapse
Affiliation(s)
- Robert J Fortuna
- Departments of Internal Medicine and Pediatrics, Center for Primary Care, University of Rochester, Rochester, New York, USA
| | - Angela K Nagel
- Department of Pharmacy Practice and Administration, Wegman's School of Pharmacy St. John Fisher College, Rochester, New York, USA
| | - Thomas A Rocco
- Department of Cardiology, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Internal Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | | |
Collapse
|
9
|
The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. J Racial Ethn Health Disparities 2017; 5:117-140. [PMID: 28275996 DOI: 10.1007/s40615-017-0350-4] [Citation(s) in RCA: 548] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Racial disparities exist in health care, even when controlling for relevant sociodemographic variables. Recent data suggest disparities in patient-physician communication may also contribute to racial disparities in health care. This study aimed to systematically review studies examining the effect of black race and racial concordance on patient-physician communication. METHODS A comprehensive search using the PRISMA guidelines was conducted across seven online databases between 1995 and 2016. The search resulted in 4672 records for review and 40 articles for final inclusion in the review. Studies were included when the sample consisted of black patients in healthcare contexts and the communication measure was observational or patient-reported. Data were extracted by pairs of authors who independently coded articles and reconciled discrepancies. Results were synthesized according to predictor (race or racial concordance) and communication domain. RESULTS Studies were heterogeneous in health contexts and communication measures. Results indicated that black patients consistently experienced poorer communication quality, information-giving, patient participation, and participatory decision-making than white patients. Results were mixed for satisfaction, partnership building, length of visit, and talk-time ratio. Racial concordance was more clearly associated with better communication across all domains except quality, for which there was no effect. CONCLUSIONS Despite mixed results due to measurement heterogeneity, results of the present review highlight the importance of training physicians and patients to engage in higher quality communication with black and racially discordant patients by focusing on improving patient-centeredness, information-giving, partnership building, and patient engagement in communication processes.
Collapse
|
10
|
Cox ED, Swedlund MP, Young HN, Moreno MA, Schopp JM, Rajamanickam V, Panepinto JA. Family Engagement in Pediatric Sickle Cell Disease Visits. HEALTH COMMUNICATION 2017; 32:51-59. [PMID: 27159356 PMCID: PMC5551046 DOI: 10.1080/10410236.2015.1099503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Adults with sickle cell disease (SCD) report problems in relationship building and information exchange during clinic visits. To explore the origin of these communication challenges, we compare communication in pediatric SCD, diabetes, and asthma visits. We collected visit videos and parent surveys from 78 children ages 9-16 years with SCD, asthma, or diabetes. Coders assessed child, parent, and physician utterances reflecting relationship building, information giving, and information gathering. Associations of engagement with type of chronic disease visit were performed with negative binomial regression. Compared to SCD visits, children in diabetes visits spoke 53% more relationship-building utterances (p < .05) and physicians in asthma visits spoke 48% fewer relationship building utterances to the child (p < .01). In diabetes visits, physicians gave almost twice as much information to children and gave 48% less information to parents (both p < .01) compared to SCD visits. Compared to SCD visits, physicians spoke fewer information-gathering utterances to parents in diabetes and asthma visits (85% and 72% respectively, both p < .001). SCD visits reflect less engagement of the children and greater physician effort to gather information from parents. These differences highlight opportunities to enhance engagement as a mechanism for ultimately improving SCD care.
Collapse
Affiliation(s)
- Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Matthew P. Swedlund
- Department of Family Medicine, University of Wisconsin School of
Medicine and Public Health
| | - Henry N. Young
- Department of Clinical and Administrative Pharmacy, University of
Georgia
| | - Megan A. Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Jennifer M. Schopp
- Department of Pediatrics, University of Wisconsin School of Medicine
and Public Health
| | - Victoria Rajamanickam
- Department of Biostatistics and Medical Informatics, University of
Wisconsin School of Medicine and Public Health
| | - Julie A. Panepinto
- Department of Pediatrics, Hematology/Oncology/Bone Marrow
Transplant, Medical College of Wisconsin, Children's Hospital of
Wisconsin
| |
Collapse
|
11
|
Kahler CW, Caswell AJ, Laws MB, Walthers J, Magill M, Mastroleo NR, Howe CJ, Souza T, Wilson I, Bryant K, Monti PM. Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients. PATIENT EDUCATION AND COUNSELING 2016; 99:1595-602. [PMID: 27161165 PMCID: PMC5028244 DOI: 10.1016/j.pec.2016.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/22/2016] [Accepted: 05/01/2016] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To elucidate patient language that supports changing a health behavior (change talk) or sustaining the behavior (sustain talk). METHODS We developed a novel coding system to characterize topics of patient speech in a motivational intervention targeting alcohol and HIV/sexual risk in 90 Emergency Department patients. We further coded patient language as change or sustain talk. RESULTS For both alcohol and sex, discussions focusing on benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change also was associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patterns and contexts, negations of drawbacks, and drawbacks of sexual risk behavior change. CONCLUSIONS Topic coding provided unique insights into the content of patient change and sustain talk. PRACTICE IMPLICATIONS Patients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behavior. Interventions addressing multiple health behaviors should address the unique motivations for maintaining specific risky behaviors.
