Concordance between physician communication style and patient attitudes predicts patient satisfaction

The Influence of Doctor-Patient Communication on Patients' Trust: The Role of Patient-Physician Consistency and Perceived Threat of Disease

Purpose

To investigate the influence mechanism of doctor-patient communication on patients' trust, especially the mediating role of patient-physician consistency and the moderating role of perceived threat of disease.

Methods

A total of 699 patients in Guangzhou, China was investigated by questionnaire. The main effect, mediating effect, and moderating effect of the model was verified by SPSS23.0 and LISREL8.71 statistical software.

Results

It was revealed that doctor-patient communication has a significant positive effect on patients' trust. The consistency between patient and physician partially mediates the relationship between doctor-patient communication and patients' trust. Additionally, the perceived threat of the disease moderates the psychological process through which doctor-patient communication affects patients' trust.

Conclusion

Both doctor-patient communication and patient-physician consistency have predictive effects on patients' trust. Doctor-patient communication is not only a direct influence on patient trust but also an indirect influence mediated by patient-physician consistency. Perceived threat of disease moderates the psychological process through which doctor-patient communication affects patients' trust. Specifically, compared to a high level of perceived threat of disease, a low level of perceived threat of disease can enhance the effect of doctor-patient communication on patients' trust. The results of this study underscore the importance of doctor-patient communication and the value of patient-physician consistency for building patients' trust. To foster a harmonious doctor-patient relationship, medical colleges should place great emphasis on cultivating medical students' communication skills. Hospitals should enhance on-the-job training and provide institutional support for doctors, encourage agreements between doctors and patients regarding disease diagnosis and decision-making, and be attentive to patients' perceived threat of disease, particularly for those with high level of perceived threat of disease.

Experience of psychosocial rehabilitation; perspectives of depressed adolescents

Given the multifaceted character of depression and its related symptoms, an adolescent living with it is at increased risk for a wide range of adverse events. This research aimed to understand and characterize the psychosocial rehabilitation experiences of depressed teenage participants in the Greater Accra Region of Ghana. A cross-sectional semi-structured interview design influenced by an interpretive phenomenological analysis (IPA) technique was adopted. We employed a nonprobability, purposeful sampling approach to recruit twenty-one adolescents (6 males, 15 females) diagnosed with depression from the community after one month of discharge from admission and undergoing psychosocial rehabilitation. Using separate interviews, we gathered and analyzed data using interpretive phenomenological analysis to produce themes and sub-themes. These were presented with the participants' direct quotations. We discovered that the perspectives of adolescents' psychosocial rehabilitation experience include hopelessness and suicide ideation, coping difficulties, undesirable attitudes from support networks, challenges related to school, and isolation. Participants suggested appropriate therapeutic environments, encouraging support systems, and the media's role in preventing and treating depression among young people as rehabilitation approaches that could assist adolescents to remain lucid for longer intervals. These results shed light on the tragic realities faced by depressed adolescents. There is an urgent need to put well-defined structures in place to aid their rehabilitation and develop coping strategies for a better life.

Physician Communication Behaviors on Patient Satisfaction in Primary Care Medical Settings in Bangladesh

OBJECTIVES

This study aims at exploring the effects of physicians' communication behaviors on patients' satisfaction in primary care medical consultations in Chattogram, Bangladesh. The study used a quantitative research approach designed with a cross-sectional survey.

METHODS

Data were collected using post-consultation and facilitator administered questionnaire from the patients who visited the physician for medical consultation in different hospitals and clinics in Chattogram city. Seven hundred patients were included as the study participants. A hierarchical linear regression analysis was performed to examine the factors contributing to the outcome variables.

RESULTS

A statistically significant difference (P < .001) appeared regarding patients' perception of adequate consultation, physicians' nonverbal behavior, inhibiting behavior and patients' participating behavior in private and public settings. However, R2 value shows that physicians' patient-centered behaviors appeared as the stronger predictors of patient satisfaction toward medical interviews, followed by socioeconomic variables of patients and physicians and patients' participation during the consultation. Presence of a third person with patients during consultation (β = -.05, P = .040), physicians' private setting of consultation (β = .16, P < .001), physicians' seniority (β = .05, P = .042), patients' participating behavior during consultation (β = .20, P < .001), physicians' nonverbal behavior (β = .10, P < .001), physicians' inhibiting behavior (β = -.39, P < .001), and physicians' facilitating behavior with patients (β = .32, P < .001) were reported as the influencing factors of patients' satisfaction with medical consultation.

CONCLUSION

This study suggests the profound impact of physicians' patient-centered communication behaviors on patient satisfaction in primary care settings, overshadowing even socioeconomic factors and patient participation.

Telemedicine Impact on the Patient-Provider Relationship in Primary Care During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has necessitated a rapid uptake of telemedicine in primary care requiring both patients and providers to learn how to navigate care remotely. This change can impact the patient-provider relationship that often defines care, especially in primary care.

OBJECTIVE

This study aims to provide insight into the experiences of patients and providers with telemedicine during the pandemic, and the impact it had on their relationship.

RESEARCH DESIGN

A qualitative study using thematic analysis of semistructured interviews.

SUBJECTS

Primary care providers (n=21) and adult patients (n=65) with chronic disease across primary care practices in 3 National Patient-centered Clinical Research Network sites in New York City, North Carolina, and Florida.

MEASURES

Experiences with telemedicine during the COVID-19 pandemic in primary care. Codes related to the patient-provider relationship were analyzed for this study.

RESULTS

A recurrent theme was the challenge telemedicine posed on rapport building and alliance. Patients felt that telemedicine affected provider's attentiveness in varying ways, whereas providers appreciated that telemedicine provided unique insight into patients' lives and living situations. Finally, both patients and providers described communication challenges.

CONCLUSIONS

Telemedicine has altered structure and process aspects of primary health care such as the physical spaces of encounters, creating a new setting to which both patients and providers must adjust. It is important to recognize the opportunities and limits that this new technology has to help providers maintain the type of one-on-one attention that patients expect and that contributes to relationship building.

