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Kuchinad K, Park JR, Han D, Saha S, Moore R, Beach MC. Which clinician responses to emotion are associated with more positive patient experiences of communication? PATIENT EDUCATION AND COUNSELING 2024; 124:108241. [PMID: 38537316 DOI: 10.1016/j.pec.2024.108241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To identify communication strategies that may improve clinician-patient interactions, we assessed the association between clinician response to emotion and patient ratings of communication. METHODS From a cohort of 1817 clinician-patient encounters, we designed a retrospective case-control study by identifying 69 patients who rated their interpersonal care as low-quality and 69 patients who rated their care as high-quality. We used the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to identify patient emotional expressions and clinician responses. Using mixed-effects logistic regression, we evaluated the association between clinician responses to patients' emotions and patient ratings of their interpersonal care. RESULTS In adjusted analyses, explicit responses that reduced space for further emotional communication were associated with high ratings of care (OR 1.94, 95% CI 1.25, 2.99); non-explicit responses providing additional space were associated with low ratings (OR 0.54, 95% CI 0.36-0.82). In terms of specific response types, neutral/passive responses were associated with low ratings (OR 0.59, 95% CI 0.39-0.90), whereas giving information/advice was associated with high ratings (OR, 95% 1.91 CI 1.17-3.1). CONCLUSIONS Patients may prefer responses to their expressed emotions that demonstrate clinician engagement, with or without expressions of empathy. PRACTICE IMPLICATIONS These findings may inform educational interventions to improve clinician-patient communication.
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Affiliation(s)
- Kamini Kuchinad
- Department of Rheumatology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jenny Rose Park
- Oregon Health and Science University, Portland, OR, United States
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Somnath Saha
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Richard Moore
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States; Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States.
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Farrell MH, Mooney KE, Laxova A, Farrell PM. Parental Preferences about Policy Options Regarding Disclosure of Incidental Genetic Findings in Newborn Screening: Using Videos and the Internet to Educate and Obtain Input. Int J Neonatal Screen 2022; 8:ijns8040054. [PMID: 36278624 PMCID: PMC9590039 DOI: 10.3390/ijns8040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Our objective was to develop and test a new approach to obtaining parental policy guidance about disclosure of incidental findings of newborn screening for cystic fibrosis (CF), including heterozygote carrier status and the conditions known as CFTR-related metabolic syndrome (CRMS) and/or cystic fibrosis screen positive inconclusive diagnosis, CFSPID. The participants were parents of infants up to 6 months old recruited from maternity hospitals/clinics, parent education classes and stores selling baby products. Data were collected using an anonymous, one-time Internet-based survey. The survey introduced two scenarios using novel, animated videos. Parents were asked to rank three potential disclosure policies-Fully Informed, Parents Decide, and Withholding Information. Regarding disclosure of information about Mild X (analogous to CRMS/CFSPID), 57% of respondents ranked Parents Decide as their top choice, while another 41% ranked the Fully Informed policy first. Similarly, when considering disclosure of information about Disease X (CF) carrier status, 50% and 43% gave top rankings to the Fully Informed and Parents Decide policies, respectively. Less than 8% ranked the Withholding Information policy first in either scenario. Data from value comparisons suggested that parents believed knowing everything was very important even if they became distressed. Likewise, parents preferred autonomy even if they became distressed. However, when there might not be enough time to learn everything, parents showed a slight preference for deferring decision-making. Because most parents strongly preferred the policies of full disclosure or making the decision, rather than the withholding option for NBS results, these results can inform disclosure policies in NBS programs, especially as next-generation sequencing increases incidental findings.
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Affiliation(s)
- Michael H. Farrell
- Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Katherine E. Mooney
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Anita Laxova
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Philip M. Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, CSC Room K4/948, 600 Highland Avenue, Madison, WI 53792, USA
- Correspondence: ; Tel.: +1-608-345-2308; Fax: +1-608-263-2820
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Barks MC, Schindler EA, Ubel PA, Jiao MG, Pollak KI, Huffstetler HE, Lemmon ME. Assessment of parent understanding in conferences for critically ill neonates. PATIENT EDUCATION AND COUNSELING 2022; 105:599-605. [PMID: 34130892 PMCID: PMC8664893 DOI: 10.1016/j.pec.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVES This study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants. METHODS We enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as "absent," "yes/no," or "elaborated." RESULTS Fifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their answers most of the time (n = 55/60, 92%). Approximately three-quarter of partial assessments yielded no verbal response from parents. No conferences included a teach-back. CONCLUSIONS Although common, most clinician assessments of understanding were partial or close-ended and rarely resulted in elaborated responses from parents. Open-ended assessments are an effective, underutilized strategy to increase parent engagement and clinician awareness of information needs. PRACTICE IMPLICATIONS Clinicians hoping to facilitate parent engagement and question-asking should rely on open-ended statements to assess understanding.
