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Siddiqi DA, Miraj F, Munir M, Naz N, Shaikh AF, Khan AW, Dossa S, Nadeem I, Hargraves MJ, Urban J, Shah MT, Chandir S. Integrating humanities in healthcare: a mixed-methods study for development and testing of a humanities curriculum for front-line health workers in Karachi, Pakistan. MEDICAL HUMANITIES 2024; 50:372-382. [PMID: 38238003 DOI: 10.1136/medhum-2022-012576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 08/16/2024]
Abstract
Lady health workers (LHWs) provide lifesaving maternal and child health services to >60% of Pakistan's population but are poorly compensated and overburdened. Moreover, LHWs' training does not incorporate efforts to nurture attributes necessary for equitable and holistic healthcare delivery. We developed an interdisciplinary humanities curriculum, deriving its strengths from local art and literature, to enhance character virtues such as empathy and connection, interpersonal communication skills, compassion and purpose among LHWs. We tested the curriculum's feasibility and impact to enhance character strengths among LHWs.We conducted a multiphase mixed-methods pilot study in two towns of Karachi, Pakistan. We delivered the humanities curriculum to 48 LHWs via 12 weekly sessions, from 15 June to 2 September 2021. We developed a multiconstruct character strength survey that was administered preintervention and postintervention to assess the impact of the training. In-depth interviews were conducted with a subset of randomly selected participating LHWs.Of 48 participants, 47 (98%) completed the training, and 34 (71%) attended all 12 sessions. Scores for all outcomes increased between baseline and endline, with highest increase (10.0 points, 95% CI 2.91 to 17.02; p=0.006) observed for empathy/connection. LHWs provided positive feedback on the training and its impact in terms of improving their confidence, empathy/connection and ability to communicate with clients. Participants also rated the sessions highly in terms of the content's usefulness (mean: 9.7/10; SD: 0.16), the success of the sessions (mean: 9.7/10; SD: 0.17) and overall satisfaction (mean: 8.2/10; SD: 3.3).A humanities-based training for front-line health workers is a feasible intervention with demonstrated impact of nurturing key character strengths, notably empathy/connection and interpersonal communication. Evidence from this study highlights the value of a humanities-based training, grounded in local literature and cultural values, that can ultimately translate to improved well-being of LHWs thus contributing to better health outcomes among the populations they serve.
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Suhaiba A, Choubey AS, Drake B, Kerns J, Gonzalez MH. From Bedside Manner to Surgical Excellence: A Historical Exploration and Contemporary Importance of Empathy in Orthopaedic Surgery. J Bone Joint Surg Am 2024; 106:1332-1337. [PMID: 38252709 DOI: 10.2106/jbjs.23.00992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Aisha Suhaiba
- University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Apurva S Choubey
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
| | - Brett Drake
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
| | - James Kerns
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
| | - Mark H Gonzalez
- Department of Orthopaedics, University of Illinois Chicago, Chicago, Illinois
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Kuchinad K, Park JR, Han D, Saha S, Moore R, Beach MC. Which clinician responses to emotion are associated with more positive patient experiences of communication? PATIENT EDUCATION AND COUNSELING 2024; 124:108241. [PMID: 38537316 DOI: 10.1016/j.pec.2024.108241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/12/2024] [Accepted: 03/03/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To identify communication strategies that may improve clinician-patient interactions, we assessed the association between clinician response to emotion and patient ratings of communication. METHODS From a cohort of 1817 clinician-patient encounters, we designed a retrospective case-control study by identifying 69 patients who rated their interpersonal care as low-quality and 69 patients who rated their care as high-quality. We used the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to identify patient emotional expressions and clinician responses. Using mixed-effects logistic regression, we evaluated the association between clinician responses to patients' emotions and patient ratings of their interpersonal care. RESULTS In adjusted analyses, explicit responses that reduced space for further emotional communication were associated with high ratings of care (OR 1.94, 95% CI 1.25, 2.99); non-explicit responses providing additional space were associated with low ratings (OR 0.54, 95% CI 0.36-0.82). In terms of specific response types, neutral/passive responses were associated with low ratings (OR 0.59, 95% CI 0.39-0.90), whereas giving information/advice was associated with high ratings (OR, 95% 1.91 CI 1.17-3.1). CONCLUSIONS Patients may prefer responses to their expressed emotions that demonstrate clinician engagement, with or without expressions of empathy. PRACTICE IMPLICATIONS These findings may inform educational interventions to improve clinician-patient communication.
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Affiliation(s)
- Kamini Kuchinad
- Department of Rheumatology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jenny Rose Park
- Oregon Health and Science University, Portland, OR, United States
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Somnath Saha
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Richard Moore
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, United States; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States; Center for Health Equity, Johns Hopkins University, Baltimore, MD, United States.
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Arora AK, Vicente S, Engler K, Lessard D, Huerta E, Ishak J, Kronfli N, Routy JP, Cox J, Lemire B, Klein M, de Pokomandy A, Del Balso L, Sebastiani G, Vedel I, Quesnel-Vallée A, Lebouché B. Patient-reported outcomes and experiences of migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite treatment dispensation: the 'ASAP' study. AIDS Res Ther 2024; 21:40. [PMID: 38890671 PMCID: PMC11184703 DOI: 10.1186/s12981-024-00632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/09/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Scholars recommend providing migrants living with HIV (MLWH) with free treatment, rapidly, once linked to care to optimize their HIV-related experiences and health outcomes. Quantitative evaluations of patient-reported measures for MLWH in such models are necessary to explore the viability of these recommendations. METHODS Within a 96-week prospective cohort study at a multidisciplinary HIV clinic, participants received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for free and rapidly following care linkage. Eight patient-reported measures were administered at weeks 4, 24, and 48: (1) mMOS-SS to measure perceived social support; (2) IA-RSS to measure internalized stigma; (3) K6 to measure psychological distress; (4) PROMIS to measure self-efficacy with treatment taking; (5) G-MISS to measure perceived compliance with clinicians' treatment plans; (6) HIVTSQ to measure treatment satisfaction; (7) CARE to measure perceived provider empathy; and (8) PRPCC to measure perceived clinician cultural competence. Linear mixed modelling with bootstrapping was conducted to identify significant differences by sociodemographics and time. RESULTS Across weeks 4, 24, and 48, results suggest that MLWH enrolled in this study experienced moderate levels of social support; elevated levels of HIV-related stigma; moderate levels of distress; high self-efficacy with daily medication self-management; great compliance with clinicians' treatment plans; high treatment satisfaction; high perceived empathy; and high perceived cultural competence. Experience of social support (i.e., mMOS-SS scores) differed significantly by birth region. Experience of HIV-related stigma (i.e., IA-RSS scores) differed significantly by birth region, age, and language. Experience of distress (i.e., K6 scores) differed significantly by sexual orientation. Experience of treatment satisfaction (i.e., HIVTSQ scores) differed significantly by birth region and age. No significant differences were identified by time for any measure. CONCLUSION Overall, participants expressed positive experiences around treatment and care, alongside comparably lower perceptions of social support, internalized stigma, and distress, potentially underscoring a need to embed targeted, well-funded, and accessible mental health support within HIV care models.
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Affiliation(s)
- Anish K Arora
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada
| | - Serge Vicente
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada
| | - Edmundo Huerta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada
| | - Joel Ishak
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Joseph Cox
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC, Canada
| | - Benoit Lemire
- Pharmacy Department, McGill University Health Centre, Montréal, QC, Canada
| | - Marina Klein
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Lina Del Balso
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Giada Sebastiani
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine & Health Sciences, McGill University, Montréal, QC, Canada
- Department of Sociology, Faculty of Arts, McGill University, Montréal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd - Office 3C.25, Montreal, QC, H4A 3S5, Canada.
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR/SPOR) Mentorship Chair in Innovative Clinical Trials in HIV Care, Montréal, Canada.
- Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada.
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Torres TK, Hamann HA, Shen M, Stone J. Empathic Communication and Implicit Bias in the Context of Cancer Among a Medical Student Sample. HEALTH COMMUNICATION 2023:1-12. [PMID: 37906434 PMCID: PMC11058116 DOI: 10.1080/10410236.2023.2272359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters (M = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student (OR = 3.24, p = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.
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Affiliation(s)
- Tara K. Torres
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ
- University of Arizona Cancer Center, Tucson, AZ
| | - Megan Shen
- Fred Hutchinson Cancer Research Institute, Seattle, WA
| | - Jeff Stone
- Department of Psychology, University of Arizona, Tucson, AZ
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Bunce AE, Morrissey S, Kaufmann J, Krancari M, Bowen M, Gold R. Finding meaning: a realist-informed perspective on social risk screening and relationships as mechanisms of change. FRONTIERS IN HEALTH SERVICES 2023; 3:1282292. [PMID: 37936880 PMCID: PMC10626542 DOI: 10.3389/frhs.2023.1282292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023]
Abstract
Background Social risk screening rates in many US primary care settings remain low. This realist-informed evaluation explored the mechanisms through which a tailored coaching and technical training intervention impacted social risk screening uptake in 26 community clinics across the United States. Methods Evaluation data sources included the documented content of interactions between the clinics and implementation support team and electronic health record (EHR) data. Following the realist approach, analysis was composed of iterative cycles of developing, testing and refining program theories about how the intervention did-or didn't-work, for whom, under what circumstances. Normalization Process Theory was applied to the realist program theories to enhance the explanatory power and transferability of the results. Results Analysis identified three overarching realist program theories. First, clinic staff perceptions about the role of standardized social risk screening in person-centered care-considered "good" care and highly valued-strongly impacted receptivity to the intervention. Second, the physicality of the intervention materials facilitated collaboration and impacted clinic leaders' perception of the legitimacy of the social risk screening implementation work. Third, positive relationships between the implementation support team members, between the support team and clinic champions, and between clinic champions and staff motivated and inspired clinic staff to engage with the intervention and to tailor workflows to their settings' needs. Study clinics did not always exhibit the social risk screening patterns anticipated by the program theories due to discrepant definitions of success between clinic staff (improved ability to provide contextualized, person-centered care) and the trial (increased rates of EHR-documented social risk screening). Aligning the realist program theories with Normalization Process Theory constructs clarified that the intervention as implemented emphasized preparation over operationalization and appraisal, providing insight into why the intervention did not successfully embed sustained systematic social risk screening in participating clinics. Conclusion The realist program theories highlighted the effectiveness and importance of intervention components and implementation strategies that support trusting relationships as mechanisms of change. This may be particularly important in social determinants of health work, which requires commitment and humility from health care providers and vulnerability on the part of patients.
