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Kidanemariam M, Neve OM, van den Heuvel I, Douz S, Hensen EF, Stiggelbout AM, Pieterse AH. Patient-reported outcome measures in value-based healthcare: A multiple methods study to assess patient-centredness. PATIENT EDUCATION AND COUNSELING 2024; 125:108243. [PMID: 38678860 DOI: 10.1016/j.pec.2024.108243] [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: 07/13/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Value-based healthcare (VBHC) involves the use of standardised outcome measures, including patient-reported outcome measures (PROMs). This study aimed to assess to what extent discussion of PROMs is associated with patient- and person-centredness. METHODS This study used a separate sample pre-/post-test design and multiple methods (observations, questionnaires, and interviews) in a VBHC care pathway for patients with a vestibular schwannoma, to assess to what extent the implementation of PROMs is associated with a difference in patient- and person-centredness. RESULTS A total of 139 patients with a vestibular schwannoma and their four treating physicians were included in the study. No significant differences were found in observed patient-centredness (Mpre=6.71 ± 2.42 vs. Mpost=6.93 ± 2.01; P = 0.60) or patient-reported patient-centredness (Mpre=1.73 vs. Mpost=1.68; P = 0.63) and person-centredness after PROM implementation (Mpre=11.81 vs. Mpost=13.42; P = 0.34). We observed more discussion of patient-reported outcomes. However, a majority of patients did not expect PRO discussion in consultations. CONCLUSIONS The implementation of standardised PROMs in a VBHC care pathway was associated with more discussion on patient-reported outcomes in clinical consultations. Overall, the implementation of PROMs was not observed or perceived as leading to more patient-centred consultations. PRACTICE IMPLICATIONS Physicians should assess whether the discussion of PROMs add value collaboratively with patients.
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Affiliation(s)
- Martha Kidanemariam
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Olaf M Neve
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Isabelle van den Heuvel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sana Douz
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik F Hensen
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Dubois H, Creutzfeldt J, Manser T. Behavioural observation tool for patient involvement and collaboration in emergency care teams (PIC-ET-tool). BMC Emerg Med 2023; 23:74. [PMID: 37393240 PMCID: PMC10314478 DOI: 10.1186/s12873-023-00841-7] [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: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Patient participation is advocated in various healthcare settings. Instruments for assessment and feedback have been developed to strengthen clinician-patient interaction. In an emergency department context, such instruments are still missing. The study aimed to develop and test an observation tool for emergency teams' behaviour regarding patient involvement and collaboration. METHODS The development of the behavioural observation tool followed a systematic approach. The tool's content was based on various data sources, i.e., published literature, interview and observational data, and expert consensus. An international expert panel reviewed the content and the rating scale and rated its importance for patient involvement and collaboration in a Delphi process. The feasibility and reliability of the tool were tested by trained observers using video recordings of simulated emergencies. Intraclass correlation (ICC) and Kappa-statistics were performed to test the tool's inter-rater reliability. RESULTS The PIC-ET tool, a 22-item observation instrument was developed in which patient involvement and collaboration behaviours are rated from 'no' to 'high' using behavioural anchors. Expert agreement was obtained after three Delphi rounds on the tool content, the behavioural anchors and its importance for patient involvement and collaboration. The content validity was assessed as high, and the tool was found feasible for research. Overall inter-rater reliability was fair (Kappa 0.52). CONCLUSIONS A novel tool for assessing emergency teams' behaviour regarding patient involvement and collaboration is introduced. The tool's psychometric properties were fair to good. Further validation of the PIC-ET tool is recommended for more robust evidence. Future adaptation to different contexts and areas of use, as well as further validity testing may be of value.
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Affiliation(s)
- Hanna Dubois
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
| | - Tanja Manser
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
- FHNW School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, CH-4600 Switzerland
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van Dongen A, Stewart D, Garry J, McCambridge J. Measurement of person-centred consultation skills among healthcare practitioners: a systematic review of reviews of validation studies. BMC MEDICAL EDUCATION 2023; 23:211. [PMID: 37016379 PMCID: PMC10074817 DOI: 10.1186/s12909-023-04184-6] [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: 05/16/2022] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Person-centred care is integral to high-quality health service provision, though concepts vary and the literature is complex. Validated instruments that measure person-centred practitioner skills, and behaviours within consultations, are needed for many reasons, including in training programmes. We aimed to provide a high-level synthesis of what was expected to be a large and diverse literature through a systematic review of existing reviews of validation studies a of instruments that measure person-centred practitioner skills and behaviours in consultations. The objectives were to undertake a critical appraisal of these reviews, and to summarise the available validated instruments and the evidence underpinning them. METHODS A systematic search of Medline, EMBASE, PsycINFO and CINAHL was conducted in September 2020. Systematic reviews of validation studies of instruments measuring individual practitioner person-centred consultation skills or behaviours which report measurement properties were included. Review quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Details of the reviews, the included validation studies, and the instruments themselves are tabulated, including psychometric data, and a narrative overview of the reviews is provided. RESULTS Four reviews were eligible for inclusion. These used different conceptualisations of person-centredness and targeted distinct, sometimes mutually exclusive, practitioners and settings. The four reviews included 68 unique validation studies examining 42 instruments, but with very few overlaps. The critical appraisal shows there is a need for improvements in the design of reviews in this area. The instruments included within these reviews have not been subject to extensive validation study. DISCUSSION There are many instruments available which measure person-centred skills in healthcare practitioners and this study offers a guide to what is available to researchers and research users. The most relevant and promising instruments that have already been developed, or items within them, should be further studied rigorously. Validation study of existing material is needed, not the development of new measures.