Predictors of patient satisfaction and perceived quality of healthcare: College healthcare providers and students' communication

Background: Prior research indicates that healthcare provider-patient communication influences health outcomes such as patient satisfaction, compliance with diagnosis or treatment, and general health quality. However, little is known about this type of inquiry in the context of healthcare centers on college and university campuses. Aim: The objective of this study was to examine the influence of students' perception of college healthcare providers' affective and instrumental behaviors on student patient satisfaction and perceived quality of healthcare at a university health center. Methods: 349 participants who were college students took an online survey. Regression analyses were conducted. Results: Affective and instrumental behaviors were important communicative behaviors predicting student patient satisfaction and perceived quality of healthcare. However, directions of these predictions differed between student patient satisfaction and perceived quality of healthcare. Conclusion: Healthcare providers at the university health center are recognizing student patients as partners in the healthcare decision-making processes.

Sustainable Healthcare System: Providers Initiatives for Quality Improvement of Healthcare Organisation

The study is designed for sustainable healthcare system with providers’ initiatives to provide quality services in healthcare organisations. Healthcare providers’ initiatives promote quality and ensure better healthcare services. Among the healthcare providers who were studied and reviewed, it was observed that the initiatives of the healthcare providers improved the overall quality. There is a distinct scope of further enhancement with the participation of healthcare providers in healthcare organisations. The purpose of this research is to learn and determine the answers to questions through scientific application.

This study shows that an augmented frequency of sustainable healthcare systems is only possible through the initiatives of healthcare providers. In healthcare services, patients remain satisfied without expressing their dissatisfaction to the management. To know the needs of patients, there has to be a certain level of relationship between healthcare providers and patients. For this purpose, the system has to be very proficient in the service conditions and their applicability for quality in the hospital.

Healthcare organisations management has the conviction that the participative role of healthcare professionals in hospitals will increase patient satisfaction. In this perspective, the pressing priority of healthcare providers for hospitals will always be patients. Thus, apart from the availability of healthcare facilities and quality of care, the location of the hospital has predominant importance. Based on the findings, it is to be stated that sustainable healthcare is subject to provider’s initiatives and actions for quality in healthcare organisations.

Factors that influence older patients’ participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature

Background

Engaging older adults in clinical communication is an essential aspect of high-quality elder care, patient safety and satisfaction in hospitals and GP clinics. However, the factors that influence older adults’ participation during their appointments with health professionals from the older patient’s perspective remain under-investigated.

Objectives

We aimed to fill this knowledge gap by reviewing research articles that have examined older patients’ involvement in clinical communication. In doing so, we hope to assist healthcare professionals and institutions in developing new strategies to improve older patients’ participation and engagement in clinical communication.

Methods

A systematic review of nine databases was conducted for studies reporting identified influences on older patients’ participation in clinical communication published from 2010. These studies were then subjected to thematic analysis for stratification.

Results

Twenty-one articles with a total of 36,797 participants were included and highlighted three major themes that influenced older patients’ participation in the clinical communication. The first theme identified includes accessibility to appointments, support, health information and person-centred care, highlighting that access to appointments, person centred care and health information significantly influences clinical communication participation. Relevant and understandable healthcare information identified that communication factors [i.e. tailored health information, health literacy and patient language barriers, and communication impairments] influences older patients’ participation. Older Patient perceptions of HCP credibility and trustworthiness highlighted how patient’s perceptions of health professionals influence their willingness to participate in clinical communications.

Conclusions and implications

This review demonstrates that there are several factors that contribute to insufficient or no participation of older patients in clinical communication in hospitals and GP clinics. These include accessibility to relevant and understandable health information, and the perceived health professional credibility and trustworthiness. Identifying ways to address these factors may improve patient participation, doctor-patient collaboration and overall health outcomes for older patients.

Medical student empathy and breaking bad news communication in a simulated consultation

OBJECTIVES

This study examined the relationship between self-reported empathy and breaking bad news (BBN) communication skills performance in a sample of undergraduate medical students (n = 100) in the clinical years of their program.

METHODS

Correlational and regression analysis examined the relationship between Jefferson Scale of Physician Empathy (JSPE-S) and Empathy Quotient (EQ) scores, and communication skills performance based on students' application of the SPIKES protocol to a BBN scenario in a simulated encounter.

RESULTS

Higher BBN communication skills performance was positively correlated with scores on the "Social Skills" EQ sub-scale (r (99) = 0.31, p = 0.002), which measures spontaneous and context-independent use of social skills. Multiple regression confirmed that "Social Skills" sub-scale variation predicted BBN score variation (B = 2.17, 95% CI = 0.65-3.69, p < 0.01). A weak positive association was also observed between BBN score and the "Standing in Patient's Shoes" JSPE sub-scale (r (99) = 0.22, p = 0.03).

CONCLUSIONS

Findings suggest that specific aspects of dispositional empathy may moderate BBN communications skills competence in medical students.

PRACTICE IMPLICATIONS

A better understanding of the moderating role of personality may lead to more tailored BBN communications skills training interventions and improved transfer of skills to workplace settings.

Experiences of adolescents and parents on the mental health management of depression in adolescents, North West province, South Africa

BACKGROUND

 Living with or managing an adolescent suffering from depression predisposes the adolescent and parents to various experiences, considering the multifactorial nature of depression and associated symptoms.

OBJECTIVE

 This study explored and described the experiences of adolescents and their parents on the mental health management of depression in the North West province (NWP), South Africa.

METHOD

 A qualitative, exploratory, descriptive, contextual research design was adopted. Data was collect from two mental health care institutions and two mental health care units attached to two general hospitals in the NWP, SA. Thirty-two participants (18 adolescents and 14 parents) were purposefully selected for the study. Data were collected through individual interviews and analysed using Tesch's open-coding method to generate themes and categories which were presented with the concurrent support of participants direct quotations.

RESULTS

 The study revealed that the experiences of adolescents with depression and their parents taking care of them at homes include the following: emotional distress, poor coping mechanisms, financial burden, repeated suicidal attempts, negative attitudes from support systems and withdrawal behaviours. Appropriate therapeutic environments, ongoing monitoring by mental healthcare practitioners and adequate support systems were suggested by participants as management approaches that could enhance the recovery of adolescents from depression.

CONCLUSION

 The findings revealed the devastating experiences of adolescents with depression and their parents taking care of them in their various homes which confirms the dire need for attention on the plights of these groups in order to facilitate adolescents' recovery and strengthen the adolescents' and parents' coping mechanisms for a healthier family.