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Affiliation(s)
- Arwen E. Bunce
- Research Department, OCHIN Inc., Portland, OR, United States
| | | | - Jorge Kaufmann
- Oregon Health & Science University, Portland, OR, United States
| | - Molly Krancari
- Research Department, OCHIN Inc., Portland, OR, United States
| | - Megan Bowen
- Research Department, OCHIN Inc., Portland, OR, United States
| | - Rachel Gold
- Research Department, OCHIN Inc., Portland, OR, United States
- Kaiser Center for Health Research, Portland, OR, United States
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Gázquez-López M, García-García I, González-García A, Martín-Salvador A, Pérez-Morente MÁ, Martínez-García E, Álvarez-Serrano MA. Validation of the attitudes towards people living with HIV/AIDS scale in nursing students. BMC Nurs 2023; 22:245. [PMID: 37496059 PMCID: PMC10373256 DOI: 10.1186/s12912-023-01414-6] [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: 03/11/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND One of the environments where people living with HIV/AIDS should feel safer is in the health care setting; however, scientific evidence has identified discriminatory behaviour on the part of health care professionals towards these people. The reduction or abolition of discriminatory practices requires, first of all, to know the attitudes of nursing students towards AIDS with tools appropriate to the socio-cultural context of the disease. The objectives of this study are to update the AIDS Attitudes Scale for Nursing Students (EASE) by adapting it to the sociocultural landscape and to analyse the reliability and structural validity of the new scale. METHODS The results of the questionnaires answered by 213 undergraduate nursing students from the Faculty of Health Sciences of Ceuta (University of Granada) were analysed. Reliability (test-retest, n = 33) and validity (n = 180) tests were carried out. RESULTS An exploratory and confirmatory factor analysis indicated that a four-factor model was the most parsimonious solution. Items were examined for their underlying relationships and labelled: professional practice, social integration, partner and family, and benevolent stigma. The new scale yielded a McDonald's Omega coefficient (ω) of 0.893. Convergent validity was established for average variance extracted per factor greater than 0.5 and divergent validity when the variance retained by each factor is greater than the variance shared between them (average variance extracted per factor > ϕ2). CONCLUSIONS The new scale is a psychometrically sound instrument for assessing attitudes towards people living with HIV/AIDS in nursing students.
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Affiliation(s)
- María Gázquez-López
- Department of Nursing, Faculty of Health Sciences, University of Granada, Ceuta, Spain
| | - Inmaculada García-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, Avenida de la Ilustración n. º 16, Granada, Granada, 18016, Spain
| | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, Avenida de la Ilustración n. º 16, Granada, Granada, 18016, Spain.
| | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, Avenida de la Ilustración n. º 16, Granada, Granada, 18016, Spain
| | | | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, Avenida de la Ilustración n. º 16, Granada, Granada, 18016, Spain
- Guadix High Resolution Hospital, Andalusian Health Service, Granada, Spain
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Yu X, Zhang L, Liu M, He B. The Effect of Empathy on Team Members' Moqi in Virtual Teams: A Moderated Mediation Model. Psychol Res Behav Manag 2023; 16:2619-2633. [PMID: 37465047 PMCID: PMC10350425 DOI: 10.2147/prbm.s414860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Moqi can help team members facilitate communication without all interlocutors present, so the researchers speculate it can be an efficient communication tool for virtual teams to compensate for its lack of synchronous communication and in-person contact. However, the only study on the predictors of team members' moqi believed that shared understandings could only arise from team tasks. Based on social exchange theory, the current study emphasizes the social and emotional benefits exchanged among team members and explores moqi-making among virtual team members through a lens of relationship-building. Methods With a two-wave time-lagged survey design, a total of 381 team members from 86 virtual teams in China participated in the study. Hierarchical regression analysis was performed to test the hypotheses. Results Results confirmed that virtual team members' empathy is conducive to their experiences of high-quality interpersonal relationships (HQIR) and moqi. Relationship closeness positively moderates the link between empathy and experiences of HQIR and the mediating effect. Conclusion This study helps unveil the significance of compassionate communication and life-giving connections in cultivating virtual team members' moqi and offers meaningful insights for facilitating virtual collaborations.
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Affiliation(s)
- Xuan Yu
- School of Economics and Management, Southwest Petroleum University, Chengdu, Sichuan, People’s Republic of China
| | - Luxiaohe Zhang
- School of Economics and Management, Southwest Petroleum University, Chengdu, Sichuan, People’s Republic of China
- School of Foreign Languages, Xi’an Shiyou University, Xi’an, Shannxi, People’s Republic of China
| | - Meilin Liu
- Antai College of Economics & Management, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Bin He
- School of National Governance, Southwest University, Chongqing, People’s Republic of China
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Kim GS, Kim L, Shim MS, Baek S, Kim N, Park MK, Lee Y. [Psychometric Properties of the Korean Version of Self-Efficacy for HIV Disease Management Skills]. J Korean Acad Nurs 2023; 53:295-308. [PMID: 37435761 DOI: 10.4040/jkan.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE This study evaluated the validity and reliability of Shively and colleagues' self-efficacy for HIV disease management skills (HIV-SE) among Korean participants. METHODS The original HIV-SE questionnaire, comprising 34 items, was translated into Korean using a translation and back-translation process. To enhance clarity and eliminate redundancy, the author and expert committee engaged in multiple discussions and integrated two items with similar meanings into a single item. Further, four HIV nurse experts tested content validity. Survey data were collected from 227 individuals diagnosed with HIV from five Korean hospitals. Construct validity was verified through confirmatory factor analysis. Criterion validity was evaluated using Pearson's correlation coefficients with the new general self-efficacy scale. Internal consistency reliability and test-retest were examined for reliability. RESULTS The Korean version of HIV-SE (K-HIV-SE) comprises 33 items across six domains: "managing depression/mood," "managing medications," "managing symptoms," "communicating with a healthcare provider," "getting support/help," and "managing fatigue." The fitness of the modified model was acceptable (minimum value of the discrepancy function/degree of freedom = 2.49, root mean square error of approximation = .08, goodness-of-fit index = .76, adjusted goodness-of-fit index = .71, Tucker-Lewis index = .84, and comparative fit index = .86). The internal consistency reliability (Cronbach's α = .91) and test-retest reliability (intraclass correlation coefficient = .73) were good. The criterion validity of the K-HIV-SE was .59 (p < .001). CONCLUSION This study suggests that the K-HIV-SE is useful for efficiently assessing self-efficacy for HIV disease management.
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Affiliation(s)
- Gwang Suk Kim
- College of Nursing, Yonsei University, Seoul, Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Layoung Kim
- College of Nursing, Yonsei University, Seoul, Korea
- Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
- S-L.E.A.P Global Nurse Scientist Program, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Mi-So Shim
- College of Nursing, Keimyung University, Daegu, Korea
| | | | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Korea
| | - Min Kyung Park
- College of Nursing, Yonsei University, Seoul, Korea
- National Police Hospital, Seoul, Korea
| | - Youngjin Lee
- S-L.E.A.P Global Nurse Scientist Program, College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea.
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Watts E, Patel H, Kostov A, Kim J, Elkbuli A. The Role of Compassionate Care in Medicine: Toward Improving Patients' Quality of Care and Satisfaction. J Surg Res 2023; 289:1-7. [PMID: 37068438 DOI: 10.1016/j.jss.2023.03.024] [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: 01/09/2023] [Revised: 03/12/2023] [Accepted: 03/19/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Despite its description as a cornerstone of a healthcare provider's professional identity, the impact of compassionate care on various aspects of medicine has been poorly defined. In this review, we aimed to elucidate the role of compassionate care in various aspects of medicine and healthcare delivery. METHODS Four databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol for a literature review regarding compassionate care and its intersection with medical education, patient-provider communication, patient care, and clinical outcomes, patient and provider characteristics, telemedicine and artificial intelligence, caregiver compassion fatigue, and cost of care. RESULTS Twenty-two articles met the inclusion criteria. Analysis revealed that clinical outcomes are correlated with the degree of patients' perception of empathy and compassion from their providers. Along with enhanced patient outcomes, compassionate care was shown to reduce the costs of care, compassion fatigue and burnout, and the number of malpractice claims. However, compassion can be perceived differently among patients of various cultural and ethnic backgrounds. Compassion training sessions can be implemented among residents in surgical and nonsurgical medical specialties to improve perceived compassion. Furthermore, the use of telehealth modalities may positively or negatively impact compassionate care, requiring further exploration. CONCLUSIONS Compassionate care plays a crucial role in improving patient care and clinical outcomes while reducing caregiver burnout and the risk of malpractice litigation. However, a lack of compassion training and caregiver compassion fatigue may detract from the delivery of effective compassionate care.
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Affiliation(s)
- Emelia Watts
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Heli Patel
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Anthony Kostov
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Jason Kim
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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11
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Childers JW, Bulls H, Arnold R. Beyond the NURSE Acronym: The Functions of Empathy in Serious Illness Conversations. J Pain Symptom Manage 2023; 65:e375-e379. [PMID: 36521764 PMCID: PMC10883350 DOI: 10.1016/j.jpainsymman.2022.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Julie W Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh (J.W.C., H.B. R.A.), Pittsburgh, Pennsylvania, USA.
| | - Hailey Bulls
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh (J.W.C., H.B. R.A.), Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh (J.W.C., H.B. R.A.), Pittsburgh, Pennsylvania, USA
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12
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Haribhai S, Khadka N, Mvududu R, Mashele N, Bekker LG, Gorbach P, Coates TJ, Myer L, Joseph Davey DL. Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study. Int J STD AIDS 2023:9564624231152776. [PMID: 36947792 DOI: 10.1177/09564624231152776] [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: 03/24/2023]
Abstract
BACKGROUND In South Africa, at least 7.5 million people (age ≥15 years) are living with Human Immunodeficiency Virus (HIV). In 2020, 220,000 new infections occurred, approximately one-third of which were among cisgender adolescent girls and women (age ≥15 years). The perspectives of pregnant adolescent girls and young women (AGYW) as key, targeted end-users of pre-exposure prophylaxis (PrEP) in this setting are not well known. METHODS We purposively recruited participants enrolled in an ongoing cohort study at an urban antenatal clinic in Cape Town, South Africa for in-depth interviews between July-September 2020. We restricted our analysis to pregnant AGYW (age: 16-25 years) who initiated daily oral PrEP (Tenofovir/Emtricitabine) antenatally and self-reported either high PrEP persistence (≥25 days in the past 30 days and no missed PrEP collection), or low PrEP persistence and/or discontinuation (missing >5 days in the last 30 days or missed PrEP collection). The findings were organized thematically, per the adapted Health Behavior Model (2000), using Nvivo-v.1.5. RESULTS We interviewed 18 AGYW (mean age = 22 years), at a mean of 14 weeks postpartum. Higher self-esteem and high-quality study provider-client relationships, including empathic psychosocial support, facilitated PrEP continuation. Reported barriers included unstable social structure characteristics (i.e., financial hardship) and individual factors (i.e., unintended pregnancy, parental rejection, and inadequate peer- and [non-cohabiting] partner support). Participants self-perceived a need for PrEP, feeling susceptible to non-consensual, forced sex, or considering partners' (presumed) sexual risk-taking. Limited community awareness regarding PrEP availability and/or perceived complexity in navigating health system access to PrEP, impede continuation. CONCLUSIONS PrEP-focused healthcare access pathways for pregnant and postpartum AGYW need to be simplified. Further research is needed on health system determinants (i.e., structural barriers, provider-client interactions, and related outcomes) of oral PrEP utilization. In 2022, South Africa announced regulatory approval of long-acting PrEP options (i.e., the dapivirine ring for non-pregnant women and injectable cabotegravir, respectively); these may mitigate implementation barriers reported in this study. However, the safety and efficacy of long-acting PrEP (e.g., injectables, implants) among pregnant or breastfeeding women, specifically, remains to be confirmed in this setting.
