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Dokos M, Schultz R, Gossner JD, Fauth EB. Supporting Persons With Dementia: Perspectives From Certified Nurse's Assistants. Innov Aging 2023; 7:igad049. [PMID: 37476503 PMCID: PMC10355141 DOI: 10.1093/geroni/igad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Indexed: 07/22/2023] Open
Abstract
Background and Objectives Many persons with Alzheimer's disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). Although CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about the attitudes of CNAs toward providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. Research Design and Methods We conducted a thematic analysis of semistructured interviews with 11 CNAs (91% female participants, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Results Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, nonverbal communication, and internal beliefs and attitudes toward persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. Discussion and Implications We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.
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Affiliation(s)
- Malinda Dokos
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Rebecka Schultz
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Jacob D Gossner
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
- Alzheimer’s Disease and Dementia Research Center, Utah State University, Logan, Utah, USA
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Byrd CT, Croft RL, Kelly EM. Improving Clinical Competence Through Simulated Training in Evidence-Based Practice for Stuttering: A Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2770-2788. [PMID: 36332141 PMCID: PMC9911129 DOI: 10.1044/2022_ajslp-22-00116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages. METHOD Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre- and post-clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy-Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale-Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire. RESULTS No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact. CONCLUSION Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.
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Affiliation(s)
- Courtney T. Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Robyn L. Croft
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Ellen M. Kelly
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Croft RL, Byrd CT, Kelly EM. The influence of active listening on parents' perceptions of clinical empathy in a stuttering assessment: A preliminary study. JOURNAL OF COMMUNICATION DISORDERS 2022; 100:106274. [PMID: 36327574 PMCID: PMC9727781 DOI: 10.1016/j.jcomdis.2022.106274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/11/2022] [Accepted: 10/23/2022] [Indexed: 05/19/2023]
Abstract
PURPOSE The primary purpose of this preliminary study was to explore whether a clinician's use of active listening skills (i.e., client-directed eye gaze and paraphrasing) influenced parents' perceptions of clinical empathy in a stuttering assessment. A secondary purpose was to determine whether parent age, education, or parent concern predicted perceived clinical empathy. METHOD Participants (n = 51 parents/guardians of children who stutter) watched two counter-balanced videos of a clinician demonstrating either high or low frequency use of active listening skills during the clinician's initial assessment with a standardized patient actor portraying a parent of a child who stutters. After each video, parents rated the clinician's empathy and active listening skills via the Jefferson Scale of Physician Empathy for Observers (JSPEO; Hojat et al., 2017) and the Counselor Activity Self-Efficacy Scales - Modified (Victorino & Hinkle, 2018). Participants then completed a demographic questionnaire and rated their concern about their child's stuttering. RESULTS Paired t-tests demonstrated significantly higher ratings of perceived clinical empathy in the high frequency active listening condition compared to the low frequency condition (d = 0.548). Simple linear regression analyses indicated parent age or level of education did not predict perceived clinical empathy. An independent samples t-test indicated that parent concern about stuttering did not predict perceived clinical empathy. CONCLUSIONS Preliminary findings suggest that the clinician was viewed as significantly more understanding, concerned, and caring (i.e., perceived as empathic) when active listening skills were used. Parents' ratings of empathy on the JSPEO, based on high levels of active listening by the clinician, were not associated with parents' ages, education levels, or concern about their children's stuttering. This may reflect the value of active listening in clinical relationships regardless of variables specific to the recipient (e.g., parent of a child who stutters). Given that parents are more apt to share thoughts and emotions about their child's communication with clinicians who demonstrate empathic qualities, this preliminary study suggests that the use of active listening skills warrant emphasis in clinical training.
