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Wolfe BH, Hintz EA. Assessing the mediating role of disenfranchising talk on the well-being of female patients with chronic overlapping pain conditions. PATIENT EDUCATION AND COUNSELING 2024; 127:108354. [PMID: 38936159 DOI: 10.1016/j.pec.2024.108354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Disenfranchising talk (DT) occurs when health care providers discredit, silence, and stereotype patients. Although ample research has suggested associations among negative patient-provider interactions and poorer well-being, this study is the first to investigate the mediating role of patient-provider DT in exacerbating poorer pain-related health correlates. METHODS Female patients living with chronic overlapping pain conditions (N = 348) completed a cross-sectional survey including measures of DT, pain severity, pain catastrophizing, and pain disability, as well as demographic information. Structural equation modeling in AMOS 29 assessed whether DT mediated the relationship between age, educational attainment, and sexual orientation (demographics), and pain severity, catastrophizing, and disability (pain-related health correlates). RESULTS Structural equation modeling revealed that DT mediated the relationship between age, educational attainment, and sexual orientation on pain-related health correlates, such that younger and LGBQA+ patients and those with less educational attainment reported heightened pain severity, catastrophizing, and disability when they also reported DT. CONCLUSION In contrast to scholarship assessing how demographics and pain-related variables influence patient-provider communication, this study instead investigated the mediating role of DT in pain-related health correlates. PRACTICE IMPLICATIONS Providers should avoid discrediting, silencing, or stereotyping female chronic pain patients' pain to potentially avoid exacerbating pain-related health correlates.
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Affiliation(s)
- Brooke H Wolfe
- Department of Communication, Michigan State University, 404 Wilson Rd., East Lansing, MI, USA.
| | - Elizabeth A Hintz
- Department of Communication, University of Connecticut, 337 Mansfield Rd., Storrs, CT, USA.
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Bock A, Wagenknecht N, Winnand P, Katz MS, Ooms M, Heitzer M, Hölzle F, Modabber A. Improvement of students' communication skills through targeted training and the use of simulated patients in dental education-a prospective cohort study. BMC MEDICAL EDUCATION 2024; 24:820. [PMID: 39080578 PMCID: PMC11290294 DOI: 10.1186/s12909-024-05818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Good communication between patients and practitioners is essential, especially during dental procedures, as these treatments are often associated with increased nervousness and anxiety. The aim of this study was to investigate, implement and evaluate a concept for communication skills training by using targeted training in combination with simulation patients in dental education. METHODS Students (n = 34) were assigned to four small groups receiving targeted training consisting of two parts. A lecture about the theoretical basics of communication skills and two practical sessions with simulation patients. During this training, one of the students performed the conversation with the patient. Immediately after self-assessment was obtained, the simulation patient, the remaining students and the lecturer provided feedback. Additionally, anonymous surveys were administered to the students at the beginning of the semester, immediately after the training and at the end of the course. RESULTS The students rated the learning of communication skills as important for later professional life at all times. After targeted training followed by subsequent use in simulated patients, there was a significant improvement in communication skills (p < 0.001). The number of open-ended questions asked to patients after attending the course significantly increased (p = 0.0245). The communication training was considered useful, especially in small groups. CONCLUSION The implementation of targeted training with subsequent use in simulated patients significantly contributed to the students' improvement in communication skills. The concept offers a good opportunity to better prepare students for interaction with patients, both in their studies and in their upcoming professional lives.
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Affiliation(s)
- Anna Bock
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany.
| | - Nina Wagenknecht
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Marie Sophie Katz
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
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Wiedmeyer ML, Machado S, Tayyar E, Sierra-Heredia C, Bozorgi Y, Hagos S, Goldenberg S, Lavergne R. How immigration shapes health disadvantages and what healthcare organizations can do to deliver more equitable care. Healthc Manage Forum 2024:8404704241265675. [PMID: 39045719 DOI: 10.1177/08404704241265675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
That immigration is a determinant of health and that immigration systems themselves contribute to structural disadvantage remains under-addressed within healthcare in Canada. This article offers context for how immigration shapes health, and recommendations for how health systems can be better prepared to respond to the diverse needs of immigrants and migrants (together referred to as im/migrants), based on a community-based research project in British Columbia. Findings call attention to the varied and intersecting ways in which immigration status, access to health insurance, language, experiences of trauma and discrimination, lack of support for health system limits access to healthcare, and the roles community-based organizations play in supporting access. Recommendations are intended to help make sure that all health services are accessible to everyone, and move beyond a homogenizing category of "newcomers" into practical, meaningful strategies that attend to diverse and intersecting community needs.
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Affiliation(s)
| | - Stefanie Machado
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Elmira Tayyar
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | | | - Yasmin Bozorgi
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Selamawit Hagos
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Shira Goldenberg
- San Diego State, San Diego, California, Unites States of America
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Wang YF, Lee YH, Lee CW, Lu JY, Shih YZ, Lee YK. The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting. HEALTH COMMUNICATION 2024; 39:1235-1245. [PMID: 37161370 DOI: 10.1080/10410236.2023.2210379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Chen-Wei Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University
| | - Jing-Yi Lu
- Department of Healthcare Administration, Asia University
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Yi-Kung Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Medicine, Tzu Chi University
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Mackley J, Ng A, Menahem S. Towards improving the lived experience of adult congenital heart patients: suggestions for health care practitioners. Cardiol Young 2024; 34:497-499. [PMID: 37466077 DOI: 10.1017/s1047951123002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
What steps may clinicians looking after adult congenital heart patients take to improve the care they provide? An adult with complex congenital heart disease (CHD) who required a Fontan circulation has developed a discussion paper with the help of his attending clinicians. Drawing on his personal experience and that of others that he has represented, the paper highlights the problems in communication between such patients and their physician, followed by suggestions as to how to improve patient engagement, empowerment, and enablement. Attention to those suggestions may well benefit all in the care provided for this growing population.
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Affiliation(s)
- Jonathan Mackley
- HeartKids Limited, Melbourne, Australia
- Australian & New Zealand Fontan Community Committee (ANZFAC), Melbourne, Australia
| | - Alexandrea Ng
- Department of Medical Education, University of Melbourne, Melbourne, Australia
| | - Samuel Menahem
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
- Australian Centre for Heart Health, Melbourne, Australia
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Rosburg T, von Allmen DY, Langewitz H, Weber H, Bunker EB, Langewitz W. Patient-centeredness in psychiatric work disability evaluations and the reproducibility of work capacity estimates. PATIENT EDUCATION AND COUNSELING 2024; 119:108093. [PMID: 38061142 DOI: 10.1016/j.pec.2023.108093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates. METHODS In our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patient-centeredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant's WC on a scale from 0% to 100%. RESULTS Patient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant's emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility. CONCLUSIONS Many of the experts' questions addressed the claimant's lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. PRACTICE IMPLICATIONS Patient-centeredness in work disability evaluations should find its entry in continuing education of experts.
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Affiliation(s)
- Timm Rosburg
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland.
| | - David Y von Allmen
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland
| | - Helena Langewitz
- Johannes Gutenberg University Mainz, Institute of Art History and Musicology, Mainz, Germany
| | - Heidemarie Weber
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
| | | | - Wolf Langewitz
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
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Çakmak C, Uğurluoğlu Ö. The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control 2024; 31:10732748241236327. [PMID: 38411086 PMCID: PMC10901059 DOI: 10.1177/10732748241236327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Patient-centered communication is a type of communication that takes place between the provider and the patient. OBJECTIVES It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction. METHOD The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye. RESULTS More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction. CONCLUSION Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.
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Affiliation(s)
- Cuma Çakmak
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Dicle University, Diyarbakır, Türkiye
| | - Özgür Uğurluoğlu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Türkiye
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Yang H, Chen S, Zhao N, Zhou X, Cui L, Xia W, Li Y, Zhu H. Effects of online continuing medical education on perspectives of shared decision-making among Chinese endocrinologists. BMC MEDICAL EDUCATION 2023; 23:878. [PMID: 37978373 PMCID: PMC10657027 DOI: 10.1186/s12909-023-04838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Shared decision-making (SDM) may influence the clinical outcomes of patients with endocrine disorders. There are few studies describing perspectives towards SDM among endocrinologists in China. METHODS In the first stage, we conducted a national survey using an online questionnaire about SDM among endocrinologists in China. The national survey focused on attitude and propensity, potential barriers, and the effectiveness of SDM implementation strategies. In the second stage, survey participants were further recruited to participate in a prospective cohort study in the online continuing medical education (CME) program of Peking Union Medical College Hospital in Beijing. The Shared Decision-Making Questionnaire (SDM-Q-Doc) was employed to assess the effects of online CME on physicians' perspectives during the process of SDM, which was conducted before and after the CME course was provided. RESULTS In the national survey, 280 endocrinologists (75.7% female, mean age 38.0 ± 4.5 years, 62.5% with a duration of practice of more than ten years) completed the questionnaire. Participants had a generally positive attitude towards SDM in clinical practice. The main perceived barriers included time consumption, information inequality between doctors and patients, and a lack of technical support and training for SDM. The main uncertainties of implementation steps included inviting patients to participate in SDM (16.3%), assisting in decision-making (15.3%), facilitating deliberation and decision-making (13.7%), and providing information on benefits and risks (12.6%). Of the physicians who participated in the national survey, 84 registered for the eight-day online CME course. The SDM-Q-Doc score increased from 87.3 ± 18.2 at baseline to 93.0 ± 9.3 at the end of the 8-day online CME training (p = 0.003, paired t test). The participants' age, sex, education level, practice duration, the annual number of patients with rare endocrine diseases, and the annual number of patients requiring MDT or CME were not significantly related to increased SDM-Q-Doc scores after online CME (all p > 0.05). CONCLUSIONS Chinese endocrinologists had a generally positive attitude towards SDM in clinical practice. There were also several uncertainties in the implementation steps of SDM. Regardless of a physician's educational background or prior professional experience, CME may help to improve their perspectives regarding SDM.