Collapse
Affiliation(s)
- Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Amy J Caswell
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - M Barton Laws
- Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Justin Walthers
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Nadine R Mastroleo
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Chanelle J Howe
- Center for Population Health and Clinical Epidemiology, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Timothy Souza
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Ira Wilson
- Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Bethesda, MD, USA
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
12
|
Henry SG, Chen M, Matthias MS, Bell RA, Kravitz RL. Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids. PAIN MEDICINE 2016; 17:1892-1905. [PMID: 26936453 DOI: 10.1093/pm/pnw005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the development and initial application of the Chronic Pain Coding System. DESIGN Secondary analysis of data from a randomized clinical trial. SETTING Six primary care clinics in northern California. SUBJECTS Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain. METHODS The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5-0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity. RESULTS Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid-related utterances. CONCLUSIONS This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing.
Collapse
Affiliation(s)
- Stephen G Henry
- *Department of Internal Medicine, University of California Davis, Sacramento, California;
| | - Meng Chen
- Department of Communication, University of California Davis, Davis, California
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert A Bell
- Department of Communication, University of California Davis, Davis, California.,Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Richard L Kravitz
- *Department of Internal Medicine, University of California Davis, Sacramento, California
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to consider a patient-centred approach to the care of people living with HIV (PLWH) who have multimorbidity, irrespective of the specific conditions. RECENT FINDINGS Interdisciplinary care to achieve patient-centred care for people with multimorbidity is recognized as important, but the evaluation of models designed to achieve this goal are needed. Key elements of such approaches include patient preferences, interpretation of the evidence, prognosis as a tool to inform patient-centred care, clinical feasibility and optimization of treatment regimens. SUMMARY Developing and evaluating the best models of patient-centred care for PLWH who also have multimorbidity is essential. This challenge represents an opportunity to leverage the lessons learned from the care of people with multimorbidity in general, and vice versa.
Collapse
|
14
|
Laws MB, Lee Y, Rogers WH, Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Moore R, Wilson IB. Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav 2014; 18:1279-87. [PMID: 24464408 PMCID: PMC4047172 DOI: 10.1007/s10461-014-0697-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Disparities in HIV care and outcomes negatively affect Black and Hispanic patients. Features of clinical communication may be a factor. This study is based on coding transcripts of 404 routine outpatient visits by people with HIV at four sites, using a validated system. In models adjusting for site and patient characteristics, with provider as a random effect, providers were more "verbally dominant" with Black patients than with others. There was more discussion about ARV adherence with both Black and Hispanic patients, but no more discussion about strategies to improve adherence. Providers made more directive utterances discussing ARV treatment with Hispanic patients. Possible interpretations of these findings are that providers are less confident in Black and Hispanic patients to be adherent; that they place too much confidence in their White, non-Hispanic patients; or that patients differentially want such discussion. The lack of specific problem solving and high provider directiveness suggests areas for improvement.
Collapse
Affiliation(s)
- M Barton Laws
- Department of Health Services, Policy and Practice, Brown University, G-S121-7, Providence, RI, 02912, USA,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Okonsky JG, Webel A, Rose CD, Johnson M, Asher A, Cuca Y, Kaihura A, Hanson JE, Portillo CJ. Appreciating Reasons for Nonadherence in Women. Health Care Women Int 2014; 36:1007-25. [PMID: 24654887 DOI: 10.1080/07399332.2014.903952] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Women aged 15-24 years have an HIV infection rate twice that of men the same age. In this study we examined reasons why HIV-infected women taking antiretroviral therapy (ART) report missing HIV medications. Women (N = 206) on ART were 2.2 times more likely to endorse reasons pertaining to forgetfulness versus reasons pertaining to problems taking pills (OR = 2.2, 95% CI = 1.63, 2.94, p <.001). There was a difference between the adherent and nonadherent groups in types of reasons overall (p <.001, 95% CI = -3.82, -2.03). Using a patient-centered approach to understand type of nonadherence (intentional vs. unintentional) may support development of novel interventions.
