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Koopman WJ, LaDonna KA, Kinsella EA, Venance SL, Watling CJ. Archetypes of incomplete stories in chronic illness medical encounters. PATIENT EDUCATION AND COUNSELING 2023; 117:107973. [PMID: 37734249 DOI: 10.1016/j.pec.2023.107973] [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: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE During encounters, patients and practitioners engage in conversations to address health concerns. Because these interactions are time-pressured events, it may be inevitable that any story exchanged during these encounters will be incomplete in some way, potentially jeopardizing how quality and safety of care is delivered. In this study, we explored how and why incomplete stories might arise in health interactions. METHODS Constructivist grounded theory methodology was used to explore how patients and practitioners approach their interactions during encounters. In this two-phase study, we interviewed patients (n = 21) then practitioners (n = 12). RESULTS We identified three distinct archetypes of incomplete storytelling - the hidden story, the interpreted story, and the tailored story. Measured information sharing, triadic encounters and pre-planned agendas influenced these storylines, respectively. CONCLUSION Both patient and practitioner participants focused on what each considered important, appropriate, and useful for productive encounters. While incomplete stories may be a reality, educating practitioners about how incomplete stories come about from both sides of the conversation creates new opportunities to optimize interactions at medical encounters for in-depth patient practitioner storytelling.
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Affiliation(s)
- Wilma J Koopman
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada.
| | - K A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
| | - E A Kinsella
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A 1A3, Canada
| | - S L Venance
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
| | - C J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
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White SJ, Nguyen A, Cartmill JA. Agency and the telephone: Patient contributions to the clinical and interactional agendas in telehealth consultations. PATIENT EDUCATION AND COUNSELING 2022; 105:2074-2080. [PMID: 35074218 PMCID: PMC9595389 DOI: 10.1016/j.pec.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/15/2021] [Accepted: 01/09/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Patient-centredness is central to providing safe care and is achieved, in part, through involving patients in developing the agenda of the consultation. Medical consultations have changed significantly over the last two years as a result of COVID-19 and thus understanding how patients contribute to the clinical and interactional agendas within a telehealth consultation is important to supporting quality care. METHODS A collection (15) of consultations (in English) between specialists (3) and patients (14) were recorded in a metropolitan gastrointestinal clinic in Australia. These recordings were closely examined using conversation analysis, which focuses on the structural and sequential organisation of interaction. RESULTS Patients used a variety of interactional approaches to contribute to the agenda throughout the consultations. This was achieved in collaboration with the doctors, whose responses generally allowed for these contributions. However, there were few doctor-driven, explicit opportunities provided to patients to contribute to the agenda. CONCLUSION Many patients and doctors are adept at managing the interactional challenges of telehealth consultations but there are clear opportunities to extend this advantage to those patients with less agency. PRACTICE IMPLICATIONS Providing an explicit space for patients to ask questions within the consultation would support those patients less inclined or able to assert themselves during a telehealth consultation.
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Affiliation(s)
- Sarah J White
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia; Centre for Social Impact, University of New South Wales, Australia.
| | - Amy Nguyen
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - John A Cartmill
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
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Noble LM, Manalastas G, Viney R, Griffin AE. Does the structure of the medical consultation align with an educational model of clinical communication? A study of physicians' consultations from a postgraduate examination. PATIENT EDUCATION AND COUNSELING 2022; 105:1449-1456. [PMID: 34649752 DOI: 10.1016/j.pec.2021.10.001] [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: 07/12/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study examined whether the structure of consultations in which physicians were tasked with sharing information corresponded to the chronological stages proposed by an established educational model of clinical communication. METHOD Seventy six simulated consultations from a postgraduate examination for general medical hospital physicians were transcribed verbatim and converted into diagrams showing consultation structure. All doctor-patient/relative talk was allocated into six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing, using the 'communication process skills' from the Calgary-Cambridge Guide to the Medical Interview. RESULTS The majority of consultations included four or five of the expected phases, with most talk (41-92%) in Explanation and Planning. There was no discernible consistency of structure across the consultations or in consultations from the same scenario. Consultations varied in the presence, sequential order, size, location and reappearance of phases. CONCLUSIONS The structure of consultations in this standardised setting bore little resemblance to the chronological order of phases predicted by an educational model. PRACTICE IMPLICATIONS Educational guidance and interventions to support patients in preparing for consultations need to take account of doctors' behaviour in practice. Assumptions about the organisation of medical consultations should be queried in the absence of an evidence base.
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Affiliation(s)
| | | | - Rowena Viney
- UCL Medical School, University College London, London, UK.
| | - Ann E Griffin
- UCL Medical School, University College London, London, UK.
