What patients want

Challenges to Exploring the Patient Perspective in Palliative Care Conversations: A Qualitative Study Among Chronic Obstructive Pulmonary Disease and Chronic Heart Failure Patients and Their Health Care Professionals

Objectives

The aim of this study was to reveal the challenges faced in exploring the patient's perspective as experienced by patients with chronic obstructive pulmonary disease or chronic heart failure and their health care professionals (HCPs), including the circumstances under which these challenges are experienced during palliative care conversations.

Methods

This is a qualitative, explorative study in the Netherlands using purposive sampling to create diversity in demographic variables of both patients and HCPs. Semistructured interviews with 12 patients and 7 HCPs were carried out with the use of topic lists. All interviews were audiorecorded, verbatim transcribed, and thematically analyzed.

Results

Patients find it challenging to express their wishes, preferences, and boundaries and say what is really preoccupying them, especially when they do not feel a good connection with their HCP. HCPs find it challenging to get to know the patient and discuss the patient's perspective particularly when patients are not proactive, open or realistic, or unable to understand or recall information.

Conclusions

Patients and HCPs seem to share the same aim: patients want to be known and understood and HCPs want to know and understand the patient as a unique individual. At the same time, they seem unable to personalize their conversations. To move beyond this impasse patients and HCPs need to take steps and be empowered to do so.

Getting to Know Your Patient: Content Analysis of Patients' Answers to a Questionnaire for Promoting Person-Centered Care

BACKGROUND

Person-centered care (PCC) encourages patients to actively participate in health care, thus facilitating care that fits the life of the patient. Therefore, health care professionals (HCPs) need to know the patient. As part of a broad policy for improving PCC, a digital questionnaire ("We would like to know you") consisting of 5 questions has previously been developed to help HCPs to get to know the patient with the help of patient and staff involvement.

OBJECTIVE

The purpose of this study was to provide insight into the content and aims of the questionnaire to understand its potential and usability.

METHODS

We conducted a qualitative, retrospective content analysis of patients' answers using NVivo Pro (QSR International). The questionnaire was used in the outpatient neuro-oncology department of a Dutch academic hospital.

RESULTS

Of 374 invited patients, 78 (20.9%) completed the questionnaire. We selected a sample of 42 (54%) of the 78 patients. Patients used a median of 16 (IQR 7-27) words per question, and most answers were easily interpretable. When asked about important activities, social activities, sports, or maintaining a normal life were most frequently mentioned. Patients wrote about fear of the disease, its possible influence on life, or fear of the future in general. Patients wanted HCPs to know about their care and communication preferences or shared personal information. They formulated expectations about effective treatment, communication, and the care process.

CONCLUSIONS

The questionnaire seems usable because patients provide interpretable answers that take little time to read, which HCPs can use to personalize care. Our study shows the potential of the questionnaire to help deliver PCC.

"Time work": An analysis of temporal experiences and agentic practices in the "good" doctor-patient relationship in general practice

This article contributes to social health research by presenting an analysis of the temporal dimensions of the "good" doctor-patient relationship as perceived and enacted by patients and general practitioners (GPs). The empirical data derive from ethnographic fieldwork comprising participant observation in four general practice clinics in Denmark, and semi-structured interviews with 27 patients and eight GPs. The analysis draws from Michael Flaherty's sociology of time: notions of temporal agency and "time work" are used as analytical tools to demonstrate that the "good" doctor-patient relationship is constructed in a tension between external temporal structures and internal temporal experiences that are the result of GPs' and patients' agentic practices of "doing time." Thus, the findings illustrate how temporal determinism and self-determinism are equally interwoven when GPs and patients talk about, enact and seek meaningful temporal experiences within the doctor-patient relationship, while resisting and avoiding others that undermine the relationship. The results challenge 1. deterministic conceptions of time demands in today's healthcare systems that are said to control healthcare providers' behavior and 2. the taken-for-granted understanding of continuity as a resource in itself.

Effective communication in palliative care from the perspectives of patients and relatives: A systematic review

OBJECTIVES

In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes exchanging information, facilitates shared decision-making, and promotes an empathic care relationship. We explored the perspectives of patients with an advanced illness and their relatives on effective communication with health-care professionals.

METHODS

A systematic review was conducted. We searched Embase, Medline, Web of Science, CINAHL, and Cochrane for original empirical studies published between January 1, 2015 and March 4, 2021.

RESULTS

In total, 56 articles on 53 unique studies were included. We found 7 themes that from the perspectives of patients and relatives contribute to effective communication: (1) open and honest information. However, this open and honest communication can also trigger anxiety, stress, and existential disruption. Patients and relatives also indicated that they preferred (2) health-care professionals aligning to the patient's and relative's process of uptake and coping with information; (3) empathy; (4) clear and understandable language; (5) leaving room for positive coping strategies, (6) committed health-care professionals taking responsibility; and (7) recognition of relatives in their role as caregiver. Most studies in this review concerned communication with physicians in a hospital setting.

SIGNIFICANCE OF RESULTS

Most patients and relatives appreciate health-care professionals to not only pay attention to strictly medical issues but also to who they are as a person and the process they are going through. More research is needed on effective communication by nurses, in nonhospital settings and on communication by health-care professionals specialized in palliative care.