The relationship between personality traits of cancer patients and their preferences when receiving bad news

OBJECTIVE

This study aimed to determine the relationship between the personality traits of cancer patients and their preferences when receiving bad news.

METHODS

In this descriptive correlational study, 200 cancer patients who were selected by the continuous sampling method participated. Patients self-reportedly completed the demographic and medical information questionnaire, the Measure of Patients' Preference (MPP) scale, and the short form of the Eysenck Personality Inventory (EPI).

RESULTS

The majority of participants were female (73%), 42.5% had higher education, and 47.5% suffered from breast cancer. In this study, the mean scores of extraversion and neuroticism in patients were 14.59 ± 2.47 and 15.17 ± 3.43, respectively. Regarding patients' preferences for receiving bad news, the score obtained by them in the content category was greater compared to two categories of context and support. This study showed a significant and negative correlation between neuroticism and patients' preferences in the support category (P < 0.001 and r =  - 0.265). Regarding the categories of the MPP, there was a significant relationship between gender (P = 0.018) and marital status (P = 0.049) with context category, education (P = 0.011) with content category, and marital status (P = 0.003) and employment (P = 0.009) with support category.

CONCLUSION

Personality traits and demographic characteristics of cancer patients can influence their preferences for receiving bad news. Therefore, the consideration of these traits by health care team members is of particular importance to communicate with and deliver bad news to patients.

Examining Different Factors in Web-Based Patients' Decision-Making Process: Systematic Review on Digital Platforms for Clinical Decision Support System

(1) Background: The appearance of physician rating websites (PRWs) has raised researchers’ interest in the online healthcare field, particularly how users consume information available on PRWs in terms of online physician reviews and providers’ information in their decision-making process. The aim of this study is to consistently review the early scientific literature related to digital healthcare platforms, summarize key findings and study features, identify literature deficiencies, and suggest digital solutions for future research. (2) Methods: A systematic literature review using key databases was conducted to search published articles between 2010 and 2020 and identified 52 papers that focused on PRWs, different signals in the form of PRWs’ features, the findings of these studies, and peer-reviewed articles. The research features and main findings are reported in tables and figures. (3) Results: The review of 52 papers identified 22 articles for online reputation, 15 for service popularity, 16 for linguistic features, 15 for doctor–patient concordance, 7 for offline reputation, and 11 for trustworthiness signals. Out of 52 studies, 75% used quantitative techniques, 12% employed qualitative techniques, and 13% were mixed-methods investigations. The majority of studies retrieved larger datasets using machine learning techniques (44/52). These studies were mostly conducted in China (38), the United States (9), and Europe (3). The majority of signals were positively related to the clinical outcomes. Few studies used conventional surveys of patient treatment experience (5, 9.61%), and few used panel data (9, 17%). These studies found a high degree of correlation between these signals with clinical outcomes. (4) Conclusions: PRWs contain valuable signals that provide insights into the service quality and patient treatment choice, yet it has not been extensively used for evaluating the quality of care. This study offers implications for researchers to consider digital solutions such as advanced machine learning and data mining techniques to test hypotheses regarding a variety of signals on PRWs for clinical decision-making.

Impact of physician empathy on patient outcomes: a gender analysis

BACKGROUND

Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and, to date, no study has concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions.

AIM

To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation's quality, and patients' trust in their physicians, and to determine whether this relationship is moderated by a physician's gender.

DESIGN AND SETTING

Analysis of the empathy of 61 primary care physicians in relation to 244 patient experience questionnaires in the French-speaking region of Switzerland.

METHOD

Sixty-one physicians were video-recorded with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded emotional arousal. After the consultation, patients indicated their satisfaction with, trust in, and quality of the consultation.

RESULTS

Female physicians self-rated their empathic concern higher than their male counterparts did, whereas male physicians were more vocally synchronised (in terms of frequencies of speech) to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was male.

CONCLUSION

Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes, and could be used as a cost-effective proxy for relational quality.

Patient-centered communication and emotional well-being in the era of medical violence in China

The past decade has witnessed an increasing number of patient assaults on doctors in China. Patient-centered communication (PCC) may be one way to mitigate this problem. This study examined the effects of PCC and patient trust on emotional health outcome, especially how patients' attitude toward medical violence affected this relationship. Data were drawn from the China Governance and Public Policy Survey administered in 2017 with a sample size of 3784. The results showed that PCC had no direct effect on emotional well-being. Instead, patient trust completely mediated this path. Also, patients' attitude toward medical violence increased the indirect effect of PCC on emotional well-being, suggesting a moderated mediation model. We call for education programs to promote PCC for both providers and patients, mass media campaigns to condemn violence against doctors and stricter law enforcement to stop medical violence.

"If at Least the Patient Could Not Be Forgotten About": Communication in the Emergency Department as a Predictor of Patient Satisfaction

Press Ganey survey data are used by institutions to understand patient experiences in the emergency department (ED). The present mixed-methods retrospective cohort study examined the effects of hallway placement, pain management reporting, communication approaches, time spent in the ED, and other demographic variables on predicting satisfaction ratings of doctors, nurses, and overall ED care. A total of 4940 patient responses between January 1, 2012, and December 31, 2017, were analyzed from 2 EDs associated with an academic institution and tertiary care center. Consensus coding was used to qualitatively capture patient responses that relate to communication issues pertaining to care/empathy and understandings of ED procedures. After controlling for multiple factors, hallway placement, pain management, and understanding of ED procedures were associated with higher odds of negative ratings for doctors, nurses, and overall assessment. Issues with patient communication, particularly regarding understanding of ED procedures, were found to be a strong predictor of negative ratings of doctors, nurses, and overall care. These findings point to the improvements in communication as a potential point of intervention in mitigating negative patient experiences.

