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Barnes RK, Woods CJ. Communication in Primary Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research. RESEARCH ON LANGUAGE AND SOCIAL INTERACTION 2024; 57:7-37. [PMID: 38707494 PMCID: PMC11067862 DOI: 10.1080/08351813.2024.2305038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
We report the first state-of-the-art review of conversation-analytic (CA) research on communication in primary healthcare. We conducted a systematic search across multiple bibliographic databases and specialist sources and employed backward and forward citation tracking. We included 177 empirical studies spanning four decades of research and 16 different countries/health systems, with data in 17 languages. The majority of studies originated in United States and United Kingdom and focused on medical visits between physicians and adult patients. We generated three broad research themes in order to synthesize the study findings: managing agendas, managing participation, and managing authority. We characterize the state-of-the-art for each theme, illustrating the progression of the work and making comparisons across different languages and health systems, where possible. We consider practical applications of the findings, reflect on the state of current knowledge, and suggest some directions for future research. Data reported are in multiple languages.
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Affiliation(s)
- Rebecca K. Barnes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, U.K.
| | - Catherine J. Woods
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health Centre, U.K.
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2
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Rodrigues MG, Manão AA, Tomada N, Pascoal PM. The role and needs of family doctors in sexual medicine: contributions of a preliminary Portuguese qualitative study for a global action. Int J Impot Res 2024:10.1038/s41443-024-00864-z. [PMID: 38472302 DOI: 10.1038/s41443-024-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024]
Abstract
Sexual health is fundamental for overall well-being and quality of life, making it the focus of intervention in Sexual Medicine (SM). Within the National Health Services, Primary Care Physicians (PCPs) guarantee comprehensive care in a biopsychosocial action, including in sexual health. This exploratory study aimed to investigate PCPs' perceptions about their role in SM and how to improve it. A cross-sectional online qualitative design was used, and a sample of 73 Portuguese PCPs was collected. Data was analyzed employing a summative content analysis. Three categories were established regarding how PCPs perceive their role in SM: "Protagonist", "Antagonist", and "Circumstantial". Concerning improving PCP's practice, two categories were identified: "Legitimizing Sexual Health" and "Enhancing Professional Development". In relation to SM, PCPs recognize themselves as institutional gatekeepers and comprehensive caregivers, resorting to familiar tasks to practice in a conditioned framework. To improve their role in SM, PCPs highlighted education investment, making specific suggestions for educational content, resource expedition, detailed guidelines creation, and raising provider and patient awareness beyond the biomedical scope. The results stress the need for an institutional effort to uphold PCPs' crucial role in SM to ensure adequate resource use and consistent, comprehensive sexual healthcare provision, enhancing overall patient care and placing sexual health as an essential field in primary care.
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Affiliation(s)
- Margarida G Rodrigues
- School of Psychology and Life Sciences (EPCV) of Lusófona University, Lisbon, Portugal
| | - Andreia A Manão
- Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal
| | - Nuno Tomada
- Institute for Health Research and Innovation (i3S) of Porto University, Porto, Portugal
| | - Patrícia M Pascoal
- Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal.
- Sociedade Portuguesa de Sexologia Clínica, Bragança, Portugal.
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3
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Paulus TM, Grubbs H, Rice-Moran R, Lester JN. How student healthcare providers in a communication skills course respond to standardized patient resistance. Soc Sci Med 2023; 337:116309. [PMID: 37879265 DOI: 10.1016/j.socscimed.2023.116309] [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: 05/10/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
Encountering and responding to patient resistance can be especially challenging for student healthcare providers. Navigating who ultimately holds the authority to know and understand a health concern, make recommendations for a course of action, and accept or resist these recommendations are all part of how epistemic authority is negotiated in medical settings. The purpose of this paper is to systematically examine how student providers enrolled in a communication skills course at an American university responded to standardized patient resistance. The data for this study were 121 video-recorded and transcribed final objective structured clinical examinations from the fall 2019 course. We used discourse analysis informed by principles of conversation analysis to identify several discursive strategies used by the students, including: 1) asking for clarification; 2) expressing uncertainty and offering to gather additional resources; 3) aligning with and offering an account for the resistance; 4) recommending a new course of action; and 5) confronting the resistance. Our findings point to the value of including instruction for both student healthcare providers and standardized patients on how to respond to resistance they encounter in ways that may help improve healthcare outcomes.