Transitions: Experiences of younger persons recently diagnosed with Alzheimer-type dementia

Receiving a diagnosis of dementia before the age of 65 has a huge impact on everyday life. Previously, the disease trajectory has mainly been described from the perspective of older persons. However, young persons with dementia are confronted with specific challenges, influencing the type of life-changing events, or 'critical points' that they may experience. The aim of this study was therefore to describe experiences of persons recently being diagnosed with young-onset dementia. In total, 14 participants with dementia due to Alzheimer's disease (10 woman/4 men) with an average age of 59 were included in the study. Interviews were conducted within 2 months after receiving the diagnosis and analyzed using qualitative content analysis with an inductive approach, resulting in three categories: (1) A life changing moment, (2) An ongoing process, and (3) Remaining in control. The findings show that receiving such a diagnosis was experienced by participants as a life changing moment, followed by them seeking to come to terms with the diagnosis and reflecting on its meaning, in which various strategies were adopted to remain in control. The current study highlights three critical points considering the diagnosis of young-onset dementia that warrant special attention and provides insight into factors related to delay in healthy transitioning after receiving the diagnosis, as well as factors that may facilitate successful transitions.

Empathy is not so perfect! -For a descriptive and wide conception of empathy

Physician empathy is considered essential for good clinical care. Empirical evidence shows that it correlates with better patient satisfaction, compliance, and clinical outcomes. These data have nevertheless been criticized because of a lack of consistency and reliability. In this paper, we claim that these issues partly stem from the widespread idealization of empathy: we mistakenly assume that physician empathy always contributes to good care. This has prevented us from agreeing on a definition of empathy, from understanding the effects of its different components and from exploring its limits. This is problematic because physicians' ignorance of the risks of empathy and of strategies to manage them can impact their work and wellbeing negatively. To address this problem, we explore the effects of the potential components of empathy and argue that it should be conceived as a purely descriptive and wide term. We end by discussing implications for medical education.

Promoting participatory research in chronicity: The ESPRIMO biopsychosocial intervention for young adults with multiple sclerosis

Background

Co-creation allows to develop tailored interventions in chronicity and to increase patients’ engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis (MS), a biopsychosocial approach to care is crucial.

Aims

This paper aims to present (i) an example of a co-creation process in the context of chronic diseases (ii) preferences and perspectives of young adults with multiple sclerosis (YawMS; aged 18–45) and healthcare professionals (HCPs) on the relevance, objectives, and modalities of a biopsychosocial intervention (named ESPRIMO) and on strategies/barriers to participation.

Methods

A participatory mixed-method approach in three consecutive steps was implemented: online surveys with YawMS (n = 121) and HCPs (n = 43), online focus groups (FGs) with YawMS, consultation with an advisory board (AB) composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey’s results.

Results

An integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction (recognized as already limited during the COVID-19 pandemic). Accessibility and lack of time resulted as the main barriers to participation.

Conclusion

The co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability.

Quality of counselling assessed by patients after total knee arthroplasty: A cross-sectional study

Patient counselling is a key function in nursing. High-quality counselling promotes adherence to treatment and reduces complications. The purpose of the study was to describe the quality of counselling experienced by total knee arthroplasty patients following surgery. The study was a descriptive cross-sectional study. The data were collected from patients following total knee arthroplasty (N = 60) in 2016 with a modified Quality of Counselling Instrument, and analysed using statistical methods. Over half of the patients (58%) were women and the mean age was 68 years (range 49-84). Over a quarter of patients (28.9%) lived alone, and about two-thirds were overweight (42.1%), or obese (31.6%). After surgery, many patients (88%) experienced moderate pain. Half of patients (52.6%) received a good quality of counselling for the disease and its treatment, and counselling for recovery from treatment (81.6%) was good. Most patients (92.1%) received satisfactory counselling about physical activity. There was a correlation between the disease and its treatment counselling and quality of life (r = -0.553, p = 0.003) and pain (r = -0657, p = 0.000). Interaction during counselling was good (97.4%) and it was implemented in a patient-centred way (89.5%). High-quality counselling implemented in a patient-centred manner can play a part in reducing pain and increasing patients' quality of life.

Mutual Role Expectations by Patients and General Practitioners-A Mixed Methods Study on Complementarity

Background: Changes in public attitudes toward “authorities” in general, as well as shifts in medical practice toward participative models of diagnosis and treatment, imply fundamental transformations in the patient−doctor relationship. However, consistency in reciprocal role expectations cannot be assumed, and this study reveals significant discrepancies in attitudes and behaviors in primary health consultations. Methods: We conducted a study in the tri-lingual northeastern Italian region of South Tyrol to determine whether perceptions of the patient’s role were congruent or differed. In a mixed method approach, the quantitative research part consisted of a survey with 34 identical questions for general practitioners (n = 109) and adult primary care patients (n = 506) on verbal communication, self-initiative and health literacy, interpersonal and social qualities of the patient−physician relationship, and formal aspects of the consultation. Patients were interviewed via telephone, and general practitioners responded online. In the qualitative part, 26 semi-structured in-depth interviews were conducted with the patients and analyzed. Results: General practitioners considered patients’ communicative efforts (p < 0.001), self-initiative (p < 0.001), compliance (p = 0.0026), and openness regarding psychosocial issues (p < 0.001) to be significantly more important, whereas patients showed a tendency to give increased importance to formal aspects such as politeness and hygiene (p < 0.001). Perception of the patient’s role differed significantly between the Italian and German linguistic groups. Conclusions: Patients and general practitioners differ in their understanding of patients’ roles. These data suggest that a considerable proportion of the population lacks a clear and tangible idea of the active role they could play in consultations. Targeted information on the identified aspects of patient−provider communication may facilitate participatory behavior and positively impact the longitudinal quality of the patient−general practitioner relationship.

Asking the right questions: towards a person-centered conception of shared decision-making regarding treatment of advanced chronic kidney disease in older patients

An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease (CKD), involving dialysis or conservative care. Shared decision-making (SDM) is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD.

