1
|
Amoakoh HB, De Kok BC, Yevoo LL, Olde Loohuis KM, Srofenyoh EK, Arhinful DK, Koi-Larbi K, Adu-Bonsaffoh K, Amoakoh-Coleman M, Browne JL. Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design. Glob Health Action 2024; 17:2336314. [PMID: 38717819 PMCID: PMC11080670 DOI: 10.1080/16549716.2024.2336314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Globally, the incidence of hypertensive disorders of pregnancy, especially preeclampsia, remains high, particularly in low- and middle-income countries. The burden of adverse maternal and perinatal outcomes is particularly high for women who develop a hypertensive disorder remote from term (<34 weeks). In parallel, many women have a suboptimal experience of care. To improve the quality of care in terms of provision and experience, there is a need to support the communication of risks and making of treatment decision in ways that promote respectful maternity care. Our study objective is to co-create a tool(kit) to support clinical decision-making, communication of risks and shared decision-making in preeclampsia with relevant stakeholders, incorporating respectful maternity care, justice, and equity principles. This qualitative study detailing the exploratory phase of co-creation takes place over 17 months (Nov 2021-March 2024) in the Greater Accra and Eastern Regions of Ghana. Informed by ethnographic observations of care interactions, in-depth interviews and focus group and group discussions, the tool(kit) will be developed with survivors and women with hypertensive disorders of pregnancy and their families, health professionals, policy makers, and researchers. The tool(kit) will consist of three components: quantitative predicted risk (based on external validated risk models or absolute risk of adverse outcomes), risk communication, and shared decision-making support. We expect to co-create a user-friendly tool(kit) to improve the quality of care for women with preeclampsia remote from term which will contribute to better maternal and perinatal health outcomes as well as better maternity care experience for women in Ghana.
Collapse
Affiliation(s)
- Hannah Brown Amoakoh
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bregje C. De Kok
- Anthropology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Lucy Yevoo
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Klaartje M. Olde Loohuis
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emmanuel K. Srofenyoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Daniel K. Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kwame Adu-Bonsaffoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joyce L. Browne
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
2
|
Dewi SP, Wilson A, Duvivier R, Kelly B, Gilligan C. Do the teaching, practice and assessment of clinical communication skills align? BMC MEDICAL EDUCATION 2024; 24:609. [PMID: 38824578 PMCID: PMC11144343 DOI: 10.1186/s12909-024-05596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Evidence indicates that communication skills teaching learnt in the classroom are not often readily transferable to the assessment methods that are applied nor to the clinical environment. An observational study was conducted to objectively evaluate students' communication skills in different learning environments. The study sought to investigate the extent to which the communication skills demonstrated by students in classroom, clinical, and assessment settings align. METHOD A mixed methods study was conducted to observe and evaluate students during the fourth year of a five-year medical program. Participants were videorecorded during structured classroom 'interactional skills' sessions, as well as clinical encounters with real patients and an OSCE station calling upon communication skills. The Calgary Cambridge Observational Guides was used to evaluate students at different settings. RESULT This study observed 28 students and findings revealed that while in the classroom students were able to practise a broad range of communication skills, in contrast in the clinical environment, information-gathering and relationship-building with patients became the focus of their encounters with patients. In the OSCEs, limited time and high-pressure scenarios caused the students to rush to complete the task which focussed solely on information-gathering and/or explanation, diminishing opportunity for rapport-building with the patient. CONCLUSION These findings indicate a poor alignment that can develop between the skills practiced across learning environments. Further research is needed to investigate the development and application of students' skills over the long term to understand supports for and barriers to effective teaching and learning of communication skills in different learning environments.
Collapse
Affiliation(s)
- Sari Puspa Dewi
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jatinangor Km. 21 Sumedang West Java, Bandung, Indonesia.
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia.
- School of Medicine and Psychology, Australian National University, Canberra, Australia.
| | - Amanda Wilson
- School of Nursing and Midwifery, The University of Technology Sydney, Ultimo, Australia
| | - Robbert Duvivier
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Center for Education Development and Research in Health Professions (CEDAR), Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Brian Kelly
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia
| | - Conor Gilligan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales , Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| |
Collapse
|
3
|
Vandecasteele R, Schelfhout S, D'hondt F, De Maesschalck S, Derous E, Willems S. Intercultural effectiveness in GPs' communication and clinical assessment: An experimental study. PATIENT EDUCATION AND COUNSELING 2024; 122:108138. [PMID: 38237531 DOI: 10.1016/j.pec.2024.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE This study aimed to investigate potential disparities in general practitioners' overall communication and clinical assessments based on patient ethnicity, while examining the influence of intercultural effectiveness. METHODS Employing a 2 × 2 experimental study design, online video recorded consultations with simulated patients were conducted and analyzed using OSCEs. Each GP (N = 100) completed a consultation with both an ethnic majority and an ethnic minority patient. Additionally, a follow-up survey was administered to gather supplementary data. Paired sample t-tests explored ethnic disparities, correlation and regression analyses determined associations with intercultural attitudes, traits and capabilities. RESULTS No statistically significant differences in GPs' communication or clinical assessment were found based on patients' ethnic background. Positive associations were observed between all aspects of intercultural effectiveness and GPs' consultation behavior. Intercultural traits emerged as a strong and robust predictor of clinical assessment of ethnic minority patients. CONCLUSION Intercultural traits, such as ethnocultural empathy, may play a critical role in GPs' clinical assessment skills during intercultural consultations. PRACTICE IMPLICATIONS Findings provide valuable insights into the determinants of intercultural effectiveness in healthcare, fostering promising targets for interventions and training programs aiming to ensure higher-quality and more equitable care delivery.
Collapse
Affiliation(s)
- Robin Vandecasteele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stijn Schelfhout
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Fanny D'hondt
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium
| | - Stéphanie De Maesschalck
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Eva Derous
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Erasmus University Rotterdam, Erasmus School of Social and Behavioural Sciences, Burgemeester Oudlaan 50, 3062 Rotterdam, the Netherlands
| | - Sara Willems
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
4
|
O'Reilly M, Kiyimba N. Investigating question-answer sequences in child mental health assessments: Engaging children and families through declarative question design. PATIENT EDUCATION AND COUNSELING 2024; 121:108105. [PMID: 38129242 DOI: 10.1016/j.pec.2023.108105] [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: 11/29/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE In mental health settings, before a child can be diagnosed with a mental health condition, they must initially be assessed. These assessments are characterised by question-answer sequences with the child and family members, and our objective is to explore the function of declarative questions. METHODS Video recordings of mental health assessments from 28 families were collected, each being approximately 90 min. Referred children were aged 6-17-years. Data were transcribed using the Jefferson approach and conversation analysis was used. RESULTS Attention to question-answer sequences identified that one common type was the declarative question. We focus on three identifiable forms: clean language short declaratives, declaratives with extreme case formulations, and reformulation declaratives. CONCLUSIONS The response to these three types of declaratives formed the basis for subsequent question-answer elaboration sequences. The question functioned both to engage the child directly and align with other family members. PRACTICE IMPLICATIONS Implications for practitioners are that these types of declarative questions offer a resource to engage in fact-checking in a way that is non-face-threatening. Conversation analysis provides a methodological tool for practitioners to engage in reflective practice to enhance their clinical skills in relation to question design.