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Affiliation(s)
- Anne van Dongen
- Department of Psychology, Health, and Technology, University of Twente, Enschede, the Netherlands.
| | - Duncan Stewart
- School of Social Sciences and Professions, London Metropolitan University, London, UK
| | - Jack Garry
- Department of Health Sciences, University of York, York, UK
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Rossi E. The Social Construction of Gender in Medical Interactions: A Case for the Perpetuation of Stereotypes? HEALTH COMMUNICATION 2021; 36:1125-1135. [PMID: 32172595 DOI: 10.1080/10410236.2020.1735698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This paper focuses on the ways in which gender, conceived as the product of an ongoing social and cultural construction in and through communication processes, is accomplished during medical encounters and through the narratives produced within these interactions. The main objective is to examine: (1) when and by what devices gender becomes interactionally relevant; (2) the participants' narratives on 'gender issues'; (3) the interplay between the narratives produced and the forms of communication created, also considering which form may be more effective in challenging gender stereotypes and bias. Data are drawn from a corpus of self-administered audio-recorded interactions between a female gynecologist/midwife and pregnant patients. The consultations (half of them mediated, half not) took place in a city of North Italy; the patients (sometimes accompanied by the husband) are migrant women from North and West Africa. The main results show that: (1) at each stage of the examinations, an orientation to gender emerges, mainly through questions that display categorizations, category-bound activities, and cultural assumptions about gender: when referred to the patient, these devices often reproduce the traditional cultural model of femininity and, connected to this, the 'normal' (heterosexual and stable) intimate relationship as socially expected; (2) medical dialogue as patient-centered approach is the most recurrent form of interaction and often leads to a co-construction of narratives in which personal uniqueness is more relevant than gender roles, expectations, and stereotyped representations; when husbands are involved, however, the interactions seem to shift toward doctor-centered forms of communication, and this usually leads to asymmetrical and directive constructions of narratives about differentiated and traditional gender roles.
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Affiliation(s)
- Elisa Rossi
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia
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van Someren JL, Lehmann V, Stouthard JM, Stiggelbout AM, Smets EMA, Hillen MA. Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis. Front Psychol 2021; 12:635422. [PMID: 34135806 PMCID: PMC8201772 DOI: 10.3389/fpsyg.2021.635422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology. Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients (N = 69) who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise. Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: (1) specifying the degree of uncertainty, (2) explaining reasons of uncertainty, (3) providing personalized estimates of uncertainty to patients, (4) downplaying or magnifying uncertainty, (5) reducing or counterbalancing uncertainty, and (6) providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their (7) choice of words/language to convey uncertainty (i.e., "I" vs. "we"; level of explicitness). Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may (un)consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these.
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Affiliation(s)
- Jamie L van Someren
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Louw JM, Hugo JFM. Learning person-centred consultation skills in clinical medicine: A randomised controlled case study. S Afr Fam Pract (2004) 2020; 62:e1-e9. [PMID: 32633995 PMCID: PMC8378123 DOI: 10.4102/safp.v62i1.5109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/03/2022] Open
Abstract
Background: Training institutions need to ensure that healthcare students learn the skills to conduct person-centred consultations. We studied changes in person-centred practice over time following a quality improvement (QI) intervention among Bachelor of Clinical Medical Practice undergraduate students.Methods: Students were randomised to intervention and control groups. The intervention group received training and did a QI cycle on their own consultation skills. Consultations with simulated patients were recorded during structured clinical examinations in June (baseline) and November (post-intervention) 2015.Results: Matched consultations for 64 students were analysed. The total SEGUE (Set the stage, Elicit information, Give information, Understand the patient’s perspective and End the encounter scores) were significantly higher in the final assessment compared to baseline for both the whole group and the intervention group (p = 0.005 and 0.015, respectively). The improvement did not differ significantly between intervention and control groups (p = 0.778). Third-year students improved significantly more than second years (p = 0.007).Conclusion: The person-centred practice (including collaboration) of clinical associate students did improve over the period studied. The results show that students’ learning of person-centred practice also happened in ways other than through the QI intervention. There is a need to develop students’ collaborative skills during the medical consultation.
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Affiliation(s)
- Jakobus M Louw
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Ekman N, Taft C, Moons P, Mäkitalo Å, Boström E, Fors A. A state-of-the-art review of direct observation tools for assessing competency in person-centred care. Int J Nurs Stud 2020; 109:103634. [PMID: 32531569 DOI: 10.1016/j.ijnurstu.2020.103634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists. OBJECTIVE To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC. DESIGN State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017. REVIEW METHODS Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles. RESULT 16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed. CONCLUSION Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.
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Affiliation(s)
- Nina Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Åsa Mäkitalo
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
| | - Eva Boström
- Department of Nursing, University of Umeå, Umeå, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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Louw JM, Marcus TS, Hugo J. How to measure person-centred practice - An analysis of reviews of the literature. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 32129646 PMCID: PMC7136800 DOI: 10.4102/phcfm.v12i1.2170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/29/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Facilitation and collaboration differentiates person-centred practice (PcP) from biomedical practice. In PcP, a person-centred consultation requires clinicians to juggle three processes: facilitation, clinical reasoning and collaboration. How best to measure PcP in these processes remains a challenge. AIM To assess the measurement of facilitation and collaboration in selected reviews of PcP instruments. METHODS Ovid Medline and Google Scholar were searched for review articles evaluating measurement instruments of patient-centredness or person-centredness in the medical consultation. RESULTS Six of the nine review articles were selected for analysis. Those articles considered the psychometric properties and rigour of evaluation of reviewed instruments. Mostly, the articles did not find instruments with good evidence of reliability and validity. Evaluations in South Africa rendered poor psychometric properties. Tools were often not transferable to other socio-cultural-linguistic contexts, both with and without adaptation. CONCLUSION The multiplicity of measurement tools is a product of many dimensions of person-centredness, which can be approached from many perspectives and in many service scenarios inside and outside the medical consultation. Extensive research into the myriad instruments found no single valid and reliable measurement tool that can be recommended for general use. The best hope for developing one is to focus on a specific scenario, conduct a systematic literature review, combine the best items from existing tools, involve multiple disciplines and test the tool in real-life situations.