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Affiliation(s)
- Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Shi Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Nan Zhao
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Zhou
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Lijia Cui
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Weibo Xia
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Yuxiu Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China.
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Findlay-White F, Dornan T, Davies M, Archer A, Kilvert A, Fox C. From fixer to facilitator: an interpretative phenomenological study of diabetes person-centred counselling and empowerment-based education. F1000Res 2023; 11:78. [PMID: 38434003 PMCID: PMC10904953 DOI: 10.12688/f1000research.73596.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/05/2024] Open
Abstract
Background The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Methods Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. Results 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. Conclusions The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.
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Affiliation(s)
- Florence Findlay-White
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, BT9 7BL, UK
| | - Mark Davies
- Clinical Psychology Department, Belfast City Hospital, Belfast, Northern Ireland, BT9 7AE, UK
| | - Alan Archer
- Derbyshire Community Health Service, Walton Hospital, Chesterfield, England, S40 3HW, UK
| | - Anne Kilvert
- Northampton Community Diabetes Service, Danetre Hospital, Daventry, England, NN11 4DY, UK
| | - Charles Fox
- Diabetes Research Centre, University of Leicester, Leicester, England, LE5 4PW, UK
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Lampart P, Häusler F, Langewitz W, Rubinelli S, Sigrist-Nix D, Scheel-Sailer A. Patients' experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury: A pilot qualitative interview study. J Spinal Cord Med 2023; 46:837-847. [PMID: 35867389 PMCID: PMC10446827 DOI: 10.1080/10790268.2022.2095496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To explore patients' experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury/disorder (SCI/D). DESIGN Qualitative design with semi-structured interviews and purposively sampled participants. Interviews were transcribed verbatim. Transcripts were analyzed for qualitative content analysis using the Mayring method. SETTING Specialized acute care and rehabilitation center for SCI/D-patients. PARTICIPANTS Patients in initial rehabilitation after a newly acquired SCI/D. INTERVENTIONS n.a. OUTCOME MEASURES n.a. RESULTS Ten participants were interviewed in the post-acute phase after a newly acquired SCI/D. Participants described individual patient characteristics as well as organizational elements influencing their experience with goal setting. Organizational elements comprised structural elements (e.g. ward rounds, rehabilitation meetings, etc.) and interaction with and among the interprofessional teams. Perspectives from various health care professionals (HCPs) were perceived as increasing adequate goal setting and motivation. Furthermore, the participants described their own involvement and motivation as crucial for goal achievement. The main point of the critique was the standardization of the goal setting process. Interviewees would have preferred individualized goal setting embedded in a clearly foreseeable rehabilitation plan. CONCLUSION Organization and collaboration with and among the HCPs should be geared towards identifying specific patient needs during the course of rehabilitation and deriving individually tailored goals from them. Communication plays an important role in the individual goal setting.
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Affiliation(s)
- Patricia Lampart
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Florin Häusler
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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11
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Zhong X, Tang F, Lai D, Guo X, Yang X, Hu R, Li D, Lu Y, Liu S, Leal-Costa C. The Chinese version of the Health Professional Communication Skills Scale: Psychometric evaluation. Front Psychol 2023; 14:1125404. [PMID: 37621938 PMCID: PMC10446878 DOI: 10.3389/fpsyg.2023.1125404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/28/2023] [Indexed: 08/26/2023] Open
Abstract
Objective This study aims to translate the Health Professional Communication Skills Scale (HP-CSS) into Chinese and assess its psychometric properties. Methods A total of 836 healthcare professionals were recruited. The demographic characteristics form and HP-CSS were used for data collection. The psychometric properties of HP-CSS were evaluated by examining item analysis, construct validity, known-group discriminant validity, internal consistency, and split-half reliability. Results In terms of item analysis, the critical ratio (CR) of 18 items was both >3 (CR ranging from 9.937 to 28.816), and the score of each item was positively correlated with the total score (r ranging from 0.357 to 0.778, P < 0.001). The fit indices showed that the original correlated four-factor model of HP-CSS was adequate: χ2 =722.801; df = 126; χ2/df = 5.737; RMSEA = 0.075; CFI = 0.923; NNFI = 0.908; TLI = 0.906; IFI = 0.923. In terms of known-group discriminant validity, the HP-CSS total score was related to gender, occupation, work years, and communication skill training. Cronbach's α coefficient was 0.922, and the split-half reliability was 0.865 for the total scale. Conclusion The Chinese version of the HP-CSS is a reliable and valid instrument to evaluate communication skills among healthcare professionals in China.
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Affiliation(s)
- Xiaoying Zhong
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Fangmei Tang
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Dongmei Lai
- Department of Child Rehabilitation, Chengdu Integrated TCM Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Xiujing Guo
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaorong Yang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Rong Hu
- Mianyang Central Hospital, University of Electronic Science and Technology, Mianyang, Sichuan, China
| | - Dehua Li
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yongguang Lu
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Sixu Liu
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Snook AG, Arnadottir SA, Forbes R. A survey of patient education practices and perceptions of physiotherapists: a mixed methods study. Physiother Theory Pract 2023; 39:772-784. [PMID: 35014932 DOI: 10.1080/09593985.2022.2025966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Patient education is an integral part of physiotherapy practice. The use of patient education and the adoption of a patient-centered approach to education has not been examined in a European setting. OBJECTIVE To explore the frequency and perceived importance of patient education practices of physiotherapists in Iceland. METHODS A convergent mixed methods study design was utilized. A cross-sectional, web-based survey was completed by 216 physiotherapists (35.1% response rate). Transformed qualitative data played a secondary role to quantitative results measuring frequencies of use and perceived importance of a spectrum of patient education practices. RESULTS Providing exercise and diagnostic information had the highest rated frequency and importance. Advising on social support and having the patient explain why their home exercises were important were rated lowest. A large difference was reported between frequency and importance when collaborating with patients on goal-setting. Therapists reported delivering education through discussions and physical demonstrations, while relying on visual cues and return demonstrations to evaluate education effectiveness. Patient-specific education, including preferred learning style, was not always considered. The highest-rated barriers to patient education were patient characteristics that were psychosocial in nature. Results regarding readiness for education indicated needs to assess patient motivation while managing external barriers. CONCLUSION The results indicate that physiotherapists engage in a wide variety of patient education activities that they consider important. Barriers to patient education identified by therapists may be managed by further skill development in a collaborative patient-centered approach to patient education.
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Affiliation(s)
| | | | - Roma Forbes
- School of Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia
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[The KomMent study: a pilot project on structured interprofessional communication in uro-oncology]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:271-278. [PMID: 36205744 PMCID: PMC9998575 DOI: 10.1007/s00120-022-01945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND Communication and interprofessional collaboration with patients diagnosed with cancer is challenging. Structured communication training has not yet been integrated into postgraduate medical education. The aim of this study was to evaluate the feasibility of an 80-teaching unit interprofessional communication training (ICT), as recommended in the National Cancer Plan, at a clinic with a uro-oncological focus. METHODS A needs assessment was conducted using focus groups and individual interviews. Learning objectives were aligned with (inter)national learning objective catalogs. The ICT was developed using the six-step approach according to Kern and design-based research. Utilization and acceptance were evaluated. The ICT comprised six face-to-face workshops (50 teaching units) and team supervision sessions (10 teaching units). Six defined settings were identified for the individual workplace-based training (20 teaching units): Ward rounds, handover, reporting of medical findings, admission and discharge interviews, and a freely choosable setting. RESULTS Physician participation rates in the workshops were 83.0% and nursing participation rates were 58.3%. Utilization of the workplace-based training was 97%. The physicians evaluated the ICT very positively. All participants felt better prepared for discussions with patients and relatives. For continuity, physicians were trained as mentors. CONCLUSION The implementation of an ICT with 80 teaching units is successfully feasible in a urological clinic and leads to a sustainable improvement of the communication culture, among other things through mentor training.
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Ahmed A, van den Muijsenbergh METC, Vrijhoef HJM. Person-centred care in primary care: What works for whom, how and in what circumstances? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3328-e3341. [PMID: 35862510 PMCID: PMC10083933 DOI: 10.1111/hsc.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 06/10/2023]
Abstract
This rapid realist review aims to explain how and why person-centred care (PCC) in primary care works (or not) among others for people with low health literacy skills and for people with a diverse ethnic and socioeconomic background, and to construct a middle-range programme theory (PT). Peered reviewed- and non-peer-reviewed literature (Jan 2013-Feb 2021) reporting on PCC in primary care was included. Selection and appraisal of documents were based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms and outcomes (CMO) were extracted. Based on the extracted data, CMO configurations were identified per source publication. Configurations containing all three constructs (CMO) were included in the PT. The middle-range PT demonstrates that healthcare professionals (HCPs) should be trained and equipped with the knowledge and skills to communicate effectively (i.e. in easy-to-understand words, emphatically, checking whether the patient understands everything, listening attentively) tailored to the wishes, needs and possibilities of the patient, which may lead to higher satisfaction. This way the patient will be more involved in the care process and in the shared decision-making process, which may result in improved concordance, and an improved treatment approach. A respectful and empathic attitude of the HCP plays an important role in establishing a strong therapeutic relationship and improved health (system) outcomes. Together with a good accessibility of care for patients, setting up a personalised care plan with all involved parties may positively affect the self-management skills of patients. Good collaboration within the team and between different domains is desirable to ensure good care coordination. The coherence of items related to PCC in primary care should be considered to better understand its effectiveness.