Collapse
Affiliation(s)
- Michelle O'Reilly
- University of Leicester and Leicestershire Partnership NHS Trust, University Road, Leicester LE1 7RH, UK.
| | - Nikki Kiyimba
- Mātai Rongo Trauma-Responsive Psychological Services, ReDefined Wellbeing Hub, 58 Ashley Place, Papamoa Beach 3118, Bay of Plenty, New Zealand
| |
Collapse
|
5
|
Obucina M, Hamill L, Huynh R, Alcorn K, Cross J, Sweeny A, Keijzers G. How Clinicians Decide? Exploring Complexity of Antibiotic Prescribing in Emergency Departments Using Video-Reflexive Ethnography. QUALITATIVE HEALTH RESEARCH 2023; 33:1333-1348. [PMID: 37870924 PMCID: PMC10666467 DOI: 10.1177/10497323231198144] [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: 10/25/2023]
Abstract
Antibiotic overprescribing is a global issue that significantly contributes to increased antimicrobial resistance. Strengthening antimicrobial prescribing practices should be considered a priority. The emergency department (ED) represents a setting where antibiotics are frequently prescribed, but the determinants that influence prescribing choices are complex and multifaceted. We conducted an exploratory qualitative study to investigate the contextual factors that influence antibiotic prescribing choices among clinicians in the ED. The study employed video-reflexive ethnography (VRE) to capture prospective clinical decision-making in situated practice. Data collection involved fieldwork observations, video observations, and delivery of facilitated group reflexive sessions, where clinicians viewed a selection of recorded video snippets relating to antibiotic prescribing. Study was conducted across two EDs within the same health service in Australia. A total of 29 clinical conversations focusing on antibiotic prescribing were recorded. Additionally, 34 clinicians participated in group reflexive sessions. Thematic analysis from the transcribed data yielded four themes: 'importance of clinical judgment', 'usability of prescribing guidelines', 'managing patient expectations', and 'context-dependent disruptions'. Our findings provide insights into the challenges faced by clinicians in navigating complex ED environment, utilising electronic decision-support tools and engaging in discussions about patient treatments with senior clinicians. The findings also indicate that VRE is useful in visualising full complexity of the ED setting, and in initiating meaningful discussions among clinical teams. Integrating the use of VRE in everyday clinical settings can potentially facilitate the implementation of pragmatic solutions for delivering effective antibiotic stewardship practices.
Collapse
Affiliation(s)
- Mila Obucina
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Laura Hamill
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
- Canterbury Health DHB, Christchurch, New Zealand
| | - Ronald Huynh
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
| | - Kylie Alcorn
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
| | - Jack Cross
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
| | - Amy Sweeny
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
- Bond University, Gold Coast, QLD, Australia
| |
Collapse
|
6
|
Paananen J. Discussing physical restrictions in care plan meetings between family members of residents with dementia and nursing home staff. DEMENTIA 2023; 22:1530-1547. [PMID: 37387268 PMCID: PMC10521163 DOI: 10.1177/14713012231186346] [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] [Indexed: 07/01/2023]
Abstract
In long-term dementia care, caregivers face a dilemma. On the one hand, they need to respect the residents' right to self-determination, but on the other hand, they sometimes rely on physical restraints to deal with potential violence and self-destructive behavior. The issue of self determination is further complicated by residents often depending on family members as advocates in decision-making. In this article, we examine 15 care plan meetings to identify the professional practices of discussing the physical restrictions posed to residents with severe dementia. Our method is conversation analysis. Our analysis demonstrates that staff members' practices involve informing, accounting, and agreeing on the goals rather than on the methods of physical restraining. Staff members tend to first inform family members about the principles of restraining and then account for the use of restraints. Accounts highlight the problems that can be avoided and the benefits that can be achieved by limiting residents' actions. Consequently, the family members' role in the discussion is to accept the decision that has already been approved by authorities. As the staff members highlight the aim of protecting the well-being of the resident, the family members tend to respond with overt agreement and even promote the use of restraints. Current negotiation practices provide insufficient opportunities for family members to advocate for residents. Therefore, we recommend involving family members in decision-making about restraining at an earlier stage, adjusting the protocol in care plan meetings, and engaging the family in minimizing and preventing restraints. In general, staff members should pay more attention to the residents' experiences and the family members' lifeworld knowledge of the residents.
Collapse
Affiliation(s)
- Jenny Paananen
- Department of Nursing Science, University of Turku, Finland
| |
Collapse
|
7
|
Lear R, Ellis S, Ollivierre-Harris T, Long S, Mayer EK. Video Recording Patients for Direct Care Purposes: Systematic Review and Narrative Synthesis of International Empirical Studies and UK Professional Guidance. J Med Internet Res 2023; 25:e46478. [PMID: 37585249 PMCID: PMC10468707 DOI: 10.2196/46478] [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: 02/13/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Video recordings of patients may offer advantages to supplement patient assessment and clinical decision-making. However, little is known about the practice of video recording patients for direct care purposes. OBJECTIVE We aimed to synthesize empirical studies published internationally to explore the extent to which video recording patients is acceptable and effective in supporting direct care and, for the United Kingdom, to summarize the relevant guidance of professional and regulatory bodies. METHODS Five electronic databases (MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC) were searched from 2012 to 2022. Eligible studies evaluated an intervention involving video recording of adult patients (≥18 years) to support diagnosis, care, or treatment. All study designs and countries of publication were included. Websites of UK professional and regulatory bodies were searched to identify relevant guidance. The acceptability of video recording patients was evaluated using study recruitment and retention rates and a framework synthesis of patients' and clinical staff's perspectives based on the Theoretical Framework of Acceptability by Sekhon. Clinically relevant measures of impact were extracted and tabulated according to the study design. The framework approach was used to synthesize the reported ethico-legal considerations, and recommendations of professional and regulatory bodies were extracted and tabulated. RESULTS Of the 14,221 abstracts screened, 27 studies met the inclusion criteria. Overall, 13 guidance documents were retrieved, of which 7 were retained for review. The views of patients and clinical staff (16 studies) were predominantly positive, although concerns were expressed about privacy, technical considerations, and integrating video recording into clinical workflows; some patients were anxious about their physical appearance. The mean recruitment rate was 68.2% (SD 22.5%; range 34.2%-100%; 12 studies), and the mean retention rate was 73.3% (SD 28.6%; range 16.7%-100%; 17 studies). Regarding effectiveness (10 studies), patients and clinical staff considered video recordings to be valuable in supporting assessment, care, and treatment; in promoting patient engagement; and in enhancing communication and recall of information. Observational studies (n=5) favored video recording, but randomized controlled trials (n=5) did not demonstrate that video recording was superior to the controls. UK guidelines are consistent in their recommendations around consent, privacy, and storage of recordings but lack detailed guidance on how to operationalize these recommendations in clinical practice. CONCLUSIONS Video recording patients for direct care purposes appears to be acceptable, despite concerns about privacy, technical considerations, and how to incorporate recording into clinical workflows. Methodological quality prevents firm conclusions from being drawn; therefore, pragmatic trials (particularly in older adult care and the movement disorders field) should evaluate the impact of video recording on diagnosis, treatment monitoring, patient-clinician communication, and patient safety. Professional and regulatory documents should signpost to practical guidance on the implementation of video recording in routine practice. TRIAL REGISTRATION PROSPERO CRD42022331825: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331825.
Collapse
Affiliation(s)
- Rachael Lear
- Imperial Clinical Analytics, Research & Evaluation (iCARE), London, United Kingdom
- National Institute for Health and Care Research North West London Patient Safety Research Collaborative, Institute of Global Health Innovation, Imperial College London - St Mary's Hospital Campus, London, United Kingdom
| | - Sophia Ellis
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Hillingdon NHS Foundation Trust, London, United Kingdom
| | | | - Susannah Long
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Erik K Mayer
- Imperial Clinical Analytics, Research & Evaluation (iCARE), Digital Collaboration Space, London, United Kingdom
- National Institute for Health and Care Research North West London Patient Safety Research Collaborative, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| |
Collapse
|
8
|
Collins P, Bridges J, Bartlett R. Gaining access to unspoken narratives of people living with dementia on a hospital ward-A new methodology. Int J Geriatr Psychiatry 2023; 38:e5987. [PMID: 37587608 DOI: 10.1002/gps.5987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND This is a methodological paper that aims to advance the conceptualisation of participatory research by focusing on the value of capturing and understanding movement as a vital means of communication for older people with dementia in a general hospital ward. Qualitative research involving people with dementia tends to be word-based and reliant upon verbal fluency. This article considers a method for capturing and understanding movement as a vital means of communication. METHOD This narrative enquiry is underpinned by the model of social citizenship that recognises people with dementia as citizens with narratives to share. The study focused on spontaneously produced conversations that were video recorded and analysed through a lens of mobility. This enabled each participant to share what was important to them in that moment of time without always using words. FINDINGS The study findings showed that people with dementia have narratives to share, but these narratives do not fit the bio-medically constructed model that is generally expected from patients. Utilising a mobilities lens enabled the narratives to be understood as containing layers of language. The first layer is the words; the second layer is gestures and movements that support the words; and the third layer is micro movements. These movements do not only support the words but in some cases tell a different story altogether. CONCLUSION This methodology brings attention to layers of communication that reveal narratives as a mobile process that require work from both the teller and the listener to share and receive. Movements are shown to be the physical manifestations of embodied language which when viewed through a lens of mobility enable a deeper understanding of the experience of living with dementia when an inpatient. Viewing narratives through a mobilities lens is important to the advancement of dementia and citizenship practices.