A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students

Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.

Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.

Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.

Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study

Background

Patients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood.

Methods

For this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs.

Results

Patients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation.

Conclusion

Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02469-3.

What is a prevention visit? A qualitative study of a structured approach to prevention and screening - the BETTER WISE project

BACKGROUND

This qualitative study is a sub-component of BETTER WISE, a comprehensive and structured approach that proactively addresses chronic disease prevention, screening, and cancer survivorship, including screening for poverty and addressing lifestyle risks for patients aged 40 to 65. Patients (n = 527) from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada agreed to participate in the study and were invited to a one-hour prevention visit delivered by a Prevention Practitioner (PP) as part of BETTER WISE. We identified the key components of a BETTER WISE prevention visit based on patients' and primary care providers' perspectives.

METHODS

Primary care providers (PPs, physicians and their staff) participated in 14 focus groups and 19 key informant interviews to share their perspectives on the BETTER WISE project. Of 527 patients who agreed to participate in the study and were invited for a BETTER WISE prevention visit with a PP, we received 356 patient feedback forms. We also collected field notes and memos and employed thematic analysis using a constant comparative method focusing on the BETTER WISE prevention visit.

RESULTS

We identified four key themes related to a BETTER WISE prevention visit: 1) Creating a safe environment and building trust with patients: PPs provided sufficient time and a safe space for patients to share what was important to them, including their concerns related to poverty, alcohol consumption, and mental health, topics that were often not shared with physicians; 2) Providing personalized health education: PPs used the BETTER WISE tools to provide patients with a personalized overview of their health status and eligible screening; 3) Non-judgmental empowering of patients: Instead of directing patients on what to do, PPs evoked patients' preferences and helped them to set goals (if desired); and 4) Integrating care for patients: PPs clarified information from patients' charts and surveys with physicians and helped patients to navigate resources within and outside of the primary care team.

CONCLUSIONS

The results of this study underscore the importance of personalized, trusting, non-judgmental, and integrated relationships between primary care providers and patients to effectively address chronic disease prevention, screening, and cancer survivorship as demonstrated by the BETTER WISE prevention visits.

TRIAL REGISTRATION

This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).

What do patients expect? Assessing patient-centredness from the patients' perspective: an interview study

OBJECTIVE

Although there has been much conceptual work on patient-centredness (PC), patients' perspectives on PC were neglected. In a previous study, participating patients rated the relevance of 16 dimensions of an integrative model of PC as high to very high. However, it remained unclear which specific behaviours described in the dimensions were considered most relevant. Thus, the aim of the current study was to further explore which of the specific behaviours described in the model are especially relevant for the high ratings in the previous study.

METHODS AND DESIGN

We conducted semistructured interviews with 20 patients with chronic diseases (16 females, 4 males, mean age: 52 years). Patients answered questions regarding their experiences in the German healthcare system and how optimal healthcare would look like from their perspective. Furthermore, patients were asked to reflect on the most important aspects which they had mentioned in the interview before. Data were analysed via content analysis.

RESULTS

Participants addressed many different aspects of PC, but mostly focused on three major themes: (1) time appropriate access to care, (2) competence, empathy and being taken seriously by HCPs, (3) HCPs' individual consideration of each patient's situation (eg, wishes and needs). Minor themes were: (1) taking a holistic perspective of the patient, (2) patient-centred communication, (3) integration of multidisciplinary treatment elements, (4) transparency regarding waiting time and (5) reduction of unequal access to care.

CONCLUSION

This study enriches the construct of PC by depicting essential aspects of PC from the patients' perspective. The results allow prioritising strategies to implement patient-centred care. Thus, this study helps to pursue the ultimate goal of fostering patient-centred healthcare delivery in Germany.

Achieving a useful and person-centred diabetes consultation is a shared responsibility between diabetologists and people with diabetes: a qualitative study of perspectives from people with type 1 diabetes

AIMS

To explore perceptions of useful routine consultations with diabetologists from the perspective of adults with type 1 diabetes, including preferences for discussing psychosocial issues.

METHODS

We conducted semi-structured interviews in 2018/2019 with 33 people with type 1 diabetes (age 22-75 years, 20 men and 13 women, median diabetes duration 25 years) recruited from two diabetes clinics in the capital region of Denmark. Interviews were audio recorded, transcribed verbatim and analysed using thematic text condensation.

RESULTS

Achieving a useful consultation was perceived as a shared responsibility between people with diabetes and diabetologists. Participants' perspectives of what constitutes a useful consultation and expectations for both consultation and diabetologist varied in relation to perceptions of (1) the interaction between the person with diabetes and diabetologist, including being prepared, being honest, experiencing good rapport and preferring a partnership with the diabetologist or 'keeping it clinical' and (2) the diabetologist's approach to diabetes care, including providing up-to-date knowledge and listening and showing understanding.

CONCLUSIONS

Both content and style of diabetes consultations need to be adapted to the individual person with type 1 diabetes. People with diabetes have an important role in expressing their needs and preferences related to both content and style. Diabetologists need to be aware of and attentive to the many individual needs and expectations among people with diabetes, including the desire and need to discuss psychosocial issues. Dialogue tools for preparation and in consultations may enable people with diabetes to voice their needs and expectations and diabetologists to juggle these diversities.

A Bio-Psycho-Social Co-created Intervention for Young Adults With Multiple Sclerosis (ESPRIMO): Rationale and Study Protocol for a Feasibility Study

BACKGROUND

Multiple sclerosis (MS), the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life (HRQoL). Since MS is generally diagnosed at a young age-a period of great significance for personal, relational, and professional development-adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity (PA) and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS (YawMS) and to the involvement of patients in the development of such programs.