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Affiliation(s)
- Mary C Barks
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA.
| | - Emma A Schindler
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Peter A Ubel
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Megan G Jiao
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hanna E Huffstetler
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA
| | - Monica E Lemmon
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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Hayeems RZ, Miller FA, Barg CJ, Bombard Y, Chakraborty P, Potter BK, Patton S, Bytautas JP, Tam K, Taylor L, Kerr E, Davies C, Milburn J, Ratjen F, Guttmann A, Carroll JC. Primary care providers' role in newborn screening result notification for cystic fibrosis. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:439-448. [PMID: 34127469 PMCID: PMC8202749 DOI: 10.46747/cfp.6706439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore primary care providers' (PCPs') role in result notification for newborn screening (NBS) for cystic fibrosis (CF), given that expanded NBS has increased the number of positive screening test results, drawing attention to the role of PCPs in supporting families. DESIGN Cross-sectional survey and qualitative interviews. SETTING Ontario. PARTICIPANTS Primary care providers (FPs, pediatricians, and midwives) who received a positive CF NBS result for an infant in their practice in the 6 months before the study. MAIN OUTCOME MEASURES Whether the PCP notified the family of the initial positive CF screening result. RESULTS Data from 321 PCP surveys (response rate of 51%) are reported, including 208 FPs, 68 pediatricians, and 45 midwives. Interviews were completed with 34 PCPs. Most (65%) surveyed PCPs reported notifying the infant's family of the initial positive screening result; 81% agreed that they have an important role to play in NBS; and 88% said it was important for PCPs, rather than the NBS centre, to notify families of initial positive results. With support and information from NBS centres, 68% would be extremely or very confident in doing so; this dropped to 54% when reflecting on their recent reporting experience. More than half (58%) of all PCPs said written point-of-care information from the NBS centre was the most helpful format. Adjusted for relevant factors, written educational information was associated with a lower rate of notifying families than written plus verbal information (risk ratio of 0.79; 95% CI 0.69 to 0.92). In the interviews, PCPs emphasized the challenge of balancing required content knowledge with the desire for the news to come from a familiar provider. CONCLUSION Most PCPs notify families of NBS results and value this role. These data are relevant as NBS programs and other genomic services expand and consider ways of keeping PCPs confident and actively involved.
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Affiliation(s)
- Robin Z Hayeems
- Scientist in the Child Health Evaluative Sciences Program at the Hospital for Sick Children in Toronto, Ont, and Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto.
| | - Fiona A Miller
- Professor of Health Policy and holds the Chair in Health Management Strategies at the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | | | - Yvonne Bombard
- Scientist at the Li Ka Shing Knowledge Institute at St Michael's Hospital in Toronto and Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Pranesh Chakraborty
- Executive Director and Chief Medical Officer of Newborn Screening Ontario in Ottawa, a medical biochemist in the Department of Pediatrics at the Children's Hospital of Eastern Ontario in Ottawa, and Associate Professor of Pediatrics at the University of Ottawa
| | - Beth K Potter
- Associate Professor in the Department of Epidemiology and Community Medicine at the University of Ottawa and holds the University Research Chair in Health Services for Children with Rare Diseases
| | - Sarah Patton
- Research Officer in the Institute of Health Policy, Management and Evaluation at the University of Toronto at the time of the study
| | - Jessica Peace Bytautas
- Doctoral student in the Dalla Lana School of Public Health and a research assistant in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Karen Tam
- Certified genetic counselor and screening specialist at Newborn Screening Ontario
| | - Louise Taylor
- Nurse practitioner with expertise in caring for children with cystic fibrosis at the Hospital for Sick Children
| | - Elizabeth Kerr
- Clinical neuropsychologist and a scientist in the Department of Pediatrics, Division of Neurology, at the Hospital for Sick Children, and Adjunct Faculty in the Department of Pediatrics at the University of Toronto
| | | | | | - Felix Ratjen
- Division Chief of Pediatric Respiratory Medicine, Co-lead of the Cystic Fibrosis Centre, Senior Scientist at the Research Institute in the Translational Medicine research program, and Medical Director of the Clinical Research Unit, all at the Hospital for Sick Children, and Professor of Pediatrics at the University of Toronto