Collapse
Affiliation(s)
- Pippa Collins
- Dorset Healthcare University NHS Foundation Trust, Kings Park Hospital, Bournemouth, UK
- School of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Wessex, UK
| | - Jackie Bridges
- School of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Wessex, UK
| | - Ruth Bartlett
- School of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Wessex, UK
| |
Collapse
|
9
|
Cash EK, Giambra BK. Audiovisual Recording in the Inpatient Setting: A Method for Studying Parent-Nurse Communication. JOURNAL OF FAMILY NURSING 2023; 29:192-201. [PMID: 37133301 DOI: 10.1177/10748407231162131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Audiovisual recordings are under-utilized for capturing interactions in inpatient settings. Standardized procedures and methods improve observation and conclusion validity drawn from audiovisual data. This article provides specific approaches for collecting, standardizing, and maintaining audiovisual data based on a study of parent-nurse communication and child and family outcomes. Data were collected using audio and video recorders at defined time points simplifying its collection. Data were downloaded, edited for size and privacy, and securely stored, then transcribed, and subsequently reviewed to ensure accuracy. Positive working relationships with families and nurses facilitated successful study recruitment, data collection, and transcript cleaning. Barriers to recruitment and data collection, such as privacy concerns and technical issues, were successfully overcome. When carefully coordinated and obtained, audiovisual recordings are a rich source of research data. Thoughtful protocol design for the successful capture, storage, and use of recordings enables researchers to take quick action to preserve data integrity when unexpected situations arise.
Collapse
Affiliation(s)
- Erin K Cash
- Cincinnati Children's Hospital Medical Center, OH, USA
| | - Barbara K Giambra
- Cincinnati Children's Hospital Medical Center, OH, USA
- University of Cincinnati College of Nursing, OH, USA
| |
Collapse
|
10
|
Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. PATIENT EDUCATION AND COUNSELING 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
Collapse
Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
11
|
McKay KJ, Shaban RZ. Video based monitoring systems for hand hygiene compliance auditing: What do patients think? PLoS One 2023; 18:e0281895. [PMID: 36893120 PMCID: PMC9997901 DOI: 10.1371/journal.pone.0281895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/02/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Compliance with hand hygiene by healthcare workers is a vital aspect of the quality and safety in healthcare. The current method of monitoring compliance, known as direct observation, has been questioned as have the various electronic measures proposed as alternatives. In our earlier work we established the capacity of video-based monitoring systems (VMS) to collect data with increased efficacy, efficiency and accuracy. However, the spectre of the approach being seen as an unacceptable invasion of patient privacy, was raised as a barrier to implementation by healthcare workers. METHODS In depth, semi structured interviews were conducted with 8 patients in order to explore their beliefs and options regarding the proposed approach. Interviews were transcribed and then thematic and content analysis was conducted in order to uncover themes from the data. RESULTS Despite healthcare worker predictions, patients were generally accepting of the use of video-based monitoring systems for the auditing of hand hygiene compliance. However, this acceptance was conditional. Four interconnected themes emerged from the interview data; quality and safety of care versus privacy, consumer Involvement-knowledge, understanding and consent, technical features of the system, and rules of operation. CONCLUSION The use of within zone VMS approaches to hand hygiene auditing has the potential to improve the efficacy, efficiency and accuracy of hand hygiene auditing and hence the safety and quality of healthcare. By combining a suite of technical and operational specifications with high level consumer engagement and information the acceptability of the approach for patients may be significantly enhanced.
Collapse
Affiliation(s)
- Katherine J. McKay
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- * E-mail:
| | - Ramon Z. Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Sydney Institute for Infectious Diseases, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Camperdown, NSW, Australia
- Communicable Disease Branch, Public Health Unit, Centre for Population Health, Western Sydney Local Health District, Westmead, North Parramatta, NSW, Australia
| |
Collapse
|
12
|
Parry R, Whittaker B, Pino M, Jenkins L, Worthington E, Faull C. RealTalk evidence-based communication training resources: development of conversation analysis-based materials to support training in end-of-life-related health and social care conversations. BMC MEDICAL EDUCATION 2022; 22:637. [PMID: 35996125 PMCID: PMC9395846 DOI: 10.1186/s12909-022-03641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Training to enhance healthcare practitioners' capabilities in engaging people in sensitive and end-of life-related conversations is in demand. However, evaluations have either not measured, or found very limited impact on actual practice and patient experience. Training effectiveness is improved when it is based on in-depth evidence, reflects the complexity of real-life interactions, and instils principles adaptable to everyday practice. A relatively new source of in-depth evidence and practice-relevant insights on healthcare interactions is conversation analytic research, a form of observational analysis of real-life interactions. However, conversation analytic research findings have largely been disseminated by and for scientists, rather than clinicians and trainers. We used conversation analytic evidence to develop resources for use by healthcare trainers. The aim was to increase training's evidence-base and authenticity. We further aimed to develop resources applicable to working with learners ranging from novices to advanced practitioners. METHODS Using an intervention development approach, we created online video-clips and supplementary written materials for professionals who deliver training, supervision, and support in healthcare communication for staff and students. The materials were reviewed by an advisory group comprising clinicians, lay consultees, educators, and researchers, and piloted by trainers in UK universities, NHS organisations and independent hospices. We refined materials based on their feedback. RESULTS The resulting 'RealTalk' resources focus on practices for communicating with patients and their companions about end-of-life and prognosis. Two core training modules were developed, each comprising several patient case studies featuring video-clips from real-life healthcare consultations. The clips featured practices that patients and experienced practitioners use in approaching end-of-life matters. The case studies also included evidence-based descriptions of observable practices and the principles underlying these, alongside transcripts and case synopses. CONCLUSIONS RealTalk training resources aim to facilitate evidence-based, experiential and reflective learning, focusing on communication challenges, practices and principles for end-of-life-related interactions. The resources are designed for use by trainers for delivering all levels of training, from introductory to advanced, in both formal and informal training settings. Our development process may serve as a blueprint for the production of future evidence-based training resources based on conversation analytic research.
Collapse
Affiliation(s)
- Ruth Parry
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Becky Whittaker
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Marco Pino
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Laura Jenkins
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Esme Worthington
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, Loughborough, LE11 3TU UK
| | - Christina Faull
- LOROS Hospice Leicester, University Hospitals of Leicester and Honorary Professor University of Leicester, Leicester, LE3 9QE UK
| |
Collapse
|
13
|
Understanding healthcare providers' experiences with video recording of patient consultations. Prim Health Care Res Dev 2022; 23:e35. [PMID: 35678200 PMCID: PMC9247682 DOI: 10.1017/s1463423622000214] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: To understand healthcare providers’ experiences with video recording of patient consultations. Background: Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development. Methods: A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens. Findings: Three themes were identified reflecting healthcare providers’ experiences with video recording of patient consultations: ‘Concerns of compromising primary work tasks’, ‘Exposing professional and personal skills’ and ‘A new learning dimension’. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations. Conclusion: Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice.
Collapse
|
14
|
Cherba M, Brummans BHJM, Hier MP, Giguère L, Chartier G, Jacobs H, Forest VI, Mlynarek A, Sultanem K, Henry M. Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions. Curr Oncol 2022; 29:3341-3363. [PMID: 35621662 PMCID: PMC9139818 DOI: 10.3390/curroncol29050272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.