Association of patient preferences on medication discussion in hypertension: Results from a randomized clinical trial

Patient-centered care has received significant attention and is an integral component of high-quality healthcare. While it is often assumed that most prefer a patient-centered role orientation, such preferences exist along a continuum with some patients preferring a more provider-centered role. The present study examines patient preference data from a randomized clinical trial designed to test the efficacy of a patient activation intervention to promote thiazide prescribing for veteran patients with uncontrolled hypertension. Patient preferences for involvement in healthcare were assessed using the 9-item Sharing subscale of the Patient-Practitioner Orientation Scale (PPOS). The primary aim was to examine differences in discussion of thiazide use in the clinical encounter by those scoring high versus low on the PPOS. Five hundred ninety-five veteran patients were randomized to either one of three intervention groups or a usual care control group. The adjusted odds ratios (OR) for the three intervention groups relative to the control group indicated that thiazide discussion increased as a function of intervention intensity across both high and low PPOS groups. ORs for the most intensive intervention group were 3.72 (95% CI = 1.61-8.65, p < .01) for high PPOS patients and 6.71 (95% CI = 2.59-10.67, p < .001) for low PPOS patients. Results suggest that this patient activation intervention is effective for veteran patients representing a range of preferred involvement. Consideration of such preferences may be useful in tailoring future interventions in the healthcare context.

Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice

Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights "predictive coding" and "bayesian brain" as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.

Protocol of a multicentric prospective cohort study for the VALIDation of the IBD-disk instrument for assessing disability in inflammatory bowel diseases: the VALIDate study

Background

Inflammatory Bowel Diseases (IBD) affect psychological, family, social and professional dimensions of patients’ life, leading to disability which is essential to quantify as part of Patient-Reported Outcomes (PROs) newly included in the targets to reach in IBD patients. Up to now, the IBD-Disability Index (IBD-DI) was the only validated tool to assess disability, but it is not appropriate for use in clinical practice. The IBD Disk was developed, a shortened and self-administered tool, adapted from the IBD-DI, in order to give immediate representation of patient-reported disability. However, the IBD Disk has not been validated yet in clinical practice. The aims of the VALIDate study are to validate this tool in a large population of IBD patients and to compare it to the already validated IBD-DI.

Methods

The VALIDate study is an ongoing multicentric prospective cohort study launched in April 2018 in 3 French University Hospitals (Nantes, Rennes, Angers), with an objective to reach a sample of 400 patients over a period inclusion of 6 months. Each patient will fill in the two questionnaires IBD Disk and IBD-DI at baseline, then between 3 and 12 months later, during a follow-up visit. Clinical and socio-demographic data will also be collected. During these two consultations, gastroenterologists and patients will evaluate disease activity thanks to a semi-quantitative 4-grade scale, named respectively PGA (Physician Global Assessment) and PtGA (Patient Global Assessment). This cohort will allow to evaluate the validity of the IBD Disk with respect to the IBD-DI in order to generalize its use for clinical practice. Other psychometric criteria of the IBD Disk will also be analysed as its reliability or its discriminant capacity. Close attention will nonetheless be needed to minimize the number of lost to follow-up patients between baseline and follow-up.

Discussion

The VALIDate study is the study designed to validate the IBD Disk, a visual tool easily useable in daily practice to assess disability in IBD patients. The results of this trial should enable the diffusion of this tool.

Trial registration

The trial is registered in ClinicalTrials.Gov with registration number NCT03590639. First posted: July 18, 2018.

You only have one chance for a first impression! Impact of Patients' First Impression on the Global Quality Assessment of Doctors' Communication Approach

Patients' first impressions obtained during early contacts with doctors represent the basis for relationship building processes. Aim of this study was to verify how patients' first impression of doctors' communication approach influences patients' global assessment of doctors' performance. This cross-sectional study was part of a larger, multicenter observational study aiming to assess lay-people's preferences regarding patient-doctor communication. All participants (N = 136) were equally distributed over two selected Italian and Dutch recruitment centers as well as for gender and age. In each center, panels of 6-9 persons each watched the same set of eight videotaped Objective Structured Clinical Examination consultations. Participants performed different tasks as to pick up salient communication elements while watching the videos and to rate doctors' global communicative performances on a 10-point Likert scale. We performed a mediation analysis to assess direct and indirect effects of participants' first impression on participants' global assessment. Among the 439 collected first impressions, 284(65%) were positive. When the first impression was positive, the mean value of the global assessment of doctors' performance was significantly higher (M = 7.4, SD = 1.5) than when the first impression was negative (M = 6.0, SD = 1.6); t(437) = 9.0 p < .001. According to the mediation analysis, this difference was due to a direct (c' = 0.53) and an indirect effect (ab = 0.86) deriving from the total effect of first impressions on the global assessment of doctors' performances (c = 1.39). In conclusion, the first impression has a strong impact on positive and negative judgments on doctors' communication approach and may facilitate or inhibit all further interactions.

Communication Deficits Among Surgical Residents During Difficult Patient Family Conversations

OBJECTIVES

To qualitatively analyze videotaped data of surgical residents and fellows interacting with standardized patients to identify communication weaknesses. To correlate our qualitative data with their quantitative scores.

DESIGN

We used discourse analysis to identify negative communication patterns among 10 surgical residents and fellows who were tested on interpersonal competencies during an objective structured clinical examination in 2014. We then correlated our findings with the validated evaluation outcomes. Descriptive statistics were then used to quantify our findings.

SETTING

The setting was an objective structured clinical examination performed in 2014 using standardized patient surrogate family members.

PARTICIPANTS

The participants were a mix of first and third year surgical residents and critical care fellows.

RESULTS

The item that most strongly differentiated the bottom 5 from the top 5 performers was not answering the patient appropriately. This was exhibited in 3 ways among the lowest performers in our study: (1) paternalism, (2) vagueness, and (3) dehumanization. Our statistical analyses showed that the overall number of negative communication behaviors correlated with negative staff scores (r = -0.653, p < 0.05). Dehumanization and paternalism were the 2 behaviors most strongly correlated with negative staff scores (r = 0.796 and 0.781 respectively, p < 0.01).

CONCLUSIONS

We found the lowest performers responded inappropriately to the patient, which we further delineated into vagueness, paternalism, and dehumanization. We propose positive communication strategies be taught to residents to improve how they are perceived by patients.

The doctor's digital double: how warmth, competence, and animation promote adherence intention

BACKGROUND

Each year, patient nonadherence to treatment advice costs the US healthcare system more than $300 billion and results in 250,000 deaths. Developing virtual consultations to promote adherence could improve public health while cutting healthcare costs and usage. However, inconsistencies in the realism of computer-animated humans may cause them to appear eerie, a phenomenon termed the uncanny valley. Eeriness could reduce a virtual doctor's credibility and patients' adherence.