| | - Astrid Guttmann
- Clinician scientist in the Division of Pediatric Medicine at the Hospital for Sick Children, Chief Science Officer and Senior Scientist at ICES, and Professor of Pediatrics with a cross appointment at the Institute of Health Policy, Management and Evaluation and the Epidemiology Division of the Dalla Lana School of Public Health at the University of Toronto
| | - June C Carroll
- Family physician and clinician scientist, Professor, and Sydney G. Frankfort Chair in Family Medicine in the Department of Family and Community Medicine with the Sinai Health System and the University of Toronto
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McCarthy L. Improving how positive newborn screening results are communicated to parents of children with sickle cell disease. Nurs Child Young People 2021; 33:11-16. [PMID: 33047520 DOI: 10.7748/ncyp.2020.e1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 11/09/2022]
Abstract
Sickle cell disease, the most common inherited disorder at birth in the UK, has been included in the UK newborn screening programme since 2006. For parents, receiving the news that their newborn has a serious long-term condition can trigger reactions such as shock, disbelief and guilt. Guidelines on sickle cell disease provide clear screening pathways, but there is variation in how and by whom positive results are communicated to parents. The way in which this is done is crucial, not only for parents' acceptance of the diagnosis but also for their future therapeutic relationships with healthcare professionals and therefore for their child's future health outcomes. Being given reliable and relevant information by confident and knowledgeable staff gives parents hope that their child will achieve a good quality of life. Based on the literature and on the author's experience as a haemoglobinopathy nurse specialist, this article discusses how to improve the communication of positive newborn screening results to parents of children with sickle cell disease.
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Affiliation(s)
- Lesley McCarthy
- Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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6
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Farrell MH, Sims AM, Kirschner ALP, Farrell PM, Tarini BA. Vulnerable Child Syndrome and Newborn Screening Carrier Results for Cystic Fibrosis or Sickle Cell. J Pediatr 2020; 224:44-50.e1. [PMID: 32826027 PMCID: PMC7444465 DOI: 10.1016/j.jpeds.2020.03.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To measure parental perceptions of child vulnerability, as a precursor to developing a population-scale mechanism to mitigate harm after newborn screening. STUDY DESIGN Participants were parents of infants aged 2-5 months. Parental perceptions of child vulnerability were assessed with an adapted version of the Vulnerable Baby Scale. The scale was included in the script for a larger study of telephone follow-up for 2 newborn blood screening samples (carrier status for cystic fibrosis or sickle cell hemoglobinopathy). A comparison sample was added using a paper survey with well-baby visits to an urban/suburban clinic. RESULTS Sample sizes consisted of 288 parents in the cystic fibrosis group, 426 in the sickle cell hemoglobinopathy group, and 79 in the clinic comparison group. Parental perceptions of child vulnerability were higher in the sickle cell group than cystic fibrosis group (P < .0001), and both were higher than the clinic comparison group (P < .0001). Parental perceptions of child vulnerability were inversely correlated with parental age (P < .002) and lower health literacy (P < .015, sickle cell hemoglobinopathy group only). CONCLUSIONS Increased parental perceptions of child vulnerability seem to be a bona fide complication of incidental newborn blood screening findings, and healthcare professionals should be alert to the possibility. From a public health perspective, we recommend routine follow-up after incidental findings to mitigate psychosocial harm.
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Affiliation(s)
- Michael H Farrell
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI.
| | - Alexandra M. Sims
- Department of Pediatrics, George Washington University, Washington DC
| | - Alison La Pean Kirschner
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Philip M. Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Beth A. Tarini
- Department of Pediatrics, George Washington University, Washington DC,Center for Translational Research, Children’s National Hospital, Washington DC
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Williams WA, Ross LF. The Harms of Carrier Status Identification: A Cautionary Warning Against Newborn Sequencing. J Pediatr 2020; 224:22-23. [PMID: 32417254 DOI: 10.1016/j.jpeds.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Lainie Friedman Ross
- Department of Pediatrics, MacLean Center for Clinical Medical Ethics, Institute for Translational Medicine, University of Chicago, Chicago, Illinois.