Collapse
Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Michael P. Hier
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Gabrielle Chartier
- Department of Nursing, Oncology Division, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Hannah Jacobs
- Department of Audiology and Speech-Language Pathology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Khalil Sultanem
- Division of Radiation Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| |
Collapse
|
15
|
Iflaifel M, Lim R, Crowley C, Greco F, Iedema R. Using video reflexive ethnography to explore the use of variable rate intravenous insulin infusions. BMC Health Serv Res 2022; 22:545. [PMID: 35461276 PMCID: PMC9034771 DOI: 10.1186/s12913-022-07883-w] [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: 07/01/2021] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background The use of variable rate intravenous insulin infusion (VRIII) is a complex process that has consistently been implicated in reports of error and consequent harm. Investment in patient safety has focused mainly on learning from errors, though this has yet to be proved to reduce error rates. The Resilient Health Care approach advocates learning from everyday practices. Video reflexive ethnography (VRE) is an innovative methodology used to capture everyday practices, reflect on and thereby improve these. This study set out to explore the use of VRIIIs by utilising the VRE methodology. Methods This study was conducted in a Vascular Surgery Unit. VRE methodology was used to collect qualitative data that involved videoing healthcare practitioners caring for patients treated with VRIII and discussing the resulting clips with participants in reflexive meetings. Transcripts of these were subjected to thematic analysis. Quantitative data (e.g. blood glucose measurements) were collected from electronic patient records in order to contextualise the outcomes of the video-observed tasks. Results The use of VRE in conjunction with quantitative data revealed that context-dependent adaptations (seeking verbal orders to treat hypoglycaemia) and standardised practices (using VRIII guidelines) were strategies used in everyday work. Reflexive meetings highlighted the challenges faced while using VRIII, which were mainly related to lack of clinical knowledge, e.g. prescribing/continuing long-acting insulin analogues alongside the VRIII, and problems with organisational infrastructure, i.e. the wireless blood glucose meter results sometimes not updating on the electronic system. Reflexive meetings also enabled participants to share the meanings of the reality surrounding them and encouraged them to suggest solutions tailored to their work, for example face-to-face, VRIII-focused training. Conclusions VRE deepened understanding of VRIII by shedding light on its essential tasks and the challenges and adaptations entailed by its use. Future research might focus on collecting data across various units and hospitals to develop a full picture of the use of VRIIIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07883-w.
Collapse
|
16
|
Seuren LM, Shaw SE. Using Linguistic Ethnography to Study Video Consultations: A Call to Action and Future Research Agenda. QUALITATIVE HEALTH RESEARCH 2022; 32:800-813. [PMID: 35245150 PMCID: PMC9152594 DOI: 10.1177/10497323221077297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Video consultations are a rapidly growing service model, particularly in secondary care. Studies, mainly using trials and post-hoc surveys, have routinely documented that they can be a safe and effective means to deliver care at a distance. While video offers new opportunities to provide health services, it also constrains how patients and clinicians can interact, raising questions about feasibility, quality, and safety-questions that cannot be adequately addressed with prevailing methods and approaches. To support successful and appropriate implementation, use and spread of video consultations, we need to investigate how video changes the interaction. In this article, we use two worked examples to demonstrate how Linguistic Ethnography, a methodological approach combining ethnographic with linguistic analysis, enables a detailed understanding of how communication in video consultations works, providing an evidence base to support patients and clinicians with using this service model.
Collapse
Affiliation(s)
- Lucas M. Seuren
- Nuffield Department of Primary Care Health
Sciences, University of Oxford, UK
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health
Sciences, University of Oxford, UK
| |
Collapse
|
17
|
Bathia NS, McAskill RE, Hancox JE, Knaggs RD. Collaboration between adult patients and practitioners when making decisions about prescribing opioid medicines for chronic non-cancer pain in primary care: a scoping review. Br J Pain 2022; 16:119-126. [PMID: 35111320 PMCID: PMC8801689 DOI: 10.1177/20494637211025560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Long-term opioid therapy (>12 months) is not effective for improving chronic non-cancer pain and function. Where patients are not experiencing pain relief with long-term opioids, the opioid should be tapered and discontinuation considered. Practitioners may find it challenging to tell patients experiencing pain that they are better off reducing or not taking medicines that do not help. This review aims to ascertain what is published about: (1) the interaction and (2) the nature of the relationship between practitioners and patients when prescribing opioids for chronic non-cancer pain in primary care. METHOD A scoping review of English-language qualitative, quantitative or mixed-method studies in databases including: MEDLINE, Embase, PsycINFO, AMED, BNI, CINALH EMCARE and HMIC. The identified papers were reviewed to provide a descriptive summary of the literature. RESULTS The review identified 20 studies. The studies used a range of methods including interviews, focus groups, audio and video recordings of clinical consultations, telephone survey and data from patient records. One study reported that researchers had engaged with a patient advisory group to guide their research. Patients expressed the importance of being treated as individuals, not being judged and being involved in prescribing decisions. Practitioners expressed difficulty in managing patient expectations and establishing trust. Opioid risk and practitioner suspicion shape opioid prescribing decisions. There is a paucity of literature about how precisely practitioners overcome interactional challenges and implement personalised care in practice. CONCLUSION The studies in this review ascertain that practitioners and patients often find it challenging to achieve shared decisions in opioid review consultations. Effective communication is essential to achieve good clinical practice. Collaborative research with PPI partners should be aimed at identifying communication practices that support practitioners to achieve shared decisions with patients when reviewing opioids for chronic non-cancer pain.
Collapse
Affiliation(s)
- Nirlas Shantilal Bathia
- NHS Nottingham and Nottinghamshire CCG, Nottingham, UK,Nirlas Shantilal Bathia, NHS Nottingham and Nottinghamshire CCG, Nottingham NG1 6GN, UK.
| | | | - Jennie E Hancox
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Roger D Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| |
Collapse
|
18
|
Lee RR, McDonagh JE, Farre A, Peters S, Cordingley L, Rapley T. Data protection, information governance and the potential erosion of ethnographic methods in health care? SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:211-217. [PMID: 34811764 DOI: 10.1111/1467-9566.13408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 06/13/2023]
Abstract
With the most recent developments to the European General Data Protection Regulations (GDPR) introduced in May 2018, the resulting legislation meant a new set of considerations for study approvers and health-care researchers. Compared with previous legislation in the UK (The Data Protection Act, 1998), it introduced more extensive and directive principles, requiring anybody 'processing' personal data to specifically define how this data will be obtained, stored, used and destroyed. Importantly, it also emphasised the principle of accountability, which meant that data controllers and processors could no longer just state that they planned to adhere to lawful data protection principles, they also had to demonstrate compliance. New questions and concerns around accountability now appear to have increased levels of scrutiny in all areas of information governance (IG), especially with regards to processing confidential patient information. This article explores our experiences of gaining required ethical and regulatory approvals for an ethnographic study in a UK health-care setting, the implications that the common law duty of confidentiality had for this research, and the ways in which IG challenges were overcome. The purpose of this article was to equip researchers embarking on similar projects to be able to navigate the potentially problematic and complex journey to approval.
Collapse
Affiliation(s)
- Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Royal Manchester Children's Hospital, Central Manchester University Hospitals Trust, Manchester, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Northumbria, UK
| |
Collapse
|
19
|
Cowell I, McGregor A, O’Sullivan P, O’Sullivan K, Poyton R, Schoeb V, Murtagh G. Physiotherapists' Approaches to Patients' Concerns in Back Pain Consultations Following a Psychologically Informed Training Program. QUALITATIVE HEALTH RESEARCH 2021; 31:2486-2501. [PMID: 34617473 PMCID: PMC8579327 DOI: 10.1177/10497323211037651] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient-focused style of communication where trained physiotherapists demonstrated a collaborative and responsive style of verbal and nonverbal communication to solicit, explore, and validate patients' concerns.