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Affiliation(s)
- Jakobus M Louw
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Hagiwara N, Elston Lafata J, Mezuk B, Vrana SR, Fetters MD. Detecting implicit racial bias in provider communication behaviors to reduce disparities in healthcare: Challenges, solutions, and future directions for provider communication training. PATIENT EDUCATION AND COUNSELING 2019; 102:1738-1743. [PMID: 31036330 PMCID: PMC7269129 DOI: 10.1016/j.pec.2019.04.023] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/02/2019] [Accepted: 04/19/2019] [Indexed: 05/16/2023]
Abstract
Since publication of Unequal Treatment by the Institute of Medicine in 2003, there has been a growing recognition of the role of provider implicit racial bias in patient care. Provider implicit racial bias has been consistently negatively associated with both care satisfaction and provider trust among racial/ethnic minority patients. This suggests provider implicit racial bias likely manifests through their communication behaviors, which in turn may offer a means of addressing racial disparities in healthcare and ultimately in health. However, identifying provider communication behaviors that mediate the links between provider implicit racial bias and patient outcomes is challenging. In this paper, we argue that identifying these provider communication behaviors requires (1) taking into account findings from social psychology research of implicit racial bias and (2) incorporating the perspectives of racial/ethnic minority patients into patient-provider communication research. We discuss the utility of mixed methods research designs as a framework for resolving this complex scientific question. Research that draws on social psychology research of implicit racial bias and incorporates the racial/ethnic minority patient perspectives can inform the development of communication skills training programs for students and residents in various healthcare fields. Such programs are one element of a broader effort to reduce racial/ethnic disparities in healthcare.
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Affiliation(s)
- Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, USA.
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, Chapel Hill, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - Scott R Vrana
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, USA
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Rangachari P, May KR, Stepleman LM, Tingen MS, Looney S, Liang Y, Rockich-Winston N, Rethemeyer RK. Measurement of Key Constructs in a Holistic Framework for Assessing Self-Management Effectiveness of Pediatric Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3060. [PMID: 31443605 PMCID: PMC6747253 DOI: 10.3390/ijerph16173060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022]
Abstract
The 2007 U.S. National Institutes of Health EPR-3 guidelines emphasize the importance creating a provider-patient partnership to enable patients/families to monitor and take control of their asthma, so that treatment can be adjusted as needed. However, major shortfalls continue to be reported in provider adherence to EPR-3 guidelines. For providers to be more engaged in asthma management, they need a comprehensive set of resources for measuring self-management effectiveness of asthma, which currently do not exist. In a previously published article in the Journal of Asthma and Allergy, the authors conducted a literature review, to develop a holistic framework for understanding self-management effectiveness of pediatric asthma. The essence of this framework, is that broad socioecological factors can influence self-agency (patient/family activation), to impact self-management effectiveness, in children with asthma. A component of socio-ecological factors of special relevance to providers, would be the quality of provider-patient/family communication on asthma management. Therefore, the framework encompasses three key constructs: (1) Provider-patient/family communication; (2) Patient/family activation; and (3) Self-management effectiveness. This paper conducts an integrative review of the literature, to identify existing, validated measures of the three key constructs, with a view to operationalizing the framework, and discussing its implications for asthma research and practice.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA.
| | - Kathleen R May
- Division of Allergy-Immunology and Pediatric Rheumatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Lara M Stepleman
- Department of Psychiatry & Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Martha S Tingen
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Stephen Looney
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Yan Liang
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA
| | - Nicole Rockich-Winston
- Department of Pharmacology & Toxicology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - R Karl Rethemeyer
- Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY 12222, USA
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Langberg EM, Dyhr L, Davidsen AS. Development of the concept of patient-centredness - A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:1228-1236. [PMID: 30846206 DOI: 10.1016/j.pec.2019.02.023] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Patient-centredness is often linked to high-quality patient care, but the concept is not well-defined. This study aims to provide an overview of how patient-centredness has been defined in the literature since Mead and Bower's review in 2000, and to provide an updated definition of the concept. METHOD & DESIGN We performed a systematic literature search in PubMed to identify original articles with a sufficient definition of patient-centredness. We analysed extracted data defining patient-centredness. RESULTS Eighty articles were included. The dimensions "biopsychosocial", "patient-as-person", "sharing power and responsibility" and "therapeutic alliance" corresponded to four of five dimensions described by Mead and Bower. "Coordinated care" was a new dimension. CONCLUSION The identified dimensions are encompassed by three elements: the patient, the doctor-patient relationship and the framework of care i.e. the health care system. The additional focus on coordinated care could reflect increasing complexity of the health care system. PRACTICE IMPLICATIONS Narrowing down the understanding of patient-centredness to these three focus areas, viz. 1) understanding of the patients' experience of the illness in their life situation, 2) the professional's relationship with the patient, and 3) coordination of care in the system, could make the operationalisation and implementation of a patient-centred approach more manageable.