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Affiliation(s)
- Sonia Haribhai
- Desmond Tutu Health Foundation/International AIDS Vaccine Initiative Fellowship, 108181Desmond Tutu Health Foundation, Cape Town, South Africa
| | - Nehaa Khadka
- Department of Epidemiology, Fielding School of Public Health, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, 37716University of Cape Town, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, 37716University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, 37716University of Cape Town, Cape Town, South Africa
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, 37716University of Cape Town, Cape Town, South Africa
| | - Dvora Leah Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, 8783University of California Los Angeles, Los Angeles, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, 37716University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases, David Geffen School of Medicine, 8783University of California Los Angeles, Los Angeles, CA, USA
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13
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Mitchell BD, Utterback L, Hibbeler P, Logsdon AR, Smith PF, Harris LM, Castle B, Kerr J, Crawford TN. Patient-Identified Markers of Quality Care: Improving HIV Service Delivery for Older African Americans. J Racial Ethn Health Disparities 2023; 10:475-486. [PMID: 35064521 PMCID: PMC8781691 DOI: 10.1007/s40615-022-01237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Over 50% of new AIDS/HIV diagnoses are older adults and disproportionately African American people. Longstanding health inequities, driven by the enduring nature of systemic racism, pose challenges to obtaining optimal HIV services. Patient experiences and identities shape the health care experience, yet patient voices are often minimized, including their assessment of quality HIV care. Understanding these markers of care, including facilitators of and barriers to care and engagement, may help enhance the patient voice, potentially improving service delivery and eradicating HIV healthcare disparities. METHOD Using a convergent mixed method design, our study identifies patient-identified markers of quality care among older African Americans (N = 35). Measurements of global stress, HIV stigma, and engagement in care were collected, and in-depth qualitative interviews explored the symbols of quality care as well as facilitators of and barriers to care. RESULTS We identified widespread participant awareness and recognition of quality care, the detection of facilitators and barriers across individual, clinic, and community levels. Facilitators of care include diet, health, relationships, community support, and compassionate HIV care. Barriers to care include health comorbidities, economic, food, and housing insecurity, lack of transportation, and structural racism. CONCLUSION Our findings illuminate how the prominence of barriers to care often uproot facilitators of care, creating impediments to HIV service delivery as patients transition through the HIV care continuum. We offer implications for practice and policy, as well as recommendations for reducing structural barriers to care by enhancing the patient voice and for aligning services toward compassionate and inclusive care.
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Affiliation(s)
- Brandon D. Mitchell
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Liz Utterback
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Paul Hibbeler
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Ashley R. Logsdon
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Patricia F. Smith
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Lesley M. Harris
- grid.266623.50000 0001 2113 1622Kent School of Social Work, University of Louisville, Louisville, KY USA
| | - Billie Castle
- grid.266623.50000 0001 2113 1622School of Public Health and Information Sciences, University of Louisville, Louisville, KY USA
| | - Jelani Kerr
- grid.266623.50000 0001 2113 1622School of Public Health and Information Sciences, University of Louisville, Louisville, KY USA
| | - Timothy N. Crawford
- grid.268333.f0000 0004 1936 7937Family Medicine and Population and Public Health Sciences, Wright State University, Dayton, OH USA
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14
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Sinclair S, Harris D, Kondejewski J, Roze des Ordons AL, Jaggi P, Hack TF. Program Leaders' and Educators' Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study. TEACHING AND LEARNING IN MEDICINE 2023; 35:21-36. [PMID: 35085055 DOI: 10.1080/10401334.2021.2017941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
PHENOMENON Training programs have been used to improve compassion in healthcare, but the factors necessary to make such programs successful and sustainable have not been identified. This thematic analysis aimed to bridge the gap between theory and practice by drawing on the experiences of international leaders and educators of compassion training programs to develop a clear understanding of what is relevant and effective and how compassion training is implemented and sustained. APPROACH International leaders and educators of compassion training programs (N = 15) were identified through convenience sampling based on academic and gray literature searches. Semi-structured face-to-face interviews with these participants were conducted between June 2020 and November 2020 in order to identify facilitators, barriers, and environmental conditions influencing the implementation and maintenance of compassion training programs. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. FINDINGS Six categories affecting the operationalization of compassion training programs were identified 1) origins, foundational principles and purpose, 2) curricular content, 3) methods of teaching and learning, 4) trainer qualities, 5) challenges and facilitators, and 6) evaluation and impact. INSIGHTS Compassion training should be rooted in the construct of interest and incorporate patients' needs and their experience of compassion, with patient-reported compassion scores integrated before and after training. Compassion training should be delivered by highly qualified educators who have an understanding of the challenges associated with integrating compassion into clinical practice, a dedicated contemplative practice, and a compassionate presence in the classroom. Prior to implementing compassion training, leadership support should be secured to create an ethos of compassion throughout the organization.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta Canada
- Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Compassion Research Lab, University of Calgary, Calgary, Alberta, Canada
| | - Daranne Harris
- Faculty of Nursing, University of Calgary, Calgary, Alberta Canada
- Compassion Research Lab, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, Calgary, Alberta Canada
- Compassion Research Lab, University of Calgary, Calgary, Alberta, Canada
| | - Amanda L Roze des Ordons
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Kelowna, British Columbia, Canada
- Divisions of Critical Care Medicine and Palliative Care, Department of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
| | - Priya Jaggi
- Faculty of Nursing, University of Calgary, Calgary, Alberta Canada
- Compassion Research Lab, University of Calgary, Calgary, Alberta, Canada
| | - Thomas F Hack
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
- Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
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15
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Lunen JC. Reflection, Sense of Belonging, and Empathy in Medical Education-Introducing a "Novel" Model of Empathetic Development by Literature. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231207702. [PMID: 37860600 PMCID: PMC10583515 DOI: 10.1177/23821205231207702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
Empathy, self-reflection, and inclusion of the medical humanities in medical education are increasingly gaining attention. This seems prudent, as studies indicate that high physician empathy is associated with better patient outcomes and could protect against physician burnout. In addition, utilizing self-reflection has been reported to surge diagnostic accuracy and increase the ability of clinical health care providers. Therefore, in medical education, there is a need to address these, however intricate, most important skills. Not oblivious to this, for decades many medical schools have reaped experience from the humanities, sprouting the field of the medical humanities. However, significant barriers encountered when teaching the medical humanities to medical students are of concern. Consequently, a theory-based, inclusive, representative, and intuitive approach to the teachings is coveted. The aim of this article is to describe and present such an approach. To this end, I introduce a novel Model of Empathetic Development by Literature, schematizing the path from reading a text to displaying an act of empathy. Ever mindful of the relevance and feasibility to medical students, this article reflects on thoughts and evidence behind the hypothesis; that sense of belonging, self-reflection, and empathy could be gained by reading and discussing literary fiction. Referring to both original research articles, books of popular science, and philosophical considerations, a clear line of reasoning for the inclusion of literary fiction in medical education is made. Thereafter, it is outlined, how-in a medical humanities course at Copenhagen University-specific literary excerpts are utilized to bring forth reflection on different aspects, circumstances, and conditions of being a physician, thereby kindling the medical students' sense of belonging to their profession. As such, this perspective piece demonstrates a concrete approach to how a literary educative technique could manifest.
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Affiliation(s)
- Jonas Christian Lunen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Occupational Health and Social Medicine, Holbæk Hospital, Holbæk, Denmark
- Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
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16
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Omollo V, Roche SD, Mogaka F, Odoyo J, Barnabee G, Bukusi EA, Katz AWK, Morton J, Johnson R, Baeten JM, Celum C, O’Malley G. Provider–client rapport in pre-exposure prophylaxis delivery: a qualitative analysis of provider and client experiences of an implementation science project in Kenya. Sex Reprod Health Matters 2022; 30:2095707. [PMID: 36169648 PMCID: PMC9542727 DOI: 10.1080/26410397.2022.2095707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Daily oral pre-exposure prophylaxis (PrEP) is being incorporated into services frequented by adolescent girls and young women (AGYW) in sub-Saharan Africa who are at a significant risk of HIV. In non-PrEP studies, positive provider–client rapport has been shown to improve patient decision-making and use of medication in clinical care. We examined AGYW and healthcare provider (HCP) perspectives on the value of and strategies for building positive provider–client rapport. We conducted in-depth interviews from January 2018 to December 2019 with 38 AGYW and 15 HCPs from two family planning clinics in Kisumu, Kenya where PrEP was being delivered to AGYW as part of the Prevention Options for Women Evaluation Research (POWER) study. We used semi-structured interview guides and audio-recorded interviews with participant consent. Verbatim transcripts were analysed using thematic content analysis. HCPs and AGYW emphasised the importance of positive provider–client rapport to meet AGYW support needs in PrEP service delivery. HCPs described how they employed rapport-building strategies that strengthened AGYW PrEP uptake and continuation, including: (1) using friendly and non-judgmental tones; (2) maintaining client confidentiality (to build client trust); (3) adopting a conversational approach (to enable accurate risk assessment); (4) actively listening and tailoring counselling (to promote client knowledge, skills, and self-efficacy); and (5) supporting client agency. Positive provider–client relationships and negative experiences identified in this analysis have the potential to facilitate/deter AGYW from using PrEP while at risk. The strategies to enhance provider–client rapport identified in this study could be integrated into PrEP provider training and delivery practices.
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Affiliation(s)
- Victor Omollo
- Clinical Research Scientist, Kenya Medical Research Institute, P. O. Box 614-40100, Agoi Street, Kisumu, Kenya
| | - Stephanie D. Roche
- Staff Scientist, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Felix Mogaka
- Clinical Research Scientist, Kenya Medical Research Institute, Kisumu, Kenya
| | - Josephine Odoyo
- Research and Evaluation Advisor, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Gena Barnabee
- Research and Evaluation Advisor, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Elizabeth A. Bukusi
- Senior Principal Clinical Research Scientist, Kenya Medical Research Institute, Kisumu, Kenya; Research Professor, Department of Global Health; Research Professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Ariana W. K. Katz
- Public Health Analyst, Women’s Global Health Imperative (WGHI), RTI International, Berkeley, CA, USA
| | - Jennifer Morton
- Operations Team Manager, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rachel Johnson
- Managing Director, International Clinical Research Center (ICRC), University of Washington, Seattle, WA, USA
| | - Jared M. Baeten
- Professor, Department of Global Health, [Professor] Department of Medicine; Professor, Department of Epidemiology, University of Washington, Seattle, WA, USA; Vice President of Clinical Development, Gilead Sciences, Foster City, CA, USA>
| | - Connie Celum
- Professor, Department of Global Health; Professor, Department of Medicine; [Professor] Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Gabrielle O’Malley
- Professor, Department of Global Health, University of Washington Seattle, Seattle, WA, USA
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17
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Reid HW, Parente V, Gupta MD, Hantzmon S, Olsen MK, Yang H, Jackson LR, Johnson KS, Pollak KI. Examining the relationship between clinician communication and patient participatory behaviors in cardiology encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:3473-3478. [PMID: 36137906 PMCID: PMC9903298 DOI: 10.1016/j.pec.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Examine the association of coder ratings of cardiologist behaviors and global scores of cardiologist communication style with patient participation in clinic encounters. METHODS We coded transcripts of clinic encounters for patient participatory behaviors: asking questions, assertive statements, and expressing negative emotions; clinician behavior counts: reflective statements, open-ended questions, empathic statements, and eliciting questions. We used general linear regression models to examine associations of mean number of patient participatory behaviors with clinician behaviors. RESULTS Our sample included 161 patients of 40 cardiologists. Patient female gender was associated with on average 2.1 (CI: 0.06, 4.1; p = 0.04) more patient participatory behaviors. In an adjusted model, clinician reflective statements were associated with on average 0.3 (CI: 0.04, 0.4; p = 0.02) more patient participatory behaviors. A clinician making at least one empathic statement was associated with on average 3.7 (CI: 0.2, 7.1; p = 0.04) more patient participatory behaviors. CONCLUSIONS These results demonstrate that some individual clinician behaviors are associated with higher patient participation in cardiology encounters. PRACTICE IMPLICATIONS Clinician reflective and empathic statements may be important targets in communication training to increase patient participation. SECTION Communication Studies.