METHODS

In a 2 × 2 × 2 between-groups posttest-only experiment, 738 participants played the role of a patient in a hypothetical virtual consultation with a doctor. The consultation varied in the doctor's Character (good or poor bedside manner), Outcome (received a fellowship or sued for malpractice), and Depiction (a recorded video of a real human actor or of his 3D computer-animated double). Character, Outcome, and Depiction were designed to manipulate the doctor's level of warmth, competence, and realism, respectively.

RESULTS

Warmth and competence increased adherence intention and consultation enjoyment, but realism did not. On the contrary, the computer-animated doctor increased adherence intention and consultation enjoyment significantly more than the doctor portrayed by a human actor. We propose that enjoyment of the animated consultation caused the doctor to appear warmer and more real, compensating for his realism inconsistency. Expressed as a path model, this explanation fit the data.

DISCUSSION

The acceptance and effectiveness of the animation should encourage the development of virtual consultations, which have advantages over creating content with human actors including ease of scenario revision, internationalization, localization, personalization, and web distribution.

An intelligent algorithm for optimizing emergency department job and patient satisfaction

Purpose Resilience engineering, job satisfaction and patient satisfaction were evaluated and analyzed in one Tehran emergency department (ED) to determine ED strengths, weaknesses and opportunities to improve safety, performance, staff and patient satisfaction. The paper aims to discuss these issues. Design/methodology/approach The algorithm included data envelopment analysis (DEA), two artificial neural networks: multilayer perceptron and radial basis function. Data were based on integrated resilience engineering (IRE) and satisfaction indicators. IRE indicators are considered inputs and job and patient satisfaction indicators are considered output variables. Methods were based on mean absolute percentage error analysis. Subsequently, the algorithm was employed for measuring staff and patient satisfaction separately. Each indicator is also identified through sensitivity analysis. Findings The results showed that salary, wage, patient admission and discharge are the crucial factors influencing job and patient satisfaction. The results obtained by the algorithm were validated by comparing them with DEA. Practical implications The approach is a decision-making tool that helps health managers to assess and improve performance and take corrective action. Originality/value This study presents an IRE and intelligent algorithm for analyzing ED job and patient satisfaction - the first study to present an integrated IRE, neural network and mathematical programming approach for optimizing job and patient satisfaction, which simultaneously optimizes job and patient satisfaction, and IRE. The results are validated by DEA through statistical methods.

Emotion recognition and extraversion of medical students interact to predict their empathic communication perceived by simulated patients

BACKGROUND

This study assessed the impact of medical students' emotion recognition ability and extraversion on their empathic communication, as perceived by simulated patients in a training context.

METHODS

This study used a crossed-effect data structure and examined 245 students in their fourth year of medical school. The students' personality traits were assessed based on a self-assessment questionnaire of the short form of the Big Five Inventory; their emotion recognition ability was measured using a performance test (Diagnostic Analysis of Nonverbal Accuracy-2, Adult Facial Expressions). Simulated patients evaluated the medical students' empathic communication.

RESULTS

Students with a combination of high emotion recognition ability and extraversion received more positive ratings from simulated patients than their fellow students with a combination of emotion recognition ability and low extraversion. The main effects of emotion recognition or extraversion were not sufficient to yield similar effects. There were no other effects related to the remaining Big Five variables.

CONCLUSIONS

The results support the hypothesis that to build rapport with patients, medical staff need to combine emotional capabilities with a dispositional interest in interpersonal encounters.

Enhancing patient value efficiently: Medical history interviews create patient satisfaction and contribute to an improved quality of radiologic examinations

Diagnostic radiology examinations are generally very efficient processes optimized for high throughput and for serving the needs of physicians. On the downside, streamlined examinations disrupt the personal relationship between diagnosticians and patients. The radiology associations RSNA and ACR consider low visibility of radiologists a threat to the profession. Therefore, they launched counter-acting initiatives that aim at increasing patient satisfaction by providing more personal attention and care, and by raising knowledge about the discipline. However, they did not formulate concrete instructions on how to integrate care by radiologists into the examination process while inhibiting the flow minimally. From an internal patient satisfaction survey, we have seen that patients rated satisfaction with care and attention by physicians relatively low, indicating that patients would welcome a possibility to communicate with radiologists. In a controlled experimental setting, we have then changed our process to include a short medical history interview. Thereby we could corroborate that lack of educated communication is the primary cause of diminished satisfaction and could establish that the duration of the encounter is not critical to achieving improvement. Importantly, the interview also helped to improve the quality of the examination. Thus, short medical history interviews are a very efficient way to increase value by maximizing patient satisfaction and examination quality. Our approach is easy to implement in other radiology clinics that are interested in becoming more patient-centered and in raising patient satisfaction.

Shared decision making for the allergist

OBJECTIVE

Shared decision making (SDM) is becoming more commonly appreciated and used in medical practice as a way to empower patients who are facing treatment preference-sensitive conditions, such as allergic rhinitis, atopic dermatitis, food allergy, and persistent asthma. The purpose of this review is to educate the allergy health care provider about how SDM works and provide practical advice and allergist-specific SDM resources.

DATA SOURCES

PubMed and online patient decision aid resources.

STUDY SELECTIONS

Studies and reviews relevant to SDM and patient decision aids relevant to the allergy health care provider were selected for discussion.

RESULTS

There are ethical, practical, economic, and psychological imperatives for the implementation of quality SDM, particularly for chronic diseases. Many benefits and barriers of SDM have been identified and models have been developed to encourage implementation of quality SDM. For the allergy health care provider, SDM for asthma has been shown to improve adherence, outcomes, and patient satisfaction with care. Patient decision aids are useful tools for SDM and have recently been developed for allergen immunotherapy, severe asthma, and atopic dermatitis.

CONCLUSION

Effective SDM has been shown to improve adherence and lead to better outcomes. SDM should be universally implemented as a key component of patient-centered health care. Allergy health care providers should work with their patients to reach treatment decisions that align with their values and preferences.

Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns

OBJECTIVE

The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample.

METHODS

Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns.