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Affiliation(s)
- Anam Ahmed
- Panaxea b.vAmsterdamThe Netherlands
- Department of Primary and Community CareRadboud University Medical CentreNijmegenthe Netherlands
| | - Maria E. T. C. van den Muijsenbergh
- Department of Primary and Community CareRadboud University Medical CentreNijmegenthe Netherlands
- Department of Prevention and CarePharos: Dutch Centre of Expertise on Health Disparities, Program Prevention and CareUtrechtThe Netherlands
| | - Hubertus J. M. Vrijhoef
- Panaxea b.vAmsterdamThe Netherlands
- Department of Patient & CareMaastricht University Medical CenterMaastrichtThe Netherlands
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Scheel-Sailer A, Eich S, Jelmoni L, Lampart P, Schwitter M, Sigrist-Nix D, Langewitz W. Effect of an interprofessional small-group communication skills training incorporating critical incident approaches in an acute care and rehabilitation clinic specialized for spinal cord injury and disorder. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:883138. [PMID: 36188965 PMCID: PMC9397787 DOI: 10.3389/fresc.2022.883138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
Aim To investigate the impact of site-specific inter-professional small-group communication skills training (CST) that incorporates critical incident approaches to learning on patient satisfaction with communication. Setting Rehabilitation clinic specialized for spinal cord injury/disorder (SCI/D). Methods Retrospective observational cohort study design using patient and health-professional self-report data. Data for patient satisfaction with communication were collected in 2014 (existing records) and each year from 2015 to 2021 (post-program; volunteers) using the MECON survey. Results Fifteen basic (n = 161 participants), 16 refresher (n = 84), and five short (n = 17) CST seminars were conducted. Overall, 262 employees (105 physicians, 63 nurses, 36 physio- and occupational therapists, and 58 others) participated; 92 participants (response rate 37.6%) responded to feedback surveys. They rated the seminars positive concerning the alternation between theory, discussion, and practical exercise in 91.3%, and rated the length of the training ideal in 80.2%. Post-program patient satisfaction overall increased from 83.1% (confidence interval (CI) 2.6%) to 90% (CI 0.8%; R2 = 0.776; p= 0.004). It was higher in specific communication-related topics: "receiving information" (81.1%, CI 3.1-90.2%, CI 1.0%; p = 0.003), "being able to bring in concerns" (83%, CI 1.0-90.8%; R2 = 0.707; p = 0.009) and "being treated with respect" (89.4%, CI 2.6-94.4%, CI 0.8%; R2 = 0.708; p = 0.004). Practice implications Inter-professional CST is feasible and well accepted by professionals from various professional groups. During seven years of continuous training, independent patient ratings of satisfaction with professional communication have improved significantly. Participants attest to the training's high credibility and usefulness in everyday life.
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Affiliation(s)
- Anke Scheel-Sailer
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stephanie Eich
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Luca Jelmoni
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
| | - Patricia Lampart
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Diana Sigrist-Nix
- Swiss Paraplegic Center, Rehabilitation, Nottwil, Switzerland
- MECON Measure & Consult GmbH, Zürich, Switzerland
| | - Wolf Langewitz
- Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
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Engler J, Güthlin C, Bertram L, Tesky V, Schall A, Joos S, Valentini J. General practitioners' communication on complementary and integrative medicine for cancer patients: Findings from an analysis of consultations with standardised patients. Eur J Cancer Care (Engl) 2022; 31:e13651. [PMID: 35844055 DOI: 10.1111/ecc.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 05/18/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our aim was to explore whether general practitioners (GPs) communicate with cancer patients on complementary and integrative medicine (CIM) in a patient-centred and case-specific manner. METHODS We designed two cases of standardised breast cancer patients and allocated 29 GPs to hold a consultation either with Case 1 or Case 2. Case 1 presented with fears of possible physical side effects of hormone treatment. Case 2 feared a loss in social functioning because of nausea and emesis as possible side effects of chemotherapy. Consultations were audiotaped and analysed using the Roter Interaction Analysis System (RIAS). We analysed whether recommended CIM treatments and GPs' focus on psychosocial or medical and therapy-related content differed according to whether they were counselling Case 1 or Case 2. RESULTS In consultations with Case 1, GPs rather focused on medical and therapy-related content and most often recommended mistletoe, diets and sports. In contrast, GPs focused on psychosocial content and they most often recommended methods of self-care when counselling Case 2. CONCLUSION The GPs in our sample reacted case-specifically to the patients' interest in CIM. Such responsive and patient-centred communication is a valuable resource but is often time-consuming. Adequate training and reimbursement should therefore be considered for GPs.
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Affiliation(s)
- Jennifer Engler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Corina Güthlin
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Laura Bertram
- Institute of General Practice and Interprofessional Care, Tuebingen, University Hospital Tuebingen, Tuebingen, Germany
| | - Valentina Tesky
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Arthur Schall
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, Tuebingen, University Hospital Tuebingen, Tuebingen, Germany
| | - Jan Valentini
- Institute of General Practice and Interprofessional Care, Tuebingen, University Hospital Tuebingen, Tuebingen, Germany
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Thackeray A, Waring J, Hoogeboom TJ, Nijhuis-van Der Sanden MWG, Hess R, Fritz JM, Conroy MB, Fernandez ME. Implementing a Dutch Physical Therapy Intervention Into a U.S. Health System: Selecting Strategies Using Implementation Mapping. Front Public Health 2022; 10:908484. [PMID: 35899163 PMCID: PMC9309571 DOI: 10.3389/fpubh.2022.908484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoach2Move is a person-centered physical therapy intervention that has demonstrated success in changing physical activity behaviors among older adults in the Netherlands. In this manuscript, we describe how we developed an implementation plan for Coach2move in a U.S. population and healthcare system using Implementation Mapping.MethodsWe established an implementation planning team of researchers, patients, and clinicians. The Consolidated Framework for Implementation Research provided an overall structure for consideration of the context for implementation. Implementation Mapping guided the planning process. The implementation planning team worked sequentially through the five tasks of Implementation Mapping (1) Identify needs, program adopters and implementers; (2) Identify adoption and implementation outcomes, performance objectives, determinants, and matrices of change; (3) Choose theoretical models and implementation strategies; (4) Produce implementation protocols; (5) Evaluate implementation outcomes. In this manuscript, we identify our evaluation plan but not results as data collection is ongoing.ResultsClinic managers and physical therapists were identified as program adopters and implementors. Performance objectives necessary steps to achieving implementation outcomes were linked to Coach2Move fidelity indicators with implementation by the physical therapist. These included delivery of person-centered care, motivational interviewing, meaningful goal setting, shared decision-making in planning, and systematic monitoring and follow-up. Determinants linked to these performance objectives included knowledge, outcome expectations, skills and self-efficacy, and perceived norms. Implementation strategies were selected based on a review of methods effective for influencing these determinants. This resulted in four primary strategies (1) educational meetings and dynamic training, (2) peer-assessment meetings, (3) changing the electronic health record template, and (4) reminders and prompts. Measures of intervention acceptability, appropriateness, and feasibility will be collected after training and early in implementation. Fidelity and effectiveness measures will be collected over the next 12-months.ConclusionImplementation mapping provided a systematic process for identifying what physical therapists would need to implement Coach2Move with fidelity. The result was a matrix linking behavioral determinants and performance objectives. These matrices of change allowed for systematic identification and tailoring of implementation strategies to the needs of our population and setting. The process was acceptable to diverse stakeholders, facilitated communication across stakeholders.
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Affiliation(s)
- Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Anne Thackeray
| | - Jackie Waring
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rachel Hess
- Division of Health System Innovation and Research, Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Molly B. Conroy
- Department of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Iversen ED, Wolderslund M, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S, Ammentorp J. Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice. J Patient Cent Res Rev 2021; 8:307-314. [PMID: 34722798 DOI: 10.17294/2330-0698.1782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. Methods This study was part of the large-scale implementation of a communication skills training program called "Clear-Cut Communication With Patients" at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers' participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. Results Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35-2.3; P=0.01) for the overall score. The consultations did not last longer after the training. Conclusions Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations.
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Affiliation(s)
- Else Dalsgaard Iversen
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Helle Poulsen
- Department of Gastrointestinal Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark'
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. "The talking bit of medicine, that's the most important bit": doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care. Int J Equity Health 2021; 20:170. [PMID: 34301261 PMCID: PMC8299635 DOI: 10.1186/s12939-021-01507-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.,Royal Darwin Hospital, Darwin, NT, 0811, Australia.,Flinders University, Northern Territory Medical Program, Darwin, NT, 0815, Australia
| | - Michelle Walker
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, NT, 0801, Australia
| | - Mandy Ahmat
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, NT, 0801, Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.,Royal Darwin Hospital, Darwin, NT, 0811, Australia
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Kuipers SJ, Nieboer AP, Cramm JM. Easier Said Than Done: Healthcare Professionals' Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116057. [PMID: 34199866 PMCID: PMC8200113 DOI: 10.3390/ijerph18116057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/18/2022]
Abstract
Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, healthcare professionals’ perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals’ lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.
