Family presence and participation during medical visits of heart failure patients: An analysis of survey and audiotaped communication data

Using family-centered communication to optimize patient-provider-companion encounters about changing to biosimilars: A randomized controlled trial

OBJECTIVE

To explore whether family-centered communication impacts decisions and optimizes patient-companion-provider consultations.

METHODS

A parallel, two-arm randomized controlled trial was conducted with 108 participants acting as patients with inflammatory arthritis or companions. Pairs attended a mock consultation where a physician explained the change from a bio-originator to a biosimilar using family-centered or patient-only communication. Participants reported their willingness to transition, risk perceptions, understanding and social support, and completed various scales including the Patient Perception Scale. Interviews helped understand perceptions towards the consultation.

RESULTS

Family-centered communication did not impact willingness to change or cognitive risk perceptions compared to patient-only communication. However, it improved emotional risk perceptions (p = 0.047, Cohen's d=.55) and satisfaction with communication (p = 0.015, Cohen's d=.71). Feeling the explanation was reassuring was associated with less worry (p = 0.004). Receiving emotional support (p = 0.014) and companions asking fewer questions (p = 0.046) were associated with higher recall. The intervention improved companion involvement (p < 0.001, Cohen's d= 1.23) and support (p = 0.002, Cohen's d=.86). Interviews showed that encouraging questions, inclusive body language, and acknowledging companions facilitated involvement.

CONCLUSION

Family-centered communication augments patient-companion-provider encounters but does not influence willingness to change treatment.

PRACTICE IMPLICATIONS

Practitioners can use family-centered communication when discussing biosimilars but should provide reassurance, encourage emotional support, and summarize key points to improve understanding.

Patient, caregiving partner, and clinician recommendations for improving heart failure care in the Veterans Health Administration

OBJECTIVE

Heart Failure (HF) care requires substantial care coordination between patients, patients' informal caregivers, and clinicians, but few studies have examined recommendations from all three perspectives. The objective of this study was to understand and identify shared recommendations to improve HF self-care from the perspective of VA persons with HF, their caregiving partners, and clinicians.

METHODS

Secondary data analysis from a study of semi-structured interviews with 16 couples (persons with HF and their caregiving partners) and 13 clinicians (physicians, nurses, other specialists) from a large Veterans Affairs (VA) hospital. Interviews were double-coded, and analyzed for themes around commonly used or recommended self-care strategies.

RESULTS

Three themes emerged: (1) Couples and clinicians believe that improvements are still needed to existing HF education, especially the need to be tailored to learning style and culture, (2) Couples and clinicians believe that technology can facilitate better HF self-care, and (3) Couples and clinicians believe that caregiving partners are part of the self-care team, and should be involved in care management to support the person with HF.

DISCUSSION

Recommendations from couples and clinicians address barriers to HF self-care and encourage patient-centered care.

The meaning of rapport for patients, families, and healthcare professionals: A scoping review

OBJECTIVE

Rapport is considered fundamental to clinical relationships but is a concept which is rarely defined. This review explores how rapport is defined, characterised, and operationalised in healthcare.

METHODS

A scoping review methodology was used. Data were synthesised using thematic analysis. The review process adhered to the Preferred Reporting System for Meta-Analysis for Scoping reviews (PRISMA-ScR).

RESULTS

Medline, CINAHL, and psychINFO were searched with thirty-four studies meeting inclusion criteria. Results were presented in two themes: The meanings of rapport and the implications for building rapport.

CONCLUSIONS

This scoping review found rapport has no commonly shared definition or conceptualisation in the reviewed research. At the same time rapport is operationalised and characterised. Factors that facilitate, and hinder rapport-building were identified. Having a consistently used definition and conceptualisation will benefit the research that is needed into patient and family experiences and outcomes of rapport.

PRACTICE IMPLICATIONS

It is crucial for health professionals to incorporate simple kind gestures into practice to facilitate rapport. Equally it is necessary for health professionals to review their practice for dismissive, avoiding behaviours that impede rapport-building and consider how they spend their time with patients.

Relationship between Provider Communication Behaviors and the Quality of Life for Patients with Advanced Cancer in Saudi Arabia

Context: Patients with advanced cancer from Saudi Arabia are often not well informed about diagnoses, prognoses, and treatment options. Poor communication can lead to health-care decisions that insufficiently meet patients’ preferences, concerns, and needs and that subsequently affect patients’ quality of life. Objectives: The purpose of this study is to examine the relationship between provider communication behaviors and the quality of life of patients with advanced cancer. Method: A cross-sectional, correlation design was used in the present study, in which 159 patients with confirmed diagnoses of stage III or IV solid cancer were surveyed. Results: The mean summary score of the patients’ quality of life was 57.31. We found a significant relationship between provider communication behaviors and patient quality of life (β = 0.18, b = 0.35, SE = 0.15, p = 0.021). In addition, R2 shows that only 3.4% of variance in patient quality of life is predicated on provider communication behaviors. Conclusions: The relationship between provider communication behaviors and patient quality of life was low (r = 0.18). A possible reason for this is that provider communication behaviors are not the only factor that affects patient quality of life; other variables, such as the patient’s age, cancer type, and level of awareness, can also have an effect. Another possible explanation is that communication behaviors between patients and providers may vary depending on the level of cultural contact.

Impact of Patients' Companions on Clinical Encounters Between Black Patients and Their Non-Black Oncologists

PURPOSE

The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists.

METHODS

This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other.

RESULTS

Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication.

DISCUSSION

Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.

Factors Affecting Family Presence During Fracture Reduction in the Pediatric Emergency Department

Introduction

Asking family members to leave during invasive procedures has historically been common practice; however, evidence-based recommendations have altered the trend of family presence during pediatric procedures. The aim of this study was to determine factors related to family members’ choice to be present or absent during fracture reductions in a pediatric emergency department (ED), and their satisfaction with that choice.

Methods

We administered role-specific, anonymous surveys to a convenience sample of patients’ family members in the ED of a Level I pediatric trauma center. All family members were given a choice of where to be during the procedure.

Results

Twenty-five family members of 18 patients completed surveys. Seventeen family members chose to stay in the room. Family member satisfaction with their decision to be inside or outside the room during the procedure (median = very satisfied) was almost uniformly high and not associated with any of the following variables: previous presence during a medical procedure; provider-reported procedure difficulty, or anxiety levels. Family member perception of procedure success (median = extremely well) was also high and not associated with other variables. Location during the procedure was associated with a desire to be in the same location in the future (Fisher’s exact test, p=0.001). Common themes found among family members’ reasons for their location decisions and satisfaction levels were a desire to support the patient, high staff competence, and their right as parents to choose their location.

Conclusion

Family members self-select their location during their child’s fracture reduction to high levels of satisfaction, and they considered the ability to choose their location as important.