AIMS

In collaboration with MS patients, this study aims to develop a bio-psycho-social intervention (ESPRIMO) for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects.

METHODS

To tailor the intervention to the specific needs of YawMS, "patient engagement principles" will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre-post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features (e.g., resilience, well-being, mindfulness traits, self-efficacy, perceived social support, psychological symptoms, illness perception, committed action, fatigue, attitudes, subjective norms, perceived behavioral control, motivation, perception of autonomy support for PA, barriers and intentions to PA) will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention.

Nationwide survey of patients’ and doctors’ perceptions of what is needed in doctor - patient communication in a Southeast Asian context

Background

Asian countries are making efforts to apply the partnership model in doctor-patient communication that has been used effectively in Western countries. However, notable differences between Western and Asian cultures, especially the acceptance of a hierarchical order and little attention to individuality in Asian cultures, could mean that the application of the partnership model in Vietnam requires adaptation.

The study aimed to investigate whether communication models used in the Western world are appropriate in Southeast Asia, and to identify key items in doctor-patient communication that should be included in a doctor-patient communication model for training in Vietnam.

Methods

In six provinces, collaborating medical schools collected data from 480 patients using face-to-face surveys with a structured guideline following a consultation session, and from 473 doctors using a cross-sectional survey on how they usually conduct consultation sessions with patients. Data collection tools covered a list of communication skills based on Western models, adapted to fit with local legislation.

Using logistic regression, we examined whether doctor patient communication items and other factors were predictors of patient satisfaction.

Results

Both patients and doctors considered most elements in the list necessary for good doctor-patient communication. Both also felt that while actual communication was generally good, there was also room for improvement. Furthermore, the doctors had higher expectations than did the patients. Four items in the Western model for doctor-patient communication, all promoting the partnership relation between them, appeared to have lower priority for both patients and doctors in Vietnam.

Conclusion

The communication model used in the Western world could be applied in Vietnam with minor adaptations. Increasing patients’ understanding of their partner role needs to be considered. The implications for medical training in universities are to focus first on the key skills perceived as needing to be strengthened by both doctors and patients. In the longer term, all of these items should be included in the training to prepare for the future.

A Survey of Patient Perspectives on Approach to Health Care: Focus on Physician Competency and Compassion

We conducted a cross-sectional, survey study of 764 volunteers to gain insight into patients’ perceptions of physician qualities of compassion and competence. Among 651 (85% response rate) survey participants, mean age was 52.4 (SD 21.4) years, 70.8% (n = 458) were female, and 84% (n = 539) identified as white. Predictors of compassion over competence included female gender (adjusted odds ratio [aOR] = 1.4, 95% CI: 1.04-1.89) and whether the respondent had a personal connection to the vignette (aOR = 1.24, 95% CI: 1.0-1.53). Thematic analysis demonstrated that preferences were influenced by: (a) explicit beliefs regarding the value of physician compassion and physician competence; (b) impact of emotional and mental health on medical experiences; (c) the type and frequency of health care exposure; and (d) perceived role of the physician in various clinical vignettes. Patients had wide-ranging, complex opinions on the qualities they valued in their physicians. These findings suggest that patients are engaged and can provide critical thoughtful feedback on the practice and delivery of health care.

Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations

Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.

Italian Validation of the Touch Avoidance Measure and the Touch Avoidance Questionnaire

Social touch is essential in relationships and well-being, but the unique personal experience of touch is not assessed and taken into account in health and social care services. The pleasantness of gentle stroking is influenced by gender, toucher genre, toucher familiarity, culture, and age. Moreover, pleasantness is influenced by touch avoidance, the attitude toward interpersonal touch. The aim of this article is to present the translation, adaptation, and validation in Italian of two scales to measure touch avoidance. For translation and validation, we selected the most used scale, the Touch Avoidance Measure (TAM) and a more recent scale, the Touch Avoidance Questionnaire (TAQ). Confirmatory factor analyses reported good model fit for the TAM [comparative fit index (CFI) = 0.947, Tucker-Lewis index (TLI) = 0.940, root-mean-square error of approximation (RMSEA) = 0.065] and excellent model fit for the TAQ (CFI = 0.954, TLI = 0.950, RMSEA = 0.058). Internal consistency was high for all subscales, except the TAQ "Stranger" subscale. One-month test-retest reliability ranged from 0.67 to 0.90 for each subscale. Lastly, convergent validity between the TAM and TAQ was also found to be high. We conclude that the TAM and TAQ can be used to assess touch avoidance with Italian samples. The instrument can be used to support healthcare professionals and to assess attitudes toward touch in individuals with interpersonal difficulties.

Complementary therapy for advanced dementia palliation in nursing homes

Purpose

This paper reports on an action research study that aimed to collaboratively develop a complementary therapy care intervention to augment palliative care choices available to nursing home residents with advanced dementia.

Design/methodology/approach

An action research design was adopted that consisted of a series of action cycles involving collaborative exploration, problem-solving planning, development and evidence gathering. A combination of mixed methods was used when gaining data at the different stages, including face to face delivered questionnaires, observational notes, focus groups, and the objective measure of the Neuropsychiatric Inventory adapted for Nursing Homes (NPI-NH).

Findings

Care home staff and relatives considered the use of Complementary Therapy to be a helpful intervention promoting that it can reduce a sense of loneliness and provide companionship for residents experiencing distress. Analysis of NPI-NH scores showed a reduction in presenting neuropsychiatric behaviours associated with stress and distress.