RESULTS

The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction.

CONCLUSIONS

Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation.

PRACTICE IMPLICATIONS

Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.

Patient-Centeredness as Physician Behavioral Adaptability to Patient Preferences

A physician who communicates in a patient-centered way is a physician who adapts his or her communication style to what each patient needs. In order to do so, the physician has to (1) accurately assess each patient's states and traits (interpersonal accuracy) and (2) possess a behavioral repertoire to choose from in order to actually adapt his or her behavior to different patients (behavioral adaptability). Physician behavioral adaptability describes the change in verbal or nonverbal behavior a physician shows when interacting with patients who have different preferences in terms of how the physician should interact with them. We hypothesized that physician behavioral adaptability to their patients' preferences would lead to better patient outcomes and that physician interpersonal accuracy was positively related to behavioral adaptability. To test these hypotheses, we recruited 61 physicians who completed an interpersonal accuracy test before being videotaped during four consultations with different patients. The 244 participating patients indicated their preferences for their physician's interaction style prior to the consultation and filled in a consultation outcomes questionnaire directly after the consultation. We coded the physician's verbal and nonverbal behavior for each of the consultations and compared it to the patients' preferences to obtain a measure of physician behavioral adaptability. Results partially confirmed our hypotheses in that female physicians who adapted their nonverbal (but not their verbal) behavior had patients who reported more positive consultation outcomes. Moreover, the more female physicians were accurate interpersonally, the more they showed verbal and nonverbal behavioral adaptability. For male physicians, more interpersonal accuracy was linked to less nonverbal adaptability.

Resonance and dissonance asymmetry in effective physician-patient relationships

This paper examines the proposed asymmetry that should occur between resonance and dissonance in physician-patient relationships in favour of resonance to facilitate an effective relationship. Resonance is represented by the positive emotional attractor, which comprises patients' conscious preferred future or ideal self, and dissonance is expressed by the negative emotional attractor and consists of the gaps between patients' ideal and real self or their fears, problems, and shortfalls. Intentional change theory is reviewed to optimise the physician-patient relationship. Concepts from complexity theory and recent research on emotions are used to explain positive and negative emotional attractors. The role of resonance and dissonance in physician-patient relationships is discussed along with how behaviour can be changed with positive and negative emotional attractors. This paper focuses on the quality and effectiveness of physician-patient relationships for physicians who create high versus low positive emotional attractor/negative emotional attractor ratios. Two theoretical propositions are offered and the research and practice implications are explained.

Patients' perception of their involvement in shared treatment decision making: Key factors in the treatment of inflammatory bowel disease

OBJECTIVES

This study aims to characterize the relationships between the quality of the information given by the physician, the involvement of the patient in shared decision making (SDM), and outcomes in terms of satisfaction and anxiety pertaining to the treatment of inflammatory bowel disease (IBD).

METHODS

A Web survey was conducted among 200 Canadian patients affected with IBD. The theoretical model of SDM was adjusted using path analysis. SAS software was used for all statistical analyses.

RESULTS

The quality of the knowledge transfer between the physician and the patient is significantly associated with the components of SDM: information comprehension, patient involvement and decision certainty about the chosen treatment. In return, patient involvement in SDM is significantly associated with higher satisfaction and, as a result, lower anxiety as regards treatment selection.

CONCLUSIONS

This study demonstrates the importance of involving patients in shared treatment decision making in the context of IBD.

PRACTICE IMPLICATIONS

Understanding shared decision making may motivate patients to be more active in understanding the relevant information for treatment selection, as it is related to their level of satisfaction, anxiety and adherence to treatment. This relationship should encourage physicians to promote shared decision making.

Differences in Outcomes of Patients Treated by Male vs Female Chiropractors

OBJECTIVE

The purpose of this study was to compare treatment outcomes of low back pain patients depending on the sex of the treating doctor of chiropractic (DC).

METHODS

For this study, 1095 adult patients with no manual therapy in the prior 3 months were recruited. Pretreatment pain levels (Numeric Rating Scale for pain [NRS]), Oswestry Disability Index (ODI), and patient demographic details were recorded. The NRS and Patient Global Impression of Change were assessed after 1 week and 1, 3, 6, and 12 months. The ODI was completed up to 3 months. The χ² test compared sex of the DC with the proportion of patients "improved" at all time points and with baseline categorical variables. The unpaired t test compared changes in NRS and ODI scores between patients of male and female DCs.

RESULTS

Female DCs saw proportionally more acute patients (P = .012). Patients of male DCs presented more often with radiculopathy (P = .007). There were no differences in NRS and ODI baseline scores between male and female DCs' patients. At 1 week and 3 and 12 months, significantly more patients of female DCs reported improvement and they had greater decreases in NRS and ODI scores at 1 week. Removing acute patients from the data, there were no longer differences in outcome.

CONCLUSIONS

Significant differences in treatment outcome in favor of female DCs was no longer present on removal of the acute subgroup from the data. This suggests that patient outcome is influenced by other factors, such as chronicity, rather than sex of the treating DC.

Development of the IBD Disk: A Visual Self-administered Tool for Assessing Disability in Inflammatory Bowel Diseases

BACKGROUND

The Inflammatory bowel disease (IBD) Disability Index is a validated tool that evaluates functional status; however, it is used mainly in the clinical trial setting. We describe the use of an iterative Delphi consensus process to develop the IBD Disk-a shortened, self-administered adaption of the validated IBD Disability Index-to give immediate visual representation of patient-reported IBD-related disability.

METHODS

In the preparatory phase, the IBD CONNECT group (30 health care professionals) ranked IBD Disability Index items in the perceived order of importance. The Steering Committee then selected 10 items from the IBD Disability Index to take forward for inclusion in the IBD Disk. In the consensus phase, the items were refined and agreed by the IBD Disk Working Group (14 gastroenterologists) using an online iterative Delphi consensus process. Members could also suggest new element(s) or recommend changes to included elements. The final items for the IBD Disk were agreed in February 2016.

RESULTS

After 4 rounds of voting, the following 10 items were agreed for inclusion in the IBD Disk: abdominal pain, body image, education and work, emotions, energy, interpersonal interactions, joint pain, regulating defecation, sexual functions, and sleep. All elements, except sexual functions, were included in the validated IBD Disability Index.

