1
|
Zhang S, Cheng M, Ma W, Liu H, Zhao C. Companion responses to diagnosis in Chinese outpatient clinical interaction. Soc Sci Med 2023; 338:116308. [PMID: 37918227 DOI: 10.1016/j.socscimed.2023.116308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
Patients regularly attend clinical consultations with companions in Chinese outpatient clinics. Despite companions' significant influence on clinical consultations, how companions respond to diagnosis and their contributions to the activity of diagnosis in Chinese outpatient clinical interaction remain under-researched. The present study, by adopting the method of conversation analysis, investigated clinicians' diagnostic deliveries and companions' subsequent responses in Chinese outpatient clinical interaction. The data for this study consisted of 79 video recordings of clinical consultations in the Chinese orthopedic outpatient clinic, approximately lasting 12 h and involving three male clinicians, 79 patients (37 male/42 female), and 91 companions (51 male/40 female). Three basic categories of companion responses to diagnosis were identified: minimal verbal responses, embodied responses, and extended responses. It was demonstrated that these distinct responses allowed companions to challenge clinicians' medical authority in the activity of diagnosis by delivering their own diagnostic judgments, resisting clinicians' diagnoses, and orienting to clinicians' accounts for their diagnostic statements and reasoning, thus displaying companion agency in the Chinese outpatient clinical decision-making and indicating a transition from a paternalistic model to a family-centered model of the doctor-patient relationship in the Chinese orthopedic outpatient interaction. This study furthers current knowledge of companion involvement across healthcare contexts and contributes to raising clinicians' awareness of the significance of companions' contributions in Chinese outpatient clinical interaction.
Collapse
Affiliation(s)
- Shuai Zhang
- School of Foreign Languages, Yantai University, Yantai, Shandong, China
| | - Meili Cheng
- School of Foreign Languages, Yantai Institute of Technology, Yantai, Shandong, China
| | - Wen Ma
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
| | - Huashui Liu
- Department of Orthopedics, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chunjuan Zhao
- School of Foreign Languages, Shandong Normal University, Jinan, China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Gasteiger C, Perera A, Yielder R, Scholz U, Dalbeth N, Petrie KJ. Using family-centered communication to optimize patient-provider-companion encounters about changing to biosimilars: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2023; 106:142-150. [PMID: 36400636 DOI: 10.1016/j.pec.2022.11.006] [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: 07/08/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Chiara Gasteiger
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Anna Perera
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael Yielder
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Urte Scholz
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland; Department of Psychology - Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
4
|
Fahmer N, Faller H, Engehausen D, Hass HG, Reuss-Borst M, Duelli K, Wöckel A, Heuschmann PU, Meng K. Patients' challenges, competencies, and perceived support in dealing with information needs - A qualitative analysis in patients with breast and gynecological cancer. PATIENT EDUCATION AND COUNSELING 2022; 105:2382-2390. [PMID: 34930628 DOI: 10.1016/j.pec.2021.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to investigate challenges, competencies, and support in breast and gynecological cancer patients when dealing with information needs and how health literacy as an interplay of these factors might be improved. METHODS Semi-structured interviews were conducted with patients in acute care (n = 19), undergoing rehabilitation (n = 20) or attending self-help groups (n = 16). Interviews were analyzed using content analysis. RESULTS Challenges: gain information according to own needs, internet as information source, information evaluation and decisions, doctor-patient communication, situationally limited information processing, difficult access to information. Competencies: self-regulation of information needs, media and social competencies, communication skills in the doctor-patient conversation, internet competencies, self-directed decisions according to own needs, interest/self-efficacy, previous knowledge, trust in the doctor. SUPPORT by professionals (e.g., patient-centered communication), relatives (e.g., support during consultations), peers (e.g., exchange), facilities (e.g., clinics). CONCLUSIONS Our findings provide insight into challenges and competencies relevant to patients' health literacy and the influence of support. The individuality of the interplay highlights the relevance of an active patient role and patient-centered care. PRACTICE IMPLICATIONS Patients' health literacy should be improved in (psycho)oncological work by both reducing challenges (e.g., by communication skills training, involving relatives) and promoting competencies (e.g., by needs- and competence-oriented information offers).
Collapse
Affiliation(s)
- Natascha Fahmer
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany.
| | - Hermann Faller
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| | | | - Holger G Hass
- Paracelsus Clinic Scheidegg, 88175 Scheidegg, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, 97708 Bad Bocklet, Germany
| | - Kristin Duelli
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Karin Meng
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| |
Collapse
|
5
|
Gasteiger C, Groom KM, Lobo M, Scholz U, Dalbeth N, Petrie KJ. Is Three a Crowd? The Influence of Companions on a Patient's Decision to Transition to a Biosimilar. Ann Behav Med 2021; 56:512-522. [PMID: 34453530 DOI: 10.1093/abm/kaab082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Involving patients in treatment decisions is commonplace in healthcare, and patients are frequently accompanied by a companion (support person). Companions are often actively involved in medical consultations, yet their impact on decisions to change medications is unknown. PURPOSE This study examines the influence of companions on a patient's decision to transition from their bio-originator therapy to a biosimilar. METHODS A parallel, two-arm randomized controlled trial was conducted with 79 patients taking a bio-originator for rheumatic diseases who regularly attend clinic with a companion. Patients were randomized to receive an explanation about a hypothetical transition to a biosimilar alone or with their companion. Patients reported willingness to transition, risk perceptions, difficulty understanding, social support, and completed the Decisional Conflict Scale and Satisfaction with Decision Scale. RESULTS Companions did not influence decisions to transition to biosimilars or cognitive and affective risk perceptions. Accompanied patients reported more difficulty understanding the explanation (p = .006, Cohen's d = .64) but thought it was more important to receive information with companions (p = .023, Cohen's d = -.52). Companions did not impact decision satisfaction or decisional conflict. Receiving emotional, but not practical support, was associated with less decisional conflict in accompanied patients (p = .038, r 2 = 0.20). CONCLUSIONS The presence of companions does not seem to influence risk perceptions or decisions about transitioning to biosimilars. Companions, however, impact the patient's reporting of their ability to understand treatment explanations. Providers should check understanding in all patients but may need to provide additional time or educational resources to accompanied patients and companions. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN12619001435178.
Collapse
Affiliation(s)
- Chiara Gasteiger
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Katie M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand.,National Women's Health, Auckland District Health Board, Auckland, New Zealand
| | - Maria Lobo
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Urte Scholz
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland.,Department of Psychology - Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland
| | - Nicola Dalbeth
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand.,Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|