Research limitations/implications

Differing levels of participant group engagement may affect this study’s findings as it was noted that care home staff provided a fuller contribution to the project in comparison to relatives.

Practical implications

Implementation guidance is needed when implementing complementary therapy within the nursing home practice to promote consistency and successful integration of an intervention that is not provided as routine care.

Originality/value

The findings of this study are encouraging and demonstrate the acceptability of complementary therapies to residents with advanced dementia, where positive impacts on otherwise difficult to address dementia symptoms related to stress and distress are highlighted.

Prescribing high-quality peritoneal dialysis: Moving beyond urea clearance

Urea removal in peritoneal dialysis (PD) has been a primary measure of dialysis adequacy, but its utility remains limited due to its poor correlation with the clearance of other important uraemic retention solutes and the low certainty of evidence relating peritoneal urea clearance and survival of individuals doing PD. Indeed, clearances of other uraemic solutes, electrolyte imbalances, hypoalbuminaemia and nutritional status, may provide a more holistic measure of dialysis adequacy when evaluating individuals on PD in addition to focusing on person-centred outcomes. Here, we review the history of the urea and creatinine-centric approach to dialysis adequacy and explore the potential importance of other uraemic retention solutes, electrolyte disturbances, phosphorus control, peritoneal protein losses and hypoalbuminaemia, as well as nutritional management to promote a broader multidimensional concept of clearance for PD.

Assessing the relevance and implementation of patient-centredness from the patients' perspective in Germany: results of a Delphi study

OBJECTIVE

Patient-centredness (PC) has particularly grown in relevance in health services research as well as in politics and there has been much research on its conceptualisation. However, conceptual work neglected the patients' perspective. Thus, it remains unclear which dimensions of PC matter most to patients. This study aims to assess relevance and current degree of implementation of PC from the perspective of chronically ill patients in Germany.

METHODS

We conducted a Delphi study. Patients were recruited throughout Germany using community-based strategies (eg, newspapers and support groups). In round 1, patients rated relevance and implementation of 15 dimensions of PC anonymously. In round 2, patients received results of round 1 and were asked to re-rate their own results. Participants had to have at least one of the following chronic diseases: cancer, cardiovascular disease, mental disorder or musculoskeletal disorder. Furthermore, patients had to be at least 18 years old and had to give informed consent prior to participation.

RESULTS

226 patients participated in round 1, and 214 patients in round 2. In both rounds, all 15 dimensions were rated highly relevant, but currently insufficiently implemented. Most relevant dimensions included 'patient safety', 'access to care' and 'patient information'. Due to small sizes of subsamples between chronic disease groups, differences could not be computed. For the other subgroups (eg, single disease vs multi-morbidity), there were no major differences.

CONCLUSION

This is one of the first studies assessing PC from patients' perspective in Germany. We showed that patients consider every dimension of PC relevant, but currently not well implemented. Our results can be used to foster PC healthcare delivery and to develop patient-reported experience measures to assess PC of healthcare in Germany.

A culture of compassion: How timeless principles of kindness and empathy become powerful tools for confronting today's most pressing healthcare challenges

The role of compassion in healthcare is receiving increased attention as emerging research demonstrates how compassionate patient care can improve health outcomes and reduce workplace stress and burnout. To date, proposals to encourage empathy, kindness, and compassion in healthcare have focused primarily on training individual care providers. This article argues that increasing the awareness and skills of individuals is necessary but insufficient. Compassionate care becomes an organizational norm only when health leaders create and nurture a "culture of compassion" that actively supports, develops, and recognizes the role of compassion in day-to-day management and practice. The article profiles four organizations that have adopted compassionate healthcare as an explicit organizational priority and implemented practical measures for building and sustaining a culture of compassion. Common principles and practices are identified. These organizations demonstrate how compassion can lead directly to improved outcomes of primary importance to healthcare organizations, including quality and safety, patient experience, employee and physician engagement, and financial performance. They show how compassion can be a powerful yet often underappreciated tool for helping organizations successfully manage current challenges.

Scoping review of the person-centered literature in adult physical rehabilitation

PURPOSE

To describe the amount, range, and key characteristics (e.g., publication years, methods, topics) of the person-centered rehabilitation literature in adults with physical impairments.

METHOD

Following the published scoping review protocol, papers were identified through: three major databases, snowball searches and expert consultation. Two independent reviewers have identified English-language papers on adult person-centered rehabilitation according to six pre-defined inclusion categories - theoretical, quantitative and qualitive research papers are included; and then have extracted their key characteristics (e.g., aims, methods, participants). Descriptive statistics, regression and content analyses were used to synthesize the results.

RESULTS

Of 5912 deduplicated records initially screened, 170 papers were included: 136 empirical, including 13 systematic reviews. Empirical papers had data from 15264 clients and 4098 providers, in total. Yearly publications grew significantly from 2009 to 2018 (r² = 0.71; b = 1.98: p < 0.01). Publications were unevenly distributed by countries (e.g., United States' publications per population was 44 times lower than New Zealand's). Most papers focused in more than one profession, setting-type or health conditions. Finally, many empirical papers (n = 67) studied implementation of person-centered rehabilitation approaches, including its effect.

CONCLUSION

This scoping review synthesizes key characteristics and publication trends in the person-centered rehabilitation literature on adults with physical impairments, a growing but unchartered territory thus far. This large and diverse body of literature can ground further person-centered rehabilitation practices and research, including toward building a transdisciplinary, trans-service model of person-centered rehabilitation.Implications for rehabilitationThe person-centered rehabilitation literature on adults with physical impairments, especially the empirical one, has been growing significantly over time, despite inequitably distributed per countries.Rehabilitation stakeholders, including practitioners, have a growing amount of literature in which they can rely for the operationalization and implementation of person-centered rehabilitation approaches into routine practice.Based on our work, person-centered rehabilitation emerges as a practice requirement that cuts across professional and other rehabilitation silos.