Collapse
Affiliation(s)
- Ian Cowell
- Imperial College, London, United Kingdom
- Brook Physiotherapy Ltd., Essex, United Kingdom
| | | | - Peter O’Sullivan
- Curtin University, Perth, Western Australia, Australia
- Bodylogic Physiotherapy, Perth, Western Australia, Australia
| | - Kieran O’Sullivan
- University of Limerick, Limerick, Ireland
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Veronika Schoeb
- University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | |
Collapse
|
20
|
Wrottesley SV, Pearson R, Prioreschi A. The headcam mother-infant interaction assessment tool: testing the feasibility and acceptability in Soweto, South Africa, using participatory engagement. Pilot Feasibility Stud 2021; 7:140. [PMID: 34225816 PMCID: PMC8256612 DOI: 10.1186/s40814-021-00875-3] [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: 11/23/2020] [Accepted: 06/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many children in low- and middle-income countries lack the stimulation needed to support healthy growth and development. Sensitive interactions between caregivers and infants may promote healthy movement behaviours in infants, which could improve childhood growth and development. However, reliable measures for such interactions require testing in the South African context. The aim of this study was to test the acceptability and feasibility of the headcam caregiver-infant interaction assessment tool in mothers from Soweto, South Africa. METHODS Nineteen mother and infant (6-24 months) pairs were asked to wear headcams (first-person observation) while participating in group and individual activities. Detailed instructions on headcam use were provided before and during these activities. Mothers were then asked to use the headcams, as well as photoframe cameras (which provided context of the interactions), in at least three, 5-min mother-infant engagement sessions at home over a 1-week period. Thereafter, focus group discussions (FGDs) were conducted to explore mothers' experiences of using the tool in the home setting. The feasibility of the headcam mother-infant interaction tool was assessed according to a priori criteria which scored (i) technical reliability of the devices and (ii) usability of the recorded footage. Acceptability was assessed according to emerging themes which were coded from the FGDs using a constant comparison method by two researchers. RESULTS The headcam mother-infant assessment tool was found to be feasible in Soweto, and sufficient data was available to code. Three main themes emerged from the FGD analysis: use of the headcam, using the headcams in the home environment and using the photoframe vs. the headcam. Mothers remarked on the ease of using the tool across daily activities, the normality of their infant's behaviour during recording and the acceptability by other members of the household. Large amounts of wasted unusable recordings were produced, and challenges related to switching the cameras on and off and to headcam placement were discussed. CONCLUSIONS Our study shows that headcams are both an acceptable and feasible method for assessing mother-infant interactions in Soweto. However, improvements to the usability of the tool and the quality of the data collected should be made prior to future work.
Collapse
Affiliation(s)
- Stephanie V Wrottesley
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Pearson
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
21
|
Duprez V, Haerens L, Wuyts D, Verhaeghe S, van Zanten R, Massey EK, Van Hecke A. Self-Determination Theory to observe healthcare professionals' counselling in chronic care encounters: Development of the COUNSEL-CCE tool. PATIENT EDUCATION AND COUNSELING 2021; 104:1773-1780. [PMID: 33342579 DOI: 10.1016/j.pec.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/03/2020] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To develop and psychometrically evaluate an observation tool to rate healthcare professionals' engagement in need-supportive and need-thwarting counselling in chronic care encounters. METHODS The observation tool was developed through three stages (January 2018 - June 2019). First, a set of items was developed according to essential components of need-supportive and need-thwarting counselling as identified in Self-Determination Theory. Second, content validation by five experts. Third, ecological validation using video-recorded real-life consultations. For the psychometric evaluation (June - October 2019), the tool was used by three observers to code 55 units of real-life encounters. RESULTS The Coding and Observing Need-Supportive Counselling in Chronic Care Encounters (COUNSEL-CCE) consists of 44 items clustered into nine theoretically underpinned behavioural approaches. Psychometric testing indicated acceptable to good consistency in scoring between observers and strong consistency within observers. CONCLUSION The COUNSEL-CCE captures person-oriented alongside process-oriented aspects during chronic care encounters. A person-oriented approach expresses counselling that is responsive to individual preferences and needs, whereas a process-oriented approach indicates the necessity to support competency building within patients, and is more instrumental of nature. PRACTICE IMPLICATIONS COUNSEL-CCE is a valuable observation tool to assess (graduate) healthcare professionals' counselling style and address if, and how, counselling evolves as a result of professional training.
Collapse
Affiliation(s)
- Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Leen Haerens
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Dorien Wuyts
- Expertise Unit Health Innovation, University Colleges Leuven Limburg, Leuven, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Nursing, VIVES University College, Roeselare, Belgium
| | - Regina van Zanten
- Department of Internal Medicine, Section Nephrology & Transplantation, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Emma K Massey
- Department of Internal Medicine, Section Nephrology & Transplantation, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
22
|
Whitehead K, Parkin T. UK Dietitians' views on communication skills for behaviour change: A 10 year follow-up survey. J Hum Nutr Diet 2021; 35:112-123. [PMID: 33829553 DOI: 10.1111/jhn.12903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2007, a survey of UK dietitians identified that dietitians were positive about the use of Communication Skills for Behaviour Change (CSBC) in practice, although barriers to the implementation of skills were acknowledged. This follow-up survey aimed to explore current perceptions of CSBC and compare them with the previous survey. METHODS A cross-sectional online survey of British Dietetic Association (BDA) members' views of CSBC was undertaken. The results for full members are presented. Quantitative data were analysed descriptively. Qualitative data were subject to either content, or inductive thematic analysis. RESULTS A response rate of 9.4% (n = 729) was achieved. Respondents were predominately female (n = 684; 95.1%) and worked in the National Health Service (n = 634; 87.4%). They were positive about the importance of CSBC in practice (n = 714; 99.5%). Pre-registration training had been completed by 346 respondents (48.7%). Post-registration training had been undertaken by 520 (74.7%) respondents and 514 of these (99.6%) had implemented training into practice, with few barriers identified. Perception of ability to use skills had increased, with 513 (83.6%) respondents rating their skills as excellent/very good compared to 62% previously. The majority (n = 594; 93.7%) reported that post-registration training was necessary, with the need for skills to be regularly reviewed (n = 456; 74.5%), and 235 (51.9%) respondents suggested this be mandatory. By contrast, some suggested that a skill review was not a priority, and would be difficult to administer and stressful. CONCLUSIONS Perception of the importance of CSBC remains high. Although the perceived ability to apply CSBC has increased, the perceived need for post-registration training is high, with respondents' favouring mandatory training.
Collapse
Affiliation(s)
- Kirsten Whitehead
- Division of Food, Nutrition and Dietetics, University of Nottingham, Loughborough, UK
| | - Tracey Parkin
- School of Health Professions, University of Plymouth, Plymouth, UK
| |
Collapse
|
23
|
Danielsen KG, Fougner M, Haugstad GK. Treating gynecological pain: key factors in promoting body awareness and movement in somatocognitive therapy (SCT). A case study of a physiotherapy student´s treatment approaches. Physiother Theory Pract 2021; 38:1705-1717. [PMID: 33427550 DOI: 10.1080/09593985.2021.1872125] [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] [Indexed: 10/22/2022]
Abstract
Background: Longstanding gynecological pain affects large numbers of women in the Western world. Somatocognitive therapy (SCT), a hybrid of cognitive psychotherapy and physiotherapy, is an evidence-based approach that has been successfully applied in the treatment of women suffering from such disorders, for example chronic pelvic pain (CPP) and provoked vestibulodynia (PVD), both demanding pain conditions. The curriculum of Oslo Metropolitan University's Mensendieck physiotherapy bachelor's program includes SCT training for the management of PVD.Purpose: The purpose of this study is to describe and explore the content of a SCT session based on a body and mind approach as performed by a physiotherapy student at a student outpatient clinic.Methods: A video-based case study of the student-patient encounter was undertaken midway through an SCT treatment course and subjected to content analysis.Findings: Three categories illustrating the learning process of body awareness, associated with the three-phase SCT were identified: 1) demystifying genital and chronic pain; 2) concentration, and body and mind experiences; and 3) patience, persistence, and willingness to change.Conclusion: The observation of the somatocognitive therapy session illustrates the value of an empathic relationship with the patient, in order to encourage her to explore body sensations and become familiar with the vulvar area. The therapy engages the patient in understanding pain mechanisms, thus educating her to overcome the fear of pain.
Collapse
Affiliation(s)
| | - Marit Fougner
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | |
Collapse
|
24
|
Bashir K, Elmoheen A, Seif M, Anjum S, Farook S, Thomas S. In Pursuit of the Most Effective Method of Teaching Feedback Skills to Emergency Medicine Residents in Qatar: A Mixed Design. Cureus 2020; 12:e8155. [PMID: 32432013 PMCID: PMC7233493 DOI: 10.7759/cureus.8155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose The study aimed to find an effective method of teaching feedback skills to residents and to gauge their preference. Method This was a mixed design study conducted at the emergency department of a large tertiary care hospital. The residents were randomized to groups A, B, and C. Group A (control) received a traditional lecture, Group B read a specifically written brief document, and Group C received 1:1 tutoring from one faculty. Each resident individually watched a four-minute video on an emergency procedure and provided feedback in simulated settings, which was audio-recorded and rated by two blinded raters. An assessment form was created and validated. The residents’ preference was attained through a semi-structured interview. Results The baseline characteristics of the three groups were similar. Compared to Group A, Groups B and C scored significantly higher on the overall assessment and were statistically similar to each other. There was no sign of association between both gender and postgraduate score (PGY) year on the total score. Residents’ equally preferred self-reading and 1:1 tutoring. Conclusion The acquisition of feedback skills by emergency medicine (EM) residents was comparable between self-learning from an appropriately written document and 1:1 teaching by adequately trained faculty.