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8
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Farrell MH, La Pean Kirschner A, Tluczek A, Farrelld PM. Experience with Parent Follow-Up for Communication Outcomes after Newborn Screening Identifies Carrier Status. J Pediatr 2020; 224:37-43.e2. [PMID: 32386871 PMCID: PMC7483722 DOI: 10.1016/j.jpeds.2020.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/15/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To conduct interviews with a multiyear sample of parents of infants found to have heterozygous status for sickle cell hemoglobinopathy or cystic fibrosis during newborn blood screening (NBS). STUDY DESIGN Interviewers with clinical backgrounds telephoned parents, and followed a structured script that blended follow-up and research purposes. Recruiting followed several steps to minimize recruiting bias as much as possible for a NBS study. RESULTS Follow-up calls were conducted with parents of 426 infant carriers of sickle cell hemoglobinopathy, and 288 parents of cystic fibrosis carriers (34.8% and 49.6% of those eligible). Among these, 27.5% and 7.8% had no recollection of being informed of NBS results. Of those who recalled a provider explanation, 8.6% and 13.0% appraised the explanation negatively. Overall, 7.4% and 13.2% were dissatisfied with the experience of learning about the NSB result. Mean anxiety levels were low but higher in the sickle cell hemoglobinopathy group (P < .001). Misconceptions that the infant might get the disease were present in 27.5% and 7.8% of parents (despite zero actual risk for disease). Several of these data were significantly predicted by NBS result, health literacy, parental age, and race/ethnicity factors. CONCLUSIONS Patient-centered public health follow-up can be effective after NBS identifies carrier status. Psychosocial complications were uncommon, but harms were substantial enough to justify mitigation.
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Affiliation(s)
- Michael H. Farrell
- Mayo Clinic Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota,Center for Patient Care and Reactions Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alison La Pean Kirschner
- Center for Patient Care and Reactions Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Audrey Tluczek
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin
| | - Philip M. Farrelld
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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9
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Emotional Communication in HIV Care: An Observational Study of Patients' Expressed Emotions and Clinician Response. AIDS Behav 2019; 23:2816-2828. [PMID: 30895426 DOI: 10.1007/s10461-019-02466-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emotional support is essential to good communication, yet clinicians often miss opportunities to provide empathy to patients. Our study explores the nature of emotional expressions found among patients new to HIV care, how HIV clinicians respond to these expressions, and predictors of clinician responses. Patient-provider encounters were audio-recorded, transcribed, and coded using the VR-CoDES. We categorized patient emotional expressions by intensity (subtle 'cues' vs. more explicit 'concerns'), timing (initial vs. subsequent), and content (medical vs. non-medical). Emotional communication was present in 65 of 91 encounters. Clinicians were more likely to focus specifically on patient emotion for concerns versus cues (OR 4.55; 95% CI 1.36, 15.20). Clinicians were less likely to provide space when emotional expressions were repeated (OR 0.32; 95% CI 0.14, 0.77), medically-related (OR 0.36; 95% CI 0.17, 0.77), and from African American patients (OR 0.42; 95% CI 0.21, 0.84). Potential areas for quality improvement include raising clinician awareness of subtle emotional expressions, the emotional content of medically-related issues, and racial differences in clinician response.
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10
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Genetic Counselors' Experience with and Opinions on the Management of Newborn Screening Incidental Carrier Findings. J Genet Couns 2018; 27:1328-1340. [PMID: 29687313 PMCID: PMC6209045 DOI: 10.1007/s10897-018-0258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 04/04/2018] [Indexed: 11/25/2022]
Abstract
Newborn screening (NBS) is a public health program whose aim is to identify infants who will be clinically affected with a serious metabolic, genetic, or endocrine disorder; however, the technology utilized by many NBS programs also detects infants who are heterozygous carriers for autosomal recessive conditions. Discussion surrounding disclosure of these incidental carrier findings remains controversial. The purpose of this study was to assess genetic counselors’ attitudes about disclosure of carrier status results generated by NBS and to gather data on their experiences with incidental carrier findings. An electronic survey was distributed to genetic counselors of all specialties via the NSGC listserv, and a total of 235 survey responses were analyzed. Quantitative data were analyzed using IBM SPSS v24, and qualitative data were manually analyzed for thematic analysis. Results show that the counselor participants were overall in favor of routine disclosure. Those with experience in NBS were much more likely to strongly agree with one or more reasons for disclosure (p < 0.001), whereas those with five or fewer years of experience were more likely to strongly agree with one or more reasons for non-disclosure (p = 0.031). Qualitative analysis identified key motivating factors for disclosure, including helping parents to understand a positive screen, parents may otherwise be unaware of reproductive risk and they may not otherwise have access to this information, and, while genetic testing is inherently a complex and ambiguous process, this does not justify non-disclosure. The main motivating factor for non-disclosure was the need for better counseling and informed consent. The data suggest that implementation of an “opt-in/out” policy for parents to decide whether or not to receive incidental findings would be beneficial. The results of this study support the continued disclosure of incidental carrier findings; however, additional research is necessary to further determine and implement the most effective disclosure practices.