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Affiliation(s)
- Trena M Paulus
- East Tennessee State University, Research Division, Department of Family Medicine, Quillen College of Medicine, PO Box 70621, Johnson City, TN, 37614, USA.
| | - Heather Grubbs
- East Tennessee State University, Research Division, Department of Family Medicine, Quillen College of Medicine, PO Box 70621, Johnson City, TN, 37614, USA.
| | - Renee Rice-Moran
- Department of Curriculum and Instruction, Clemmer College, East Tennessee State University, 402 Warf-Pickel Hall, Johnson City, TN, 37614, USA.
| | - Jessica N Lester
- Department of Counseling and Educational Psychology, School of Education, 201 North Rose Avenue, Indiana University, Bloomington, IN, 47405-1006, USA.
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4
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Tremblett M, Webb H, Ziebland S, Stokoe E, Aveyard P, Albury C. The Basis of Patient Resistance to Opportunistic Discussions About Weight in Primary Care. HEALTH COMMUNICATION 2023:1-13. [PMID: 37904324 DOI: 10.1080/10410236.2023.2266622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Clinicians expect that talking to patients with obesity about potential/future weight loss will be a difficult conversation, especially if it is not the reason that a patient is seeking medical help. Despite this expectation, many governments ask clinicians to take every opportunity to talk to patients about weight to help manage increasing levels of obesity. Although this is recommended, little is known about what happens in consultations when clinicians opportunistically talk to patients about weight, and if the anticipated difficulties are reality. This paper examines displays of explicit patient resistance following opportunistic weight-loss conversations initiated by GPs. We analyzed audio recordings and transcribed them for conversation analysis. We focused on the precursors of explicit resistance displays during opportunistic weight loss discussions, the format of the resistance, and the ways it was managed by GPs. We found relatively few instances of explicit resistance displays. When it did occur, rather than be related to the opportunistic nature of the advice, or the topic of weight itself, resistance was nuanced and associated to the sensitivity of the GPs managing unknown patient levels of awareness of weight loss benefits, or prior efforts to lose weight. Clinicians tended not to challenge this resistance from patients, and we suggest this tactic may be acceptable to patients and help foster the long-term collaborative relationships needed to tackle obesity. Data are in British English.
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Affiliation(s)
- Madeleine Tremblett
- Nuffield Department of Primary Care Health Sciences, University of Oxford
- School of Social Sciences, University of the West of England
| | - Helena Webb
- School of Computer Science, University of Nottingham
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Elizabeth Stokoe
- Department of Psychological and Behavioural Science, The London School of Economics and Political Science
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford
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5
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Ho EY, Leung G, Jih J. "It Looks Like You're Making Very Healthy Choices": Attending to the Lifeworld and Medicine in Photo-Based Talk in Primary Care. HEALTH COMMUNICATION 2023; 38:2387-2398. [PMID: 35642446 PMCID: PMC9712590 DOI: 10.1080/10410236.2022.2071390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Addressing patient-clinician communication barriers to improve multiple chronic disease care is a public health priority. While significant research exists about the patient-clinician encounter, less is known about how to support patient-clinician communication about lifestyle changes that includes the context of people's lives. Data come from a larger photo-based primary care study collected from 13 participants who were adults 60 or older with at least two chronic conditions, in English, Chinese (Cantonese or Mandarin), or Spanish. We use discourse analysis of three examples as anchor points demonstrating different interactional pathways for the photo-based communication. Patients and clinicians can move smoothly through a pathway in which photos are shared, clinicians acknowledge and align with the patient's explanation, and clinicians frame their medical evaluations of food choices, nutrition suggestions, and shared goal-setting by invoking the voice of lifeworld (VOL). On the other hand, when clinicians solely press the voice of medicine (VOM) in their evaluations of patients' pictures with little attention to patients' presentations, it can lead to patient resistance and difficulty moving to the next activity. Because photo-sharing is still relatively novel, it offers unique interactional spaces for both clinicians and patients. Photo-sharing offers a sanctioned moment for a primary care visit to operate in the VOL and promote goal-setting that both parties can agree upon, even if clinicians and patients framed the activity as one in which patients' lifeworld choices should be assessed as medically healthy or unhealthy based on the ultimate judgment of clinicians operating from the VOM.