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Affiliation(s)
- Emil Mørup Langberg
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Lise Dyhr
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
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Groeneveld B, Melles M, Vehmeijer S, Mathijssen N, Dekkers T, Goossens R. Developing digital applications for tailored communication in orthopaedics using a Research through Design approach. Digit Health 2019; 5:2055207618824919. [PMID: 30719322 PMCID: PMC6348501 DOI: 10.1177/2055207618824919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Tailored communication and information provision is expected to contribute to patient-centred care (PCC) in total hip arthroplasty (THA). In previous research, three subgroups of THA patients were identified that are similar in their clinical, psychological and communication characteristics. Preliminary subgroup-specific design guidelines were also formulated. Using these insights as a starting point, a theoretical framework was developed for tailored information provision and communication using digital applications. This study aims to refine the framework as well as subgroup-specific design guidelines for digital applications. METHODS This study uses a Research through Design (RtD) approach, generating insights both from the development and evaluation of prototypes in the early design stage. Paper-based prototypes will be made for each subgroup and evaluated with patients and care providers. Semi-structured interviews are held with participants exploring their experiences with the prototype. A quasi-experiment with a non-random control cohort is used to validate the qualitative findings. Post-surgery consultations with and without prototype are videotaped and scored using a structured instrument. RESULTS A design diary will be used to summarize design decisions and considerations. Feedback from participants is analysed inductively. Adaptations in subgroup-specific guidelines will be based on comparison of verbal feedback and descriptive statistics from consultations with and without prototype. CONCLUSIONS Although mixed-method feasibility studies of digital health interventions are common, this protocol also considers the utility of the early design process and the designer's perspective for realizing PCC and tailored care.
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Asan O, Chiou E, Montague E. Quantitative ethnographic study of physician workflow and interactions with electronic health record systems. INTERNATIONAL JOURNAL OF INDUSTRIAL ERGONOMICS 2015; 49:124-130. [PMID: 26279597 PMCID: PMC4531379 DOI: 10.1016/j.ergon.2014.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study explores the relationship between primary care physicians' interactions with health information technology and primary care workflow. Clinical encounters were recorded with high-resolution video cameras to capture physicians' workflow and interaction with two objects of interest, the electronic health record (EHR) system, and their patient. To analyze the data, a coding scheme was developed based on a validated list of primary care tasks to define the presence or absence of a task, the time spent on each task, and the sequence of tasks. Results revealed divergent workflows and significant differences between physicians' EHR use surrounding common workflow tasks: gathering information, documenting information, and recommend/discuss treatment options. These differences suggest impacts of EHR use on primary care workflow, and capture types of workflows that can be used to inform future studies with larger sample sizes for more effective designs of EHR systems in primary care clinics. Future research on this topic and design strategies for effective health information technology in primary care are discussed.
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Affiliation(s)
- Onur Asan
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Erin Chiou
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Enid Montague
- Division of General Internal Medicine, Feinberg School of Medicine Northwestern University
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Pinto MB. Social media's contribution to customer satisfaction with services. SERVICE INDUSTRIES JOURNAL 2015. [DOI: 10.1080/02642069.2015.1062881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zill JM, Christalle E, Müller E, Härter M, Dirmaier J, Scholl I. Measurement of physician-patient communication--a systematic review. PLoS One 2014; 9:e112637. [PMID: 25532118 PMCID: PMC4273948 DOI: 10.1371/journal.pone.0112637] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. METHODS A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. RESULTS Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. DISCUSSION This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of psychometric property studies as well as the comparability of the studies' results.
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Affiliation(s)
- Jördis M. Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Eva Christalle
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Linn AJ, van Dijk L, Smit EG, Jansen J, van Weert JCM. May you never forget what is worth remembering: the relation between recall of medical information and medication adherence in patients with inflammatory bowel disease. J Crohns Colitis 2013; 7:e543-50. [PMID: 23660489 DOI: 10.1016/j.crohns.2013.04.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/26/2013] [Accepted: 04/02/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nurses play an important role in educating patients with inflammatory bowel disease (IBD) about immunosuppressive or biological therapy during prescribing consultations. The education for immunosuppressive or biological therapy often contains complex information. Poor medication intake behavior can be a result of poor information recall, which is often caused by complex information. OBJECTIVES The aim of this study is to measure information recall by IBD patients, and to investigate the relationship between recall and medication intake behavior. METHODS Data collection took place from September 2009 until March 2012. Eight nurses at six Dutch hospitals and 68 IBD patients participated in this study. Prescribing consultations were videotaped and patients completed surveys immediately after the consultation and after three weeks. Information recall was based on the actual communication in video recordings of the consultations. Medication intake behavior was measured by self-report. RESULTS Issues most frequently discussed were side effects and how patients had to administer their medication. IBD patients could reproduce half of the information. Recall of medical information was a significant predictor for self-reported medication intake behavior (β=0.37, p=0.007), indicating that higher recall of medical information relates to improved self-reported medication intake behavior. CONCLUSIONS This study revealed a significant relation between IBD patients' recall and self-reported medication intake behavior. When educating IBD patients about their newly prescribed medication, providers should consider recall-promoting techniques to increase medication intake behavior.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research / ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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Linn AJ, van Weert JCM, Smit EG, Perry K, van Dijk L. 1+1=3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence. PATIENT EDUCATION AND COUNSELING 2013; 93:381-388. [PMID: 23579041 DOI: 10.1016/j.pec.2013.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically. METHODS The development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients. RESULTS The components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention. CONCLUSION By applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior. PRACTICE IMPLICATIONS This study could serve as a guide for the development of other health interventions.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands.
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Chalamon I, Chouk I, Heilbrunn B. Does the patient really act like a supermarket shopper? Proposal of a typology of patients' expectations towards the healthcare system. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2013. [DOI: 10.1179/2047971913y.0000000036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kuis EE, Hesselink G, Goossensen A. Can quality from a care ethical perspective be assessed? A review. Nurs Ethics 2013; 21:774-93. [DOI: 10.1177/0969733013500163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.