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Farrell MH, Sprenger CR, Sullivan SL, Trisler BA, Kram JJF, Ruppel EK. Benefit of Report Card Feedback After Point-of-Care Assessment of Communication Quality Indicators. J Patient Cent Res Rev 2017; 4:7-17. [PMID: 31413965 DOI: 10.17294/2330-0698.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Communication is crucial for patient experience and biomedical outcomes. Training programs improve communication but are too resource-intensive for sustained use across an entire health care organization. This study demonstrates in a heterogeneous set of encounters the efficacy of quantitative feedback on two groups of physician communication behaviors: 1) jargon explanation, and 2) assessment of patient understanding. METHODS We used a secure Internet application to audio-record conversations between primary care physicians and 54 patients. Transcripts were quantitatively abstracted using explicit-criteria definitions for assessments of understanding and jargon explanations. These data were conveyed to physicians using a previously tested report card. Finally, physicians were audio-recorded with 48 other patients and compared against their baseline. RESULTS Baseline transcripts included an average of 15.5 unique jargon words. Many words were spoken more than once so the total jargon count averaged 25.1. Jargon explanations were infrequent (median of 2.6/transcript). The jargon explanation ratio (fraction of jargon words spoken after or alongside a jargon explanation for that word) averaged 0.26 out of 1.0. Assessments of understanding were found in 61.1% of transcripts, but most were "OK?" questions (median of 2.22/transcript) or close-ended assessments of understanding (median of 0.59/transcript). After the report card, use of jargon explanations improved to a median of 4.8/transcript (P<0.001), and the jargon explanation ratio improved to 0.37 (P<0.02). Assessments of understanding improved to 81.3% of transcripts (P<0.03), largely due to increased use of close-ended assessments of understanding to 1.08/transcript (P<0.006). CONCLUSIONS It is feasible to audio-record at the point of care, abstract transcripts at a central office and improve physician-to-patient communication quality via a report card. A larger, multifaceted program may improve patient experience and biomedical outcomes.
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Affiliation(s)
- Michael H Farrell
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Clair R Sprenger
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Shelbie L Sullivan
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Bree A Trisler
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Diederich College of Communication, Marquette University, Milwaukee, WI
| | - Jessica J F Kram
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Erin K Ruppel
- Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Department of Communication, University of Wisconsin-Milwaukee, Milwaukee, WI
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12
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Dyson SM, Ahmad WI, Atkin K. Narrative as re-fusion: Making sense and value from sickle cell and thalassaemia trait. Health (London) 2016; 20:616-634. [PMID: 27491942 DOI: 10.1177/1363459316660861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The moral turn within sociology suggests that we need to be attentive to values and have a rapprochement with philosophy. The study of illness narratives is one area of sociology that has consistently addressed itself to moral domains but has tended to focus on stories of living with genetic or chronic illness per se rather than liminal states such as genetic traits. This article takes the case of genetic carriers within racialized minority groups, namely, those with sickle cell or thalassaemia trait, and takes seriously the notion that their narratives are ethical practices. In line with the work of Paul Ricoeur, such storied practices are found to link embodiment, social relationships with significant others and wider socio-cultural and socio-political relations. At the same time, such practices are about embodying values. These narratives may be considered as practices that re-fuse what genetic counselling has de-fused, in order to make sense of a life in its entirety and to strive ethically and collectively towards preferred social realities.
