Determinants of patients' attitudes toward patient-centered care: a cross-sectional study in Greece

Factors affecting physicians' attitudes towards patient-centred care: a cross-sectional survey in Beijing

OBJECTIVES

Patient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians' attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design.

DESIGN

A cross-sectional survey.

SETTING

Twelve hospitals in Beijing, China.

PARTICIPANTS

1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research.

METHODS

This research used a survey containing a previously validated 6-point Likert scale called 'Chinese-revised Patient-Practitioner Orientation Scale' (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants' attitudes and to identify the sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care.

RESULTS

Gender, professional title (ie, seniority) and hospital type influence Chinese physicians' attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor-patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales.

CONCLUSIONS

This research identified sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician-patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability.

Development of patient-centred care in acute hospital settings: A meta-narrative review

BACKGROUND

Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context.

AIM

To understand the development of patient-centred care in the context of acute hospital settings over the past decade.

METHODS

A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic.

RESULTS

One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care.

CONCLUSIONS

Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions.

TWEETABLE ABSTRACT

Patient-centred care in acute care settings - we have arrived! Is it sustainable?

Attitudes of medical professionals towards patient-centredness: a cross-sectional study in H City, China

OBJECTIVES

Patient-centred communication improves patient experiences and patient care outcomes. This study aimed to assess the preference of medical professionals in China towards patient-centred communication under the context of the deteriorating doctor-patient relationship.

METHODS

A cross-sectional survey of medical professionals was conducted in January and February 2018 in H City of Heilongjiang province, the northeast of China. The Chinese-Revised Patient-Practitioner Orientation Scale (CR-PPOS) was adopted to measure the individual preference of respondents towards patient-centredness in clinical communication. Multivariate logistic regression models were established to identify the sociodemographic (gender, age, marital status and educational attainment) and work experience (years of working, seniority, satisfaction with income, daily workload and perceived doctor-patient relationship) predictors of the preference towards patient-centredness.

PATIENT AND PUBLIC INVOLVEMENT

Not applicable.

RESULTS

A total of 618 valid questionnaires were returned. The CR-PPOS demonstrated acceptable reliability and validity. Overall, a low level of preference towards patient-centredness in clinical communication was found. Relatively higher scores on 'caring for patients' (20.42±4.42) was found compared with those on 'information/responsibility sharing' (15.26±4.21). Younger age, higher educational attainment, lower daily workload and a perception of harmonious doctor-patient relationship were associated with a higher preference towards patient-centredness in clinical communication.

CONCLUSIONS

A low level of preference towards patient-centredness in clinical communication was found in medical professionals in the northeast of China, which may further jeopardise the efforts to improve doctor-patient relationship.

Bioethical Decisions in Neonatal Intensive Care: Neonatologists' Self-Reported Practices in Greek NICUs

This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to withhold or withdraw neonatal intensive care (p < 0.05). Conclusions: Our research shows that Greek NICU physicians report considerably lower levels of ethical decision-making regarding preterm and ill newborns compared to their counterparts in other European countries. Clinical practices and attitudes towards ethical decision-making appear to be influenced mainly by the Greek physicians’ values.

Medical Students' Knowledge and Attitudes Toward Shared Decision Making: Results From a Multinational, Cross-Sectional Survey

Introduction. We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes toward, knowledge of, and experience with shared decision making (SDM). Methods. We conducted the survey from September 2016 until May 2017 using the following: 1) a convenience sample of students from four medical schools each in Canada, the United States, and the Netherlands (n = 12), and 2) all medical schools in the United Kingdom through the British Medical School Council (n = 32). We also distributed the survey through social media. Results. A total of 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range = 18.8% to 100%; 95% confidence interval [CI] = 82.8% to 84.5%). US students had the highest knowledge scores (86.2%, 95% CI = 84.8% to 87.6%). The mean risk communication score was 57.4% (range = 0% to 100%; 95% CI = 57.4% to 60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients, and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, P < 0.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% v. 48.8%). A total of 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion. SDM knowledge is high among medical students in all four countries. Risk communication is less well understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.

Gender differences on medical students' attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China

Objectives

Assessing medical students' attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform.

Methods

A cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students' attitudes. The medical students' demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category.