Understanding patients' satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England

BACKGROUND

Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences.

METHODS

A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication.

RESULTS

Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion.

CONCLUSIONS

PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles.

Patient-centered communication in type 2 diabetes: The facilitating and constraining factors in clinical encounters

OBJECTIVE

To explore the perceptions of the constraining and facilitating factors to patient-centered communication in clinical encounters of patients with type 2 diabetes and the providers involved in their care.

DATA SOURCES/STUDY SETTING

Patients (n = 12) and providers (n = 33) involved in diabetes care in northern Portugal.

STUDY DESIGN

Seven focus groups.

DATA COLLECTION/EXTRACTION METHODS

Grounded theory, using open, axial, and selective coding.

PRINCIPAL FINDINGS

Patients focused on the patient-provider relationship, while providers emphasized the constraining factors when exchanging information and the facilitating factors regarding disease and treatment-related behavior. Patients and providers both agreed on some constraints (power imbalance, avoidance of criticism, disease minimization, use of jargon, and insufficient competencies and consistency among providers) and facilitators (seeing patients as persons, providing tailored information in plain language, and recognizing the "wake-up call"). Patients perceived an aggressive attitude as a barrier to communication, but providers perceived it as a facilitator. Patients included issues related to trust, respect, and psychosocial support as important factors to them. Only providers mentioned the influence of macro-level interventions and patients' socioeconomic position as essential factors.

CONCLUSIONS

Improvements in patient-centered communication depend on fostering the patient-provider relationship, patients' participation and involvement, and training providers' communication skills.

Opinion leader empowered patients about the era of digital health: a qualitative study

OBJECTIVES

We aimed to explore the opinion leader empowered patients' relationship with their medical professionals, their experiences and beliefs about technologies, and how they see the future. We also attempted to determine whether technologies, the access to it or patient empowerment are the main driving forces behind these changes.

DESIGN

A qualitative interview study analysed with interpretative phenomenological analysis.

SETTING

All interviews were conducted and recorded individually with the same trained interviewer via a Skype call.

PARTICIPANTS

The study is based on qualitative, semistructured interviews with 11 opinion leader empowered patients from six countries including UK, USA, Australia, Sweden, South Africa and Ireland.

RESULTS

We identified four superordinate themes emerging from e-patients' experiences: (1) impact of technology, (2) the meaning of empowerment, (3) the changing physician-patient relationship and (4) expectations for the future. The relationship e-patients have with their physicians is based on efficient communication, proactivity, the desire for asking questions and the use of technologies. The interviews have shown that the rapid development of technology has fundamentally changed the lives of these e-patients, and technology eventually is transforming the physician-patient relationship into a partnership. Regarding the future of the physician-patient partnership, e-patients emphasised that change will rather be cultural than technological.

CONCLUSIONS

The interviews have shown that cooperation between technology and healthcare is not enough on its own: the most decisive factor is the return of the human touch and reciprocal communication. All of these suggest that technology is an important ally in the 'renaissance of medicine' that starts to treat patients as it should have always had.

Understanding compassion in family medicine: a qualitative study

BACKGROUND

Patients and physicians have traditionally valued compassion; however, there is concern that physician compassion has declined with the increasing emphasis on science and technology in medicine. Although the literature on compassion is growing, very little is known about how family physicians experience compassion in their work.

AIM

To explore family physicians' capacity for and experiences of compassion in practice.

DESIGN AND SETTING

This was a qualitative study designed using a phenomenological approach in rural and urban Ontario, Canada.

METHOD

In-depth interviews were audiotaped and transcribed verbatim, followed by independent and team coding. An iterative and interpretive analysis was conducted using immersion and crystallisation techniques. Purposive sampling recruited 22 participants (nine males and 13 females aged 26-64 years) that included family medicine residents from Western University (n = 6), and family physicians practising <5 years (n = 7) or >10 years (n = 9) in Ontario, Canada.

RESULTS

From the data, the authors derived the Compassion Trichotomy as a theoretical model to describe three interrelated areas that determine the evolution or devolution of compassion experienced by family physicians: motivation (core values), capacity (energy), and connection (relationship).

CONCLUSION

The Compassion Trichotomy highlights the importance and interdependence in physician compassion of motivation (personal reflection and values), capacity (awareness and regulation of energy, emotion, and cognition), and connection (sustained patient-physician relationship). This model may assist practising family physicians, educators, and researchers to explore how compassion development might enhance physician effectiveness and satisfaction.

Assessment of patient centredness through patient-reported experience measures (ASPIRED): protocol of a mixed-methods study

INTRODUCTION

The impact of patient centredness (PC) in healthcare has grown over the years. However, conceptualisations of PC are heterogeneous. Existing patient-reported measures of PC have shown inconsistencies and shortcomings. This impedes the comparison of results across studies. To foster PC, it is important to know which dimensions matter most to patients and to be able to measure its current extent from the patients' perspective. This study aims (1) to assess relevance of dimensions of PC from the patients' perspective, (2) to develop and psychometrically test a core set of patient-reported experience measures (PREMs) assessing PC and (3) to investigate the feasibility of implementation of this core set in routine healthcare.