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13
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Rodgers CC, Laing CM, Herring RA, Tena N, Leonardelli A, Hockenberry M, Hendricks-Ferguson V. Understanding Effective Delivery of Patient and Family Education in Pediatric Oncology A Systematic Review From the Children's Oncology Group [Formula: see text]. J Pediatr Oncol Nurs 2016; 33:432-446. [PMID: 27450361 PMCID: PMC5235950 DOI: 10.1177/1043454216659449] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A diagnosis of childhood cancer is a life-changing event for the entire family. Parents must not only deal with the cancer diagnosis but also acquire new knowledge and skills to care safely for their child at home. Best practices for delivery of patient/family education after a new diagnosis of childhood cancer are currently unknown. The purpose of this systematic review was to evaluate the existing body of evidence to determine the current state of knowledge regarding the delivery of education to newly diagnosed pediatric oncology patients and families. Eighty-three articles regarding educational methods, content, influencing factors, and interventions for newly diagnosed pediatric patients with cancer or other chronic illnesses were systematically identified, summarized, and appraised according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. Based on the evidence, 10 recommendations for practice were identified. These recommendations address delivery methods, content, influencing factors, and educational interventions for parents and siblings. Transferring these recommendations into practice may enhance the quality of education delivered by health care providers and received by patients and families following a new diagnosis of childhood cancer.
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Affiliation(s)
| | | | | | - Nancy Tena
- University of Michigan Health System, Ann Arbor, MI, USA
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Patterson RP, Roedl SJ, Farrell MH. Internet searching after parents receive abnormal newborn screening results. ACTA ACUST UNITED AC 2015. [DOI: 10.1179/1753807615y.0000000007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Finan C, Nasr SZ, Rothwell E, Tarini BA. Primary care providers' experiences notifying parents of cystic fibrosis newborn screening results. Clin Pediatr (Phila) 2015; 54:67-75. [PMID: 25104730 PMCID: PMC4257864 DOI: 10.1177/0009922814545619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines primary care provider (PCP) experiences with the initial parental disclosure of cystic fibrosis (CF) newborn screening (NBS) results in order to identify methods to improve parent-provider communication during the CF NBS process. PCPs of infants who received positive CF NBS results participated in semistructured phone interviews. Interviews were analyzed using a qualitative content analysis. PCPs acknowledged the difficulty of "breaking bad news" to parents, and emphasized minimizing parental anxiety and maximizing parental understanding. PCPs used a variety of methods to notify parents, and shared varying information about the significance of the results. Variation in the method of parental notification, information discussed, and attention to parents' emotional needs may limit successful follow-up of children with positive CF NBS results. A multifaceted intervention to improve PCP knowledge, management, and communication could improve provider confidence, optimize information transfer, and minimize parental distress during the initial disclosure of CF NBS results.
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Farrell MH, Christopher SA, La Pean Kirschner A, Roedl SJ, O'Tool FO, Ahmad NY, Farrell PM. Improving the quality of physician communication with rapid-throughput analysis and report cards. PATIENT EDUCATION AND COUNSELING 2014; 97:248-55. [PMID: 25224315 PMCID: PMC5279851 DOI: 10.1016/j.pec.2014.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/02/2014] [Accepted: 07/29/2014] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Problems with clinician-patient communication negatively impact newborn screening, genetics, and all of healthcare. Training programs teach communication, but educational methods are not feasible for entire populations of clinicians. To address this healthcare quality gap, we developed a Communication Quality Assurance intervention. METHODS Child health providers volunteered for a randomized controlled trial of assessment and a report card. Participants provided telephone counseling to a standardized parent regarding a newborn screening result showing heterozygous status for cystic fibrosis or sickle cell disease. Our rapid-throughput timeline allows individualized feedback within a week. Two encounters were recorded (baseline and after a random sample received the report card) and abstracted for four groups of communication quality indicators. RESULTS 92 participants finished both counseling encounters within our rapid-throughput time limits. Participants randomized to receive the report card improved communication behaviors more than controls, including request for teach-back (p<0.01), opening behaviors (p=0.01), anticipate/validate emotion (p<0.001) and the ratio of explained to unexplained jargon words (p<0.03). CONCLUSION The rapid-throughput report card is effective at improving specific communication behaviors. PRACTICE IMPLICATIONS Communication can be taught, but this project shows how healthcare organizations can assure communication quality everywhere. Further implementation could improve newborn screening, genetics, and healthcare in general.
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Affiliation(s)
- Michael H Farrell
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA; Aurora University of Wisconsin Medical Group, Center for Urban Population Health, Milwaukee, USA; Program in Genomics and Ethics, Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, USA; Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA.
| | | | - Alison La Pean Kirschner
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA; Program in Genomics and Ethics, Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, USA
| | - Sara J Roedl
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA
| | - Faith O O'Tool
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA
| | - Nadia Y Ahmad
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, USA; Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Philip M Farrell
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA
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Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding. Genome Med 2014; 6:58. [PMID: 25473429 PMCID: PMC4254435 DOI: 10.1186/s13073-014-0058-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients’ health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.