Results

A total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for 'Caring' (including patients' preferences into the decision-making process) than for 'Sharing' (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P < 0.05) were significantly associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores. Student category (P < 0.05) was associated with 'Sharing' and 'Caring' scores. Clinical hospital students (P < 0.05) were associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores, Students without siblings (p < 0.07) were associated with the higher 'Sharing' subscale scores.

Conclusions

In China, gender has a significant impact on medical students' patient-centred attitudes, which is similar to findings from other countries. If medical schools want to raise patient-centred attitudes across the board and bridge the gap between male and female patient-centred attitudes, gender, student category, and other factors should be incorporated into medical education.

Socio-economic differences in patient participation behaviours in doctor-patient interactions-A systematic mapping review of the literature

Background

The degree to which patients participate in their care can have a positive impact on health outcomes. This review aimed to map the current literature on patient participation behaviours in interactions with physicians and the extent to which differences in these behaviours can be explained by socio‐economic status (SES).

Search strategy

Four electronic databases were searched from 1980 onwards using key words related to socio‐economic status and patient participation behaviours.

Study selection

Titles, abstracts and full texts were screened by two reviewers, with the second reviewer screening 20% of all entries.

Data extraction

Data on year of publication, country, patient population, setting, patient participation behaviour studied, and SES measure used were extracted.

Main results

Forty‐nine studies were included in the review. Most studies were conducted in the United States, and the most commonly studied patient participation behaviour was involvement in decision making. Most studies measured SES using education as an indicator, with very few studies using occupation as a measure. Many studies did not report on participants’ medical condition or study setting. Patient participation in their health‐care appointment increased with increasing SES in 24 studies, although in 27 studies no significant association was found.

Discussion and conclusions

Current literature was found to be mainly US‐centric. Many studies did not specify participants’ medical condition or in what setting the study was undertaken. More studies are needed on less commonly studied patient participation behaviours. It would be helpful for further studies to also include a wider range of SES indicators.

Attitudes Toward Patient-Centered Care in the Mental Care Services in Isfahan, Iran

Understanding patient-physician relationships in mental care services is an indispensable element to improve the quality of mental care, yet little is known about it in Iran. This study measured the attitudes of the patients' family and personal caregivers (FPCs) and psychiatrists toward patient-centered care. A sample of 88 FPCs of mental patients and 29 psychiatrists in four teaching hospitals of Isfahan city, Iran, providing mental care, were asked to complete the patient-practitioner orientation scale (PPOS). Results showed mean scores of PPOS, sharing and caring for the psychiatrists were 3.4, 3.8, and 3.1, compared to 3.9, 4.2, and 3.7 for the mental patients' FPCs. There was a significant difference between the PPOS mean scores of the FPC and psychiatrist groups (p < 0.05) indicating that psychiatrists' attitudes were less patient-centered. Developing medical training interventions, establishing communication skills workshops, and increasing patients' awareness are some approaches to address the low level of patient-centered care.

Interconnections: Spirituality, Spiritual Care, and Patient-Centered Care

The interconnections of spirituality, spiritual care (SC), and patient-centered care (PCC) have implications for advanced practice nurses (APNs) and specialty care nurses (SNs) in their everyday practice. Spirituality has been identified as an inner resource for health, promoting hope, coping, and resilience during illness concerns; encouraging health promotion and maintenance; and improving patient outcomes. SC supports this inner resource and is provided by others. Systems can help facilitate SC by supporting the inter-personal relationships as well as transdisciplinary collaborations of PCC models. SC and PCC occur within inter-personal relationships and specific healthcare environments or systems when implementing them within a spirituality framework. This article provides a brief review on conceptual definitions of spirituality, SC, and PCC models and their relationship to each other within the inter-personal connections. Exploration of implementing such care in practice is presented. Search parameters for this review included manuscripts which provided conceptual as well as quantitative and qualitative research between 1990 and 2018, in English only, with keywords of spirituality, SC, PCC, nurse, nurse practitioner, APNs, and systems. Databases searched included CINHAL, Medline, PubMed, ALTA Religion, Psych-INFO, and Ovid. Articles included in this review were based on research of the above concepts as well as operationalizing the concepts into practice.

Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study

BACKGROUND/OBJECTIVE

Patient-centred attitudes have been shown to decline during medical training in high-income countries, yet little is known about attitudes among West African medical students. We sought to measure student attitudes towards patient-centredness and examine validity of the 18-item Patient-Practitioner Orientation Scale (PPOS) in this context.