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Draaisma E, Maggio LA, Bekhof J, Jaarsma ADC, Brand PLP. Impact of deliberate practice on evidence-based medicine attitudes and behaviours of health care professionals. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:118-124. [PMID: 33242154 PMCID: PMC7952477 DOI: 10.1007/s40037-020-00634-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 09/24/2020] [Accepted: 11/05/2020] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Although evidence-based medicine (EBM) teaching activities may improve short-term EBM knowledge and skills, they have little long-term impact on learners' EBM attitudes and behaviour. This study examined the effects of learning EBM through stand-alone workshops or various forms of deliberate EBM practice. METHODS We assessed EBM attitudes and behaviour with the evidence based practice inventory questionnaire, in paediatric health care professionals who had only participated in a stand-alone EBM workshop (controls), participants with a completed PhD in clinical research (PhDs), those who had completed part of their paediatric residency at a department (Isala Hospital) which systematically implemented EBM in its clinical and teaching activities (former Isala residents), and a reference group of paediatric professionals currently employed at Isala's paediatric department (current Isala participants). RESULTS Compared to controls (n = 16), current Isala participants (n = 13) reported more positive EBM attitudes (p < 0.01), gave more priority to using EBM in decision making (p = 0.001) and reported more EBM behaviour (p = 0.007). PhDs (n = 20) gave more priority to using EBM in medical decision making (p < 0.001) and reported more EBM behaviour than controls (p = 0.016). DISCUSSION Health care professionals exposed to deliberate practice of EBM, either in the daily routines of their department or by completing a PhD in clinical research, view EBM as more useful and are more likely to use it in decision making than their peers who only followed a standard EBM workshop. These findings support the use of deliberate practice as the basis for postgraduate EBM educational activities.
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Affiliation(s)
- Eelco Draaisma
- Lifelong Learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands.
- Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands.
| | - Lauren A Maggio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Jolita Bekhof
- Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands
| | - A Debbie C Jaarsma
- Lifelong Learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands
| | - Paul L P Brand
- Lifelong Learning, Education & Assessment Research Network (LEARN), University Medical Centre Groningen, Groningen, The Netherlands
- Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands
- Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
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Liu PL, Jiang S. Patient-Centered Communication Mediates the Relationship between Health Information Acquisition and Patient Trust in Physicians: A Five-Year Comparison in China. HEALTH COMMUNICATION 2021; 36:207-216. [PMID: 31617412 DOI: 10.1080/10410236.2019.1673948] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Public trust in medical profession has declined in the past decades. The deluge of health information available in various sources may be one contributing factor. However, how the health information acquisition influences patient trust remains unclear. With a general basis of Longo's Health Information Model, we proposed and tested mediation pathways linking three types of health information acquisition behaviors (scanning, seeking, and discussing) to patient trust in physicians, mediated by patient-centered communication. By using two iterations of probability sample surveys conducted in 2012 (N = 2568) and 2017 (N = 3090), respectively, in China, this study found that from 2012 to 2017, health information scanning declined. Specifically, the scanning via traditional media (e.g., newspaper, tv) decreased, but increased in the new media (e.g., Web). Besides, both health information seeking and discussing slumped. Among the three dimensions of health information acquisition, health information scanning and discussing exerted direct effects on patient trust. However, patient-centered communication was found to be mediated the relationships between all three types of health information acquisition and patient trust in physicians over time.
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Affiliation(s)
- Piper Liping Liu
- Department of Communications and New Media, National University of Singapore
| | - Shaohai Jiang
- Department of Communications and New Media, National University of Singapore
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Świątoniowska-Lonc N, Polański J, Tański W, Jankowska-Polańska B. Impact of satisfaction with physician-patient communication on self-care and adherence in patients with hypertension: cross-sectional study. BMC Health Serv Res 2020; 20:1046. [PMID: 33198739 PMCID: PMC7670590 DOI: 10.1186/s12913-020-05912-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension (HT) requires patients to continuously monitor their blood pressure, strictly adhere to therapeutic recommendations, and self-manage their illness. A few studies indicate that physician-patient communication and the patient's satisfaction with the therapeutic relationship may affect the course and outcomes of the treatment process. Research is still lacking on the association between satisfaction with physician-patient communication and adherence to treatment or self-care in chronically ill patients. The aim of the study was to evaluate the relationship between satisfaction with physician-patient communication and self-care and adherence in patients with HT undergoing chronic treatment. METHODS The following instruments were used: the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence (12-48 points), the Self-Care of Hypertension Inventory (SCHI) for self-care level (0-100 points), and the Communication Assessment Tool (CAT) for evaluating satisfaction with physician-patient communication. Socio-demographic and clinical data were obtained from patients' medical records. The research has a cross-sectional and observational study design. Inclusion criteria were as follows: age > 18 years, hypertension diagnosed per European Society of Hypertension (ESH) guidelines, treatment with at least one antihypertensive drug for the past 6 months, and informed consent. Cognitively impaired patients unable to complete the surveys without assistance were excluded (MMSE ≤18). Correlations between quantitative variables were analyzed using Pearson's or Spearman's correlation coefficient. Linear regression was performed. Variable distribution normality was verified using the Shapiro-Wilk test. RESULTS The study included 250 patients (110 male, mean age 61.23 ± 14.34) with HT, treated at a hypertension clinic. In the CAT questionnaire individual questions pertaining to satisfaction with physician communication (on the CAT) were rated "excellent" 28.4-50.4% of the time. The best-rated aspects of communication included: letting the patient talk without interruptions (50.4% "excellent" ratings), speaking in a way the patient can understand (47.6%), and paying attention to the patient (47.2%). According to patient reports, physicians most commonly omitted such aspects as encouraging the patient to ask questions (28.4%), involving them in decisions (29.2%), and discussing the next steps (35.2%). The respondents had a low level of adherence to pharmaceutical treatment (16.63 ± 4.6). In terms of self-care, they scored highest in self-care management (64.17 ± 21.18), and lowest in self-care maintenance (56.73 ± 18.57). In correlation analysis, satisfaction with physician-patient communication (total CAT score) was positively correlated with all SCHI domains (self-care maintenance β = 0.276, self-care management β = 0.208, self-care confidence β = 0.286, p < 0.05), and negatively correlated with ARMS scores (indicating better adherence). CONCLUSIONS Satisfaction with physician-patient communication has a significant impact on self-care and pharmaceutical adherence in patients with hypertension. The more satisfied the patient is with communication, the better their adherence and self-care. TRIAL REGISTRATION SIMPLE: RID.Z501.19.016.
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Affiliation(s)
- Natalia Świątoniowska-Lonc
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, K. Bartla 5, 51-616, Wroclaw, Poland
| | - Jacek Polański
- Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Tański
- Department of Internal Medicine, 4th Military Teaching Hospital, Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, K. Bartla 5, 51-616, Wroclaw, Poland.
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Mendi O, Yildirim N, Mendi B. Cross-cultural Adaptation, Reliability, and Validity of the Turkish Version of the Health Professionals Communication Skills Scale. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:312-319. [PMID: 32937201 DOI: 10.1016/j.anr.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the psychometric properties of the Turkish version of the Health Professionals Communication Skills Scale (HP-CSS). METHODS The HP-CSS was translated into Turkish following an international instrument translation guideline. A convenience sample of 394 health professionals participated in this study. Internal consistency reliability, content validity, test-retest reliability, and convergent validity were assessed. A confirmatory factor analysis was conducted to evaluate the construct validity. RESULTS The Turkish version of HP-CSS comprised four factors (empathy, informative communication, respect, and social skill). The HP-CSS-TR demonstrated adequate internal consistency (Cronbach's α values .72-.79). In terms of the content validity, the scale-level content validity index (CVI) was .94, and the item-level CVI ranged from .83 to 1.00. The HP-CSS-TR showed good test-retest reliability (intraclass correlation coefficients were above .82). No statistically significant difference was found between the applications. There was a good agreement between the HP-CSS-TR and communication skills inventory (CSI) scales. Confirmatory factor analysis results (χ2/df, GFI, AGFI, IFI, TLI, CFI, RMSEA, and SRMR) showed a good fit for the original four-factor model. CONCLUSION Results showed that the Turkish version of the HP-CSS is a valid and reliable tool for the assessment of communication skills of health professionals in Turkey. The use of the HP-CSS-TR measure in clinical settings could be useful in enhancing the quality of care by identifying inadequacies and improving communication skills.
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Affiliation(s)
- Onur Mendi
- Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey.
| | - Nurdan Yildirim
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey.
| | - Basak Mendi
- Faculty of Health Sciences, Demiroglu Bilim University, Istanbul, Turkey.