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Affiliation(s)
- Evelyn Y. Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric & Language, University of San Francisco, San Francisco, CA, USA
| | - Jane Jih
- Asian American Research Center on Health, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, CA, USA
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Sun K, Chen XS, Muzhylko T, Andrade FCD. Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil. Prev Med Rep 2023; 35:102315. [PMID: 37576845 PMCID: PMC10413139 DOI: 10.1016/j.pmedr.2023.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023] Open
Abstract
Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.
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Affiliation(s)
- Kang Sun
- University of Illinois at Urbana-Champaign, United States
| | | | - Tonya Muzhylko
- University of Illinois at Urbana-Champaign, United States
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7
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Osborn-Jenkins L, Day E, Payne H, White R, Roberts L. Advice-giving skills in pre-registration physiotherapy training. Physiother Theory Pract 2023:1-15. [PMID: 37668054 DOI: 10.1080/09593985.2023.2247485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome. OBJECTIVES This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice. METHODS Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year. RESULTS Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients. CONCLUSIONS Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients.
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Affiliation(s)
- Lisa Osborn-Jenkins
- Therapy Services, Department, University Hospital Southampton NHS Foundation Trust, Hampshire, UK
- School of Health Sciences, University of Southampton, Hampshire, UK
| | - Elizabeth Day
- School of Health Sciences, University of Southampton, Hampshire, UK
| | - Hayley Payne
- School of Health Sciences, University of Southampton, Hampshire, UK
| | - Robin White
- School of Health Sciences, University of Southampton, Hampshire, UK
| | - Lisa Roberts
- Therapy Services, Department, University Hospital Southampton NHS Foundation Trust, Hampshire, UK
- School of Health Sciences, University of Southampton, Hampshire, UK
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Tremblett M, Webb H, Ziebland S, Stokoe E, Aveyard P, Albury C. Talking delicately: Providing opportunistic weight loss advice to people living with obesity. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531292 PMCID: PMC9748302 DOI: 10.1016/j.ssmqr.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 01/26/2023]
Abstract
Obesity is a major worldwide public health problem. Clinicians are asked to communicate public health messages, including encouraging and supporting weight loss, during consultations with patients living with obesity. However, research shows that talking about weight with patients rarely happens and both parties find it difficult to initiate. Current guidelines on how to have such conversations do not include evidence-based examples of what to say, when to say it and how to avoid causing offence (a key concern for clinicians). To address this gap, we examined 237 audio recorded consultations between clinicians and patients living with obesity in the UK in which weight was discussed opportunistically. Conversation analysis revealed that framing advice as depersonalised generic information was one strategy clinicians used when initiating discussions. This contrasted to clinicians who made advice clearly relevant and personalised to the patient by first appraising their weight. However not all personalised forms of advice worked equally well. Clinicians who spoke delicately when personalising the discussion avoided the types of patient resistance that we found when clinicians were less delicate. More delicate approaches included forecasting upcoming discussion of weight along with delicacy markers in talk (e.g. strategic use of hesitation). Our findings suggest that clinicians should not avoid talking about a patient's weight, but should speak delicately to help maintain good relationships with patients. The findings also demonstrate the need to examine communication practices to develop better and specific guidance for clinicians. Data are in British English.