CONCLUSIONS

The IBD Disk has the potential to be a valuable tool for use at a clinical visit. It can facilitate assessment of inflammatory bowel disease-related disability relevant to both patients and physicians, discussion on specific disability-related issues, and tracking changes in disease burden over time.

Communication Skills Assessment Using Human Avatars: Piloting a Virtual World Objective Structured Clinical Examination

INTRODUCTION

Proficiency in communication skills is a core competency of residency training. We evaluated the feasibility, acceptability and applicability of a virtual world objective structured clinical examination that enables practice based learning and assessment of resident communication skills.

METHODS

A virtual clinical encounter situated in 2 practice settings was developed that uses a human avatar physician and a standardized patient. Following an online tutorial house staff participated in 4 communication tasks, including shared decision making, delivering bad news, obtaining informed consent and disclosing a medical error. Validated instruments and semistructured interviews were used to assess house staff acceptability and applicability of the platform. Three faculty members used ACS (Affective Competency Scale) and communication specific assessment instruments to evaluate house staff performance.

RESULTS

A total of 12 urology house staff completed the simulation. Direct costs were approximately $1,000. The virtual world was easy to use and immersive. Applicability directly correlated with presence (Pearson r = 0.67, p = 0.01) and co-presence (Pearson r = 0.8, p = 0.002). House staff identified problems with 1) limited nonverbal cues, 2) too much information presented and 3) a lack of immediate feedback. The ICC (intraclass correlation) of faculty assessments was high for ACS at 0.53 (95% CI 0.36-0.69) for single measures, 0.77 (95% CI 0.63-0.86) for average measures and less for other assessment instruments.

CONCLUSIONS

A virtual world objective structured clinical examination is a feasible, acceptable and applicable method of communication skills assessment. Improving nonverbal cues, focusing on individual skill sets and providing immediate feedback are measures to be adopted in future iterations of this platform.

Serious Illness Conversations With Doctors: Patients Using Information Obtained From Sources Other Than Their Doctors

The purpose of this study was to examine how people with serious illnesses communicate information they have acquired about their illness from the Internet and social or mass media to their doctors. Twenty-two in-depth interviews of patients with serious or life-threatening illnesses were conducted and analyzed. Street's ecological perspective of communication was used to understand the processes that influence when and how patients bring information that they obtained from external sources to their doctors. The reactions patients received from their doctors affected their future communication with them. Results indicate doctors who have a dominant communication style often discourage patients from bringing outside information to them, and in some cases this results in patients changing doctors. On the other hand, doctors who are more attentive make patients feel more comfortable about bringing outside information to them, and this leads to more meaningful and beneficial conversations.

Enhancing Health Communication Outcomes Among Ethnic Minority Patients: The Effects of the Match Between Participation Preferences and Perceptions and Doctor-Patient Concordance

Ethnic minority patients are less participative in medical consultations compared to ethnic majority patients. It is thus important to find effective strategies to enhance ethnic minority patients' participation and improve subsequent health outcomes. This study therefore aimed to investigate the relation between the match between patients' preferred and perceived participation and doctor-patient concordance in preferred doctor-patient relationship on patient satisfaction, fulfillment of information needs, and understanding of information among Turkish-Dutch and Dutch patients. Pre- and postconsultation questionnaires were filled out by 136 Dutch and 100 Turkish-Dutch patients in the waiting rooms of 32 general practitioners (GPs). GPs completed a questionnaire too. Results showed that a match between patients' preferred and perceived participation was related to higher patient satisfaction, more fulfillment of information needs, and more understanding of information than a mismatch for both patient groups. For doctor-patient concordance a conditional main effect on all outcome measures emerged only among Turkish-Dutch patients. That is, for patients who were discordant with their GP, higher perceived participation was related to lower satisfaction, worse fulfillment of information needs, and worse understanding of the information. In order to improve medical communication GPs should thus primarily be trained to tailor their communication styles to match patients' preferences for participation.

Beyond "One Size Fits All": Physician Nonverbal Adaptability to Patients' Need for Paternalism and Its Positive Consultation Outcomes

In this study, we tested whether physicians' ability to adapt their nonverbal behavior to their patients' preferences for a paternalistic interaction style is related to positive consultation outcomes. We hypothesized that the more physicians adapt their nonverbal dominance behavior to match their patients' preferences for physician paternalism, the more positively the patients perceive the medical interaction. We assessed the actual nonverbal dominance behavior of 32 general practitioners when interacting with two of their patients and compared it with each of their patients' preferences for paternalism to obtain a measure of adaptability. Additionally, we measured patient outcomes with a questionnaire assessing patient satisfaction, trust in the physician, and evaluation of physician competence. Results show that the more nonverbal dominance the physician shows toward the patient who prefers a more paternalistic physician, as compared to toward the patient who prefers a less paternalistic physician (i.e., the more the physician shows nonverbal behavioral adaptability), the more positive the consultation outcomes are. This means that physicians' ability to adapt aspects of their nonverbal dominance behavior to their individual patients' preferences is related to better outcomes for patients. As this study shows, it is advantageous for patients when a physician behaves flexibly instead of showing the same behavior towards all patients. Physician training might want to focus more on teaching a diversity of different behavior repertoires instead of a given set of behaviors.

The impact of general practice nursing care on patient satisfaction and enablement in Australia: A mixed methods study

BACKGROUND

The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement METHODS: A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models.

RESULTS

Data from 678 completed patient surveys (response rate=42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR=2.50, 95% CI: 1.43-4.35) and more enabled (OR=2.55, 95% CI: 1.45-4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR=2.31, 95% CI: 1.33-4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR=1.76, 95% CI: 1.09-2.82) and more enabled (OR=2.56, 95% CI: 1.40-4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR=2.64, 95% CI: 1.32-5.30) were more enabled than those receiving preventive health care.

CONCLUSIONS

This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.

Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician-patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients' experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.

The patient-provider discordance in patients' needs assessment: a qualitative study in breast cancer patients receiving oral chemotherapy

AIMS AND OBJECTIVES

To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy.

BACKGROUND

The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients.

DESIGN

A descriptive qualitative design was used.

METHODS

A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information.

RESULTS

Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication.

CONCLUSION

Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy.