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Affiliation(s)
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, USA
| | - Maya Das Gupta
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, USA
| | - Sarah Hantzmon
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, USA
| | - Maren K Olsen
- Duke University Department of Biostatistics and Bioinformatics, Durham Veterans Affairs Health Care System, Durham, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, USA
| | - Hongqiu Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, USA; Center for Aging and Human Development, Duke University School of Medicine, Durham, USA; Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
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18
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Sprague C. What Matters Most? The Power of Kafka's Metamorphosis to Advance Understandings of HIV Stigma and Inform Empathy in Medical Health Education. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:561-584. [PMID: 35188615 PMCID: PMC8858723 DOI: 10.1007/s10912-022-09729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka's Metamorphosis advance understandings of HIV stigma in medical health education? Metamorphosis amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. Metamorphosis may ultimately promote medical health humanities' social mission-allowing literature to unfold such revelations towards greater equity in health.
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19
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Shi C, Cleofas JV. Professional commitment and willingness to care for people living with HIV among undergraduate nursing students: The mediating role of empathy. NURSE EDUCATION TODAY 2022; 119:105610. [PMID: 36306636 DOI: 10.1016/j.nedt.2022.105610] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND As future registered nurses, undergraduate students play a vital role in integrated care for acquired immunodeficiency syndrome; hence, there is a need to examine factors that can increase their willingness to care for persons with such conditions. OBJECTIVE This study examined the relationship among nursing professional commitment, empathy, and willingness to care for people living with human immunodeficiency virus and acquired immunodeficiency syndrome among undergraduate student nurses, and the mediating role of empathy in this relationship. DESIGN Quantitative, cross-sectional design. SETTINGS Nursing schools from five provinces of China, including Hunan, Jiangxi, Guangxi, Henan, and Hebei. PARTICIPANTS A total of 747 undergraduate student nurses were recruited via cluster sampling. METHODS Online survey was used to collect data. Nursing Willingness Questionnaire, Professional Commitment Scale, and Jefferson Scale of Empathy were the scales used to measure the variables. Structural equation modeling was used to determine significant relationships. RESULTS Respondents' professional commitment and empathy demonstrated moderate positive associations with willingness to care. Empathy demonstrated a 21 % mediating effect on the effect of professional commitment and willingness to care (p < 0.05). CONCLUSIONS Findings highlight the enabling role of professional commitment and empathy in improving undergraduate student nurses' willingness to care for persons living with human deficiency virus. Nurse educators can help improve the impact of students' professional commitment on their willingness by using educational strategies that enhance their empathy.
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Affiliation(s)
- Chunhong Shi
- School of Nursing, XiangNan University, Chenzhou 423000, China; College of Nursing and Allied Health Sciences, St. Paul University Manila, Manila 1004, Philippines
| | - Jerome V Cleofas
- Department of Sociology and Behavioral Sciences, De La Salle University, Manila 1004, Philippines.
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20
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Ayakaka I, Armstrong-Hough M, Hannaford A, Ggita JM, Turimumahoro P, Katamba A, Katahoire A, Cattamanchi A, Shenoi SV, Davis JL. Perceptions, preferences, and experiences of tuberculosis education and counselling among patients and providers in Kampala, Uganda: A qualitative study. Glob Public Health 2022; 17:2911-2928. [PMID: 35442147 PMCID: PMC11005908 DOI: 10.1080/17441692.2021.2000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
Tuberculosis (TB) education seeks to increase patient knowledge about TB, while TB counselling seeks to offer tailored advice and support for medication adherence. While universally recommended, little is known about how to provide effective, efficient, patient-centred TB education and counselling (TEC) in low-income, high HIV-TB burden settings. We sought to characterise stakeholder perceptions of TEC in a public, primary care facility in Kampala, Uganda, by conducting focus group discussions with health workers and TB patients in the TB and HIV clinics. Participants valued TEC but reported that high-quality TEC is rarely provided, because of a lack of time, space, staff, planning, and prioritisation given to TEC. To improve TEC, they recommended adopting practices that have proven effective in the HIV clinic, including better specifying educational content, and employing peer educators focused on TEC. Patients and health workers suggested that TEC should not only improve TB patient knowledge and adherence, but should also empower and assist all those undergoing evaluation for TB, whether confirmed or not, to educate their households and communities about TB. Community-engaged research with patients and front-line providers identified opportunities to streamline and standardise the delivery of TEC using a patient-centred, peer-educator model.
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Affiliation(s)
- Irene Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Liverpool School of Tropical Medicine, LSTM IMPALA Program, Liverpool, UK
| | - Mari Armstrong-Hough
- Department of Social and Behavioural Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alisse Hannaford
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph M. Ggita
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | | | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre, School of Medicine; College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adithya Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Sheela V. Shenoi
- Center for Interdisciplinary Research on AIDS, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - J. L. Davis
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Center for Interdisciplinary Research on AIDS, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases and Centre for Methods in Implementation and Prevention Science, Yale School of Public Health, and Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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21
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López Rios J, Lentz C, Balán IC, Grosskopf N, D'Angelo A, Stief M, Grov C. Engagement in Care Among Newly Diagnosed HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From the Together 5,000 Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:349-364. [PMID: 36181497 PMCID: PMC9619412 DOI: 10.1521/aeap.2022.34.5.349] [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] [Indexed: 06/16/2023]
Abstract
One-quarter of gay, bisexual, and other men who have sex with men (GBMSM) with diagnosed HIV are not engaged in HIV care. Between 2018 and 2019, 50 GBMSM completed qualitative interviews 3 months after receiving an HIV-positive result. Interviews explored barriers to and facilitators of engagement and retention in HIV testing and care. Thematic analysis revealed five major themes: (1) reason for HIV testing (e.g., self-testing), (2) linkage to care (e.g., appointment/logistic issues and social support as encouragement), (3) barriers to engagement in care (e.g., financial burden, competing priorities, and fear/stigma), (4) facilitators of engagement (e.g., financial assistance, patient-provider relationships, auxiliary support services, and health agency), and (5) PrEP as a missed prevention opportunity. Addressing individual-, social-, and policy-level barriers could improve GBMSM's engagement in HIV care. Further, capitalizing on GBMSM's health agency through partnerships with local agencies and fostering better patient-provider relationships could optimize HIV care continuity.
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Affiliation(s)
- Javier López Rios
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Cody Lentz
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | - Iván C Balán
- Center for Translational Behavioral Science, Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, Florida
| | - Nicholas Grosskopf
- Department of Health and Human Performance, York College of the City University of New York, Queens, New York
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Alexa D'Angelo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Matthew Stief
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York. Christian Grov is also affiliated with the CUNY Institute for Implementation Science in Population Health, New York
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22
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Winter R, Leanage N, Roberts N, Norman RI, Howick J. Experiences of empathy training in healthcare: A systematic review of qualitative studies. PATIENT EDUCATION AND COUNSELING 2022; 105:3017-3037. [PMID: 35811257 DOI: 10.1016/j.pec.2022.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/27/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To synthesise qualitative studies reporting student, practitioner, or patient experiences of empathy-training in healthcare. METHODS We included qualitative studies exploring (i) student or practitioner experiences of empathy training, or (ii) patient experiences of being treated by someone who has undergone empathy training. We used the Critical Appraisal Skills Programme (CASP) tool to assess study quality. Thematic synthesis was used to integrate findings from studies and to generate new insights. RESULTS Our search yielded 2768 citations, of which 23 (1487 participants) met inclusion criteria. Two clusters of themes were identified from included studies. Firstly, themes related to practitioner/trainee professionalism and wellbeing, where the main finding was that participants experienced benefit from therapeutic empathy training. Secondly, themes related to the understanding and treatment of patients, where the main finding was practitioners' deeper recognition of the positive impact of empathic care. CONCLUSIONS This review found that taking part in empathy-focused training can benefit practitioner/student personal growth and professional development, and benefits patient care. This review is limited by the difficulty in defining empathy and heterogeneity amongst included studies. PRACTICE IMPLICATIONS These results support a rationale for empathy training and the development of a framework to ensure training is having the desired effect.
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Affiliation(s)
- Rachel Winter
- Leicester Medical School, College of Life Sciences, University of Leicester, George Davies Centre, Leicester LE1 7RH, United Kingdom.
| | - Navin Leanage
- Leicester Medical School, College of Life Sciences, University of Leicester, George Davies Centre, Leicester LE1 7RH, United Kingdom
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford OX1 3BG, United Kingdom
| | - Robert I Norman
- Leicester Medical School, College of Life Sciences, University of Leicester, George Davies Centre, Leicester LE1 7RH, United Kingdom
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford OX2 6GG, United Kingdom
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Experiences of Migrant People Living with HIV in a Multidisciplinary HIV Care Setting with Rapid B/F/TAF Initiation and Cost-Covered Treatment: The ‘ASAP’ Study. J Pers Med 2022; 12:jpm12091497. [PMID: 36143282 PMCID: PMC9503330 DOI: 10.3390/jpm12091497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to explore the experiences of migrant people living with HIV (MLWH) enrolled in a Montreal-based multidisciplinary HIV care clinic with rapid antiretroviral treatment (ART) initiation and cost-covered ART. Between February 2020 and March 2022, 32 interviews were conducted with 16 MLWH at three time-points (16 after 1 week of ART initiation, 8 after 24 weeks, 8 after 48 weeks). Interviews were analyzed via the Framework Method. Thirty categories were identified, capturing experiences across the HIV care cascade. At diagnosis, most MLWH described “initially experiencing distress”. At linkage, almost all MLWH discussed “navigating the health system with difficulty”. At treatment initiation, almost all MLWH expressed “being satisfied with treatment”, particularly due to a lack of side effects. Regarding care retention, all MLWH noted “facing psychosocial or health-related challenges beyond HIV”. Regarding ART adherence, most MLWH expressed “being satisfied with treatment” with emphasis on their taking control of HIV. At viral suppression, MLWH mentioned “finding more peace of mind since becoming undetectable”. Regarding their perceived health-related quality of life, most MLWH indicated “being helped by a supportive social network”. Efficient, humanizing, and holistic approaches to care in a multidisciplinary setting, coupled with rapid and free ART initiation, seemed to help alleviate patients’ concerns, address their bio-psycho-social challenges, encourage their initial and sustained engagement with HIV care and treatment, and ultimately contribute to positive experiences.
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24
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Yang N, Zhang Y, Liu Z, Wang F, Yang G, Hu X. Influence of Social Workers' Empathy Ability on Suicidal Ideation of Cancer Patients. Front Public Health 2022; 10:925307. [PMID: 35968492 PMCID: PMC9364132 DOI: 10.3389/fpubh.2022.925307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background The nursing goal of patients with cancer is to provide them with holistic care, including physical, psychological, and social adaptation, and spirituality. This research aimed to explore the influence of the social workers' empathy ability on suicidal ideation of patients with cancer and its path. Methods There was a sum of 358 patients with cancer and the 45 social workers serving them participated in the survey. Data of their self-efficacy, depression symptom, stigma, and suicidal ideation were measured before the social work provided (T1) and 3 months after the social work finished (T2) were collected and compared. Pearson correlation analysis was used to assess the relationships between social workers' empathy ability and patient indicators at T2. The influence path of social workers' empathy ability on cancer patients' suicidal ideation was explored by path analysis at T2. Results At T2, patients reported higher self-efficacy and lower depression symptoms, stigma, and suicidal ideation than at T1. At T2, social workers' empathy ability was positively related to patients' self-efficacy and was negatively related to depression symptoms, stigma, and suicidal ideation. Social workers' empathy ability affected patients' suicidal ideation directly. In addition, patients' self-efficacy, depression symptoms, and stigma played mediating roles in the influence of social workers' empathy abilities on their suicidal ideation. Conclusion Social workers' empathy ability not only directly affected cancer patients' suicide ideation but also affected suicide ideation through the mediating roles of self-efficacy, depression symptoms, and stigma. Therefore, the improvement of the empathy ability of medical social workers needs to be paid attention to.
