Measuring the quality of clinician-patient information exchange

Parents' experiences of their child's best interests during a hospital stay in Australia

Determining the child's best interests in a hospital setting will ideally involve the combined views of children, parents, and healthcare professionals. However, few studies have explored parents' experiences of their child's best interests when they engage with the healthcare system. Therefore, this study aimed to explore parents' experiences of their child's best interests during hospitalisation. A descriptive qualitative inductive design using face-to-face parent-child combined interviews, analysed by latent content analysis, was used. Sixteen parents recruited from a tertiary hospital in Western Australia were interviewed. Collaboration, development of trustworthy relationships, and effective communication were essential in shaping parents' experiences of their child's best interests during hospitalisation.

Assessment of parent understanding in conferences for critically ill neonates

OBJECTIVES

This study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants.

METHODS

We enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as "absent," "yes/no," or "elaborated."

RESULTS

Fifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their answers most of the time (n = 55/60, 92%). Approximately three-quarter of partial assessments yielded no verbal response from parents. No conferences included a teach-back.

CONCLUSIONS

Although common, most clinician assessments of understanding were partial or close-ended and rarely resulted in elaborated responses from parents. Open-ended assessments are an effective, underutilized strategy to increase parent engagement and clinician awareness of information needs.

PRACTICE IMPLICATIONS

Clinicians hoping to facilitate parent engagement and question-asking should rely on open-ended statements to assess understanding.

Promoting High-Quality Health Communication Between Young Adults With Diabetes and Health Care Providers

Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.

Priority-setting and feasibility of health information exchange for primary care patients with intellectual disabilities: A modified Delphi study

OBJECTIVE

Accurate health information exchange (HIE) is fragile in healthcare for patients with intellectual disabilities (ID), threatening the health outcomes for this patient group. In conjunction with a group of experts, we aimed to identify the principal actions and organisational factors facilitating HIE for primary care patients with ID and to assess their perceived feasibility in daily practice.

METHODS

We conducted a two-round modified Delphi study with Dutch GPs (n=22), support workers (n=18) and ID physicians (n=20). In an extensive set of 61 items covering actions and organisational factors, experts ranked items in order of importance and rated their feasibility.

RESULTS

Agreement was reached on the importance of 22 actions and eight organisational factors, of which 82% were deemed (very) feasible in daily practice. Experts stressed the importance of listed actions and factors being implemented simultaneously and remarked that further priority should be based on contextual demands.

CONCLUSION AND PRACTICE IMPLICATIONS

This study indicates the principal actions and organisational factors for HIE regarding primary care patients with ID. The set can be used as a practical guide to optimise inter-professional cooperation and arrange the distribution of HIE roles and responsibilities in relation to this patient group.

Communication and patient participation influencing patient recall of treatment discussions

CONTEXT

Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall.

OBJECTIVES

To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients.

DESIGN

Observational study within a RCT.

SETTING & PARTICIPANTS

Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia.

MAIN VARIABLES

Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE.

MAIN OUTCOME MEASURES

Recall of CD, lifestyle treatment and medication information.

RESULTS

Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall.

DISCUSSION

Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC.

CONCLUSION

Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.

The influence of contextual factors on patient involvement during follow-up consultations after colorectal cancer surgery: a case study

AIMS AND OBJECTIVES

To identify the contextual factors that influence individual patient involvement during colorectal cancer surgical follow-up consultations.

BACKGROUND

The healthcare system is subject to the requirement and expectation of greater involvement of patients and relatives. Increased patient involvement requires the development and implementation of new communication initiatives. Research shows that it is also necessary to consider the contextual circumstances surrounding patient involvement in specific situations.

DESIGN

Case study of a single Danish outpatient clinic, which allows the issues and circumstances involved in an everyday situation to be captured.

METHOD

12 nonparticipative observations of outpatient visits and, subsequently, seven in-depth patient interviews.

ANALYSIS

Content analysis based on a dialogical, interactive framework, which underpinned the identification of current contextual factors.

RESULTS

The results showed five contextual factors that seemed to have an impact on patient involvement. The first, 'Two dimensions of patient involvement: treatment-oriented and person-oriented' highlighted a dual interpretation of patient involvement in the consultation situation. The two dimensions seemed to be influenced by four additional factors: 'Doctors leading the agenda', 'Traditional health professional roles', 'Unclear responsibilities' and 'Guidance primarily focused on treatment'.

CONCLUSION

The results showed how patient involvement in clinical practice could be understood as a two-way movement, in which patients are invited to participate in clinical practice, while health professionals are invited to participate in the patients' lives. The movement will change from situation to situation and is influenced by several contextual factors.

RELEVANCE TO CLINICAL PRACTICE

The results can help doctors and nurses to navigate using a goal-oriented approach towards patient involvement. The study makes visible the need for research-based development of the independent role of the nursing profession in cancer care follow-up, with a view to enhanced patient-centred care.