PARTICIPANTS/SETTING

430 medical students in years 1, 3, 5 and 6 of a 6-year medical training programme in Bamako, Mali.

DESIGN

We conducted a cross-sectional survey, compared the proportion of students who agreed with each PPOS item by gender and academic year, and calculated composite PPOS scores. To examine psychometrics of the PPOS and its two subscales ('sharing' and 'caring'), we calculated internal consistency (Cronbach's alpha) and performed confirmatory and exploratory factor analyses (CFA and EFA).

RESULTS

In seven of the nine 'sharing' items, the majority of students held attitudes favouring a provider-dominant style. For five of the nine 'caring' items, the majority of student responded consistently with patient-centred attitudes, while in the other four, responses indicated a disease-centred orientation. In eight items, a greater proportion of fifth/sixth year students held patient-centred attitudes as compared with first year students; there were few gender differences. Average PPOS scores indicated students were moderately patient-centred, with more favourable attitudes towards the 'caring' aspect than 'sharing'. Internal consistency of the PPOS was inadequate for the full scale (α=0.58) and subscales ('sharing' α=0.37; 'caring' α=0.48). CFA did not support the original PPOS factors and EFA did not identify an improved structure.

CONCLUSIONS

West African medical students training in Bamako are moderately patient-centred and do not show the same declines in patient-centred attitudes in higher academic years as seen in other settings. Medical students may benefit from training in shared power skills and in attending to patient lifestyle factors. Locally validated tools are needed to guide West African medical schools in fostering patient-centredness among students.

Measuring the preference towards patient-centred communication with the Chinese-revised Patient-Practitioner Orientation Scale: a cross-sectional study among physicians and patients in clinical settings in Shanghai, China

OBJECTIVES

To adapt the Patient-Practitioner Orientation Scale (PPOS), to a Chinese context, and explore the preference towards patient-centred communication among physicians and patients with the Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS).

DESIGN

A cross-sectional questionnaire-based study.

SETTING

Clinical settings from eight medical units, including four community hospitals and four general hospitals, in Shanghai, China.

PARTICIPANTS

1018 participants, including 187 physicians and 831 patients, completed this study in two successive stages.

OUTCOME MEASUREMENTS

Psychometric properties of the CR-PPOS and participants' score on the CR-PPOS.

RESULTS

Compared with the original PPOS, the 11-item CR-PPOS obtained better psychometric indices. Physicians and patients scored differently on both the total CR-PPOS and its two subscales. Compared with physicians, the scores of patients were more influenced by their personal characteristics, such as age and education.

CONCLUSIONS

The CR-PPOS is a better instrument in a Chinese context than the original translated version. The divergence in the extent to which patient-centred communication is preferred among Chinese physicians and patients should be noted. Adapting physicians' communication strategy to patients' preferences based on their personal characteristics can be a viable approach towards improving clinical efficiency.

Health Social Media and Patient-Centered Care: Buzz or Evidence? Findings from the Section "Education and Consumer Health Informatics" of the 2015 Edition of the IMIA Yearbook

OBJECTIVE

To summarize the 2014 state of the art in the areas related to consumer health informatics and social media.

METHODS

We conducted a systematic review of articles published in 2014 in PubMed with a predefined set of queries. We identified 439 articles relevant for the review. The two section editors independently screened those papers taking into account their relevance to the topics covered by the section. In a second step, they jointly selected the 20 most representative papers as candidate best papers. Candidate best papers were then submitted for full review and scoring by external reviewers. Based on the scoring, section editors together with the IMIA Yearbook editorial board selected the four best papers published in 2014 in consumer health informatics.

RESULTS

Helping patients acquire a healthier lifestyle is a crucial part of patient empowerment. In this line of work, new studies are exploring the efficacy of online health interventions for patient behavioral change. The special case of smoking cessation for consumers with low socio-economic status is particularly noticeable. Another study has explored how an online intervention can reduce the anxiety of women who experience an abnormal mammography. The team of PatientsLikeMe has studied how online support groups could play a role in the quality of life of organ transplant recipients. The patient perspective of online forums' users is also analyzed in the domain of anticoagulation therapy.

CONCLUSIONS

Online health interventions, many of them using social media, have confirmed their potential to impact consumer behavioral change. However, there are still many methodological issues that need to be addressed in order to prove cost-effectiveness.

Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis

INTRODUCTION

Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries.

METHODS AND ANALYSIS

The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data.

ETHICS AND DISSEMINATION

The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.