RELEVANCE TO CLINICAL PRACTICE

Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of both patients and health providers.

"It's Not Like You Need to Live 10 or 20 Years": Challenges to Patient-Centered Care in Gynecologic Oncologist-Patient Interactions

The literature suggests that the patient-perspective approach (i.e., eliciting and responding to patients' perspectives, including beliefs, preferences, values, and attitudes) to patient-centered care (PCC) is not a reliable predictor of positive outcomes; however, little is known about why the patient-perspective approach does not necessarily lead to positive outcomes. By using discourse analysis to examine 44 segments of oncologist-patient interactions, we found that providers' use of patient-perspective contextualization can affect the quality of care through (a) constructing the meanings of patient conditions, (b) controlling interpreting frames for patient conditions, and (c) manipulating patient preferences through strategic information sharing. We concluded that providers' use of patient-perspective contextualization is an insufficient indicator of PCC because these discursive strategies can be used to control and manipulate patient preferences and perspectives. At times, providers' patient-perspective contextualization can silence patients' voice and appear discriminatory.

Parent Satisfaction With Communication Is Associated With Physician's Patient-Centered Communication Patterns During Family Conferences

OBJECTIVES

To evaluate the association between physician's patient-centered communication patterns and parental satisfaction during decision-making family conferences in the PICU.

DESIGN

Single-site, cross-sectional study.

SETTING

Forty-four-bed PICUs in a free-standing children's hospital.

PARTICIPANTS

Sixty-seven English-speaking parents of 39 children who participated in an audiorecorded family conference with 11 critical care attending physicians.

MEASUREMENTS AND MAIN RESULTS

Thirty-nine family conferences were audiorecorded. Sixty-seven of 77 (92%) eligible parents were enrolled. The conference recordings were coded using the Roter Interaction Analysis System and a Roter Interaction Analysis System-based patient-centeredness score, which quantitatively evaluates the conversations for physician verbal dominance and discussion of psychosocial elements, such as a family's goals and preferences. Higher patient-centeredness scores reflect higher proportionate dialogue focused on psychosocial, lifestyle, and socioemotional topics relative to medically focused talk. Parents completed satisfaction surveys within 24 hours of the conference. Conferences averaged 45 minutes in length (SD, 19 min), during which the medical team contributed 73% of the dialogue compared with parental contribution of 27%. Physicians dominated the medical team, contributing 89% of the team contribution to the dialogue. The majority of physician speech was medically focused (79%). A patient-centeredness score more than 0.75 predicted parental satisfaction (β = 12.05; p < 0.0001), controlling for the length of conference, child severity of illness, parent race, and socioeconomic status. Parent satisfaction was negatively influenced by severity of illness of the patient (β = -4.34; p = 0.0003), controlling for previously mentioned factors in the model.

CONCLUSIONS

Parent-physician interactions with more patient-centered elements, such as increased proportions of empathetic statements, question asking, and emotional talk, positively influence parent satisfaction despite the child's severity of illness.

Physician behavioral adaptability: A model to outstrip a "one size fits all" approach

OBJECTIVE

Based on a literature review, we propose a model of physician behavioral adaptability (PBA) with the goal of inspiring new research. PBA means that the physician adapts his or her behavior according to patients' different preferences. The PBA model shows how physicians infer patients' preferences and adapt their interaction behavior from one patient to the other. We claim that patients will benefit from better outcomes if their physicians show behavioral adaptability rather than a "one size fits all" approach.

METHOD

This literature review is based on a literature search of the PsycINFO(®) and MEDLINE(®) databases.

RESULTS

The literature review and first results stemming from the authors' research support the validity and viability of parts of the PBA model. There is evidence suggesting that physicians are able to show behavioral flexibility when interacting with their different patients, that a match between patients' preferences and physician behavior is related to better consultation outcomes, and that physician behavioral adaptability is related to better consultation outcomes.

PRACTICE IMPLICATIONS

Training of physicians' behavioral flexibility and their ability to infer patients' preferences can facilitate physician behavioral adaptability and positive patient outcomes.

Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship

OBJECTIVE

Although dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about one's mental illness, being offered and asked one's opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction.

METHODS

Participants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction.

RESULTS

Preferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

When consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers' interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship.

Partners in health: a conceptual framework for the role of community health workers in facilitating patients' adoption of healthy behaviors

We formulated a conceptual framework that begins to answer the national call to improve health care access, delivery, and quality by explaining the processes through which community health workers (CHWs) facilitate patients' adoption of healthy behaviors. In September 2011 to January 2012, we conducted a qualitative study that triangulated multiple data sources: 26 in-depth interviews, training documents, and patient charts. CHWs served as partners in health to immigrant Filipinos with hypertension, leveraging their cultural congruence with intervention participants, employing interpersonal communication techniques to build trust and rapport, providing social support, and assisting with health behavior change. To drive the field forward, this work can be expanded with framework testing that may influence future CHW training and interventions.

Patients respond more positively to physicians who focus on their ideal affect

Previous findings suggest that patients choose physicians whose affective focus matches how they ideally want to feel (Sims et al., 2014). For instance, the more people wanted to feel excitement, the more likely they were to hypothetically choose a new physician who promoted excitement. What remains unknown is whether this match shapes how patients actually respond to physicians after being assigned to them (i.e., whether they adhere to physicians' recommendations more and evaluate physicians more positively). To this end, community adults reported their global ideal affect and actual affect (how they ideally want to feel and actually feel during a typical week, respectively), and were randomly assigned to receive health recommendations from either a physician who expressed and promoted high arousal positive states (HAP) (e.g., excitement), or one who expressed and promoted low arousal positive states (LAP) (e.g., calm). For the next 5 days, participants reported their daily adherence to the recommendations and their daily ideal and actual affect. At the end of the week, participants evaluated their physician. As predicted, the more participants wanted to feel HAP, the more they adhered to the "HAP-focused" physician's recommendations, and the more participants wanted to feel LAP, the more they adhered to the "LAP-focused" physician's recommendations. Participants also evaluated their physician more positively when his affective focus matched their ideal affect. Neither global nor daily actual affect systematically predicted how patients responded to their physicians. These findings suggest that patients respond better to physicians whose affective focus matches their ideal affect.