METHODS AND ANALYSIS

A mixed-methods approach will be used. In phase 1, 200 patients will assess the relevance of the dimensions of PC in a Delphi study using a plain language description. In phase 2, the core set of PREMs will be developed through literature reviews, focus groups, key informant interviews and content validity ratings. The core set will be tested psychometrically in a cross-sectional study with 2000 inpatient and outpatients with different chronic conditions (ie, cancer, cardiovascular diseases, mental disorders and musculoskeletal disorders). In phase 3, the feasibility of implementation of the core set will be assessed through semistructured interviews with healthcare practitioners after piloting in routine care. Furthermore, an expert workshop will be held on how to foster implementation.

ETHICS AND DISSEMINATION

The study will be carried out in accordance to the latest version of the Helsinki Declaration of the World Medical Association and principles of good scientific practice. The study was approved by the Ethics Committee of the Medical Association Hamburg, Germany (study ID: PV5724). The study results will be disseminated in scientific journals and through collaboration partners and plain language press releases.

Consensus statement on an updated core communication curriculum for UK undergraduate medical education

OBJECTIVES

Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine.

METHOD

The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education.

RESULTS

The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed.

CONCLUSION

Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula.

PRACTICE IMPLICATIONS

The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources.

Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations

Purpose

To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present.

Data sources

Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety.

Study selection

Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals.

Data extraction

Study characteristic and outcome data were abstracted by two authors and reviewed by the research team.

Results of data synthesis

Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization.

Conclusion

Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE.

'He should feel your pain': Patient insights on patient-provider communication in Rwanda

Background

Patient–provider communication is an interpersonal interaction between a patient and a health care provider.

Objective

This study explored patients’ communication preferences and perceptions on what factors influence the patient–provider communication in primary health care settings in Rwanda.

Methods

In-depth semi-structured interviews with 15 individuals including 8 with limited literacy. A thematic inductive analysis was used.

Results

Patients valued communication with providers and expressed the need for interacting with caring, empathic providers who can share all the information they want and involve them in their own care. Health literacy and power issues were factors that may influence patient–provider communication. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care.

Conclusion

The expressed preferences, including those of patients with limited literacy, aligned well with the patient-centred care model. There were indications of a power imbalance weighing on the provider’s side. Although patients with limited literacy were reliant on providers for decision-making, they were ready to be more involved in the care, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These patients’ insights can impact policies and curricula to optimise clinical practice. Generated knowledge will contribute to the indispensable yet underdeveloped field of health communication in sub-Saharan Africa.

Practice implications

Findings call for more inclusion of patient perspectives in the patient–provider encounter. This could require more training of professionals and research on the topic, both in Rwanda and in other regions.

The Quality of Patient Education in Day Surgery by Adult Patients

PURPOSE

The purpose of the study was to describe the quality of patient education in day surgery as evaluated by adult patients.

DESIGN

Descriptive design using survey methodology.

METHODS

The data were collected by questionnaire and measured the quality and implementation of education resources for day surgery patients (n = 600) in a university hospital. The data were analyzed statistically using basic and multivariate methods.

FINDINGS

The implementation of patient education has been done in a patient-centered and goal-oriented way by half of respondents. Most respondents (81%) were satisfied with the interaction in patient education. The education resources were reported as good by 77% of respondents.

CONCLUSIONS

Health care staff should assess for the presence of anxiety as a barrier to the comprehension of information. In developing patient education, the professional expertise and skills of health care staff in educating patients should be used.

Assessing patient-centred communication in teaching: a systematic review of instruments

CONTEXT

Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments.

OBJECTIVES

The aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor-patient communication and can be used to provide direct feedback.

METHODS

A systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor-patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist.

RESULTS

Thirteen articles describing 14 instruments measuring patient centredness in doctor-patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity.

CONCLUSIONS

This review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor-patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient-centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and enhancement of existing instruments in terms of validity and reliability, along with enhancement of their generalisability, responsiveness and aspects of interpretability in different contexts (real patients, simulated patients, doctors in different specialties, etc.). Comprehensibility and feasibility should also be taken into account.

Patients' perspectives on BETTER 2 prevention and screening: qualitative findings from Newfoundland & Labrador

Background

Chronic disease prevention and screening (CDPS) has been identified as a top priority in primary care. However, primary care providers often lack time, evidence-based tools, and consistent guidelines to effectively address CDPS. Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER) is a novel approach that introduces a new role, that of the prevention practitioner; the prevention practitioner meets with patients, one on one, to undertake a personalised CDPS visit. Understanding patients’ perspectives is important for clinicians and other stakeholders aiming to address and integrate CDPS.

Aim

To describe patients’ perspectives regarding visits with a prevention practitioner in BETTER 2, an implementation study that was carried out after the BETTER trial and featured a higher proportion of patients in rural and remote locations.

Design & setting

Qualitative description based on patient feedback surveys, completed by patients in three primary care clinics (urban, rural, and remote) in Newfoundland and Labrador, Canada.

Method

Patients’ perspectives were assessed based on responses from 91 feedback forms. In total, 154 patients (aged 40–65 years) received ≥1 prevention visit(s) from a prevention practitioner and were asked to provide written feedback. In addition to demographics, patients were asked what they liked about their visit(s), what they would have liked to be different, and invited to make any other comments. Qualitative description was used to analyse the data.

Results

Four main themes emerged from patients’ feedback: value of visit (patients appreciated the visit with a prevention practitioner); visit characteristics (the visit was personalised, comprehensive, and sufficiently long); prevention practitioners' characteristics (professionalism and interpersonal skills); and patients’ concerns (termination of the programme and access to preventative care).