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Schmitz FM, Schnabel KP, Bauer D, Woermann U, Guttormsen S. Learning how to break bad news from worked examples: Does the presentation format matter when hints are embedded? Results from randomised and blinded field trials. PATIENT EDUCATION AND COUNSELING 2020; 103:1850-1855. [PMID: 32303364 DOI: 10.1016/j.pec.2020.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Video-based worked examples enable medical students to successfully prepare for breaking-bad-news (BBN) encounters with simulated patients (SPs). This is especially true when examples include hints that signal important content. This paper investigates whether the beneficial effect of hints only applies to video-based worked examples or also text-based examples. METHODS One-hundred-and-forty-seven fourth-year medical students attending a BBN training participated in either of two equally scaffolded, randomised field trials. Prior to encountering SPs, the students worked through an e-learning module introducing the SPIKES protocol for delivering bad news; it contained the same worked example presented to either of four groups as text or video, with or without additional hints denoting the SPIKES steps being implemented. RESULTS Only a main effect of 'hints' was revealed, implying that students in the hints groups delivered the news to an SP significantly more appropriately than those in the without-hints groups. CONCLUSIONS Independent of their presentation format, worked examples with hints best foster students' BBN skills learning. PRACTICE IMPLICATIONS In addition to video, text-based worked examples can effectively prepare students for BBN simulations if hints are included. This offers an affordable alternative to video examples, as text examples can be generated with less effort.
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Affiliation(s)
| | | | - Daniel Bauer
- Institute for Medical Education, University of Bern, 3010, Bern, Switzerland.
| | - Ulrich Woermann
- Institute for Medical Education, University of Bern, 3010, Bern, Switzerland.
| | - Sissel Guttormsen
- Institute for Medical Education, University of Bern, 3010, Bern, Switzerland.
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Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, Safaeinili N, Fischer M, Shaw JG, Thadaney S, Piccininni G, Lorenz KA, Asch SM, Verghese A, Zulman DM. Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. J Gen Intern Med 2020; 35:2107-2117. [PMID: 31919725 PMCID: PMC7351919 DOI: 10.1007/s11606-019-05525-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). METHODS We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes. RESULTS Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. DISCUSSION Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.
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Affiliation(s)
- Marie C Haverfield
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA. .,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA.
| | - Aaron Tierney
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Schwartz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA
| | | | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Dani L Zionts
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Fischer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonoo Thadaney
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Kerrigan V, Lewis N, Cass A, Hefler M, Ralph AP. "How can I do more?" Cultural awareness training for hospital-based healthcare providers working with high Aboriginal caseload. BMC MEDICAL EDUCATION 2020; 20:173. [PMID: 32471490 PMCID: PMC7260793 DOI: 10.1186/s12909-020-02086-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/21/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Aboriginal cultural awareness training aims to build a culturally responsive workforce, however research has found the training has limited impact on the health professional's ability to provide culturally safe care. This study examined cultural awareness training feedback from healthcare professionals working with high Aboriginal patient caseloads in the Top End of the Northern Territory of Australia. The aim of the research was to assess the perception of training and the potential for expansion to better meet workforce needs. METHODS Audit and qualitative thematic analysis of cultural awareness training evaluation forms completed by course participants between March and October 2018. Course participants ranked seven teaching domains using five-point Likert scales (maximum summary score 35 points) and provided free-text feedback. Data were analysed using the Framework Method and assessed against Kirkpatrick's training evaluation model. Cultural safety and decolonising philosophies shaped the approach. RESULTS 621 participants attended 27 ACAP sessions during the study period. Evaluation forms were completed by 596 (96%). The mean overall assessment score provided was 34/35 points (standard deviation 1.0, range 31-35) indicating high levels of participant satisfaction. Analysis of 683 free text comments found participants wanted more cultural education, designed and delivered by local people, which provides an opportunity to consciously explore both Aboriginal and non-Aboriginal cultures (including self-reflection). Regarding the expansion of cultural education, four major areas requiring specific attention were identified: communication, kinship, history and professional relevance. A strength of this training was the authentic personal stories shared by local Aboriginal cultural educators, reflecting community experiences and attitudes. Criticism of the current model included that too much information was delivered in one day. CONCLUSIONS Healthcare providers found cultural awareness training to be an invaluable entry point. Cultural education which elevates the Aboriginal health user's experience and provides health professionals with an opportunity for critical self-reflection and practical solutions for common cross-cultural clinical encounters may improve the delivery of culturally safe care. We conclude that revised models of cultural education should be developed, tested and evaluated. This requires institutional support, and recognition that cultural education can contribute to addressing systemic racism.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Nicole Lewis
- Department of Health, Northern Territory Government, GPO Box 2391, Darwin, NT 0801 Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
- Royal Darwin Hospital, Darwin, Northern Territory 0811 Australia
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Grünewald M, Klein E, Hapfelmeier A, Wuensch A, Berberat PO, Gartmeier M. Improving physicians' surgical ward round competence through simulation-based training. PATIENT EDUCATION AND COUNSELING 2020; 103:971-977. [PMID: 31810763 DOI: 10.1016/j.pec.2019.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Ward rounds are an essential part of physicians' daily routine. Existing studies suggest that their practical implementation is inconsistent. Therefore, developing interventions to train ward round competence and assessing if they are effective educational tools are crucial goals for research. METHODS We analysed a simulation-based tutorial dedicated to fourth-year medical students, including casework and ward round simulation. We investigated the effectiveness of this intervention regarding ward round competence through a randomized controlled trial. Performance was assessed with the modified/validated surgical ward round assessment tool by two blinded and trained raters. Supplementary, motivation during the ward round tutorial was assessed for all students at different time points. RESULTS Analysis of the ratings show that, in contrast to the control group (pre: 66.1 vs. post: 64.8 points, p = 0.72), the ward round competence of the intervention group (pre: 62.6 vs. post: 69.6 points, p = 0.0169) improved significantly after participating in the ward round tutorial. CONCLUSION The results show that our simulation-based training is an effective way to improve competence of medical students in conducting surgical ward rounds. PRACTICE IMPLICATIONS Participation in ward round trainings is a valuable tool to prepare students for their future professional practise.
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Affiliation(s)
- Marc Grünewald
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| | - Evelyn Klein
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 Munich, Germany.
| | - Alexander Hapfelmeier
- Technical University of Munich, Institute of Medical Informatics, Statistics and Epidemiology, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Alexander Wuensch
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany; Clinic of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5a, 79104 Freiburg, Germany.
| | - Pascal O Berberat
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| | - Martin Gartmeier
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
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de Groot E, Schönrock-Adema J, Zwart D, Damoiseaux R, Van den Bogerd K, Diemers A, Grau Canét-Wittkampf C, Jaarsma D, Mol S, Bombeke K. Learning from patients about patient-centredness: A realist review: BEME Guide No. 60. MEDICAL TEACHER 2020; 42:380-392. [PMID: 31852313 DOI: 10.1080/0142159x.2019.1695767] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Patient-centred work is an essential part of contemporary medicine. Literature shows that educational interventions contribute to developing patient-centredness, but there is a lack of insight into the associated learning processes.Objective: Through reviewing articles about educational interventions involving patients, we aspire to develop a program theory that describes the processes through which the educational interventions are expected to result in change. The processes will clarify contextual elements (called contexts) and mechanisms connected to learning patient-centredness.Methods: In our realist review, an initial, rough program theory was generated during the scoping phase, we searched for relevant articles in PubMed, PsycINFO, ERIC, CINAHL and Embase for all years before and through 2016. We included observational studies, case reports, interviews, and experimental studies in which the participants were students, residents, doctors, nurses or dentists. The relevance and rigour of the studies were taken into account during analysis. With deductive as well as inductive coding, we extended the rough program theory.Results: In our review, we classified five different contexts which affect how upcoming professionals learn patient-centredness. These aspects are influenced through components in the intervention(s) related to the learner, the teacher, and the patient. We placed the mechanisms together in four clusters - comparing and combining as well as broadening perspectives, developing narratives and engagement with patients, self-actualisation, and socialisation - to show how the development of (dimensions of) patient-centredness occurs. Three partial-program-theories (that together constituting a whole program theory) were developed, which show how different components of interventions within certain contexts will evoke mechanisms that contribute to patient-centredness.Translation into daily practice: These theories may help us better understand how the roles of patients, learners and teachers interact with contexts such as the kind of knowledge that is considered legitimate or insight in the whole illness trajectory. Our partial program theories open up potential areas for future research and interventions that may benefit learners, teachers, and patients.
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Affiliation(s)
- Esther de Groot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna Schönrock-Adema
- Center for Education Development and Research in Health Professions (CEDAR), University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Dorien Zwart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roger Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kristin Van den Bogerd
- Department of Primary and Interdisciplinary Care, Skills Lab, University of Antwerp, Antwerp, Belgium
| | - Agnes Diemers
- Center for Education Development and Research in Health Professions (CEDAR), University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Christel Grau Canét-Wittkampf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Debbie Jaarsma
- Center for Education Development and Research in Health Professions (CEDAR), University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Saskia Mol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Katrien Bombeke
- Department of Primary and Interdisciplinary Care, Skills Lab, University of Antwerp, Antwerp, Belgium
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Vatandost S, Cheraghi F, Oshvandi K. Facilitators of Professional Communication Between Nurse and Opposite Gender Patient: A Content Analysis. MAEDICA 2020; 15:45-52. [PMID: 32419860 PMCID: PMC7221273 DOI: 10.26574/maedica.2020.15.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Caring for a patient of the opposite gender is followed by many challenges. Hence, making an appropriate professional communication between the patient and the nurse is of great importance in order to provide a high-quality care to the patient and reduce tensions. Identifying positive factors in the formation of an appropriate professional communication can play an important role in preventing such challenges. Materials and methodology: The current study aimed to identify the facilitators of professional communication between nurse and opposite gender patient in Iran. A qualitative method and a conventional content analysis approach were used. A total of 25 nurses were included in the study by purposive sampling. Data were collected through unstructured and semi-structured interviews in hospitals of three provinces of Northwestern Iran, and were analyzed by Graneheim and Lundman method. Results: The results included seven categories and three main themes: prevention of misunderstanding, non-violation of therapeutic relationship boundaries, and observance of the socio-individual context. Discussion: Despite accepting the difficulties of nursing care for an opposite gender patient, the results of the present study showed that paying more attention to, and carefully watching, the mentioned factors could enhance the chance to establish a proper professional communication between a nurse and an opposite gender patient, which is crucial in providing a high quality care, also improving nurses' comfort in their work environment. Therefore, it is recommended to consider these factors in academic and in-service training of nurses.