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Affiliation(s)
- Ningxi Yang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, China
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yuting Zhang
- Health Science Center, Shenzhen University, Shenzhen, China
| | - Zhibo Liu
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, China
| | - Fang Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Guoqing Yang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
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25
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Bluemer-Miroite S, Potter K, Blanton E, Simmonds G, Mitchell C, Barnaby K, Zeribi KA, Babb D, Skyers N, O'Malley G, Anderson C. “Nothing for Us Without Us”: An Evaluation of Patient Engagement in an HIV Care Improvement Collaborative in the Caribbean. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00390. [PMID: 36332062 PMCID: PMC9242602 DOI: 10.9745/ghsp-d-21-00390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
This evaluation suggests that it is both possible and valuable to include patients as partners in quality improvement efforts, especially when resources must be prioritized for the highest impact efforts. Patient engagement in the improvement process is particularly powerful when addressing illnesses that may be stigmatized such as HIV. Introduction: Patient engagement is increasingly recognized as a key strategy to promote patient-centered care and accelerate health care improvements. Ensuring patient participation in improvement efforts is particularly important with stigmatized illnesses and marginalized populations. Despite the attention it has garnered, patient engagement is still not widely implemented and has not been well documented in global health literature. Methods: We implemented a patient-engagement strategy to involve people living with HIV in quality improvement efforts. As part of the Caribbean Regional Quality Improvement Collaborative, quality improvement teams from Barbados (1 team), Jamaica (20 teams), Suriname (3 teams), and Trinidad and Tobago (2 teams) engaged health care providers from care facilities and people living with HIV to serve as community representatives (CRs) to lead the improvement efforts alongside them. This strategy was evaluated via a mixed method design that included 2 rounds of semistructured, in-depth interviews with patients and providers. Results: Findings suggest that the patient engagement strategy had several key strengths: it promoted the collection, use, and appreciation of patient input to inform health care improvements at the facility level; facilitated the empowerment of CRs; enhanced mutual understanding and empathy between CRs and providers; and helped to dispel HIV stigma and discrimination in health care settings. Moreover, both health care providers and CRs reported that CR opinions and perspectives are as important as providers' and that CR participation in the improvement process was beneficial.
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Affiliation(s)
| | | | | | - Georgia Simmonds
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | - Conrad Mitchell
- International Training and Education Center for Health, Port of Spain, Trinidad and Tobago
| | - Kenyatta Barnaby
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | | | - Dale Babb
- Ladymeade Reference Unit, Barbados Ministry of Health, St. Michael, Barbados
| | - Nicola Skyers
- HIV Programme, Jamaica Ministry of Health, Kingston, Jamaica
| | - Gabrielle O'Malley
- University of Washington, Seattle, WA, USA
- International Training and Education Center for Health, Seattle, WA, USA
| | - Clive Anderson
- International Training and Education Center for Health, Kingston, Jamaica
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26
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Whitley GA, Hemingway P, Law GR, Siriwardena AN. Improving ambulance care for children suffering acute pain: a qualitative interview study. BMC Emerg Med 2022; 22:96. [PMID: 35659188 PMCID: PMC9164349 DOI: 10.1186/s12873-022-00648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pain is a highly complex sensory and emotional experience. When a child suffers acute pain through illness or injury, they are often transported to hospital by ambulance. Pre-hospital pain management in children is poor, with 61% of children receiving suboptimal pain management. Consequences of poor pain management include the risk of developing post-traumatic stress disorder and altered pain perception. We aimed to identify clinicians’ perceptions of barriers, facilitators and potential improvements for the management of pre-hospital acute pain in children. Methods Qualitative face to face semi-structured recorded interviews were performed in one large UK ambulance service. Audio files were transcribed verbatim with thematic analysis used to generate themes. NVivo 12 was used to support data analysis. Findings were combined with existing evidence to generate a driver diagram. Results Twelve ambulance clinicians participated, including 9 registered paramedics and 3 emergency medical technicians. Median (IQR) age was 43.50 (41.50, 45.75) years, 58% were male, median (IQR) experience was 12 (4.25, 15.50) years and 58% were parents. Several themes relating to barriers and facilitators were identified, including physical, emotional, social, organisational, environmental, management, knowledge and experience. Improvement themes were identified relating to management, organisation and education. These data were combined to create a driver diagram; the three primary drivers were 1) explore methods to increase rates of analgesic administration, including utilising intranasal or inhaled routes; 2) reduce fear and anxiety in children, by using child friendly uniform, additional non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training and optimising crew mix. Conclusions The quality of care that children receive for acute pain in the ambulance service may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research involving children and parents would be useful to determine the most important outcome measures and facilitate intervention development. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00648-y.
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27
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Middour-Oxler B, Hirschmann K, Chace C, Collins L, Gordon C, Mann M, Swope C, George C. “Acquiring the Skills Needed to Communicate What Is in Our Teams’ Heart: Love, Compassion and Partnership”: Qualitative Analysis of Intact Multidisciplinary Teams’ Experience of Relationship-Centered Communication Training. J Patient Exp 2022; 9:23743735221103025. [PMID: 35677227 PMCID: PMC9168940 DOI: 10.1177/23743735221103025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Partnership Enhancement Program (PEP) is a 6-hour relationship-centered
communication training for intact cystic fibrosis (CF) teams. The aim of this
study was to analyze qualitative responses from survey participants regarding
their takeaways from the training. A total of 210 professionals participated in
20 pilot workshops at 19 care centers in the United States from November 2018 to
December 2019. After the workshop, qualitative feedback was captured by PEP
facilitators during a feedback gathering session or submitted immediately in
writing by participants. The manuscript team used grounded theory and
qualitative methods of coding to identify recurring themes across participant
responses. Thematic analysis revealed 5 primary themes and a web of
interconnected subthemes. Primary themes include the acquisition of skills to
improve communication, strengthened patient/provider connection, improved
quality of communication, improved team building, and the ability to change and
enhance practice. Participants who completed PEP training endorse acquiring
communication skills that increase coproduction of care with patients and
caregivers as well as improve relationships across the healthcare system.
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Affiliation(s)
- Brandi Middour-Oxler
- Children’s Healthcare of Atlanta + Emory University Cystic Fibrosis Care Center, Atlanta, GA, USA
| | | | - Carol Chace
- Children’s National Hospital, Washington, DC, USA
| | | | - Chandra Gordon
- University of Kansas Health System, Kansas City, KS, USA
| | - Michelle Mann
- Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA
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28
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LeBaron V, Boukhechba M, Edwards J, Flickinger T, Ling D, Barnes LE. Exploring the use of wearable sensors and natural language processing technology to improve patient-clinician communication: Protocol for a feasibility study (Preprint). JMIR Res Protoc 2022; 11:e37975. [PMID: 35594139 PMCID: PMC9166632 DOI: 10.2196/37975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mehdi Boukhechba
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
| | - James Edwards
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - David Ling
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Laura E Barnes
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
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29
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Han Y, Lie RK, Li Z, Guo R. Trust in the Doctor-Patient Relationship in Chinese Public Hospitals: Evidence for Hope. Patient Prefer Adherence 2022; 16:647-657. [PMID: 35283627 PMCID: PMC8910463 DOI: 10.2147/ppa.s352636] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/13/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Trust is an essential component in a successful health care relationship. Doctor-patient trust involves the subjects of both sides, including the direction of patients' trust in physicians (patients' perception) and physicians' trust in patients (physicians' perception). This study aims to assess the status quo and explore suggestions for improving trust between doctors and patients. PATIENTS AND METHODS In May 2018, we collected data from six representative hospitals in Beijing, China, including 610 questionnaires (310 physicians and 300 patients). Participants were Chinese-speaking, age 14 and older, who expressed their opinions clearly. Kruskal-Wallis H-test and Wilcoxon rank sum test were used to analyze the difference in the trust scores of the responses. RESULTS Based on the doctor and patient characteristics, the data show that inpatients are trusted more than outpatients, and patients who often visit the clinic are more doubtful of doctors. The family trust is the highest, and social trust is the lowest. In general, the degree of trust between doctors and patients is good, but the score of physicians (Mean=3.87; SD=0.79) is lower than that of patients (Mean=4.05; SD=0.76). Physicians' evaluation of the degree of trust tends to be more negative than patients'. CONCLUSION In spite of recent negative press reports, there remains a high degree of trust between patients and doctors in Beijing. Despite this, one should not be complacent. We need to explore the root cause of the trust between doctors and patients from a deeper perspective to promote better medical services to meet the health needs of patients.
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Affiliation(s)
- Yangyang Han
- Department of Outpatient, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China
| | - Reidar K Lie
- Department of Philosophy, University of Bergen, Bergen, Norway
| | - Zhenlin Li
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Rui Guo
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Rui Guo, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, 100069, People’s Republic of China, Tel +86-10-83911573, Email
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Improving the Quality of Patient Care and Healthcare Staff Well-Being through an Empathy Immersion Educational Programme in New Zealand: Protocol of a Feasibility and Pilot Study. Methods Protoc 2021; 4:mps4040089. [PMID: 34940400 PMCID: PMC8706397 DOI: 10.3390/mps4040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Empathy is positively related to healthcare workers and patients’ wellbeing. There is, however, limited research on the effects of empathy education delivered in acute clinical settings and its impact on healthcare consumers. This research tests the feasibility and the potential efficacy outcomes of an immersive education programme developed by the research team in collaboration with clinical partners and a multidisciplinary advisory group. Healthcare worker participants in the intervention ward will receive an 8-week immersive empathy education. The primary outcome (feasibility) will be assessed by evaluating the acceptability of the intervention and the estimated resources. The secondary outcome (efficacy) will be assessed using a quasi-experimental study design. Non-parametric tests will be used to test healthcare worker participants’ empathy, burnout, and organisational satisfaction (within-group and across groups), and healthcare consumer participants’ satisfaction (between-group) over time. Despite growing interest in the importance of empathy in professional relationships, to our knowledge, the present pilot study is the first to explore the feasibility and efficacy of an immersive empathy education in New Zealand. Our findings will provide critical evidence to support the development of a randomised cluster trial and potentially provide preliminary evidence for the effectiveness of this type of empathy education.