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Affiliation(s)
- Robyn L Croft
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, United States; 9 University Station A1100, Austin, TX 78759, United States.
| | - Courtney T Byrd
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, United States; 9 University Station A1100, Austin, TX 78759, United States
| | - Ellen M Kelly
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, United States; 9 University Station A1100, Austin, TX 78759, United States
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Das Gupta K, Gregory G, Meiser B, Kaur R, Scheepers-Joynt M, McInerny S, Taylor S, Barlow-Stewart K, Antill Y, Salmon L, Smyth C, McInerney-Leo A, Young MA, James PA, Yanes T. Communicating polygenic risk scores in the familial breast cancer clinic. PATIENT EDUCATION AND COUNSELING 2021; 104:2512-2521. [PMID: 33706980 DOI: 10.1016/j.pec.2021.02.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the communication of polygenic risk scores (PRS) in the familial breast cancer setting. METHODS Consultations between genetic healthcare providers (GHP) and female patients who received their PRS for breast cancer risk were recorded (n = 65). GHPs included genetic counselors (n = 8) and medical practitioners (n = 5) (i.e. clinical geneticists and oncologists). A content analysis was conducted and logistic regression was used to assess differences in communication behaviors between genetic counselors (n = 8) and medical practitioners (n = 5). RESULTS Of the 65 patients, 31 (47.7 %) had a personal history of breast cancer, 18 of whom received an increased PRS (relative risk >1.2). 25/34 unaffected patients received an increased PRS. Consultations were primarily clinician-driven and focused on biomedical information. There was little difference between the biomedical information provided by genetic counselors and medical practitioners. However, genetic counselors were significantly more likely to utilize strategies to build patient rapport and counseling techniques. CONCLUSIONS Our findings provide one of the earliest reports on how breast cancer PRSs are communicated to women. PRACTICE IMPLICATIONS Key messages for communicating PRSs were identified, namely: discussing differences between polygenic and monogenic testing, the multifactorial nature of breast cancer risk, polygenic inheritance and current limitation of PRSs.
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Affiliation(s)
- Kuheli Das Gupta
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gillian Gregory
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Maatje Scheepers-Joynt
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Simone McInerny
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Shelby Taylor
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2065, Australia
| | - Yoland Antill
- Familial Cancer Clinic, Cabrini Health, Melbourne, VIC 3144, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Lucinda Salmon
- Clinical Genetics Service, Austin Hospital, Melbourne, VIC 3084, Australia
| | - Courtney Smyth
- Familial Cancer Clinic, Monash Medical Centre, Melbourne, VIC 3168, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Mary-Anne Young
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia; Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, 2010, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic, 3052, Australia
| | - Tatiane Yanes
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia; The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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Lanier C, Dominicé Dao M, Baer D, Haller DM, Sommer J, Junod Perron N. How Do Patients Want Us to Use the Computer During Medical Encounters?-A Discrete Choice Experiment Study. J Gen Intern Med 2021; 36:1875-1882. [PMID: 33904040 PMCID: PMC8298679 DOI: 10.1007/s11606-021-06753-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves. OBJECTIVE To explore patients' preferences regarding physicians' EHR-related behaviors. DESIGN Discrete choice experiment study. PATIENTS French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland. MAIN MEASURES We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians' hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen. KEY RESULTS Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0-40.2% vs 31.6%; 95% CI: 24.9-39.0% or 14.9%; 95% CI: 10.2-21.1%) and psychosocial issues (38.7%; 95% CI: 31.6-46.3% vs 24.4% 95% CI: 18.4-31.5% or 17.9%; 95% CI; 12.7-24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9-46.3%) over verbal (30.3%; 95% CI: 23.9-37.5%) or visual contact only (11.4%; 95% CI: 7.5-17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5-64.0% vs 34.8%; 95% CI: 29.9-40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0-57.4%) favored the position with the physician's bust towards the patient and hands away from the keyboard. CONCLUSIONS Our study shows that patients' preferences regarding EHR-related behaviors are in line with most experts' recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.