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Mak CM, Lee HCH, Chan AYW, Lam CW. Inborn errors of metabolism and expanded newborn screening: review and update. Crit Rev Clin Lab Sci 2014; 50:142-62. [PMID: 24295058 DOI: 10.3109/10408363.2013.847896] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Inborn errors of metabolism (IEM) are a phenotypically and genetically heterogeneous group of disorders caused by a defect in a metabolic pathway, leading to malfunctioning metabolism and/or the accumulation of toxic intermediate metabolites. To date, more than 1000 different IEM have been identified. While individually rare, the cumulative incidence has been shown to be upwards of 1 in 800. Clinical presentations are protean, complicating diagnostic pathways. IEM are present in all ethnic groups and across every age. Some IEM are amenable to treatment, with promising outcomes. However, high clinical suspicion alone is not sufficient to reduce morbidities and mortalities. In the last decade, due to the advent of tandem mass spectrometry, expanded newborn screening (NBS) has become a mandatory public health strategy in most developed and developing countries. The technology allows inexpensive simultaneous detection of more than 30 different metabolic disorders in one single blood spot specimen at a cost of about USD 10 per baby, with commendable analytical accuracy and precision. The sensitivity and specificity of this method can be up to 99% and 99.995%, respectively, for most amino acid disorders, organic acidemias, and fatty acid oxidation defects. Cost-effectiveness studies have confirmed that the savings achieved through the use of expanded NBS programs are significantly greater than the costs of implementation. The adverse effects of false positive results are negligible in view of the economic health benefits generated by expanded NBS and these could be minimized through increased education, better communication, and improved technologies. Local screening agencies should be given the autonomy to develop their screening programs in order to keep pace with international advancements. The development of biochemical genetics is closely linked with expanded NBS. With ongoing advancements in nanotechnology and molecular genomics, the field of biochemical genetics is still expanding rapidly. The potential of tandem mass spectrometry is extending to cover more disorders. Indeed, the use of genetic markers in T-cell receptor excision circles for severe combined immunodeficiency is one promising example. NBS represents the highest volume of genetic testing. It is more than a test and it warrants systematic healthcare service delivery across the pre-analytical, analytical, and post-analytical phases. There should be a comprehensive reporting system entailing genetic counselling as well as short-term and long-term follow-up. It is essential to integrate existing clinical IEM services with the expanded NBS program to enable close communication between the laboratory, clinicians, and allied health parties. In this review, we will discuss the history of IEM, its clinical presentations in children and adult patients, and its incidence among different ethnicities; the history and recent expansion of NBS, its cost-effectiveness, associated pros and cons, and the ethical issues that can arise; the analytical aspects of tandem mass spectrometry and post-analytical perspectives regarding result interpretation.
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Affiliation(s)
- Chloe Miu Mak
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital , Hong Kong, SAR , China and
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Disparities in current and future childhood and newborn carrier identification. J Genet Couns 2014; 23:701-7. [PMID: 25009079 DOI: 10.1007/s10897-014-9740-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 06/24/2014] [Indexed: 01/02/2023]
Abstract
International carrier testing guidelines discourage testing in childhood to preserve autonomous decision making and prevent detrimental psychosocial consequences. Despite the discouragement of autosomal recessive carrier testing during childhood, some sickle cell disease (SCD) or cystic fibrosis (CF) carriers are incidentally identified through UK and international newborn screening (NBS). This creates a scenario where parents may have knowledge of their newborn's, but not older child's carrier status. In addition, there is wide variation in the identification of CF and SCD carriers due to the screening technologies implemented by different NBS programs. The current and future availability of childhood testing are determined to some extent by the impact of testing on children and parents (whether this is beneficial or detrimental to wellbeing). However empirical research informing carrier guidance and practice is conflicting. Echoing previous calls, this discussion highlights the need for further qualitative and longitudinal research with children to consider the psychosocial impact of carrier testing on children and role of disclosure from parents on adaptation to results. It is recommended that professionals aim to minimize harms resulting from carrier identification by providing support for parents and children following NBS. Support for non-genetics specialists from genetic counselors to enable discussion of carrier results with children is suggested.
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