Collapse
Affiliation(s)
- Jennifer G Okonsky
- a Department of Community Health Systems, School of Nursing , University of California San Francisco , San Francisco , California , USA
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Wallace BC, Laws MB, Small K, Wilson IB, Trikalinos TA. Automatically annotating topics in transcripts of patient-provider interactions via machine learning. Med Decis Making 2014; 34:503-12. [PMID: 24285151 PMCID: PMC3991772 DOI: 10.1177/0272989x13514777] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Annotated patient-provider encounters can provide important insights into clinical communication, ultimately suggesting how it might be improved to effect better health outcomes. But annotating outpatient transcripts with Roter or General Medical Interaction Analysis System (GMIAS) codes is expensive, limiting the scope of such analyses. We propose automatically annotating transcripts of patient-provider interactions with topic codes via machine learning. METHODS We use a conditional random field (CRF) to model utterance topic probabilities. The model accounts for the sequential structure of conversations and the words comprising utterances. We assess predictive performance via 10-fold cross-validation over GMIAS-annotated transcripts of 360 outpatient visits (>230,000 utterances). We then use automated in place of manual annotations to reproduce an analysis of 116 additional visits from a randomized trial that used GMIAS to assess the efficacy of an intervention aimed at improving communication around antiretroviral (ARV) adherence. RESULTS With respect to 6 topic codes, the CRF achieved a mean pairwise kappa compared with human annotators of 0.49 (range: 0.47-0.53) and a mean overall accuracy of 0.64 (range: 0.62-0.66). With respect to the RCT reanalysis, results using automated annotations agreed with those obtained using manual ones. According to the manual annotations, the median number of ARV-related utterances without and with the intervention was 49.5 versus 76, respectively (paired sign test P = 0.07). When automated annotations were used, the respective numbers were 39 versus 55 (P = 0.04). While moderately accurate, the predicted annotations are far from perfect. Conversational topics are intermediate outcomes, and their utility is still being researched. CONCLUSIONS This foray into automated topic inference suggests that machine learning methods can classify utterances comprising patient-provider interactions into clinically relevant topics with reasonable accuracy.
Collapse
Affiliation(s)
- Byron C. Wallace
- Dept of Health Services, Policy and Practice,121 South Main Street, Providence, RI, 02903, USA
| | - M. Barton Laws
- Dept of Health Services, Policy and Practice,121 South Main Street, Providence, RI, 02903, USA
| | - Kevin Small
- National Institutes of Health, 2 Center Drive, Bethesda, MD 20892, USA
| | - Ira B. Wilson
- Dept of Health Services, Policy and Practice,121 South Main Street, Providence, RI, 02903, USA
| | - Thomas A. Trikalinos
- Dept of Health Services, Policy and Practice,121 South Main Street, Providence, RI, 02903, USA
| |
Collapse
|
17
|
Lau SR, Christensen ST, Andreasen JT. Patients' preferences for patient-centered communication: a survey from an outpatient department in rural Sierra Leone. PATIENT EDUCATION AND COUNSELING 2013; 93:312-8. [PMID: 23906648 DOI: 10.1016/j.pec.2013.06.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 05/11/2013] [Accepted: 06/29/2013] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone. METHODS A survey was conducted using an adapted version of the Patient-Practitioner Orientation Scale (PPOS) as a structured interview guide. The study population was drawn from the population of all adults attending for treatment or treatment for their children. RESULTS 144 patients were included in the analysis. Factors, such as doctor's friendly approach, the interpersonal relationship and information-sharing were all scored high (patient-centered) on the PPOS. Factors associated with shared-decision making had a lower (doctor-centered) score. A high educational level was associated with a more patient-centered scoring, an association that was most pronounced in the female population. CONCLUSION The results provide an insight into the patients' preferences for PCC. Patients expressed a patient-centered attitude toward certain areas of PCC, while other areas were less expressed. More research is needed in order to fully qualify the applicability of PCC in resource-poor settings. PRACTICE IMPLICATIONS Stakeholders and healthcare professionals should aim to strengthen healthcare practice by focusing on PCC in the medical encounter while taking into considerations the patients' awareness and preferences for PCC.
Collapse
|
18
|
Brooks AT, Silverman L, Wallen GR. Shared decision making: a fundamental tenet in a conceptual framework of integrative healthcare delivery. INTEGRATIVE MEDICINE INSIGHTS 2013; 8:29-36. [PMID: 24092959 PMCID: PMC3782399 DOI: 10.4137/imi.s12783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
With the increased usage of complementary and alternative medicine (CAM) in the US comes a need for evidence-based and integrated care systems which encourage open communication between patients and providers. This paper introduces a conceptual framework for integrative care delivery, with shared decision making being the "connecting force" between holistic treatment and improved health outcomes for patients.