Collapse
Affiliation(s)
- Khalid Bashir
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT.,Medicine, Qatar University, Doha, QAT
| | - Amr Elmoheen
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Mohammed Seif
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Shahzad Anjum
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Saleem Farook
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Stephen Thomas
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| |
Collapse
|
25
|
Murdoch J, Salter C, Ford J, Lenaghan E, Shiner A, Steel N. The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions. Soc Sci Med 2020; 256:113040. [PMID: 32473530 PMCID: PMC7306159 DOI: 10.1016/j.socscimed.2020.113040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
Goal-setting is widely recommended for supporting patients with multiple long-term conditions. It involves a proactive approach to a clinical consultation, requiring doctors and patients to work together to identify patient's priorities, values and desired outcomes as a basis for setting goals for the patient to work towards. Importantly it comprises a set of activities that, for many doctors and patients, represents a distinct departure from a conventional consultation, including goal elicitation, goal-setting and action planning. This indicates that goal-setting is an uncertain interactional space subject to inequalities in understanding and expectations about what type of conversation is taking place, the roles of patient and doctor, and how patient priorities may be configured as goals. Analysing such spaces therefore has the potential for revealing how the principles of goal-setting are realised in practice. In this paper, we draw on Goffman's concept of ‘frames’ to present an examination of how doctors' and patients' sense making of goal-setting was consequential for the interactions that followed. Informed by Interactional Sociolinguistics, we used conversation analysis methods to analyse 22 video-recorded goal-setting consultations with patients with multiple long-term conditions. Data were collected between 2016 and 2018 in three UK general practices as part of a feasibility study. We analysed verbal and non-verbal actions for evidence of GP and patient framings of consultation activities and how this was consequential for setting goals. We identified three interactional patterns: GPs checking and reframing patients' understanding of the goal-setting consultation, GPs actively aligning with patients' framing of their goal, and patients passively and actively resisting GP framing of the patient goals. These reframing practices provided “telling cases” of goal-setting interactions, where doctors and patients need to negotiate each other's perspectives but also conflicting discourses of patient-centredness, population-based evidence for treating different chronic illnesses and conventional doctor-patient relations. First study of GP goal-setting interactions for patients with multiple conditions. Goal-setting involves novel activities in an uncertain interactional space. GPs and patients may need to negotiate different framings of patient's priorities. GPs may actively align with patient's goal, patients may resist GP framing of goal. Negotiation of frames reveal conflicting discourses invoked at interactional level.
Collapse
Affiliation(s)
- Jamie Murdoch
- School of Health Sciences & Norwich Medical School, Faculty of Medicine and Health Sciences University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Charlotte Salter
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - John Ford
- Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - Elizabeth Lenaghan
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Alice Shiner
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Nicholas Steel
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| |
Collapse
|
26
|
Understanding General Practitioners' Antibiotic Prescribing Decisions in Out-of-Hours Primary Care: A Video-Elicitation Interview Study. Antibiotics (Basel) 2020; 9:antibiotics9030115. [PMID: 32156082 PMCID: PMC7148451 DOI: 10.3390/antibiotics9030115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022] Open
Abstract
Infections are the most common reason why patients consult out-of-hours (OOH) primary care. Too often there is an overprescribing of antibiotics for self-limiting infections and general practitioners (GPs) do not always choose the guideline recommended antibiotics. To improve antibiotic prescribing quality, a better understanding is needed of the (non) antibiotic prescribing decisions of GPs. This study sets out to unravel GPs’ (non) antibiotic prescribing decisions in OOH primary care. We video-recorded 160 consultations on infections during OOH primary care by 21 GPs and performed video-elicitation interviews with each GP. GPs reflected on their decision-making process and communication while watching their consultation. A qualitative thematic analysis was used. GPs found that their (non) antibiotic prescribing decision-making was not only based on objective arguments, but also subconsciously influenced by their own interpretation of information. Often GPs made assumptions (about for example the patients’ reason for encounter or expectations for antibiotics) without objectifying or verifying this with the patient. From the beginning of the consultation GPs follow a dichotomous thinking process: urgent versus not urgent, viral versus bacterial, antibiotics versus no antibiotics. Safety-netting is an important but difficult tool in the OOH care context, with no long-term follow-up or relationship with the patient. GPs talk about strategies they use to talk about diagnostic uncertainty, what patients can expect or should do when things do not improve and the difficulties they encounter while doing this. This video- elicitation interview study provides actionable insights in GPs’ (non) antibiotic prescribing decisions during OOH consultations on infections.
Collapse
|
27
|
O'Reilly M, Muskett T, Karim K, Lester JN. Parents' constructions of normality and pathology in child mental health assessments. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:544-564. [PMID: 31777968 DOI: 10.1111/1467-9566.13030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Central to a contemporary understanding of childhood is the developmental and clinical-medical construct of the 'normal' child. When judged to fall outside of culturally, socially and historically situated parameters of 'normality', children become labelled as 'deviant from the norm'; for instance, in mental health contexts where this may provide the basis for psychiatric diagnosis. However, judgements of a child's 'normality' are further complicated by the range of individuals who may have a stake in that construction, including parents/carers, professionals and the child themselves. Using discursive psychology, we analysed 28 video-recorded UK child mental health assessments, to examine ways that parents presented concerns about their children's development. They did this by drawing on notions of 'ab/normal', in ways that functioned to legitimise their need for services and built a rhetorical case to demonstrate clinical need; often by contrasting the child with other 'typical' children and/or contrasting the same child's behaviour in different settings or contexts. We concluded that given the growing crisis in child mental health, initial assessments play a crucial clinical role in determining diagnosis and labelling, and therefore, a critical discussion of these concepts and processes is essential.
Collapse
Affiliation(s)
- Michelle O'Reilly
- The Greenwood Institute, University of Leicester (and Leicestershire Partnership NHS Trust), Leicester, UK
| | - Tom Muskett
- Psychology Group, Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Khalid Karim
- The Greenwood Institute, University of Leicester (and Leicestershire Partnership NHS Trust), Leicester, UK
| | | |
Collapse
|
28
|
Brogaard L, Uldbjerg N. Filming for auditing of real-life emergency teams: a systematic review. BMJ Open Qual 2019; 8:e000588. [PMID: 31909207 PMCID: PMC6937091 DOI: 10.1136/bmjoq-2018-000588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 08/02/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Lise Brogaard
- Department of Obstetrics and Gynaecology, Regionshospitalet Horsens, Horsens, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
29
|
Ye B, Khan SS, Chikhaoui B, Iaboni A, Martin LS, Newman K, Wang A, Mihailidis A. Challenges in Collecting Big Data in A Clinical Environment with Vulnerable Population: Lessons Learned from A Study Using A Multi-modal Sensors Platform. SCIENCE AND ENGINEERING ETHICS 2019; 25:1447-1466. [PMID: 30357559 DOI: 10.1007/s11948-018-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Agitation is one of the most common behavioural and psychological symptoms in people living with dementia (PLwD). This behaviour can cause tremendous stress and anxiety on family caregivers and healthcare providers. Direct observation of PLwD is the traditional way to measure episodes of agitation. However, this method is subjective, bias-prone and timeconsuming. Importantly, it does not predict the onset of the agitation. Therefore, there is a need to develop a continuous monitoring system that can detect and/or predict the onset of agitation. In this study, a multi-modal sensor platform with video cameras, motion and door sensors, wristbands and pressure mats were set up in a hospital-based dementia behavioural care unit to develop a predictive system to identify the onset of agitation. The research team faced several barriers in the development and initiation of the study, namely addressing concerns about the study ethics, logistics and costs of study activities, device design for PLwD and limitations of its use in the hospital. In this paper, the strategies and methodologies that were implemented to address these challenges are discussed for consideration by future researchers who will conduct similar studies in a hospital setting.
Collapse
Affiliation(s)
- Bing Ye
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada.