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Affiliation(s)
- Cédric Lanier
- Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland.
| | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Dagmar M Haller
- Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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Jamal L, Schupmann W, Berkman BE. An ethical framework for genetic counseling in the genomic era. J Genet Couns 2020; 29:718-727. [PMID: 31856388 PMCID: PMC7302959 DOI: 10.1002/jgc4.1207] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023]
Abstract
The field of genetic counseling has grown and diversified since the profession emerged in the early 1970s. In the same period, genomic testing has become more complex, profitable, and widespread. With these developments, the scope of ethical considerations relevant to genetic counseling has expanded. In light of this, we find it helpful to revisit how ethical and relational variables are used to inform genetic counseling practice. Our specific focus is on whether, and to what extent, it is ethically acceptable for genetic counselors to make normative recommendations to patients. This article builds on prior literature that has critiqued nondirectiveness, a concept that has influenced and constrained the modern profession of genetic counseling since its origin. In it, we review scholarly efforts to move beyond nondirectiveness, which we believe privilege patient autonomy at the expense of other important values. We then argue that genetic counselors should favor a more explicit commitment to the principles of beneficence and non-maleficence, as well as a broader understanding of autonomy and the relational variables that impact genetic counseling. Finally, to translate our arguments into practice, we present a framework of six considerations that genetic counselors should take into account when deciding whether it is ethically acceptable, or even desirable, to make recommendations to patients in certain areas of their work.
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Affiliation(s)
- Leila Jamal
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD
| | - Will Schupmann
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Benjamin E. Berkman
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD
- National Human Genome Research Institute, NIH, Bethesda, MD
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Roth DE, Ramtekkar U, Zeković-Roth S. Telepsychiatry: A New Treatment Venue for Pediatric Depression. Child Adolesc Psychiatr Clin N Am 2019; 28:377-395. [PMID: 31076115 DOI: 10.1016/j.chc.2019.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The benefits and acceptability of using telepsychiatry to provide psychiatric treatment to youth in their homes, schools, primary care provider offices, juvenile correction centers, and residential facilities are well established. Telepsychiatry removes geographic barriers between patients and providers and improves the access to and ease of receiving quality care. Effective telepsychiatrists use strategic room staging, enhanced nonverbal communication, and technical experience to ensure sessions provide an authentic treatment experience and strong provider-patient alliances are forged. When the telepsychiatry venue is used properly, sessions feel authentic and pediatric treatment outcomes meet and sometimes exceed those of sessions conducted in traditional venues.
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Affiliation(s)
- David E Roth
- Mind & Body Works, Inc., 3340 Wauke Street, Honolulu, HI 96815-4452, USA.
| | - Ujjwal Ramtekkar
- Partners for Kids, Nationwide Children's Hospital, 700 Children's Way, Columbus, OH 43215, USA
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Paul J, Metcalfe S, Stirling L, Wilson B, Hodgson J. Analyzing communication in genetic consultations--a systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:15-33. [PMID: 25312331 DOI: 10.1016/j.pec.2014.09.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/21/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To systematically review studies that have analyzed communication within medical consultations involving genetic specialists and report on their findings and design. METHODS Drawing from PRISMA and appropriate guidelines for reviewing qualitative research, a systematic search of seven databases was conducted, followed by selection of studies for inclusion based on a set of criteria. Three authors conducted data extraction and narrative synthesis. RESULTS Twenty-two studies were identified and were heterogeneous in setting, design, and methods, with many including limited descriptions of health professionals involved. Despite this variability, studies generally pursued the following three main objectives: searching for structural patterns within consultations, investigating communication and genetic counseling concepts, and linking process with input- and outcome-measures. Structural patterns identified included clinician dialog dominating consultations, and talk being mostly biomedical. Counseling and communication concepts investigated were: risk communication, the negotiation of power and knowledge, and adherence to genetic counseling ideals. Attempts to link consultation data to input- or outcome-measures were often unsuccessful. CONCLUSION More interdisciplinary research, grounded in appropriate theoretical frameworks, is needed to explore inherent complexities in this setting. PRACTICE IMPLICATIONS Findings from this review can be used to guide the design of future research into the process of genetic consultations.