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Affiliation(s)
- Salam Vatandost
- School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Cheraghi
- School of Nursing and Midwifery, Chronic disease (home care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- School of Nursing and Midwifery, Child & Maternity Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Nurash P, Kasevayuth K, Intarakamhang U. Learning programmes and teaching techniques to enhance oral health literacy or patient-centred communication for healthcare providers: A systematic review. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:134-144. [PMID: 31675468 DOI: 10.1111/eje.12477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the learning programmes and teaching techniques used in interventions to enhance oral health literacy (OHL) or patient-centred communication (PCC) for healthcare providers. MATERIALS AND METHODS A systematic review of OHL and PCC were obtained from four electronic databases (PubMed, ScienceDirect, ProQuest and Scopus) was undertaken. These searches covered the period from January 2008 to December 2017. The quality assessment tool was the Joanna Briggs Institute Critical Appraisal tool for systematic reviews of effectiveness. RESULTS The final review included nine studies amongst a total of 1475 studies. They showed three learning programmes (workshops, training and community-based rotation) and 17 related teaching techniques to promote OHL and PCC. The most commonly used learning programmes to enhance OHL and PCC for healthcare providers were workshops, and the teaching techniques included feedback and reflection. The intervention periods of the programmes took 20 minutes to half a day. The three studies did not have a follow-up, whilst the rest showed a follow-up range of 2 months to 3 years. Interestingly, there was one study, which applied double follow-ups to show the effectiveness of the programme. CONCLUSION Either workshops or training programmes with a combination of teaching techniques were effective in terms of enhancing their OHL or PCC. The more frequent follow-up might increase the long-term effectiveness of the learning programme.
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Affiliation(s)
- Pariyawit Nurash
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
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Du L, Wu R, Chen X, Xu J, Ji H, Zhou L. Role of Treatment Adherence, Doctor-Patient Trust, and Communication in Predicting Treatment Effects Among Tuberculosis Patients: Difference Between Urban and Rural Areas. Patient Prefer Adherence 2020; 14:2327-2336. [PMID: 33262582 PMCID: PMC7700001 DOI: 10.2147/ppa.s277650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE China is the second highest tuberculosis (TB) burden in the world, and TB patients in the rural areas are about twice as many as urban patients. The purpose of present study was to explore the roles of medication adherence, doctor-patient trust and communication on treatment effects, and its inequality between urban and rural areas. METHODS There were 564 eligible TB patients, from four tuberculosis hospitals in China, participating in this cross-sectional study. They filled out questionnaires regarding socio-demographic characteristics, medication adherence, treatment effect, doctor-patient trust, and communication. The structural equation model (SEM) was applied to explore the hypotheses in this study. All statistical analysis was done by SPSS 25.0 and Mplus 7.0 statistical software. RESULTS This study included 267 (47.34%) urban and 297 (52.66%) rural eligible TB patients. The data fitted the research model well, and the urban TB patients reported better treatment effect than the rural ones (P=0.027). Overall, treatment adherence positively predicted treatment effect (Est.=0.353, P<0.001); doctor-patient communication positively influenced treatment adherence (Est.=0.214, P=0.002); and treatment adherence positively mediated the role of communication on treatment effect (Est.=0.076), 95% CI (0.026, 0.152). While in the grouping model, the urban patients' treatment effect was only influenced by adherence (Est.=0.286, P=0.003); for the rural patients, treatment adherence (Est.=0.464, P<0.001) and doctor-patient trust (Est.=0.382, P=0.019) directly predicted treatment effects, and treatment adherence positively mediated the role of doctor-patient communication on treatment effect (Est.=0.175, P=0.006). CONCLUSION The treatment effect of TB patients, from urban and rural China, was influenced by a different mechanism, among which rural TB patients need not only improve the treatment adherence but also establish good doctor-patient trust and communication to improve treatment effects. These findings provided a theoretical guide on treatment and control for rural TB patients.
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Affiliation(s)
- Liang Du
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, Liaoning116044, People’s Republic of China
- Correspondence: Ling Zhou School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian116044, People’s Republic of ChinaTel +86-411-8611-0368 Email
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Santarém Semedo C, Moreira Diniz A, Herédia V. Training health professionals in patient-centered communication during magnetic resonance imaging to reduce patients' perceived anxiety. PATIENT EDUCATION AND COUNSELING 2020; 103:152-158. [PMID: 31402071 DOI: 10.1016/j.pec.2019.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/26/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE We examined how a patient-centered communication training program for magnetic resonance imaging (MRI) affected health professional (HP) practice and patients' perceived anxiety (PA). METHODS We implemented an intervention program. Six of the 17 eligible HPs completed the study. The proportion of observed desired behaviors (PODBs), including MRI procedure explanation (MRI-PE), communication, and MRI checking procedures was measured using an observation grid. We tested 182 patients (85 pre-, 58 post-, and 39 at follow-up) for PA pre- and post-MRI. RESULTS The Bayesian ANOVA effect size suggested moderate evidence of improvement in HP PODBs, pre- to post-intervention. Use of MRI-PE declined between post-intervention and follow-up (6 months later). Observed changes in PA, pre- to post-MRI, could be related to time constraints and perceived pressure to explain the exam in detail once institutional routines are reestablished. CONCLUSION In MRI units, time constraints condition the performance of HPs who address patients' PA. PRACTICE IMPLICATIONS "Real workplace" interventions that promote better patient-centered communication and provide each patient with a comprehensive explanation of MRI procedures also appear to improve HP PODBs.
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Affiliation(s)
- Carla Santarém Semedo
- Research Centre in Education and Psychology, Department of Psychology, School of Social Sciences, University of Évora, Évora, Portugal.
| | - António Moreira Diniz
- Research Centre in Education and Psychology, Department of Psychology, School of Social Sciences, University of Évora, Évora, Portugal
| | - Vasco Herédia
- Radiology Department, Hospital do Espírito Santo, EPE, Évora, Portugal and Affidea-Évora, Évora, Portugal
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Aggarwal NK, Cedeno K, Lewis-Fernandez R. Patient and clinician communication practices during the DSM-5 cultural formulation interview field trial. Anthropol Med 2019; 27:192-211. [PMID: 31550913 DOI: 10.1080/13648470.2019.1641014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cultural psychiatrists and medical anthropologists have collaborated to help clinicians screen for culture-related issues in patient explanatory models of illness and to enhance the clinical processes of engagement, diagnosis, and treatment planning. This effort prioritises patient perspectives on suffering and healing to counter the trend of symptom-based interviews which assume biologically determined models of mental disorders. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes the Cultural Formulation Interview (CFI), a semi-structured questionnaire for eliciting patient explanatory models. This paper analyses specific linguistic meanings and practices that could account for patient perceptions of improved rapport with clinicians, clinician perceptions of improving information gathering, and cultural models of health and illness during the DSM-5 field trial piloting the CFI. Twenty-seven audiotapes were analysed through the Roter Interaction Analysis System (RIAS), a standardised method for examining medical interviews based on ethnographic studies of small-group communication. After an introduction with procedural and reassurance statements to orient communication, the CFI's open-ended questions elicited patients' opinions on interpersonal, environmental, and biomedical information. Clinicians made facilitation and activation statements for patients to speak more and informed patients about what to expect. Patients constructed cultural models of illness that weaved interpersonal, environmental, and biomedical information. Clinicians and patients made rapport-building statements to each other. A RIAS-derived patient-centred score indicates that CFI sessions addressed patient concerns. Our work offers a way to analyse the discursive construction of culture in health settings and patient-centredness through detailed examinations of linguistic meanings and practices.
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Affiliation(s)
- Neil Krishan Aggarwal
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Medical Center, New York, NY, USA
| | - Kryst Cedeno
- New York State Psychiatric Institute, New York, NY, USA
| | - Roberto Lewis-Fernandez
- New York State Psychiatric Institute, New York, NY, USA.,Columbia University Medical Center, New York, NY, USA
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Smith C, Likourezos A, Schiller J. Focused Teaching Improves Medical Student Professionalism and Data Gathering Skills in the Emergency Department. Cureus 2019; 11:e5765. [PMID: 31723524 PMCID: PMC6825500 DOI: 10.7759/cureus.5765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/25/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Leaders in medical education have developed milestones and core competencies in an attempt to ensure that relational skills, such as communication and professionalism, are emphasized in addition to the usual skills of medical knowledge, data gathering, and emergency stabilization during students' emergency medicine (EM) medical education. Providers facile in each of these areas have better patient outcomes, patient experiences, and decreased incidence of malpractice cases. The authors attempted to demonstrate that by deliberate teaching of these skills during an EM medical student clerkship, students could significantly improve their clinical performance. METHODS This prospective, randomized, single-blinded cohort study was performed at an academic, tertiary, urban ED to investigate the effects of a one-on-one preceptor shift on the clinical performance of fourth-year medical students. Students were randomized into two groups and assessed by pre- and post-intervention objective structured clinical encounters (OSCEs) with standardized patients (SPs) at weeks one and three. A crossover design was employed so that students in the control group participated in a preceptor shift after their second OSCE. Measurements were based on a five-point Likert scale assessment linked to early EM milestones as defined by the Accreditation Council on Graduate Medical Education (ACGME). Results: The mean improvement in total overall score was significantly greater in the intervention group: 4.31 versus 2.57 (Cohen's d = 0.57, p = 0.029). When each milestone was assessed individually, students in the intervention group improved significantly in data gathering (Cohen's d = 0.47, p = 0.048) and professionalism (Cohen's d = 0.66, p = 0.011). There was a nonstatistically significant improvement for the intervention compared to control group in emergency management and communication skills. There was no improvement for either group in medical knowledge. CONCLUSION A one-on-one preceptor shift can result in a statistically significant improvement in data gathering and professionalism skills as measured by OSCEs.