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Affiliation(s)
| | - Gijs Hesselink
- Radboud University Nijmegen Medical Centre, The Netherlands
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M van Es J, Wieringa-de Waard M, Visser MRM. Differential growth in doctor-patient communications skills. MEDICAL EDUCATION 2013; 47:691-700. [PMID: 23746158 DOI: 10.1111/medu.12175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/04/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Although doctor-patient communication is considered a core competency for medical doctors, the effect of training has not been unequivocally established. Moreover, knowledge about the variance in the growth of different skills and whether certain patterns in growth can be detected could help us to develop more efficient programmes. We therefore investigated the growth in general practitioner (GP) trainees' doctor-patient communication skills in their first year and whether the growth was different for distinct categories of skills. METHODS Seventy-one first-year GP trainees were invited to participate in a study aimed at measuring their consultation skills at the beginning (baseline) and at the end of their first year (follow-up). Consultation skills were assessed with the MAAS-Global rating list for consultation skills. RESULTS Data on 29 general practitioner trainees were collected. MAAS-Global scores showed a significant growth on all items but one. Patient-oriented skills showed significantly more growth than task-oriented skills. Empathy as a separate skill seems to be mastered predominantly before the start of training. CONCLUSIONS Three patterns in the growth in skills were distinguished: (i) low baseline, relatively high follow-up, (ii) moderate baseline, moderate growth and (iii) high baseline, hardly any growth. Patient-oriented skills follow either pattern (i) or (iii), whereas task-oriented skills follow pattern (ii). These findings may help to define where the focus should lie in the training of doctor-patient communication skills.
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Affiliation(s)
- Judith M van Es
- Academic Medical Center, Department of General Practice, Amsterdam, the Netherlands.
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Speer SA, McPhillips R. Patients' perspectives on psychiatric consultations in the Gender Identity Clinic: implications for patient-centered communication. PATIENT EDUCATION AND COUNSELING 2013; 91:385-391. [PMID: 23369376 DOI: 10.1016/j.pec.2012.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/13/2012] [Accepted: 12/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore transsexual patients' perceptions of communication with psychiatrists in a Gender Identity Clinic and advance understanding of patient centered communication (PCC) in psychiatric, 'gatekeeping' settings. METHODS 21 qualitative interviews with a convenience sample of clinic patients. Interviews were coded at a semantic level and subject to an inductive thematic analysis. RESULTS Patients' perceptions clustered into three themes: (1) aspects of communication that patients described liking; (2) aspects of communication that patients described disliking; and (3) aspects of communication that patients deemed challenging but necessary or useful. CONCLUSION Patients described liking or disliking aspects of communication that reflect existing understandings of PCC. However, a striking feature of their accounts was how they were able to rationalize and reflect pragmatically on their negative communication experiences, welcoming doctors' challenges as an opportunity to consider their life-changing decision to transition from their natal gender. PRACTICE IMPLICATIONS In certain clinical settings, current operationalizations of PCC may not apply. Patients' perceptions of communication may be enhanced if an analysis of their experiences formed part of the professional training of doctors, who could be invited to consider the functional specificity of communication across settings and the consequences (both immediate and post hoc) of their communication practices.
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Affiliation(s)
- Susan A Speer
- School of Psychological Sciences, The University of Manchester, Manchester, UK.
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Laws MB, Taubin T, Bezreh T, Lee Y, Beach MC, Wilson IB. Problems and processes in medical encounters: the cases method of dialogue analysis. PATIENT EDUCATION AND COUNSELING 2013; 91:192-9. [PMID: 23391684 PMCID: PMC3622168 DOI: 10.1016/j.pec.2012.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/21/2012] [Accepted: 12/28/2012] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. METHODS Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The comprehensive analysis of the structure of encounters system (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads--the problems or issues addressed; and processes within threads--basic tasks of clinical care labeled presentation, information, resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. RESULTS 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. CONCLUSIONS In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. PRACTICE IMPLICATIONS Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
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Affiliation(s)
- M Barton Laws
- Brown University, Department of Health Services, Policy & Practice, USA.
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Deledda G, Moretti F, Rimondini M, Zimmermann C. How patients want their doctor to communicate. A literature review on primary care patients' perspective. PATIENT EDUCATION AND COUNSELING 2013; 90:297-306. [PMID: 22709720 DOI: 10.1016/j.pec.2012.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/03/2012] [Accepted: 05/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the literature on the communicative behaviours primary care patients want from a "good" physician. METHODS An electronic search used the key words doctor-patient relation AND patient desires OR patient expectations OR patient preferences (from now on referred to as expectations). The qualitative and quantitative articles meeting the selection criteria were analysed separately, comparing methods, definitions, measures and outcomes. The physician behaviours desirable from a patient perspective were grouped by linking them to the communicative functions of an effective medical encounter as defined from a professional perspective. RESULTS Twenty-seven studies were included. Critical issues were the heterogeneity of definitions and measures and the lack of integration between quantitative and qualitative findings. Most of the expectations in qualitative studies were related to the function "Fostering the relationship". Similar expectations arose less often in quantitative studies. CONCLUSIONS Patients do have concrete expectations regarding each of the functions to be met in the medical encounters. The research approach tends to bias the results. PRACTICE IMPLICATIONS The collected expectations suggest how physicians may perform each of their tasks according to the patient perspective. Future research on patients' communicative expectations needs to overcome the gap between qualitative and quantitative findings.
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Affiliation(s)
- Giuseppe Deledda
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
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Wouda JC, Zandbelt LC, Smets EMA, van de Wiel HBM. Assessment of physician competency in patient education: reliability and validity of a model-based instrument. PATIENT EDUCATION AND COUNSELING 2011; 85:92-98. [PMID: 21075590 DOI: 10.1016/j.pec.2010.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 08/13/2010] [Accepted: 09/04/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Establish the inter-rater reliability and the concept, convergent and construct validity of an instrument for assessing the competency of physicians in patient education. METHODS Three raters assessed the quality of patient education in 30 outpatient consultations with the CELI instrument. This instrument is based on a goal-directed model of patient education and assesses distinctive skills for patient education categorized in four subcompetencies. The inter-rater reliability was calculated. The concept validity was explored by factor analysis. The convergent validity was established by a comparison with two measures of patient-centred behaviour. The construct validity was explored by relating the subcompetencies with physician gender and patient satisfaction. RESULTS The inter-rater reliability for the subcompetencies varied between 0.65 and 0.91. The factor analysis distinguished the four subcompetencies. All subcompetencies correlated with the measures of patient-centred behaviour. Female physicians performed better than male physicians on three subcompetencies. Positive correlations were found for three subcompetencies and patient satisfaction. CONCLUSION The CELI instrument appears to be a reliable and valid instrument. However, further research is needed to establish the generalizability and construct validity. PRACTICE IMPLICATION The CELI instrument is a useful tool for assessment and feedback in medical education since it assesses the performance of distinctive skills.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University Medical Centre, Groningen, The Netherlands.