Conclusion

Patients appreciated the visits they received with a prevention practitioner and expressed their desire to receive sustained CDPS in primary care.

Living with life-prolonging chemotherapy-control and meaning-making in the tension between life and death

Chemotherapy, radiotherapy, hormone therapy and immune therapy have made many cancers chronic, potential curable diseases rather than inevitably fatal, but the treatments are often both mentally and physically stressful even if the side effects varies. The right use of palliative chemotherapy is a complex issue and there are many aspects to take into consideration. The aim of the study was to gain insight into the illness narratives of cancer patients, from the day they suspected that something was wrong up to the present day where they are living with incurable cancer, undergoing life-prolonging chemotherapy. Thirteen narrators were included. They were all cancer patients on chemotherapy with the intention of prolonging life (informed by their oncologist) in an outpatient's clinic in Norway. Narrative analyse of their illness stories was applied. The main findings showed that the narrators considered their lives worth living in spite of the treatment. They seemed to take control and build a new life on "what was left after the storm," and described how they found meaning living in the tension between life and death.

Can we trust what parents tell us? A systematic review

Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations.

Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial

OBJECTIVE

To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.

METHODS

Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.

RESULTS

Positive affect-oriented communication reduced anxiety (p<0.001), negative mood (p=0.001), and increased satisfaction (p<0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p<0.001) and outcome expectancies (p<0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001).

CONCLUSION

Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best.

PRACTICE IMPLICATIONS

Continued medical training is needed to harness placebo-effects of medical communication into practice.

Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients

OBJECTIVE

There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care.

METHODS

Participants were recruited by a press report in local newspapers.

INCLUSION CRITERIA

adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis.

RESULTS

In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP.

CONCLUSION

Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP.

PRACTICE IMPLICATIONS

More explicit attention should be given to empathy during medical education in general and during vocational GP-training.

Information provision and attentive listening as determinants of patient perceptions of shared decision-making around chronic illnesses

Background

While chronic illnesses are a major concern of the health system worldwide, little is known about patients–physicians communication. Growing demand for patient-centered care and shared decision-making have increased the interest for patients–physicians communication. Based on previous literature, we propose a model in which the effect of information provision and attentive listening over patients’ perceptions of shared decision-making (PPSDM) is mediated by the variables self-efficacy and proactivity. Primary data were collected between April and August 2014 through an online survey of patients with haemophilia. Haemophilia is a chronic disease in which many options of treatment are available. The right option depends, to some extent, on patient’s preferences. In this context, great uncertainty exists when choosing treatment option and shared decision-making plays an essential role.

Results

A total of 181 patients with haemophilia participated in the survey. The psychometric properties of the measurement scales were evaluated by means of a confirmatory factor analysis. A structural equation model was designed. Results show that provision of information and attentive listening determine PPSDM through patients’ self-efficacy and proactivity in requesting information.

Conclusions

It is important to incorporate communication training in medical education, particularly provision of information and attentive listening. These skills help the healthcare professional to gain a deeper understanding of the patient. Furthermore, provision of information and attentive listening are fundamental in helping patients not to undervalue their personal knowledge and expertise in relation to their doctors. These strategies encourage them to adopt a more active position in requesting information. Encouraging a proactive behaviour of patients and their relatives helps them to realize the need to participate and to make them feel that they are part of the decision-making process.

Calling the GP surgery: patient burden, patient satisfaction, and implications for training

BACKGROUND

Good communication is central to the effectiveness of GP service provision, as well as to patient satisfaction with surgeries, but very little is known about the actual communication that occurs between patients and surgeries.

AIM

This study was carried out to examine, for the first time, how receptionists interact with patients on the telephone, to identify features of communication associated with efficacy and patient satisfaction.

DESIGN AND SETTING

A qualitative conversation analysis of incoming patient telephone calls, recorded 'for training purposes', in three English GP surgeries.

METHOD

Data were analysed qualitatively to identify effective communication, then coded to establish the relative prevalence of communication types across each surgery.

RESULTS

Analysis identified a burden on patients to drive calls forward and achieve service. 'Patient burden' occurred when receptionists failed to offer alternatives to patients whose initial requests could not be met, or to summarise relevant next actions (for example, appointment, call-back, or other query) at the end of calls. Coding revealed that 'patient burden' frequency differed across the services. Increased 'patient burden' was associated with decreased satisfaction on published satisfaction survey scores.

CONCLUSION

Patients in some practices have to push for effective service when calling GP surgeries. Conversation analysis specifies what constitutes (in)effective communication. Findings can then underpin receptionist training and improve patient experience and satisfaction.

Patient burden during appointment-making telephone calls to GP practices

OBJECTIVE

This study addresses, for the first time, the effectiveness of receptionists handling incoming calls from patients to access General Practice services.

METHODS

It is a large-scale qualitative study of three services in the UK. Using conversation analysis, we identified the issue of 'patient burden', which we defined based on the trouble patients display pursuing service. We quantified instances of 'patient burden' using a coding scheme.

RESULTS

We demonstrate how 'patient burden' unfolds in two phases of the telephone calls: (i) following an initial rejection of a patient's request; and (ii) following a receptionist's initiation of call closing. Our quantitative analysis shows that the three GP services differ in the frequency of 'patient burden' and reveals a correlation between the proportion of 'patient burden' and independent national satisfaction scores for these surgeries.

CONCLUSION

Unlike post-hoc surveys, our analysis of live calls identifies the communicative practices which may constitute patient (dis)satisfaction.

PRACTICE IMPLICATIONS

Through establishing what receptionists handle well or less well in encounters with patients, we propose ways of improving such encounters through training or other forms of intervention.