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Affiliation(s)
- Jean Paul
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; School of Languages and Linguistics, The University of Melbourne, Melbourne, Australia
| | - Sylvia Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Lesley Stirling
- School of Languages and Linguistics, The University of Melbourne, Melbourne, Australia
| | - Brenda Wilson
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Jan Hodgson
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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Street RL, Liu L, Farber NJ, Chen Y, Calvitti A, Zuest D, Gabuzda MT, Bell K, Gray B, Rick S, Ashfaq S, Agha Z. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. PATIENT EDUCATION AND COUNSELING 2014; 96:315-9. [PMID: 24882086 PMCID: PMC4339111 DOI: 10.1016/j.pec.2014.05.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. METHODS Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. RESULTS The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. CONCLUSIONS PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously managing data in the EHR. PRACTICE IMPLICATIONS EHR activity consumes an increasing proportion of clinicians' time during consultations. To ensure effective communication with their patients, clinicians may benefit from using communication strategies that maintain the flow of conversation when working with the computer, as well as from learning EHR management skills that prevent extended periods of gaze at computer and long periods of silence. Next-generation EHR design must address better usability and clinical workflow integration, including facilitating patient-clinician communication.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Department of Medicine, Baylor College of Medicine, Houston, USA; Houston VA Center for Innovations in Quality, Effectiveness and Safety, USA.
| | - Lin Liu
- Department of Family and Preventive Medicine, University of California, San Diego USA
| | - Neil J Farber
- Department of Medicine, University of California, San Diego USA
| | - Yunan Chen
- Department of Informatics, University of California, Irvine, USA
| | | | | | - Mark T Gabuzda
- Department of Medicine, University of California, San Diego USA
| | - Kristin Bell
- Department of Internal Medicine, VA San Diego Health Care System, USA
| | - Barbara Gray
- Veterans Medical Research Foundation, VASDHS, USA
| | - Steven Rick
- Veterans Medical Research Foundation, VASDHS, USA
| | | | - Zia Agha
- Department of Medicine, University of California, San Diego USA; West Health Policy Center, West Health Institute, San Diego, California, USA
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Albada A, Ausems MGEM, van Dulmen S. Counselee participation in follow-up breast cancer genetic counselling visits and associations with achievement of the preferred role, cognitive outcomes, risk perception alignment and perceived personal control. Soc Sci Med 2014; 116:178-86. [PMID: 25016325 DOI: 10.1016/j.socscimed.2014.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 06/02/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
The purpose of the study was to assess the counselee participation in the follow-up visits, compared to the first visits, for breast cancer genetic counselling and to explore associations with counselees' achievement of their preferred role in decision making, information recall, knowledge, risk perception alignment and perceived personal control. First and follow-up visits for breast cancer genetic counselling of 96 counselees of a Dutch genetics center were videotaped (2008-2010). Counselees completed questionnaires before counselling (T1), after the follow-up visit (T2) and one year after the follow-up visit (T3). Consultations were rated with the Roter Interaction Analysis System (RIAS). Counselee participation was measured as the percentage of counselee utterances, the percentage of counselee questions and the interactivity (number of turns per minute). Follow-up visits had higher levels of counselee participation than first visits as assessed by the percentage of counselee talk, the interactivity and counselee questions. More counselee talk in the follow-up visit was related to higher achievement of the preferred role (T2) and higher perceived personal control (T3). Higher interactivity in the follow-up visit was related to lower achievement of the preferred role in decision making and lower information recall (T2). There were no significant associations with the percentage of questions asked and none of the participation measures was related to knowledge, risk perception alignment and perceived personal control (T2). In line with the interviewing admonishment 'talk less and listen more', the only assessment of counselee participation associated to better outcomes is the percentage of counselee talk. High interactivity might be associated with lower recall in breast cancer genetic counselees who are generally highly educated. However, this study was limited by a small sample size and a heterogeneous group of counselees. Research is needed on the interactions causing interactivity and its relationships with involvement in decision making and recall.
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Affiliation(s)
- Akke Albada
- Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Health Sciences, Buskerud University College, Drammen, Norway
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11
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Austin J, Semaka A, Hadjipavlou G. Conceptualizing genetic counseling as psychotherapy in the era of genomic medicine. J Genet Couns 2014; 23:903-9. [PMID: 24841456 DOI: 10.1007/s10897-014-9728-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Abstract
Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals. In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new--in 1979 Seymour Kessler explicitly described genetic counseling as a "kind of psychotherapeutic encounter," an "interaction with a psychotherapeutic potential"--we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple "conduit for information" function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.