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Gorawara-Bhat R, Cook MA. Eye contact in patient-centered communication. PATIENT EDUCATION AND COUNSELING 2011; 82:442-447. [PMID: 21211926 DOI: 10.1016/j.pec.2010.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To understand the relationship between eye contact and patient-centered communication (PC) in physician-elder patient interactions. METHODS Two instruments-Patient-centered Behavior Coding Instrument (PBCI) and Eurocommunication Global Ratings Scale-were used to measure PC in 22 National Institute of Aging videotapes. Eye contact was measured using a refined eye contact scale in NDEPT. Qualitative observational techniques were used to understand how eye contact can implicate communication. RESULTS 'High' eye contact tapes were found to be 'high' in PC using both instruments. However, the majority of 'low' tapes were also found to be 'high' in PC. Physicians' behavior distinctly differed in two ways: (1) high tapes were characterized by more 'sustained' eye contact episodes; low tapes consisted of a greater number of 'brief' episodes; (2) brief episode tapes showed a greater focus on 'charts', i.e. 'listening' was bereft of 'looking'; sustained episodes showed a focus on 'patients', i.e. 'listening' was accompanied by 'looking' indicating patient-centered communication. CONCLUSIONS A comprehensive understanding of elder patient-physician interaction needs to include both-'listening' and 'looking'-components of patient-centered communication. PRACTICE IMPLICATIONS Eye contact serves as a salient factor in the expression of PC, making it imperative to incorporate as a nonverbal dimension in PC instruments.
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Affiliation(s)
- Rita Gorawara-Bhat
- The University of Chicago, Department of Medicine, Chicago, IL 60637, USA.
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Dielissen P, Bottema B, Verdonk P, Lagro-Janssen T. Attention to gender in communication skills assessment instruments in medical education: a review. MEDICAL EDUCATION 2011; 45:239-48. [PMID: 21299599 DOI: 10.1111/j.1365-2923.2010.03876.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT Gender is increasingly regarded as an important factor in doctor-patient communication education. This review aims to assess if and how gender is addressed by current assessment instruments for communication skills in medical education. METHODS In 2009 at Radboud University Nijmegen Medical Centre, an online search was conducted in the bibliographic databases PubMed, PsycINFO and ERIC for references about communication skills assessment instruments designed to be completed by trained faculty staff and used in medical education. The search strategy used the following search terms: 'consultation skills'; 'doctor-patient communication'; 'physician-patient relations'; 'medical education'; 'instruments'; 'measurement', and 'assessment'. Papers published between January 1999 and June 2009 were included. The assessment instruments identified were analysed for gender-specific content. RESULTS The search yielded 21 communication skills assessment instruments. Only two of the 17 checklists obtained explicitly considered gender as a communication-related issue. Only six of 21 manuals considered gender in any way and none gave specific details to explain which aspects of communication behaviour should be assessed with regard to gender. CONCLUSIONS Very few communication assessment instruments in medical education focus on gender. Nevertheless, interest exists in using gender in communication skills assessment. The criteria for and purpose of assessing gender in communication skills in medical education are yet to be clarified.
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Affiliation(s)
- Patrick Dielissen
- Department of Primary Care and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Jansen J, van Weert JCM, de Groot J, van Dulmen S, Heeren TJ, Bensing JM. Emotional and informational patient cues: the impact of nurses' responses on recall. PATIENT EDUCATION AND COUNSELING 2010; 79:218-24. [PMID: 20005066 DOI: 10.1016/j.pec.2009.10.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 09/27/2009] [Accepted: 10/03/2009] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To investigate older cancer patients' informational and emotional cues, how nurses respond to these cues and the effect of cues and responses on patients' information recall. METHODS 105 cancer patients (aged >or=65 years) completed a recall questionnaire after an educational session preceding chemotherapy treatment. Recall was checked against the actual communication in videorecordings of the consultations. Patients' emotional and informational cues and subsequent responses by the nurse were rated using an adaptation of the Medical Interview Aural Rating Scale (MIARS). RESULTS Patients gave more informational than emotional cues. The most frequent response to emotional cues was distancing followed by acknowledgement. Nurses gave appropriate information in response to the majority of informational cues. Patients' expression of emotional or informational cues did not influence recall; neither did nurses' responses to informational cues. Responses to emotional cues did affect recall. The more nurses responded by giving 'minimal' encouragements (e.g. 'Hmmm'), the more patients recalled, while distancing responses (e.g. switching focus) were associated with lower recall scores. CONCLUSION Responding to patients' emotions is likely to impact information recall. PRACTICE IMPLICATIONS These results highlight the importance of addressing patients' expressions of emotions in the context of patient education, as it enhances information recall.