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Affiliation(s)
- Madeleine Tremblett
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Helena Webb
- School of Computer Science, University of Nottingham, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Elizabeth Stokoe
- Discourse and Rhetoric Group, Loughborough University, Loughborough, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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9
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Wheat H, Barnes RK, Aveyard P, Stevenson F, Begh R. Brief opportunistic interventions by general practitioners to promote smoking cessation: A conversation analytic study. Soc Sci Med 2022; 314:115463. [PMID: 36332533 DOI: 10.1016/j.socscimed.2022.115463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Abstract
Very brief opportunistic interventions for smoking cessation are effective, cost-saving for health systems, and universally recommended in guidelines. However, evidence suggests that clinicians are reluctant to intervene, citing interactional difficulties. Only one UK study has specifically examined smoking discussions, within naturally occurring primary care consultations. However smoking cessation treatment was not available at the time. We examined existing datasets amounting to 519 video-recordings of GP consultations in England for instances of talk about smoking. We used conversation analytic methods to assess patients' responses to doctors asking about smoking, giving advice on smoking, and offering cessation treatment. In 31 recordings it was apparent that the patient smoked, and, in 25/31 consultations, doctors initiated the topic of smoking. They did so by asking about smoking status, commonly during the history-taking phase of the consultation. In many instances, these questions led to active resistance from patients against being placed in a discreditable category, for example by minimising their smoking. This was more pronounced when GPs pursued efforts to quantify the amount smoked. Thereafter, where doctors returned to the topic of smoking, they did so typically by linking smoking to the patient's medical condition, which likewise led to resistance. Guidance recommends that GPs advise on how best to quit smoking where patients are interested in doing so, but this was only evident in a minority of consultations. Where GPs offered support for cessation, they did so using interactional practices that minimised the need for the patient to respond and thereby accept. Interactional difficulties were found to be common in consultations between GPs and people who smoke when GPs actions aligned with some VBA guidelines. Future research should examine when and how advice on how best to quit, and offers of support, should be delivered within primary care consultations.
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Affiliation(s)
- H Wheat
- Community and Primary Care Research Group, University of Plymouth, Plymouth, UK.
| | - R K Barnes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - F Stevenson
- Primary Care and Population Health, University College London, UK
| | - R Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Tietbohl CK, White AEC. Making Conversation Analysis Accessible: A Conceptual Guide for Health Services Researchers. QUALITATIVE HEALTH RESEARCH 2022; 32:1246-1258. [PMID: 35616449 DOI: 10.1177/10497323221090831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The quality of healthcare communication can impact both experiences and outcomes. We highlight aspects of communication that can be systematically examined using Conversation Analysis (CA) and provide guidance about how researchers can incorporate CA into healthcare studies. CA is a qualitative method for studying naturally occurring communication by analyzing recurrent, systematic practices of verbal and nonverbal behavior. CA involves examining audio- or video-recorded conversations and their transcriptions to identify practices speakers use to communicate and interpret behavior. We explain what distinguishes CA from other methods that study communication and highlight three accessible CA approaches that researchers can use in their research design, analysis, or implementation of communication interventions. Specifically, these approaches focus on how talk is produced (specific words, framing, and syntax), by whom, and when it occurs in the conversation. These approaches can be leveraged to generate hypotheses and to identify patterns of behavior that inform empirically driven communication interventions.
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Affiliation(s)
- Caroline K Tietbohl
- Adult and Child Center for Health Outcomes Research and Delivery Science, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne E C White
- Department of Family Medicine, Sanford Institute for Empathy and Compassion, University of California San Diego, La Jolla, CA, USA
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Dietary advice in chronic care: Comparing traditional Chinese and western medicine practiced in mainland China. Soc Sci Med 2021; 292:114621. [PMID: 34883312 DOI: 10.1016/j.socscimed.2021.114621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
The study examines dietary advice-giving in regular consultations for patients with chronic conditions in two types of clinical practices: Traditional Chinese Medicine and Western Medicine practiced in mainland China. Dietary habits are unanimously considered relevant to the patient's health, particularly in chronic conditions. This article reports the differences in where and how dietary advice is occasioned and co-constructed by participants in two settings. One significant finding of this paper is that while Traditional Chinese Medicine doctors take dietary talk to instruct patients and put it into the treatment recommendation, WM doctors may treat it as incidental and only valuable for diagnostic assessment, leaving its treatment opaque and not discussed with the patient. Data are in Mandarin Chinese. Using Conversation Analysis, the article describes the interactional organisation of dietary advice delivery in different medical practices and ascribes their differences to clinical pathology.