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.
| | - Shehroz S Khan
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | - Belkacem Chikhaoui
- TELUQ University, 455 Rue du Parvis, Ville De Québec, QC, G1K 9H6, Canada
| | - Andrea Iaboni
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| | | | - Kristine Newman
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Angel Wang
- Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Alex Mihailidis
- University of Toronto, 160 - 500 University Ave., Toronto, ON, M5G 1V7, Canada
- 12th Floor, Research Department, Toronto Rehabilitation Institute - University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada
- AGE-WELL Network of Centres of Excellence, 550 University Ave., Toronto, ON, M5G 2A2, Canada
| |
Collapse
|
30
|
Land V, Parry R, Pino M, Jenkins L, Feathers L, Faull C. Addressing possible problems with patients' expectations, plans and decisions for the future: One strategy used by experienced clinicians in advance care planning conversations. PATIENT EDUCATION AND COUNSELING 2019; 102:670-679. [PMID: 30528873 DOI: 10.1016/j.pec.2018.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/04/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Giving terminally ill people opportunities to participate in advance care planning involves tensions between: endorsing and supporting patients' expectations, plans and decisions, and addressing how realistic these are. The latter risks exerting undue pressure to change plans; undermining autonomy; jeopardising therapeutic relationships. Our objective is to describe how experienced hospice doctors raise potential/actual problems with patients' expectations, plans or decisions. METHODS Conversation analysis of video-recorded consultations between five UK hospice consultants, 37 patients and their companions. RESULTS Eleven episodes involving five doctors were found. In all of these we identified a 'Hypothetical Scenario Sequence' where doctors raise a hypothetical future scenario wherein current plans/expectations turn out to be problematic, then engage patients in discussing what could be done about this. We describe features of this sequence and how it can circumvent the risks of addressing problems with patients' expectations and plans. CONCLUSION Our research breaks new ground, showing that by treating expectations, plans and decisions as potentially not actually problematic, practitioners can recognise and support patients' preferences whilst preparing them for possible difficulties and inevitable uncertainties. PRACTICE IMPLICATIONS Where professionals judge it appropriate to raise problems about patients' preferences, plans and decisions, this sequence can manage the associated risks.
Collapse
Affiliation(s)
| | | | | | | | - Luke Feathers
- LOROS Hospice Care for Leicestershire and Rutland, and Medicine University Hospitals Leicester, UK
| | - Christina Faull
- LOROS Hospice Care for Leicestershire and Rutland, and Medicine University Hospitals Leicester, UK
| |
Collapse
|
31
|
Pino M, Parry R. Talking about death and dying: Findings and insights from five conversation analytic studies. PATIENT EDUCATION AND COUNSELING 2019; 102:185-187. [PMID: 30765048 DOI: 10.1016/j.pec.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Marco Pino
- School of Social Sciences, Loughborough University, Margaret Keay Rd, LE11 3TU, UK.
| | - Ruth Parry
- School of Social Sciences, Loughborough University, Margaret Keay Rd, LE11 3TU, UK
| |
Collapse
|
32
|
Pino M, Parry R. How and when do patients request life-expectancy estimates? Evidence from hospice medical consultations and insights for practice. PATIENT EDUCATION AND COUNSELING 2019; 102:223-237. [PMID: 29685640 DOI: 10.1016/j.pec.2018.03.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 03/02/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so. METHODS Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists. RESULTS Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients' companions also contribute to this preparatory work. CONCLUSION Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates. PRACTICE IMPLICATIONS Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.
Collapse
Affiliation(s)
- Marco Pino
- Department of Social Sciences, Loughborough University, Brockington Building, Margaret Keay Rd, Loughborough, Leicestershire, LE11 3TU, UK.
| | - Ruth Parry
- Department of Social Sciences, Loughborough University, Brockington Building, Margaret Keay Rd, Loughborough, Leicestershire, LE11 3TU, UK.
| |
Collapse
|
33
|
Harwood RH, O’Brien R, Goldberg SE, Allwood R, Pilnick A, Beeke S, Thomson L, Murray M, Parry R, Kearney F, Baxendale B, Sartain K, Schneider J. A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundTwenty-five per cent of hospital beds are occupied by a person living with dementia. Dementia affects expressive communication and understanding. Health-care professionals report a lack of communication skills training.ObjectivesTo identify teachable, effective strategies for communication between health-care professionals and people living with dementia, and to develop and evaluate a communication skills training course.DesignWe undertook a systematic literature review, video-recorded 41 encounters between staff and people with dementia, and used conversation analysis to investigate communication problems and solutions. We designed a communication skills training course using coproduction and multiple pedagogic approaches. We ran a pilot, followed by six courses for health-care professionals. We measured knowledge, confidence and communication behaviours before, immediately after and 1 month after the course, and undertook interviews with participants and managers. Behaviours were measured using blind-rated videos of simulations.SettingGeneral hospital acute geriatric medical wards and two hospital clinical skills centres.ParticipantsWe video-recorded 26 people with dementia and 26 professionals. Ten experts in dementia care, education, simulation and communication contributed to intervention development. Six health-care professionals took part in a pilot course, and 45 took part in the training.ResultsThe literature review identified 26 studies describing 10 communication strategies, with modest evidence of effectiveness. Health-care professional-initiated encounters followed a predictable phase structure. Problems were apparent in requests (with frequent refusals) and in closings. Success was more likely when requests were made directly, with high entitlement (authority to ask) and with lowered contingencies (made to sound less difficult, by minimising the extent or duration of the task, asking patients ‘to try’, offering help or proposing collaborative action). Closings were more successful if the health-care professional announced the end of the task, made a specific arrangement, body language matched talk, and through use of ‘closing idioms’. The training course comprised 2 days, 1 month apart, using experiential learning, including lectures, video workshops, small group discussions, simulations (with specially trained actors) and reflections. We emphasised the incorporation of previous expertise and commitment to person-centred care. Forty-four participants returned for the second training day and 43 provided complete evaluation data. Knowledge and confidence both increased. Some behaviours, especially relating to closings, were more commonly used after training. The course was rated highly in interviews, especially the use of simulations, real-life video clips and interdisciplinary learning. Participants reported that they found the methods useful in practice and were using them 1 month after the course finished.LimitationsData were from people with moderate to severe dementia, in an acute hospital, during health-care professional-initiated interactions. Analysis was limited to problems and solutions that were likely to be ‘trainable’. Actors required careful preparation to simulate people with dementia. Communication skills training course participants were volunteers, unlikely to be representative of the general workforce, who displayed high levels of baseline knowledge, confidence and skills. Before-and-after evaluations, and qualitative interviews, are prone to bias.ConclusionsRequests and closings pose particular difficulties for professionals communicating with people with dementia. We identified solutions to these problems and incorporated them into communication skills training, which improved knowledge, confidence and some communication behaviours. Simulation was an effective training modality.Future workFurther research should investigate a wider range of health, social care and family carers. Conversation analysis should be used to investigate other aspects of health-care communication.Study registrationThe systematic literature review is registered as CRD42015023437.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Rowan H Harwood
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, UK
- CityCare Partnership CIC, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rebecca Allwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Suzanne Beeke
- Language and Cognition Research, University College London, London, UK
| | - Louise Thomson
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Megan Murray
- Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ruth Parry
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Kearney
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bryn Baxendale
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate Sartain
- Patient and Public Contributor, Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
34
|
Garcia-Burgos D, Maglieri S, Vögele C, Munsch S. How Does Food Taste in Anorexia and Bulimia Nervosa? A Protocol for a Quasi-Experimental, Cross-Sectional Design to Investigate Taste Aversion or Increased Hedonic Valence of Food in Eating Disorders. Front Psychol 2018; 9:264. [PMID: 29593595 PMCID: PMC5859071 DOI: 10.3389/fpsyg.2018.00264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Despite on-going efforts to better understand dysregulated eating, the olfactory-gustatory deficits and food preferences in eating disorders (ED), and the mechanisms underlying the perception of and responses to food properties in anorexia nervosa (AN) and bulimia nervosa (BN) remain largely unknown; both during the course of the illness and compared to healthy populations. It is, therefore, necessary to systematically investigate the gustatory perception and hedonics of taste in patients with AN and BN. To this end, we will examine whether aversions to the taste of high-calorie food is related to the suppression of energy intake in restricting-type AN, and whether an increased hedonic valence of sweet, caloric-dense foods may be part of the mechanisms triggering binge-eating episodes in BN. In addition, the role of cognitions influencing these mechanisms will be examined. Method: In study 1, four mixtures of sweet-fat stimuli will be presented in a sensory two-alternative forced-choice test involving signal detection analysis. In study 2, a full-scale taste reactivity test will be carried out, including psychophysiological and behavioral measures to assess subtle and covert hedonic changes. We will compare the responses of currently-ill AN and BN patients to those who have recovered from AN and BN, and also to those of healthy normal-weight and underweight individuals without any eating disorder pathology. Discussion: If taste response profiles are differentially linked to ED types, then future studies should investigate whether taste responsiveness represents a useful diagnostic measure in the prevention, assessment and treatment of EDs. The expected results on cognitive mechanisms in the top-down processes of food hedonics will complement current models and contribute to the refinement of interventions to change cognitive aspects of taste aversions, to establish functional food preferences and to better manage food cravings associated with binge-eating episodes. No trial registration was required for this protocol, which was approved by the Swiss ethics committee (CER-VD, n° 2016-02150) and the Ethics Review Panel of the University of Luxembourg.