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Affiliation(s)
- Jesse Jansen
- Screening and Test Evaluation Program, Sydney School of Public Health, Centre for Medical Psychology and Evidence-based Decision-Making, University of Sydney, NSW, Australia
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Del Piccolo L, Angela Mazzi M, Scardoni S, Gobbi M, Zimmermann C. A theory‐based proposal to evaluate patient‐centred communication in medical consultations. HEALTH EDUCATION 2008. [DOI: 10.1108/09654280810899984] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zinken KM, Cradock S, Skinner TC. Analysis System for Self-Efficacy Training (ASSET). Assessing treatment fidelity of self-management interventions. PATIENT EDUCATION AND COUNSELING 2008; 72:186-193. [PMID: 18534809 DOI: 10.1016/j.pec.2008.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 04/16/2008] [Accepted: 04/21/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The paper presents the development of a coding tool for self-efficacy orientated interventions in diabetes self-management programmes (Analysis System for Self-Efficacy Training, ASSET) and explores its construct validity and clinical utility. METHODS Based on four sources of self-efficacy (i.e., mastery experience, role modelling, verbal persuasion and physiological and affective states), published self-efficacy based interventions for diabetes care were analysed in order to identify specific verbal behavioural techniques. Video-recorded facilitating behaviours were evaluated using ASSET. RESULTS The reliability between four coders was high (K=0.71). ASSET enabled assessment of both self-efficacy based techniques and participants' response to those techniques. Individual patterns of delivery and shifts over time across facilitators were found. In the presented intervention we observed that self-efficacy utterances were followed by longer patient verbal responses than non-self-efficacy utterances. CONCLUSION These detailed analyses with ASSET provide rich data and give the researcher an insight into the underlying mechanism of the intervention process. PRACTICE IMPLICATIONS By providing a detailed description of self-efficacy strategies ASSET can be used by health care professionals to guide reflective practice and support training programmes.
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Affiliation(s)
- Katarzyna M Zinken
- School of Psychology, University of Southampton, Highfield, Southampton, UK.
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Ghods BK, Roter DL, Ford DE, Larson S, Arbelaez JJ, Cooper LA. Patient-physician communication in the primary care visits of African Americans and whites with depression. J Gen Intern Med 2008; 23:600-6. [PMID: 18264834 PMCID: PMC2324146 DOI: 10.1007/s11606-008-0539-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 10/23/2007] [Accepted: 01/29/2008] [Indexed: 01/22/2023]
Abstract
BACKGROUND Little research investigates the role of patient-physician communication in understanding racial disparities in depression treatment. OBJECTIVE The objective of this study was to compare patient-physician communication patterns for African-American and white patients who have high levels of depressive symptoms. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional study of primary care visits of 108 adult patients (46 white, 62 African American) who had depressive symptoms measured by the Medical Outcomes Study-Short Form (SF-12) Mental Component Summary Score and were receiving care from one of 54 physicians in urban community-based practices. MAIN OUTCOMES Communication behaviors, obtained from coding of audiotapes, and physician perceptions of patients' physical and emotional health status and stress levels were measured by post-visit surveys. RESULTS African-American patients had fewer years of education and reported poorer physical health than whites. There were no racial differences in the level of depressive symptoms. Depression communication occurred in only 34% of visits. The average number of depression-related statements was much lower in the visits of African-American than white patients (10.8 vs. 38.4 statements, p = .02). African-American patients also experienced visits with less rapport building (20.7 vs. 29.7 statements, p = .009). Physicians rated a higher percentage of African-American than white patients as being in poor or fair physical health (69% vs. 40%, p = .006), and even in visits where depression communication occurred, a lower percentage of African-American than white patients were considered by their physicians to have significant emotional distress (67% vs. 93%, p = .07). CONCLUSIONS This study reveals racial disparities in communication among primary care patients with high levels of depressive symptoms. Physician communication skills training programs that emphasize recognition and rapport building may help reduce racial disparities in depression care.
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Affiliation(s)
- Bri K Ghods
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Del Piccolo L, Mazzi MA, Dunn G, Sandri M, Zimmermann C. Sequence analysis in multilevel models. A study on different sources of patient cues in medical consultations. Soc Sci Med 2007; 65:2357-70. [PMID: 17868965 DOI: 10.1016/j.socscimed.2007.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Indexed: 11/25/2022]
Abstract
The aims of the study were to explore the importance of macro (patient, physician, consultation) and micro (doctor-patient speech sequences) variables in promoting patient cues (unsolicited new information or expressions of feelings), and to describe the methodological implications related to the study of speech sequences. Patient characteristics, a consultation index of partnership and doctor-patient speech sequences were recorded for 246 primary care consultations in six primary care surgeries in Verona, Italy. Homogeneity and stationarity conditions of speech sequences allowed the creation of a hierarchy of multilevel logit models including micro and macro level variables, with the presence/absence of cues as the dependent variable. We found that emotional distress of the patient increased cues and that cues appeared among other patient expressions and were preceded by physicians' facilitations and handling of emotion. Partnership, in terms of open-ended inquiry, active listening skills and handling of emotion by the physician and active participation by the patient throughout the consultation, reduced cue frequency.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Medicine and Public Health, University of Verona, Italy.
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Smets E, van Zwieten M, Michie S. Comparing genetic counseling with non-genetic health care interactions: two of a kind? PATIENT EDUCATION AND COUNSELING 2007; 68:225-34. [PMID: 17604936 DOI: 10.1016/j.pec.2007.05.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 05/22/2007] [Accepted: 05/22/2007] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Increasingly clinicians other than genetic counselors will advise people with genetic risks. Although some express concerns about this development because of the need for non-genetic clinicians to have additional training, we argue that genetic counseling has more in common with other health care interactions than is generally assumed. METHODS In this narrative review we investigate the health communication literature taking the perspective that all provider-patient/client interactions share the following goals: forming a relationship, the exchange of information, decision making, promoting health-related behavior and providing support. RESULTS We found that both non-genetic and genetic 'disciplines' endorse an egalitarian relationship, based on a patient-centered approach and both have difficulties with attuning to the patients' agendas and enhancing patient understanding. Shared decision making is increasingly the preferred model for geneticists and non-geneticists alike, and both need skills to constructively discuss patients' risk-reducing behavior and provide emotional support. CONCLUSION Rather than developing separate vocabularies and research traditions, the discipline of genetic counseling may benefit by drawing on non-genetic patient-provider interaction research. PRACTICE IMPLICATIONS Since geneticists face the same challenges as non-geneticists, medical training should continue to improve basic consultation skills, regardless of whether the consultation involves genetic information.