Collapse
Affiliation(s)
| | - Leanne Silverman
- Medstar Georgetown University Hospital, Neuroscience Stroke and Intermediate Care Unit
| | | |
Collapse
|
19
|
King A, Hoppe RB. "Best practice" for patient-centered communication: a narrative review. J Grad Med Educ 2013; 5:385-93. [PMID: 24404300 PMCID: PMC3771166 DOI: 10.4300/jgme-d-13-00072.1] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/15/2013] [Accepted: 05/23/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians. OBJECTIVE This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed. RESULTS A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes "best practice" for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior. CONCLUSIONS Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.
Collapse
|
20
|
Laws MB, Taubin T, Bezreh T, Lee Y, Beach MC, Wilson IB. Problems and processes in medical encounters: the cases method of dialogue analysis. PATIENT EDUCATION AND COUNSELING 2013; 91:192-9. [PMID: 23391684 PMCID: PMC3622168 DOI: 10.1016/j.pec.2012.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/21/2012] [Accepted: 12/28/2012] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. METHODS Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The comprehensive analysis of the structure of encounters system (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads--the problems or issues addressed; and processes within threads--basic tasks of clinical care labeled presentation, information, resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. RESULTS 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. CONCLUSIONS In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. PRACTICE IMPLICATIONS Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
Collapse
Affiliation(s)
- M Barton Laws
- Brown University, Department of Health Services, Policy & Practice, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Laws MB, Beach MC, Lee Y, Rogers WH, Saha S, Korthuis PT, Sharp V, Wilson IB. Provider-patient adherence dialogue in HIV care: results of a multisite study. AIDS Behav 2013; 17:148-59. [PMID: 22290609 DOI: 10.1007/s10461-012-0143-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Few studies have analyzed physician-patient adherence dialogue about ARV treatment in detail. We comprehensively describe physician-patient visits in HIV care, focusing on ARV-related dialogue, using a system that assigns each utterance both a topic code and a speech act code. Observational study using audio recordings of routine outpatient visits by people with HIV at specialty clinics. Providers were 34 physicians and 11 non-M.D. practitioners. Of 415 patients, 66% were male, 59% African-American. 78% reported currently taking ARVs. About 10% of utterances concerned ARV treatment. Among those using ARVs, 15% had any adherence problem solving dialogue. ARV problem solving talk included significantly more directives and control parameter utterances by providers than other topics. Providers were verbally dominant, asked five times as many questions as patients, and made 21 times as many directive utterances. Providers asked few open questions, and rarely checked patients' understanding. Physicians respond to the challenges of caring for patients with HIV by adopting a somewhat physician-centered approach which is particularly evident in discussions about ARV adherence.
Collapse
Affiliation(s)
- M Barton Laws
- Department of Health Services Policy and Practice, Brown University, G-S121-7, Providence, RI 02912, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Zill JM, Scholl I, Härter M, Dirmaier J. Evaluation of dimensions and measurement scales in patient-centeredness. Patient Prefer Adherence 2013; 7:345-51. [PMID: 23723692 PMCID: PMC3666547 DOI: 10.2147/ppa.s42759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient-centeredness has gained importance over the last two decades. However, there is an absence of theoretical clarity regarding the term patient-centeredness. This results in inconsistent measurement of patient-centeredness, which leads to difficulties in comparing research results. To overcome these difficulties, the aims of this study are (1) to identify the dimensions of patient-centeredness and include them in an integrative model, (2) to select and assess the most relevant dimensions of the model, (3) to identify and assess measurement instruments and find evidence for the selected dimensions, and (4) to assess the relevance and applicability of the conceptualization and measurement of patient-centeredness in clinical practice and health services research. METHODS This project is divided into four phases. First, a systematic review will be conducted to identify the constructs and dimensions of patient-centeredness. Second, experts (eg, researchers, clinicians, and patient representatives) will assess and prioritize the identified relevant dimensions using a Delphi survey. Third, the selected dimensions will be assessed regarding their operationalization, and the results will be summarized in a systematic review. Evidence of the measures will be assessed in a scoping review. Fourth, an expert workshop will be held. Experts will assess the results of the previous phases regarding the relevance and applicability of the conceptualization and measurement of patient-centeredness. DISCUSSION This study will provide an integrative model of patient-centeredness based on the current literature. This model can be used to improve upon the comparability of research results. Through a detailed insight into the existence and evidence of measurement dimensions of patient-centeredness, existing gaps in this field will be shown. Finally, the expert assessment will show the relevance and feasibility of the concept and measures in clinical practice and health services research. Therefore, this study will contribute important knowledge to enhance future research on patient-centeredness and establish a foundation for its implementation.
Collapse
Affiliation(s)
- Jördis M Zill
- Correspondence: Jördis M Zill, Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany, Tel +49 40 7410 58649, Fax +49 40 7410 54965, Email
| | | | | | | |
Collapse
|