Collapse
Affiliation(s)
| | - Sabine Maglieri
- School of Agricultural, Forest and Food Sciences HAFL, Bern University of Applied Sciences, Bern, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Simone Munsch
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
35
|
Kevers R, Rober P, De Haene L. Unraveling the Mobilization of Memory in Research With Refugees. QUALITATIVE HEALTH RESEARCH 2018; 28:659-672. [PMID: 29251552 DOI: 10.1177/1049732317746963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher's responsibility in sensitively dealing with participants' alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence.
Collapse
|
36
|
Pino M, Parry R, Feathers L, Faull C. Is it acceptable to video-record palliative care consultations for research and training purposes? A qualitative interview study exploring the views of hospice patients, carers and clinical staff. Palliat Med 2017; 31:707-715. [PMID: 28590153 PMCID: PMC5557161 DOI: 10.1177/0269216317696419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. AIM To explore views of hospice patients, carers and clinical staff about whether videoing patient-doctor consultations is acceptable for research and training purposes. DESIGN We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views. We used Braun and Clark's thematic analysis. SETTING/PARTICIPANTS Interviews were conducted at one English hospice to inform the development of a larger video-based study. We invited patients with capacity to consent and whom the care team judged were neither acutely unwell nor severely distressed (11), carers of current or past patients (5), palliative medicine doctors (7), senior nurses (4) and communication skills educators (5). RESULTS Participants viewed video-based research on communication as valuable because of its potential to improve communication, care and staff training. Video-based research raised concerns including its potential to affect the nature and content of the consultation and threats to confidentiality; however, these were not seen as sufficient grounds for rejecting video-based research. Video-based research was seen as acceptable and useful providing that measures are taken to reduce possible risks across the recruitment, recording and dissemination phases of the research process. CONCLUSION Video-based research is an acceptable and worthwhile way of investigating communication in palliative medicine. Situated judgements should be made about when it is appropriate to involve individual patients and carers in video-based research on the basis of their level of vulnerability and ability to freely consent.
Collapse
Affiliation(s)
- Marco Pino
- 1 Department of Social Sciences, Loughborough University, Loughborough, UK
| | - Ruth Parry
- 2 School of Health Sciences, The University of Nottingham, Nottingham, UK
| | | | | |
Collapse
|
37
|
Land V, Parry R, Seymour J. Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research. Health Expect 2017; 20:1228-1247. [PMID: 28520201 PMCID: PMC5690232 DOI: 10.1111/hex.12557] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 11/29/2022] Open
Abstract
Background Shared decision making (SDM) is generally treated as good practice in health‐care interactions. Conversation analytic research has yielded detailed findings about decision making in health‐care encounters. Objective To map decision making communication practices relevant to health‐care outcomes in face‐to‐face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. Search strategy We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Inclusion criteria Published conversation analyses (no restriction on publication dates) using recordings of health‐care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness‐related decision making. Data extraction and synthesis We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Results Twenty‐eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision‐making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Conclusions Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non‐negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale).
Collapse
Affiliation(s)
| | - Ruth Parry
- University of Nottingham, Nottingham, UK
| | | |
Collapse
|
38
|
The 'One in a Million' study: creating a database of UK primary care consultations. Br J Gen Pract 2017; 67:e345-e351. [PMID: 28396369 PMCID: PMC5409421 DOI: 10.3399/bjgp17x690521] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/08/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Around 1 million primary care consultations happen in England every day. Despite this, much of what happens in these visits remains a 'black box'. AIM To create an archive of videotaped consultations and linked data based on a large sample of routine face-to-face doctor-patient consultations with consent for use in future research and training. DESIGN AND SETTING Cross-sectional study in 12 general practices in the west of England, UK. METHOD Up to two GPs from each practice took part in the study. Over 1 to 2 days, consecutive patients were approached until up to 20 eligible patients for each GP consented to be videotaped. Eligible patients were aged ≥18 years, consulting on their own behalf, fluent in English, and with capacity to consent. GP questionnaires were self-administered. Patient questionnaires were self-administered immediately pre-consultation and post-consultation, and GPs filled in a checklist after each recording. A follow-up questionnaire was sent to patients after 10 days, and data about subsequent related consultations were collected from medical records 3 months later. RESULTS Of the 485 patients approached, 421 (86.8%) were eligible. Of the eligible patients, 334 (79.3%) consented to participate and 327 consultations with 23 GPs were successfully taped (307 video, 20 audio-only). Most patients (n = 300, 89.8%) consented to use by other researchers, subject to specific ethical approval. CONCLUSION Most patients were willing to allow their consultations to be videotaped, and, with very few exceptions, to allow recordings and linked data to be stored in a data repository for future use for research and training.
Collapse
|
39
|
Emilson C, Åsenlöf P, Pettersson S, Bergman S, Sandborgh M, Martin C, Demmelmaier I. Physical therapists' assessments, analyses and use of behavior change techniques in initial consultations on musculoskeletal pain: direct observations in primary health care. BMC Musculoskelet Disord 2016; 17:316. [PMID: 27464877 PMCID: PMC4964306 DOI: 10.1186/s12891-016-1173-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/20/2016] [Indexed: 12/30/2022] Open
Abstract
Background Behavioral medicine (BM) treatment is recommended to be implemented for pain management in physical therapy. Its implementation requires physical therapists (PTs), who are skilled at performing functional behavioral analyses based on physical, psychological and behavioral assessments. The purpose of the current study was to explore and describe PTs’ assessments, analyses and their use of behavioral change techniques (BCTs) in initial consultations with patients who seek primary health care due to musculoskeletal pain. Methods A descriptive and explorative research design was applied, using data from video recordings of 12 primary health care PTs. A deductive analysis was performed, based on a specific protocol with definitions of PTs’ assessment of physical and psychological prognostic factors (red and yellow flags, respectively), analysis of the clinical problem, and use of BCTs. An additional inductive analysis was performed to identify and describe the variation in the PTs’ clinical practice. Results Red and yellow flags were assessed in a majority of the cases. Analyses were mainly based on biomedical assessments and none of the PTs performed functional behavioral analyses. All of the PTs used BCTs, mainly instruction and information, to facilitate physical activity and improved posture. The four most clinically relevant cases were selected to illustrate the variation in the PTs’ clinical practice. The results are based on 12 experienced primary health care PTs in Sweden, limiting the generalizability to similar populations and settings. Conclusion Red and yellow flags were assessed by PTs in the current study, but their interpretation and integration of the findings in analyses and treatment were incomplete, indicating a need of further strategies to implement behavioral medicine in Swedish primary health care physical therapy.
Collapse
Affiliation(s)
- C Emilson
- Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden.
| | - P Åsenlöf
- Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden
| | - S Pettersson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - S Bergman
- Research and Development Center Spenshult, Halmstad, Sweden.,Department of Public Health, and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Sandborgh
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - C Martin
- Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden
| | - I Demmelmaier
- Department of Neuroscience, Uppsala University, Box 5932 S-751 24, Uppsala, Sweden
| |
Collapse
|
40
|
Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying. PLoS One 2016; 11:e0156174. [PMID: 27243630 PMCID: PMC4887020 DOI: 10.1371/journal.pone.0156174] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design Conversation analysis of video- and audio-recorded consultations. Participants Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce–then later further articulate–EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions Through communicating–via open elaboration solicitations–in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
Collapse
|