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Affiliation(s)
- Ellen Smets
- Department of Medical Psychology and Clinical Genetics, Academic Medical Center/University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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Zandbelt LC, Smets EMA, Oort FJ, Godfried MH, de Haes HCJM. Medical specialists' patient-centered communication and patient-reported outcomes. Med Care 2007; 45:330-9. [PMID: 17496717 DOI: 10.1097/01.mlr.0000250482.07970.5f] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physicians' patient-centered communication in the medical consultation is generally expected to improve patient outcomes. However, empirical evidence is contradictory so far, and most studies were done in primary care. OBJECTIVE We sought to determine the association of specialists' patient-centered communication with patient satisfaction, adherence, and health status. METHODS Residents and specialists in internal medicine (n = 30) and their patients (n = 323) completed a questionnaire before a (videotaped) follow-up encounter. Patients' satisfaction was assessed immediately after the consultation and their self-reported treatment adherence, symptoms, and distress 2 weeks later. Specialists' patient-centered communication was assessed by coding behaviors that facilitate or rather inhibit patients to express their perspective. Patient participation was assessed by determining their relative contribution to the conversation and their active participation behavior. Outcomes were assessed using standard questionnaires. Analyses accounted for relevant patient, visit and physician characteristics. RESULTS AND CONCLUSIONS Medical specialists' facilitating behavior was associated with greater satisfaction in patients who were less confident in communicating with their doctor. Patient-centered communication was not associated with patients' health status or adherence in general, but facilitating behavior was positively related to the adherence of patients with a foreign primary language. In general, patients appeared to be more satisfied after an encounter with a more-facilitating and a less-inhibiting physician, but these associations diminished when controlling for background characteristics. We conclude that the absence of strong associations between patient-centered communication and patient-reported outcomes may be explained by medical specialists being responsive to patients' characteristics.
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Affiliation(s)
- Linda C Zandbelt
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, The Netherlands.
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Zandbelt LC, Smets EMA, Oort FJ, Godfried MH, de Haes HCJM. Patient participation in the medical specialist encounter: does physicians' patient-centred communication matter? PATIENT EDUCATION AND COUNSELING 2007; 65:396-406. [PMID: 17085006 DOI: 10.1016/j.pec.2006.09.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 09/22/2006] [Accepted: 09/27/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Physicians' patient-centred communication is assumed to stimulate patients' active participation, thus leading to more effective and humane exchange in the medical consultation. We investigated the relationship between physicians' patient-centred communication and patient participation in a medical specialist setting. METHODS Participants were 30 residents and specialists in internal medicine, and 323 of their patients. Participants completed a questionnaire prior to a (videotaped) follow-up consultation. Physicians' patient-centred communication was assessed by coding behaviours that facilitate or rather inhibit patients to express their perspective. Patient participation was determined by assessing (a) their relative contribution to the conversation, and (b) their active participation behaviour. Analyses accounted for relevant background characteristics. RESULTS Physicians' facilitating behaviour was found to be positively associated with patients' relative contribution to the conversation as well as patients' active participation behaviour. Physicians' inhibiting behaviour was not related to patients' relative contribution, and was, unexpectedly, positively associated with patients' active participation behaviour. Physicians' behaviour was particularly associated with patients' expression of concerns and cues. CONCLUSIONS Physicians in internal specialist medicine appear to be able to facilitate patients' active participation in the visit. The findings indicate that inhibiting behaviour may not have the expected blocking effect on patient participation: patients voiced their perspectives just the same and expressed even more concerns. Showing inhibiting behaviour may, alternatively, be a physician's response to the patient's increased participation in the encounter. PRACTICE IMPLICATIONS The results may give directions for future medical education and specialist training.
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Affiliation(s)
- Linda C Zandbelt
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, The Netherlands.
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Zandbelt LC, Smets EMA, Oort FJ, Godfried MH, de Haes HCJM. Determinants of physicians' patient-centred behaviour in the medical specialist encounter. Soc Sci Med 2006; 63:899-910. [PMID: 16530904 DOI: 10.1016/j.socscimed.2006.01.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Indexed: 11/18/2022]
Abstract
It has been suggested that patient-centred communication does not necessarily translate into a 'one-size fits all' approach, but rather that physicians should use a flexible style and adapt to the particular needs of their patients. This paper examines variability in physicians' patient-centred behaviour in medical specialist encounters, and determines whether patient, visit, and physician characteristics influence this variability. Participants were 30 residents and specialists in internal medicine at an academic teaching hospital in The Netherlands, and 323 patients having a (videotaped) outpatient follow-up appointment. Physicians and patients completed a questionnaire prior to the encounter. Consultations were coded using the Patient-centred Behaviour Coding Instrument (PBCI); physicians' patient-centred behaviour was determined by behaviours that facilitated rather than inhibited the patient's expression of his/her perspective. The results show that physicians differ in their communicative behaviour (i.e. inter-individual variability): some internists had a more 'patient-centred' communication style and others less so. At the same time, physicians show intra-individual variation; apparently they adjust their style according to the situation. Physicians displayed more facilitating behaviour when patients were older, reported more physical symptoms, when they rated patients' health condition as more severe and when the physician was a woman. Physicians also displayed more inhibiting behaviour when patients reported more physical symptoms and when the physician rated patients' health condition as more severe. Apparently, sicker patients were targets of both greater facilitation and greater inhibition. Variability in physicians' facilitating and inhibiting behaviour was explained by patient characteristics, i.e. patients' age and health condition, and-with the exception of physician gender-not by physician or visit characteristics. This indicates that physician patient-centred behaviour is related to the type of patient visiting, especially in relation to the seriousness of symptoms.
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Affiliation(s)
- Linda C Zandbelt
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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