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Affiliation(s)
- Colleen Smith
- Assistant Professor Emergency Medicine, Medical Education and Simulation, Elmhurst Hospital, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Joshua Schiller
- Emergency Medicine, Maimonides Medical Center, Brooklyn, USA
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Wagner A, Radionova N, Rieger MA, Siegel A. Patient Education and Continuing Medical Education to Promote Shared Decision-Making. A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142482. [PMID: 31336828 PMCID: PMC6678248 DOI: 10.3390/ijerph16142482] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
Background: Over recent years, the use of decision aids to promote shared decision-making have been examined. Studies on patient education and on continuing medical education for physicians are less common. This review analyzes intervention and evaluation studies on patient education and continuing medical education which aim to enhance shared decision-making. The following study parameters are of interest: Study designs, objectives, numbers of participants in the education courses, interventions, primary results, and quality of the studies. Methods: We systematically searched for suitable studies in two databases (Pubmed and the Cochrane Database of Systematic Reviews) from the beginning of April through to mid-June 2016. Results: 16 studies from a total of 462 hits were included: Three studies on patient education and 13 studies on continuing medical education for physicians. Overall, the study parameters were heterogeneous. Major differences were found between the courses; how the courses were conducted, their length, and participants. Conclusions: The differences found in the studies made it difficult to compare the interventions and the results. There is a need for studies that systematically evaluate and further develop interventions in this area to promote shared decision-making.
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Affiliation(s)
- Anke Wagner
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany.
| | - Natalia Radionova
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Achim Siegel
- Institute of Occupational and Social Medicine and Health Service Research, University Hospital Tübingen, Wilhelmstraße 27, 72074 Tübingen, Germany
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Hemming P, Revels JA, Tran AN, Greenblatt LH, Steinhauser KE. Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians. Int J Psychiatry Med 2019; 54:188-202. [PMID: 30269631 DOI: 10.1177/0091217418802159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Behavioral health services frequently delivered by primary care providers include care for mental health and substance abuse disorders and assistance with behavioral risk factor reduction. Internal medicine residencies in the United States lack formal expectations regarding training in behavioral health for residents. This qualitative study aimed to determine learners' and teachers' perceptions about appropriate behavioral health curricular components for internal medicine residents. METHOD Focus groups and interviews were conducted with the following individuals from the Duke Outpatient Clinic: residents with continuity practice (n = 27), advanced practice providers (n = 2), internal medicine attending physicians (n = 4), internal medicine/psychiatry attending physicians (n = 2), and behavioral health clinicians (n = 4). A focus group leader asked regarding residents' successes and challenges in managing behavioral health issues and about specific learning components considered necessary to understand and manage these behavioral health conditions. Transcripts were coded using an editing analysis style to identify central themes and concordance/discordance between groups. RESULTS Regarding mental health management (Theme 1), residents emphasized a need for better care coordination with specialty mental health, while attendings and behavioral health clinicians gave priority to residents' skills in primary management of mental health. Residents, attendings, and behavioral health clinicians all emphasized advanced interviewing skills (Theme 2) with subthemes: eliciting the patient's perspective, managing time in encounters, improving patients' understanding, and patient counseling. CONCLUSIONS Internal medicine residents, attendings, and behavioral health clinicians may differ significantly in their perceptions of primary care's role in mental health care. Future internal medicine behavioral health curricula should specifically address these attitudinal differences. Curricula should also emphasize interview skills training as an essential component of behavioral health learning.
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Affiliation(s)
- Patrick Hemming
- 1 Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Jessica A Revels
- 2 Department of Clinical Research, Duke University Medical Center, Durham, NC, USA
| | - Anh N Tran
- 3 Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Lawrence H Greenblatt
- 1 Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Karen E Steinhauser
- 4 Center for Health Services Research in Primary Care, Durham, VA Medical Center, Durham, NC, USA.,5 Department of Medicine, Division of General Internal Medicine, Palliative Care Section, Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Essig S, Steiner C, Kühne T, Kremens B, Langewitz W, Kiss A. Communication Skills Training for Professionals Working with Adolescent Patients with Cancer Based on Participants' Needs: A Pilot. J Adolesc Young Adult Oncol 2019; 8:354-362. [PMID: 30648933 DOI: 10.1089/jayao.2018.0078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We aimed to pilot and evaluate communication skills training (CST) for health care professionals (HCPs) interacting with adolescent patients with cancer and their parents based on participants' needs. Methods: We developed and piloted a 2-day CST with physicians and nurses in adolescent oncology. The CST's agenda was determined by the critical incidents reported by the participants. Training consisted of experiential learning based on role-play between HCPs and simulated patients and parents. Whenever suited, short lectures were given on specific communication techniques. Skills were self-assessed by questionnaires before, immediately after, and 6 months after training. We compared the proportion of participants who felt confident in 19 predefined areas of difficult communication before and 6 months after training. Responses to open-ended questions were analyzed qualitatively by thematic analysis. Results: Twenty-six physicians and 24 nurses participated in 6 CSTs. The proportion of participants who felt confident increased significantly in 6 of 19 communication items (p < 0.05). Positive feedback outweighed negative in quantity and quality. Predominant themes immediately after training were the training's practical orientation and intensity, and 6 months later, increased self-confidence and applied communication techniques. Participants noted that the effect diminishes with time, and expressed their need for booster trainings. Conclusion: The results of CST tailored to the specific needs of HCPs in adolescent oncology were promising. We suggest that similar training opportunities are implemented elsewhere.
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Affiliation(s)
- Stefan Essig
- 1 Institute of Primary and Community Care, Lucerne, Switzerland.,2 Swiss Paraplegic Research, Nottwil, Switzerland
| | - Claudia Steiner
- 3 Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Thomas Kühne
- 4 Division of Oncology/Hematology, University Children's Hospital, Basel, Switzerland
| | - Bernhard Kremens
- 5 Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolf Langewitz
- 3 Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Alexander Kiss
- 3 Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
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Lloyd CE, Wilson A, Holt RIG, Whicher C, Kar P. Language matters: a UK perspective. Diabet Med 2018; 35:1635-1641. [PMID: 30103276 DOI: 10.1111/dme.13801] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 01/04/2023]
Abstract
AIM To review the existing evidence regarding the use of language in clinical encounters. BACKGROUND Awareness of the importance of language in clinical encounters is mostly lacking or located within broader discussions on communication. METHODS A scoping study was conducted to review existing research that could increase our understanding of the role language plays as well as identify gaps in knowledge and inform the development of a position statement on language in diabetes care. RESULTS Evidence shows that, although carefully chosen language can have a positive effect, there is a potential negative impact of language on people's experiences of diabetes care. The use of stigmatizing and discriminatory words during communication between healthcare practitioners and people with diabetes can lead to disengagement with health services as well as sub-optimal diabetes self-management. Clinical encounters can be compromised where language barriers exist or where there is limited understanding of cultural differences that may have an impact on diabetes self-management. What little empirical evidence there is shows that training can improve language and communication skills. CONCLUSION This review raises a number of questions that are being addressed by the NHS England Language Matters Group, which has developed a set of recommendations to support the use of appropriate language in clinical encounters.
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Affiliation(s)
- C E Lloyd
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes
| | - A Wilson
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton
| | - C Whicher
- Southern Health NHS Foundation Trust, Southampton
| | - P Kar
- NHS Trust, NHS England, London, UK
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Blackmore A, Kasfiki EV, Purva M. Simulation-based education to improve communication skills: a systematic review and identification of current best practice. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 4:159-164. [PMID: 35519010 PMCID: PMC8990192 DOI: 10.1136/bmjstel-2017-000220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/03/2022]
Abstract
Background Good communication in healthcare between professionals and between professionals and patients is important in delivering high-quality care. Evidence of translation of technical skills taught through simulation into the clinical environment has been demonstrated, but the evidence for the impact of communication skills is less well known. Objectives To identify and critically appraise the evidence for the impact of communication taught through simulation-based education (SBE) and use this evidence to suggest a model for future SBE interventions for communication skills. Study selection MEDLINE, CINAHL, EMBASE and PsycINFO were searched for articles pertaining to communication skills taught through simulation. A content expert was consulted to suggest additional studies. 1754 studies were initially screened for eligibility, with 274 abstracts screened further. 147 full-text articles were further assessed for eligibility, with 79 of these excluded. The remaining 68 studies were reviewed and 18 studies were included in the qualitative synthesis as studies designed to show benefits beyond the simulation centre. Findings The 18 identified studies with an impact at a Kirkpatrick level of ≥3, are analysed; 4 looking specifically at communication between healthcare professionals and 14 looking at communication between health professionals and patients or relatives. Conclusions There is some evidence that the improvements in communication taught through simulation can be translated into benefits measurable beyond the simulation centre, but this evidence is limited due to the way that most of the studies are designed. We suggest a model for SBE aimed at teaching communication skills that is informed by the current evidence and takes into account the need to collect higher-level outcome data.