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Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Gulbrandsen P, Gerwing J, Landmark AM. Time to advance the educational model of clinical communication in medicine. PATIENT EDUCATION AND COUNSELING 2022; 105:1351-1352. [PMID: 35461745 DOI: 10.1016/j.pec.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Pål Gulbrandsen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway; Akershus University Hospital, HØKH Health Services Research Unit, 1478 Lørenskog, Norway.
| | - Jennifer Gerwing
- Akershus University Hospital, HØKH Health Services Research Unit, 1478 Lørenskog, Norway
| | - Anne Marie Landmark
- University of South-Eastern Norway, Department of Educational Science and Department of Medicine, Nordland Hospital Trust, Bodø, Norway
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Imafuku R, Saiki T, Woodward-Kron R. Revisiting discourse analysis in medical education research. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:138-142. [PMID: 35640066 PMCID: PMC9902170 DOI: 10.5116/ijme.6278.c1b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Rintaro Imafuku
- Medical Education Development Center, Gifu University, Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University, Japan
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Bernhardt C, Hou SI, King C, Miller A. Identifying Barriers to Effective Patient-Provider Communication About Food Insecurity Screenings in Outpatient Clinical Settings in Central Florida: A Mixed-Methods Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E595-E602. [PMID: 34608888 DOI: 10.1097/phh.0000000000001449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Screening for food insecurity in health care settings is inconsistently performed among health care providers. This study examined how patient-provider interactions influenced patient comfort discussing food insecurity, an important social determinant of health. DESIGN We conducted a convergent mixed-methods study and surveyed patients on their experiences with patient-centered care when communicating and interacting with their providers, and their comfort level being screened for food insecurity. Telephone interviews were also conducted to better understand the concepts in the survey. SETTING Various clinical organizations in Central Florida, as well as food pantries affiliated with Second Harvest Food Bank. PARTICIPANTS Forty-six patients in Central Florida completed the survey, 12 of whom completed qualitative portions of the study (7 completing the qualitative survey questions and 5 completing a telephone interview). MAIN OUTCOME MEASURE Patient comfort discussing food insecurity with their health care providers. RESULTS Quantitative findings show that patient involvement in care planning and cultural sensitivity of health care providers were 2 important factors associated with patient comfort being screened for food insecurity. Qualitative findings suggest that providers' effective communication and empathy are other factors that can influence patient comfort. CONCLUSION To effectively address food insecurity of vulnerable patients and communities, it is important that providers conduct screenings within their practice. This study points to specific actions that providers may employ to increase patient comfort discussing this topic. Efficiently identifying food-insecure patients and connecting them to appropriate community resources would improve patient health and aid in efforts to eliminate health disparities.
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Affiliation(s)
- Christina Bernhardt
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia (Dr Bernhardt); Doctoral Program in Public Affairs, College of Community Innovation and Education (Dr Hou), School of Global Health Management and Informatics (Drs Hou and King), and Nicholson School of Communication and Media (Dr Miller), University of Central Florida, Orlando, Florida
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Manalastas G, Noble LM, Viney R, Griffin AE. What does the structure of a medical consultation look like? A new method for visualising doctor-patient communication. PATIENT EDUCATION AND COUNSELING 2021; 104:1387-1397. [PMID: 33272747 DOI: 10.1016/j.pec.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This project developed an innovative methodology for visualising consultation structure by categorising doctor-patient talk into the phases proposed by an established educational model of clinical communication. METHOD Consultation phases were identified from verbatim transcripts using the tasks and process skills of the Calgary-Cambridge Guide to the Medical Interview. Seventy-eight simulated consultations from a 'History-taking' station of a postgraduate examination for physicians were analysed by two independent raters. Transcripts were converted into diagrams comprising up to six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing. RESULTS The dominant phases were Gathering information, Planning and Explanation (66 %, 10 % and 12 % of talk respectively). While consultations broadly followed the expected chronological sequence, less than a third (23/78) contained all six phases, with Closing and Summary most frequently absent. Half of consultations (40/78) did not include phases in the predicted order, with intertwined phases commonly observed. CONCLUSIONS In this standardised setting, doctors created variable consultation structures, typically omitting phases involving consolidation and agreement of plans going forward. PRACTICE IMPLICATIONS The method enables visualisation and comparison of consultation structure. The findings pose questions about the alignment of practice with educational guidance and the opportunities afforded to patients to actively engage in consultations.
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Affiliation(s)
| | | | - Rowena Viney
- UCL Medical School, University College London, London, UK.
| | - Ann E Griffin
- UCL Medical School, University College London, London, UK.
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