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Affiliation(s)
- Jehannine Austin
- Departments of Psychiatry and Medical Genetics, University of British Columbia, Rm A3-112 - 3rd Floor, CFRI Translational Lab Building, 938 W28th Ave, Vancouver, BC, V5Z 4H4, Canada,
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12
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Butrick MN, Vanhusen L, Leventhal KG, Hooker GW, Nusbaum R, Peshkin BN, Salehizadeh Y, Pavlick J, Schwartz MD, Graves KD. Discussing race-related limitations of genomic testing for colon cancer risk: implications for education and counseling. Soc Sci Med 2014; 114:26-37. [PMID: 24908172 DOI: 10.1016/j.socscimed.2014.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 12/23/2022]
Abstract
This study examines communication about limitations of genomic results interpretation for colon cancer risk during education and counseling of minority participants. As part of a larger study conducted from 2010 to 2012, participants recruited from a large primary care clinic were offered testing for a research panel of 3 genomic markers (single nucleotide polymorphisms or SNPs) for colorectal cancer risk. Genetic counselors conducted pre- and post-test sessions which included discussion of limitations of result interpretation due to the lack of racial/ethnic diversity in research populations from which risk data are derived. Sessions were audio-recorded, transcribed and thematically analyzed. Many participants did not respond directly to this limitation. Among the participants that responded directly to this race-related limitation, many responses were negative. However, a few participants connected the limited minority information about SNPs with the importance of their current research participation. Genetic counselor discussions of this limitation were biomedically focused with limited explanations for the lacking data. The communication process themes identified included: low immediacy (infrequent use of language directly involving a participant), verbal dominance (greater speaking ratio of the counselor to the patient) and wide variation in the degree of interactivity (or the amount of turn-taking during the discussion). Placed within the larger literature on patient-provider communication, these present results provide insight into the dynamics surrounding race-related educational content for genomic testing and other emerging technologies. Clinicians may be better able to engage patients in the use of new genomic technology by increasing their awareness of specific communication processes and patterns during education or counseling sessions.
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Affiliation(s)
- Morgan N Butrick
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Lauren Vanhusen
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Kara-Grace Leventhal
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Gillian W Hooker
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Rachel Nusbaum
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Beth N Peshkin
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Yasmin Salehizadeh
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Jessica Pavlick
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Marc D Schwartz
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Kristi D Graves
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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13
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Kelly KM, Ellington L, Schoenberg N, Agarwal P, Jackson T, Dickinson S, Abraham J, Paskett ED, Leventhal H, Andrykowski M. Linking genetic counseling content to short-term outcomes in individuals at elevated breast cancer risk. J Genet Couns 2014; 23:838-48. [PMID: 24671341 DOI: 10.1007/s10897-014-9705-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/20/2014] [Indexed: 11/26/2022]
Abstract
Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, and 6 knowledge measures (Meaning of Positive Test; Meaning of Negative Test; Personal Behavior; Practitioner Knowledge; Mechanisms of Cancer Inheritance; Frequency of Inherited Cancer) measured at pre- and post-counseling. Proportion of participant cognitive and affective and counselor cognitive and affective content during sessions (using LIWC software) were predictors in regressions. Knowledge increased for 5 measures and decreased for Personal Behavior, Distress and Perceived Risk. Controlling for age and education, results were significant/marginally significant for three measures. More counselor content was associated with decreases in knowledge of Personal Behavior. More participant and less counselor affective content was associated with gains in Practitioner Knowledge. More counselor cognitive, and interaction of counselor cognitive and affective content, were associated with higher perceived risk. Genetic counselors dominate the content of counseling sessions. Therefore, their content is tied more closely to short term outcomes than participant content. A lack of patient communication in sessions may pose problems for understanding of complex concepts.
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Affiliation(s)
- Kimberly M Kelly
- School of Pharmacy, West Virginia University, Morgantown, WV, USA,
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