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Affiliation(s)
| | | | - Makani Purva
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Siegle A, Villalobos M, Bossert J, Krug K, Hagelskamp L, Krisam J, Handtke V, Deis N, Jünger J, Wensing M, Thomas M. The Heidelberg Milestones Communication Approach (MCA) for patients with prognosis <12 months: protocol for a mixed-methods study including a randomized controlled trial. Trials 2018; 19:438. [PMID: 30107809 PMCID: PMC6092809 DOI: 10.1186/s13063-018-2814-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022] Open
Abstract
Background The care needs of patients with a limited prognosis (<12 months median) are complex and dynamic. Patients and caregivers must cope with many challenges, including physical symptoms and disabilities, uncertainty. and compromised self-efficacy. Healthcare is often characterized by disruptions in the transition between healthcare providers. The Milestones Communication Approach (MCA) is a structured, proactive, interprofessional concept that involves physicians and nurses and is aimed at providing coherent care across the disease trajectory. This study aims to evaluate these aspects of MCA: (1) the training of healthcare professionals, (2) implementation context and outcomes, (3) patient outcomes, and (4) effects on interprofessional collaboration. Methods/design A multiphase mixed-methods design will be used for the study. A total of 100 patients and 120 healthcare professionals in a specialized oncology hospital will be involved. The training outcomes will be documented using a questionnaire. Implementation context and outcomes will be explored through semi-structured interviews and written questionnaires with healthcare professionals and with the training participants and through a content analysis of patient files. Patient outcomes will be assessed in a pragmatic non-blinded randomized controlled trial and in qualitative interviews with patients and caregivers. Trial outcomes are supportive care needs (SCNS-SF34-G), quality of life (SeiQol and Fact-L), depression and anxiety symptoms (PHQ-4), and distress (Distress Thermometer). Qualitative semi-structured interviews on patients’ views will focus on shared decision-making, communication needs, feeling empathy, and further utilization of healthcare services. Interprofessional collaboration will be explored using the UWE-IP-D before the implementation of MCA (t0) and after 3 (t1), 9 (t2), and 12 (t3) months. Discussion Using guideline-concordant early palliative care, MCA aims to foster patient-centered communication with shared decision-making and facilitation of advance care planning including end-of-life decisions, thus increasing patient quality of life and decreasing aggressive medical care at the end of life. It is assumed that the communication skills training and interprofessional coaching will improve the communication behavior of healthcare providers and influence team communications and team processes. Trial registration German Clinical Trials Register, DRKS00013649 and DRKS00013469. Registered on 22 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2814-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Siegle
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany. .,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
| | - Matthias Villalobos
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Laura Hagelskamp
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany.,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Violet Handtke
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Nicole Deis
- The German National Institute for State Examinations in Medicine, Pharmacy and Psychotherapy, Große Langgasse 8, 55116, Mainz, Germany
| | - Jana Jünger
- The German National Institute for State Examinations in Medicine, Pharmacy and Psychotherapy, Große Langgasse 8, 55116, Mainz, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
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Kari H, Kortejärvi H, Airaksinen M, Laaksonen R. Patient involvement is essential in identifying drug-related problems. Br J Clin Pharmacol 2018; 84:2048-2058. [PMID: 29774588 DOI: 10.1111/bcp.13640] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/17/2022] Open
Abstract
AIMS The aim of this study is to evaluate how critical patient involvement is in pharmacist-led clinical medication reviews and in identifying the most significant clinical drug-related problems (DRPs). METHODS Pharmacist-led clinical medication reviews were conducted with 161 consenting patients aged ≥75 years with at least seven prescribed medicines, living independently at home in Finland. A pharmacist, a nurse and a physician evaluated the clinical significance of the DRPs identified during the patient interview at an interprofessional case conference. It was evaluated whether the most significant clinical DRPs could also have been identified through reviewing the medication list only or the medication list and certain patient details. RESULTS Altogether, the 111 most significant clinical DRPs were evaluated. Only 6% could have been identified through reviewing the medication list only, and 16% through reviewing the medication list and certain patient details. Hence, 84% of the most significant clinical DRPs could only have been identified with patient involvement. The most common DRPs were: poor therapy control (25%); nonoptimal drug (22%); intentional nonadherence (12%); and additional drug needed (11%). patient involvement was critical when identifying DRPs related to additional drug needed, unintentional nonadherence, use of over-the-counter medicines or dietary supplements, or contradictions in counselling. CONCLUSION Patient involvement is essential when identifying clinical DRPs. Indeed, poor therapy control, nonoptimal drug use, intentional or unintentional nonadherence might otherwise be missed.
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Affiliation(s)
- Heini Kari
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Hanna Kortejärvi
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Raisa Laaksonen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Deter HC, Kruse J, Zipfel S. History, aims and present structure of psychosomatic medicine in Germany. Biopsychosoc Med 2018; 12:1. [PMID: 29434655 PMCID: PMC5795290 DOI: 10.1186/s13030-017-0120-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
Combining its two traditions of integrated psychosomatics in internal medicine and focusing on psychotherapeutic/psychiatric methods in many clinical fields, German psychosomatic medicine has developed well over the last decades. It benefits from its institutional independence and the progressive changes in health care. Clinically, disorder-oriented psychotherapy is a core method integrated with other modes of therapy. As a conceptual base for empirical research, non-reductionist accounts of the interactions of (sick) persons with their environment are most important. Germany has developed a model of Psychosomatic Medicine that has conceptualized and integrated psychotherapeutic methods into clinical practice and realized one way to practice bio-psycho-social medicine in the health care system of the country.
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Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Johannes Kruse
- Clinic for Psychosomatic Medicine and Psychotherapy, German Association of Psychosomatic Medicine and Psychotherapy (DGPM), University Gießen und Marburg GmbH, Giessen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, German College of Psychosomatic Medicine (DKPM), Tuebingen, Germany
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46
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Zodan T, Orelli SV. Teaching communication in an emergency gynecological setting. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1491092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Tina Zodan
- Department of Gynecology and Obstetrics, Triemli Municipal Hospital, Zurich, Switzerland
| | - Stephanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Municipal Hospital, Zurich, Switzerland
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Nicholls D, Sweet L, Muller A, Hyett J. A model to teach concomitant patient communication during psychomotor skill development. NURSE EDUCATION TODAY 2018; 60:121-126. [PMID: 29096384 DOI: 10.1016/j.nedt.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/18/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
Many health professionals use psychomotor or task-based skills in clinical practice that require concomitant communication with a conscious patient. Verbally engaging with the patient requires highly developed verbal communication skills, enabling the delivery of patient-centred care. Historically, priority has been given to learning the psychomotor skills essential to clinical practice. However, there has been a shift towards also ensuring competent communication with the patient during skill performance. While there is literature outlining the steps to teach and learn verbal communication skills, little is known about the most appropriate instructional approach to teach how to verbally engage with the patient when also learning to perform a task. A literature review was performed and it identified that there was no model or proven approach which could be used to integrate the learning of both psychomotor and communication skills. This paper reviews the steps to teach a communication skill and provides a suggested model to guide the acquisition and development of the concomitant -communication skills required with a patient at the time a psychomotor skill is performed.
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Affiliation(s)
- Delwyn Nicholls
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Sydney Ultrasound for Women, Sydney, Australia.
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Amanda Muller
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Australia
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48
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Villalobos M, Coulibaly K, Krug K, Kamradt M, Wensing M, Siegle A, Kuon J, Eschbach C, Tessmer G, Winkler E, Szecsenyi J, Ose D, Thomas M. A longitudinal communication approach in advanced lung cancer: A qualitative study of patients', relatives' and staff's perspectives. Eur J Cancer Care (Engl) 2017; 27:e12794. [PMID: 29168594 DOI: 10.1111/ecc.12794] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Abstract
Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.
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Affiliation(s)
- M Villalobos
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - K Coulibaly
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - K Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - M Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - M Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - A Siegle
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - J Kuon
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - C Eschbach
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
| | - G Tessmer
- Evangelische Lungenklinik Berlin, Berlin, Germany
| | - E Winkler
- National Center for Tumor Diseases, University Heidelberg, Heidelberg, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - D Ose
- Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M Thomas
- Department of Thoracic Oncology, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Heidelberg, Germany
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[Bio-psycho-socio or psychotherapeutic medicine - actual development of psychosomatics in clinical practice]. Wien Med Wochenschr 2017; 168:52-61. [PMID: 28744775 DOI: 10.1007/s10354-017-0582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
In Germany a model of Psychosomatic Medicine has developed, which integrated several psychotherapeutic methods in clinical practice. The concept, which focused on disease mechanisms in the human body and the interaction between diseased individuals and their environment became a basic psychosomatic research strategy and was imlemented in medical care. In this paper the result of a psychosomatic development in clinical health care and research and possible deficiences are described. Perspectives of development and future tasks of Psychosomatic Medicine will be reviewed.
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50
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Zipfel S, Herzog W, Kruse J, Henningsen P. Psychosomatic Medicine in Germany: More Timely than Ever. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:262-9. [PMID: 27509065 DOI: 10.1159/000447701] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
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