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Sinclair S, Kondejewski J, Jaggi P, Roze des Ordons AL, Kassam A, Hayden KA, Harris D, Hack TF. What works for whom in compassion training programs offered to practicing healthcare providers: a realist review. BMC MEDICAL EDUCATION 2021; 21:455. [PMID: 34454489 PMCID: PMC8403363 DOI: 10.1186/s12909-021-02863-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Patients and families want their healthcare to be delivered by healthcare providers that are both competent and compassionate. While compassion training has begun to emerge in healthcare education, there may be factors that facilitate or inhibit the uptake and implementation of training into practice. This review identified the attributes that explain the successes and/or failures of compassion training programs offered to practicing healthcare providers. METHODS Realist review methodology for knowledge synthesis was used to consider the contexts, mechanisms (resources and reasoning), and outcomes of compassion training for practicing healthcare providers to determine what works, for whom, and in what contexts. RESULTS Two thousand nine hundred ninety-one articles underwent title and abstract screening, 53 articles underwent full text review, and data that contributed to the development of a program theory were extracted from 45 articles. Contexts included the clinical setting, healthcare provider characteristics, current state of the healthcare system, and personal factors relevant to individual healthcare providers. Mechanisms included workplace-based programs and participatory interventions that impacted teaching, learning, and the healthcare organization. Contexts were associated with certain mechanisms to effect change in learners' attitudes, knowledge, skills and behaviors and the clinical process. CONCLUSIONS In conclusion this realist review determined that compassion training may engender compassionate healthcare practice if it becomes a key component of the infrastructure and vision of healthcare organizations, engages institutional participation, improves leadership at all levels, adopts a multimodal approach, and uses valid measures to assess outcomes.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
- Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Priya Jaggi
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Amanda L Roze des Ordons
- Department of Critical Care Medicine and Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Daranne Harris
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 99 Curry Place, Winnipeg, Manitoba, R3T 2M6, Canada
- Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Room CR3018, 369 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada
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Rong R, Chen W, Dai Z, Gu J, Chen W, Zhou Y, Kuang M, Xiao H. Improvement of the management of mental well-being and empathy in Chinese medical students: a randomized controlled study. BMC MEDICAL EDUCATION 2021; 21:378. [PMID: 34246265 PMCID: PMC8272356 DOI: 10.1186/s12909-021-02813-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 06/28/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Among Chinese medical students, there is a high prevalence of mental health-related issues and low empathy. Effective strategies to improve this situation are lacking. This study aims to investigate the efficacy of the intervention courses designed to enhance the mental health and empathy of senior Chinese medical students. METHODS A total of 146 3rd - and 4th -year medical students were randomized to an intervention group (n = 74) and a control group (n = 72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and content of the intervention courses. The designed courses were delivered in the intervention group once a month three times, while the control group had no specific intervention. Five self-assessment questionnaires, including the General Self-Efficacy (GSE) scale, Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS), were completed by the students before and one month after the courses to evaluate their levels of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy, respectively. Qualitative data were collected via e-mail two years after the intervention. RESULTS Compared to the control group, the intervention group showed significantly higher scores for empathy (111.0 [IQR 102.0, 118.0] vs. 106.0 [IQR 93.0, 111.5]; P = .01) and QoL (32.0 [IQR 28.0, 35.0] vs. 29.5 [IQR 26.0, 34.0]; P = .04). The rate of depression was significantly lower in the intervention group than in the control group (13.5 % vs. 29.2 %; chi-square test, P = .02). However, no significant differences in self-efficacy (25.6 ± 4.8 vs. 24.3 ± 6.3; P = .16) or burnout (27.0 % vs. 34.7 %; Chi-square test, P = .31) were observed between the two groups. CONCLUSIONS The intervention courses had a positive impact on mental well-being and empathy in senior Chinese medical students, which might help provide novel information for their incorporation into the medical school curriculum. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02645643; Date of registration: 05/01/2016.
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Affiliation(s)
- Rong Rong
- Clinical Trials Unit, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Zihao Dai
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Jingli Gu
- Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Weiying Chen
- Department of Diagnostics, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Yanbin Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Ming Kuang
- Department of Medical Education, Department of Liver Surgery, College of Basic Surgery, Zhongshan School of Medicine, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan Road 2, 510080, Guangzhou, People's Republic of China.
| | - Haipeng Xiao
- Department of Medical Education, Department of Endocrinology, Zhongshan School of Medicine, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan Road 2, 510080, Guangzhou, People's Republic of China.
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Molero Jurado MDM, Herrera-Peco I, Pérez-Fuentes MDC, Oropesa Ruiz NF, Martos Martínez Á, Ayuso-Murillo D, Gázquez Linares JJ. Communication and humanization of care: Effects over burnout on nurses. PLoS One 2021; 16:e0251936. [PMID: 34111138 PMCID: PMC8191999 DOI: 10.1371/journal.pone.0251936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/03/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Healthcare professionals may have certain psychological characteristics which contribute to increasing the quality of their professional performance. OBJECTIVE Study the effect that humanization of care and communication have on the burnout syndrome in nursing personal. METHODS The sample included a total of 330 Spanish nurses. Analytical instruments used were the Health Professional's Humanization Scale (HUMAS), Communication Styles Inventory Revised (CSI-R) and Brief Burnout Questionnaire Revised (CBB-R). RESULTS Two broad nursing profiles could be differentiated by their level of humanization (those with scores over the mean and those with scores below it in optimistic disposition, openness to sociability, emotional understanding, self-efficacy, and affection), where the largest group had the high scores. A communication repertoire based on verbal aggressiveness impacted indirectly on the effect of humanization on burnout, mainly in the personal impact component. We observed the relation of humanization profiles in nursing staff with the job dissatisfaction and burnout components. Besides that, some communication styles, verbal aggressiveness and questioningness, have an indirect effect on the relationship between humanization profiles and job dissatisfaction. CONCLUSIONS The results on the relationship between communication styles and burnout, and the mediator effect of communication styles on the relationship between humanization of care and burnout in nursing personnel are discussed.
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Affiliation(s)
| | - Iván Herrera-Peco
- Nursing Department, Faculty of Health Sciences, Alfonso X El Sabio University, Madrid, Spain
- Alfonso X El Sabio Foundation, Madrid, Spain
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. METHODS Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. RESULTS Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. CONCLUSION These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. TRIAL REGISTRATION Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
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Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study. AIDS Behav 2021; 25:961-972. [PMID: 33026574 PMCID: PMC7936969 DOI: 10.1007/s10461-020-03055-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
To assess challenges with daily oral antiretroviral therapy (ART), we analyzed data for 2389 participants in the 2019 Positive Perspectives survey of people living with HIV in 25 countries. ART-related challenges reported included difficulty swallowing pills (33.1% [790/2389]); stress from daily dosing routine (33.3% [795/2389]); bad memories from daily intake of HIV medication (35.1%[839/2389]), and concern “that having to take pills every day means a greater chance of revealing my HIV status to others” (37.9% [906/2389]). Individuals who felt empowered by daily oral dosing [“taking my pill(s) every day reassures me that my HIV is being kept under control”] had 69% higher odds of optimal overall health (AOR 1.69, 95% CI 1.40–2.04). Conversely, odds of optimal overall health were lower among those who felt daily pill intake “limits my day-to-day life” (AOR 0.53, 95% CI 0.44–0.64). These findings show that there is need for increased flexibility of ART delivery to meet diverse patient needs.
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Wilson BN, Murase JE, Sliwka D, Botto N. Bridging racial differences in the clinical encounter: How implicit bias and stereotype threat contribute to health care disparities in the dermatology clinic. Int J Womens Dermatol 2021; 7:139-144. [PMID: 33937479 PMCID: PMC8072500 DOI: 10.1016/j.ijwd.2020.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Positive interactions that build good relationships between patients and providers demonstrate improved health outcomes for patients. Yet, racial minority patients may not be on an equal footing in having positive interactions. Stereotype threat and implicit bias in clinical medicine negatively affect the quality of care that racial minorities receive. Dermatology, one of the least racially diverse specialties in medicine, further falls short in providing patients with options for race-concordant visits, which are noted to afford improved experiences and outcomes. OBJECTIVE This study aimed to analyze implicit bias and stereotype threat in a dermatology clinical scenario with the goal of identifying actions that providers, particularly those that are not racial minorities, can take to improve the quality of the clinical interactions between the minority patient and provider. METHODS We illustrate a hypothetical patient visit and identify elements that are susceptible to both stereotype threat and implicit bias. We then develop an action plan that dermatologists can use to combat stereotype threat and implicit bias in the clinical setting. RESULTS The details of an action plan to combat the effect of stereotype threat and implicit bias are as follows: 1) Invite practices that increase representation within all aspects of the patient visit (from wall art to mission statements to creating a culture that embraces difference and not just diversity); 2) employ communication techniques targeted to invite and understand the patient perspective; and 3) practice making empathic statements to normalize anxiety and foster connection during the visit. CONCLUSION Knowledge of stereotype threat and implicit bias and their sequelae, as well as an understanding of steps that can be taken preemptively to counteract these factors, create opportunities to improve clinical care and patient outcomes in racial minority patients.
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Affiliation(s)
- Britney N. Wilson
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Jenny E. Murase
- Department of Dermatology, University of California-San Francisco, San Francisco, CA, United States
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, CA, United States
| | - Diane Sliwka
- Department of Medicine, University of California-San Francisco, San Francisco, CA, United States
| | - Nina Botto
- Department of Dermatology, University of California-San Francisco, San Francisco, CA, United States
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Yoshida T, Watanabe S, Kono T, Taketa H, Shiotsu N, Shirai H, Nakai Y, Torii Y. What impact does postgraduate clinical training have on empathy among Japanese trainee dentists? BMC MEDICAL EDUCATION 2021; 21:53. [PMID: 33446194 PMCID: PMC7807681 DOI: 10.1186/s12909-020-02481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Enhancing empathy in healthcare education is a critical component in the development of a relationship between healthcare professionals and patients that would ensure better patient care; improved patient satisfaction, adherence to treatment, patients' medication self-efficacy, improved treatment outcomes, and reduced patient anxiety. Unfortunately, however, the decline of empathy among students has been frequently reported. It is especially common when the curriculum transitions to a clinical setting. However, some studies have questioned the significance and frequency of this decline. Thus, the purpose of this study was to determine the impact of postgraduate clinical training on dental trainees' empathy from cognitive, behavioral, and patients' perspective. METHODS This study included 64 trainee dentists at Okayama University Hospital and 13 simulated patients (SPs). The trainee dentists carried out initial medical interviews with SPs twice, at the beginning and the end of their clinical training. The trainees completed the Japanese version of the Jefferson Scale of Empathy for health professionals just before each medical interview. The SPs evaluated the trainees' communication using an assessment questionnaire immediately after the medical interviews. The videotaped dialogue from the medical interviews was analyzed using the Roter Interaction Analysis System. RESULTS No significant difference was found in the self-reported empathy score of trainees at the beginning and the end of the clinical training (107.73 [range, 85-134] vs. 108.34 [range, 69-138]; p = 0.643). Considering the results according to gender, male scored 104.06 (range, 88-118) vs. 101.06 (range, 71-122; p = 0.283) and female 109.17 (range, 85-134) vs. 111.20 (range, 69-138; p = 0.170). Similarly, there was no difference in the SPs' evaluation of trainees' communication (10.73 vs. 10.38, p = 0.434). Communication behavior in the emotional responsiveness category for trainees in the beginning was significantly higher than that at the end (2.47 vs. 1.14, p = 0.000). CONCLUSIONS Overall, a one-year postgraduate dental training program neither reduced nor increased trainee dentists' empathy levels. Providing regular education support in this area may help trainees foster their empathy.
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Affiliation(s)
- Toshiko Yoshida
- Center for Education in Medicine and Health Sciences (Dental Education), Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita- ku, 700-8558, Okayama, Okayama, Japan.
| | - Sho Watanabe
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Takayuki Kono
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Hiroaki Taketa
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Noriko Shiotsu
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Hajime Shirai
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Yukie Nakai
- Department of Dental Hygiene, University of Shizuoka, Junior College, 2-2-1 Oshika, Suruga- ku, 422-8021, Shizuoka, Shizuoka, Japan
| | - Yasuhiro Torii
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
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Leu GR, Links AR, Tunkel DE, Walsh JM, Ryan MA, DiCarlo H, Jelin EB, Beach MC, Boss EF. Understanding Bias in Surgery: Perceived Cultural Similarity Between Surgeons and Patient Families. Otolaryngol Head Neck Surg 2021; 165:282-289. [PMID: 33430701 DOI: 10.1177/0194599820982639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We describe surgeon and parent perceptions of similarity toward each other and evaluate differences in the perceptions of similarity by race. STUDY DESIGN Observational cohort analysis. SETTING Three outpatient sites. METHODS Following consultations for children undergoing evaluation for 1 of 3 surgical procedures (tonsillectomy, hernia repair, circumcision), surgeons and parents rated their perception of cultural similarity toward each other on a 6-point Likert scale. Surgeon evaluation of 9 parent characteristics was measured with 7-point Likert scales. Regression analyses were performed to identify predictors of greater surgeon-perceived similarity and to assess associations of perceived similarity with evaluation of parent characteristics. RESULTS Most parents were women (n = 38, 84%), whereas surgeons were primarily men (n = 7, 54%). Of 45 parents, 23 (51%) were non-White, whereas only 4 of 13 clinicians (31%) were non-White. Mean perceived similarity score was 21.7 for parents (range, 10-24) and 18.2 for surgeons (range, 10-24). There was no difference in parent-perceived similarity based on race (White vs non-White parents, mean [SD] = 22.3 [3.4] vs 21.1 [3.0]; P = .26). Surgeons perceived greater similarity with White parents (odds ratio = 4.78; 95% CI, 1.02-22.54; P = .04) and parents with higher income (odds ratio = 11.84; 95% CI, 1.32-106.04; P = .03). Greater perceived similarity by the surgeons was associated with more positive assessments of parent personality characteristics. CONCLUSION Surgeons perceived similarity more commonly with White parents, while parents' perception of similarity to surgeons was uniform regardless of parent race. Elucidating biases of surgeons may help to tailor interventions promoting culturally competent, equitable communication and decision making for elective surgery.
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Affiliation(s)
- Grace R Leu
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heather DiCarlo
- Department of Pediatric Urology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric B Jelin
- Department of Pediatric Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mary Catherine Beach
- Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Leyva-Moral JM, Gómez-Ibáñez R, San Rafael S, Guevara-Vásquez G, Aguayo-González M. Nursing students' satisfaction with narrative photography as a method to develop empathy towards people with Hiv: A mixed-design study. NURSE EDUCATION TODAY 2021; 96:104646. [PMID: 33160157 DOI: 10.1016/j.nedt.2020.104646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/29/2020] [Accepted: 10/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A major concern for people living with HIV during their lifetime is stigma and discrimination. It is therefore crucial to improve new generations of nurses' empathetic attitude towards these patients to eliminate fear and reduce discrimination using new educational interventions. OBJECTIVE To analyze nursing students' satisfaction with narrative photography as a method to develop empathy towards people living with HIV. DESIGN Concurrent mixed-method design. PARTICIPANTS Seventeen first-year nursing students from a public university in Barcelona, Spain. METHODS A 32-item questionnaire was administered at the end of the narrative photography training activity to determine nursing students' satisfaction with the methodology. Sociodemographic, attitudinal, skills, and satisfaction data were collected. Qualitative data were collected using a reflective open-ended question. RESULTS Of the participants, 82.4% stated that narrative photography helped them to develop reflective thinking and perceive how people living with HIV may feel. Further, 88.2% said that the new method helped them to eliminate some of their prejudices about HIV/AIDS, consider different points of view, understand the importance of providing humanized care, and identify discriminatory behaviors when caring for people living with HIV. Finally, 70.6% stated that narrative photography taught them more than traditional lectures. CONCLUSIONS Nursing students' satisfaction with narrative photography as a teaching strategy is very high; as a result, empathy is advanced in an academic and professional way during the nursing degree. However, more research is needed to demonstrate its efficacy in different scenarios.
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Affiliation(s)
- Juan M Leyva-Moral
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain.
| | - Rebeca Gómez-Ibáñez
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain
| | - Sabiniana San Rafael
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain
| | | | - Mariela Aguayo-González
- Universitat Autònoma de Barcelona, Faculty of Medicine, Department of Nursing, Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Barcelona, Spain
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Can Empathy Improve Therapeutic Adherence in Schizophrenia? J Clin Psychopharmacol 2020; 40:89-90. [PMID: 31804453 DOI: 10.1097/jcp.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Robinson SA, Zocchi MS, Netherton D, Ash A, Purington CM, Connolly SL, Vimalananda VG, Hogan TP, Shimada SL. Secure Messaging, Diabetes Self-management, and the Importance of Patient Autonomy: a Mixed Methods Study. J Gen Intern Med 2020; 35:2955-2962. [PMID: 32440998 PMCID: PMC7572993 DOI: 10.1007/s11606-020-05834-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Diabetes is a complex, chronic disease that requires patients' effective self-management between clinical visits; this in turn relies on patient self-efficacy. The support of patient autonomy from healthcare providers is associated with better self-management and greater diabetes self-efficacy. Effective provider-patient secure messaging (SM) through patient portals may improve disease self-management and self-efficacy. SM that supports patients' sense of autonomy may mediate this effect by providing patients ready access to their health information and better communication with their clinical teams. OBJECTIVE We examined the association between healthcare team-initiated SM and diabetes self-management and self-efficacy, and whether this association was mediated by patients' perceptions of autonomy support from their healthcare teams. DESIGN We surveyed and analyzed content of messages sent to a sample of patients living with diabetes who use the SM feature on the VA's My HealtheVet patient portal. PARTICIPANTS Four hundred forty-six veterans with type 2 diabetes who were sustained users of SM. MAIN MEASURES Proactive (healthcare team-initiated) SM (0 or ≥ 1 messages); perceived autonomy support; diabetes self-management; diabetes self-efficacy. KEY RESULTS Patients who received at least one proactive SM from their clinical team were significantly more likely to engage in better diabetes self-management and report a higher sense of diabetes self-efficacy. This relationship was mediated by the patient's perception of autonomy support. The majority of proactive SM discussed scheduling, referrals, or other administrative content. Patients' responses to team-initiated communication promoted patient engagement in diabetes self-management behaviors. CONCLUSIONS Perceived autonomy support is important for diabetes self-management and self-efficacy. Proactive communication from clinical teams to patients can help to foster a patient's sense of autonomy and encourage better diabetes self-management and self-efficacy.
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Affiliation(s)
- Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | - Mark S Zocchi
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Arlene Ash
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Carolyn M Purington
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,School of Medicine, Boston University, Boston, MA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA.,School of Public Health, Boston University, Boston, MA, USA
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Howick J, Mittoo S, Abel L, Halpern J, Mercer SW. A price tag on clinical empathy? Factors influencing its cost-effectiveness. J R Soc Med 2020; 113:389-393. [PMID: 32930031 PMCID: PMC7575288 DOI: 10.1177/0141076820945272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- J Howick
- Faculty of Philosophy, 6396University of Oxford, Oxford OX2 6GG, UK
| | - S Mittoo
- University Health Network, 7938University of Toronto, Toronto, Ontario, M5G 2C4 Canada
| | - L Abel
- Nuffield Department of Primary Care Health Sciences, 6396University of Oxford, Oxford OX2 6GG, UK
| | - J Halpern
- School of Public Health, University of California at Berkeley, CA 94720-7360, USA
| | - S W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, EH8 9AG UK
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Park J, Saha S, Han D, Jindal M, Korthuis PT, Moore R, Beach MC. Are clinicians' self-reported empathic concern and perspective-taking traits associated with their response to patient emotions?: Communication Studies. PATIENT EDUCATION AND COUNSELING 2020; 103:1745-1751. [PMID: 32362523 PMCID: PMC7423637 DOI: 10.1016/j.pec.2020.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To understand whether clinicians' empathic concern and perspective-taking traits are associated with their response to patient emotions. METHODS We audio-recorded 41 HIV clinician interactions with 342 patients at two academic medical centers. We assessed clinicians' self-reported empathic concern and perspective-taking traits using the Interpersonal Reactivity Index and coded emotional communication using the Verona Coding Definitions of Emotional Sequences. We used random effects models to assess associations between clinician traits and clinician responses to patients' negative emotions, accounting for clustering of emotions within encounters and patients within clinicians. RESULTS Clinicians with more self-reported empathic concern received fewer emotional expressions from their patients (β -0.06; 95% CI -0.10, -0.01) and had greater odds of responding to emotions by giving information/advice (OR 1.10; 95% CI 1.01, 1.20). There were no associations between empathic concern or perspective-taking and any other clinician responses. CONCLUSION Clinicians with higher levels of empathic concern respond to patient emotions by giving information and advice, a response traditionally thought of as a missed empathic opportunity, not by exploring emotions or providing empathy. Whether this is helpful to patients is unknown. PRACTICE IMPLICATIONS Clinicians should be aware of their tendency to give information to patients with emotional distress, and consider whether this response is helpful to patients.
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Affiliation(s)
- Jenny Park
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Somnath Saha
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Dingfen Han
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monique Jindal
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Todd Korthuis
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Richard Moore
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
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Sack DE, Frisby MB, Diemer MA, De Schacht C, Graves E, Kipp AM, Emílio A, Matino A, Barreto E, Van Rompaey S, Wallston KA, Audet CM. Interpersonal reactivity index adaptation among expectant seroconcordant couples with HIV in Zambézia Province, Mozambique. BMC Psychol 2020; 8:90. [PMID: 32859272 PMCID: PMC7456002 DOI: 10.1186/s40359-020-00442-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) - an empathy scale - among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial - a cluster randomized controlled trial assessing couple-based versus individual treatment on viral suppression - in Zambézia Province, Mozambique. METHODS Using baseline data from 1332 HoPS+ trial participants (666 couples), an exploratory factor analysis assessed culturally relevant questions from the IRI. Because empathy is interdependent among couples, we validated the results of the exploratory factor analysis using a dyadic confirmatory factor analysis (CFA) with dyadic measurement invariance testing. Finally, we assessed the relationship between scores on our final scale and basic demographic characteristics (sex, age, education, and depression) using t-tests. RESULTS We found two subscales: 1) a seven-item cognitive empathy subscale (Cronbach's alpha 0.78) and 2) a six-item affective empathy subscale (Cronbach's alpha 0.73). The dyadic CFA found acceptable model fit and metric invariance across partners (Comparative Fit Index (CFI) = 0.914, Tucker Lewis Index = 0.904, Root Mean Squared Error of Approximation = 0.056, ΔCFI = 0.011). We observed higher cognitive (p: 0.012) and affective (p: 0.049) empathy among males and higher cognitive (p: 0.031) and affective (p: 0.030) empathy among younger participants. More educated participants had higher affective empathy (p: 0.017) and depressed participants had higher cognitive empathy (p: < 0.001). This two-subscale, 13-item version of the IRI measures cognitive and affective empathy in HoPS+ trial participants and adults while accounting for the interdependent nature of empathy within partner dyads. CONCLUSIONS This scale will allow us to assess the interplay between empathy and other psychometric constructs (stigma, social support, etc.) in the HoPS+ trial and how each relates to retention in HIV, adherence to treatment, and prevention of maternal to child HIV transmission. Furthermore, this scale can be adapted for other sub-Saharan African populations, which will allow researchers to better assess HIV-related intervention efficacy. TRIAL REGISTRATION This study is within the context of the HoPS+ trial, registered at ClinicalTrials.gov as number NCT03149237 . Registered May 11, 2017.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | | | | | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | | | | | | | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
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Underwood M, Ronald K. A pilot study assessing the impact of a polypharmacy mock medication simulation on student adherence and empathy. CURRENTS IN PHARMACY TEACHING & LEARNING 2020; 12:956-962. [PMID: 32564998 DOI: 10.1016/j.cptl.2020.04.020] [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: 03/31/2019] [Revised: 02/14/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION With non-adherence rates rising among patients, educational activities to prepare future practitioners to be more empathetic and have a more personal understanding of patients' complex medication regimens need to be developed and assessed. The objective of this study was to assess student adherence as well as change in empathy after students immerse themselves in a polypharmacy mock medication simulation. METHODS First professional year pharmacy (P1) students were recruited to participate in a pilot polypharmacy simulation consisting of eight prescriptions taken for seven days. Baseline characteristics and empathy (Kiersma-Chen Empathy Scale [KCES]) were assessed in pre-surveys, and student medication adherence, empathy (KCES), and insight into activity were assessed in post-surveys. RESULTS There was not a statistically significant change in the total mean empathy score between pre- and post-KCES (83 vs. 82, p = 1.0). One KCES question, "I will not allow myself to be influenced by someone's feeling when determining the best treatment," produced a significant change in mean score (4.77 vs. 4.10, p = 0.02). The average percentage of late and missed doses as self-reported by students, was 5.63% and 5.04%, respectively. Two themes emerged regarding student perception of the experience: improved patient counseling regarding adherence and improved empathy and patient perspective on medication regimen complexity. CONCLUSIONS Despite a lack of significant change in KCES after participating in the mock medication regimen, qualitative analysis revealed students believed the experience improved their patient counseling skills regarding adherence and further developed their empathy and patient perspective regarding medication regimen complexity.
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Affiliation(s)
- Megan Underwood
- Illinois CancerCare, P.C., 8940 N. Wood Sage Rd, Peoria, IL 61615, United States.
| | - Katie Ronald
- Southern Illinois University Edwardsville School of Pharmacy, 200 University Park Dr, Campus Box 2000, Edwardsville, IL 62026-2000, United States.
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England JA, Howell M, White BAA. Creating a culture of communication in undergraduate medical education. Proc AMIA Symp 2020; 33:485-491. [PMID: 32676001 PMCID: PMC7340425 DOI: 10.1080/08998280.2020.1746156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
Quality communication improves outcomes across a wide variety of health care metrics. However, communication training in undergraduate medical education remains heterogeneous, with real-life clinical settings notably underutilized. In this perspective, the authors review the current landscape in communication training and propose the development of communication-intensive rotations (CIRs) as a method of integrating communication training into the everyday clinical environment. Despite its importance, communication training is often relegated to a "parallel curriculum." Through integration, CIRs can provide opportunities for real-life skills training, decrease parallel curriculum burden, and provide specialty-specific training in preparation for residency. Clear, efficient communication and human connection remain central in a physician's practice. CIRs reinforce these crucial principles. Potential benefits of a CIR model include role modeling of expert communication techniques; real-time, specific feedback on communication behaviors; development of relationship-centered communication skills and human connection, thereby decreasing burnout; and the opportunity for quality communication practices to become habits in a medical student's daily routine.
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Affiliation(s)
- Julie A. England
- College of Medicine, Texas A&M Health Sciences CenterTempleTexas
| | - Martha Howell
- Office of Patient Experience, Baylor Scott & White HealthTempleTexas
| | - Bobbie Ann Adair White
- Department of Humanities in Medicine, Texas A&M College of MedicineTempleTexas
- MGH Health Professions InstituteBostonMassachusetts
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Roberts BW, Trzeciak CJ, Puri NK, Mazzarelli AJ, Trzeciak S. Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e034247. [PMID: 32595149 PMCID: PMC7322320 DOI: 10.1136/bmjopen-2019-034247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/23/2020] [Accepted: 05/21/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Clinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities exist in patient satisfaction with clinicians. However, it is currently unclear if there are disparities in patient experience of empathy from clinicians. Our objective is to systematically analyse the scientific literature to test the hypothesis that racial and socioeconomic status (SES) disparities exist in patient-reported experience of clinician empathy. METHODS AND ANALYSIS In accordance with published methodological guidelines for conducting a systematic review, we will analyse studies reporting patient assessment of clinician empathy using the Consultation and Relational Empathy (CARE) measure, which to date is the most commonly used and well-validated methodology in clinical research for measuring clinician empathy from the patient's perspective. We will use a standardised data collection template and assess study quality (risk of bias) using the Newcastle-Ottawa Scale. We will abstract data for the CARE measure stratified by race and SES, and we will contact the corresponding authors to obtain stratified data by race/SES if not reported in the original manuscript. Where appropriate, we will pool the data and perform quantitative meta-analysis to test if non-white (compared to white) patients and low SES (compared to high SES) patients report lower scores for clinician empathy. ETHICS AND DISSEMINATION No individual patient-level data will be collected and thus the proposed systematic review does not require ethical approval. This systematic review will test if racial and SES differences exist in patient experience of clinician empathy, and will inform future research to help promote healthcare equity. PROSPERO REGISTRATION NUMBER CRD42019142809.
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Affiliation(s)
- Brian W Roberts
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Christian J Trzeciak
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
| | - Nitin K Puri
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Anthony J Mazzarelli
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Stephen Trzeciak
- Departments of Medicine and Emergency Medicine, Cooper University Health Care, Camden, New Jersey, USA
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Arango Restrepo MC, Salazar Maya AM. “Estableciendo vínculos dialógicos que alivian”: una mirada desde el patrón estético. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: La enfermedad cardiovascular es la segunda causa de morbimortalidad en el mundo, genera carga social y económica. La falta de adherencia a los medicamentos cardiovasculares está asociada con múltiples riesgos. Objetivo: Describir la categoría: Estableciendo vínculos dialógicos que alivian desde el patrón estético Materiales y Métodos: Investigación cualitativa con enfoque en la teoría fundamentada basado en Corbin y Strauss. Participaron 12 personas, la recolección de la información fue la entrevista en profundidad. En el análisis se codifico, línea por línea los textos, se etiquetaron códigos, que dieron origen a las subcategorías y categorías, luego se direccionó a examinar los datos de forma teórica, se integró y refinó la categoría. Resultados: Estableciendo vínculos dialógicos que alivian, compuesta por las subcategorías: Experimentado clima de afecto y confianza para el aprendizaje: creando empatía; Estableciendo conexiones de cuidado que dan satisfacción y construyendo sentimientos positivos del encuentro dialógico. Discusión: El establecimiento de vínculos dialógicos que alivian hace parte del conocimiento estético, uno de los patrones de conocimiento identificados por Carper, descrito como "arte de la enfermería”. Se caracteriza por ser intangible, y no va más allá del contexto de la experiencia personal de cada individuo. Conclusiones: El vínculo dialógico que alivia, es un encuentro genuino que permite interacción creativa enfermera-paciente. Este se experimenta a través de palabras y gestos que expanden la conciencia del ser humano que vive la experiencia de la enfermedad coronaria y requiere de tratamiento de uso crónico para mantener su control.
Como citar este artículo: Arango Restrepo María Cristina, Salazar Maya Angela María. Estableciendo vínculos dialógicos que alivian”: una mirada desde el patrón estético. Revista Cuidarte. 2020; 11(2): e1086. http://dx.doi.org/10.15649/cuidarte.1086
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Irungu EM, Ngure K, Mugwanya KK, Awuor M, Dollah A, Ongolly F, Mugo N, Bukusi E, Wamoni E, Odoyo J, Morton JF, Barnabee G, Mukui I, Baeten JM, O'Malley G. "Now that PrEP is reducing the risk of transmission of HIV, why then do you still insist that we use condoms?" the condom quandary among PrEP users and health care providers in Kenya. AIDS Care 2020; 33:92-100. [PMID: 32207327 DOI: 10.1080/09540121.2020.1744507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Communication around condom use in the context of PrEP services presents a potential conundrum for patients and providers. Within the Partners Scale-Up Project, which supports integration of PrEP delivery in HIV care clinics, we interviewed 41 providers and 61 PrEP users and identified themes relating to condom messaging and use. Most providers counselled PrEP initiators to always use both PrEP and condoms, except when trying to conceive. However, others reported contexts and rationales for not emphasizing condom use. Providers reported that PrEP users were sometimes confused, even frustrated, with their insistence on using condoms in addition to PrEP. PrEP users generally regarded PrEP as a more feasible and desirable HIV prevention method than condoms, enabling increased sexual pleasure and conception, and reducing the conflict and stigma associated with condom use. Innovative approaches to condom counselling in PrEP programs are needed.
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Affiliation(s)
- Elizabeth M Irungu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington
| | - Kenneth Ngure
- Department of Global Health, University of Washington.,School of Public Health, Jomo Kenyatta University of Agriculture and Technology
| | | | - Merceline Awuor
- Centre for Microbiology Research, Kenya Medical Research Institute
| | - Annabelle Dollah
- Centre for Microbiology Research, Kenya Medical Research Institute
| | - Fernandos Ongolly
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington.,Centre for Microbiology Research, Kenya Medical Research Institute
| | - Elizabeth Wamoni
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute
| | | | - Gena Barnabee
- Department of Global Health, University of Washington
| | | | - Jared M Baeten
- Department of Global Health, University of Washington.,Department of Epidemiology, University of Washington.,Department of Medicine, University of Washington
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50
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Halpin SN, Ge L, Mehta CC, Gustafson D, Robertson KR, Rubin LH, Sharma A, Vance D, Valcour V, Waldrop-Valverde D, Ofotokun I. Psychosocial Resources and Emotions in Women Living With HIV Who Have Cognitive Impairment: Applying the Socio-Emotional Adaptation Theory. Res Theory Nurs Pract 2020; 34:49-64. [PMID: 31937636 PMCID: PMC8062986 DOI: 10.1891/1541-6577.34.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Decreased cognitive function is related to undesirable psychological outcomes such as greater emotional distress and lower quality of life, particularly among women living with HIV who experience cognitive impairment (WLWH-CI). Yet, few studies have examined the psychosocial resources that may attenuate these negative emotional outcomes. The current study sought to identify the interrelated contributions of social relationships and psychological resources in 399 WLWH-CI by applying Socio-Emotional Adaptation (SEA) theory using data from the Women's Interagency HIV Study (WIHS). Cognitive impairment (CI) was defined as impairment on two or more cognitive domains. Logistic regression models were used to estimate the odds of experiencing specific emotions due to a combination of four psychosocial resources. Emotions (i.e., depression, apathy, fear, anger, and acceptance) were related to a combination of binary (positive/negative) psychosocial resources including relationship with an informal support partner, relationship with a formal caregiver, coping, and perceived control. Understanding the conditions that may influence emotions in WLWH-CI is important for identifying and appropriately addressing the needs of this population. As CI increases, these individuals experience increasing challenges with articulating their care needs and having their needs met. As such, it becomes increasingly important to identify possible triggers for emotional responses to best address these underlying challenges.
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Affiliation(s)
| | - Lin Ge
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Christina C Mehta
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | | | - Kevin R Robertson
- AIDS Neurological Center, Department of Neurology.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah H Rubin
- Departments of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Anjali Sharma
- Albert Einstein College of Medicine, Yeshiva University, New York, NY
| | - David Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Victor Valcour
- Global Brain Health Institute, San Franscisco, CA.,Department of Neurology, University of California San Fransisco, San Fransisco, CA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
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