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Connabeer K. Lifestyle advice in UK Primary Care consultations: Doctors' use of conditional forms of advice. PATIENT EDUCATION AND COUNSELING 2021; 104:2706-2715. [PMID: 33863585 DOI: 10.1016/j.pec.2021.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate how doctors deliver lifestyle advice to patients in ordinary general practice consultations. METHOD A secondary analysis of audio/video recorded primary care consultations between doctors and patients. Instances of lifestyle related talk were identified and analysed according to the methods of Conversation Analysis. RESULTS The most frequently used format for delivering advice was found to be if-conditional forms. Conditional forms work to convey how advice is relevant to the individual's health circumstances 1) topicalising the problematic risk to the patient, 2) informing and warning the patient of reoccurring or future health risks, and 3) offering changes in lifestyle in addition to or as a replacement for medication. CONCLUSION The results show that doctors use if-conditional constructions to navigate anticipated or actual difficulties evidenced through misalignment in delivering lifestyle advice, by conveying the importance of the advice to the individual patient. PRACTICE IMPLICATIONS Using if-conditional constructions when talking with patients regarding their problematic risk factors provides a technique enabling doctors to navigate the sensitivities associated with giving advice, whilst delivering personalised and preventative medicine.
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Bergen C, McCabe R. Negative stance towards treatment in psychosocial assessments: The role of personalised recommendations in promoting acceptance. Soc Sci Med 2021; 290:114082. [PMID: 34217546 DOI: 10.1016/j.socscimed.2021.114082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
People presenting to the emergency department with self-harm or thoughts of suicide undergo a psychosocial assessment involving recommendations for e.g. contact with other practitioners, charity helplines or coping strategies. In these assessments, patients frequently adopt a negative stance towards potential recommendations. Analysing 35 video-recorded liaison psychiatry psychosocial assessments from an emergency department in England (2018-2019), we ask how these practitioners transform this negative stance into acceptance. We show that practitioners use three steps to anticipate and address negative stance (1) asking questions about the patient's experience/understanding that help the patient to articulate a negative stance (e.g., "what do you think about that"); (2) accepting or validating the reasons underlying the negative stance (e.g., "that's a very real fear and thought to have"); and (3) showing the patient that their reasons were incorporated in the recommendation (e.g., "it's telephone support if you're a bit more uncomfortable with face to face"). These steps personalise the recommendation based on the patient's specific experiences and understanding. When practitioners followed all three of these steps, the patient moved from a negative stance to acceptance in 84% of cases. When practitioners made a recommendation but did not follow all three steps, the patient moved from a negative stance to acceptance in only 14% of cases. It is not the case that each communication practice works on its own to promote patient acceptance, rather Steps 1 and 2 build on each other sequentially to develop and demonstrate shared understanding of the patient's negative stance. In this way, acceptance and validation play an indispensable role in addressing a patient's concerns about treatment.
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Affiliation(s)
- Clara Bergen
- City University of London, School of Health Sciences, Division of Health Sciences Research and Management, 1 Myddelton St, Clerkenwell, London, EC1R 1UB, UK.
| | - Rose McCabe
- City University of London, School of Health Sciences, Division of Health Sciences Research and Management, 1 Myddelton St, Clerkenwell, London, EC1R 1UB, UK.
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14
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Rzewuska M, Carolina Guidorizzi Zanetti A, Skea ZC, Moscovici L, Almeida de Oliveira C, Mazzoncini de Azevedo-Marques J. Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers. PLoS One 2021; 16:e0251320. [PMID: 33983998 PMCID: PMC8118469 DOI: 10.1371/journal.pone.0251320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/26/2021] [Indexed: 11/26/2022] Open
Abstract
Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.
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Affiliation(s)
- Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Scotland, United Kingdom
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, São Paulo, Brazil
| | - Zoë C. Skea
- Health Services Research Unit, University of Aberdeen, Scotland, United Kingdom
| | - Leonardo Moscovici
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Primary Health Care, Academic Health Services Complex at Ribeirão Preto Medical School of the São Paulo University, XIII Regional Health Department, Unified Health System, São Paulo State, Brazil
| | - Camila Almeida de Oliveira
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - João Mazzoncini de Azevedo-Marques
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- Primary Health Care, Academic Health Services Complex at Ribeirão Preto Medical School of the São Paulo University, XIII Regional Health Department, Unified Health System, São Paulo State, Brazil
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Madden M, Morris S, Ogden M, Lewis D, Stewart D, O'Carroll RE, McCambridge J. Introducing alcohol as a drug in medicine reviews with pharmacists: Findings from a co-design workshop with patients. Drug Alcohol Rev 2021; 40:1028-1036. [PMID: 33648016 DOI: 10.1111/dar.13255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol poses a range of potential problems to people taking medications, but health professionals are usually not comfortable talking about drinking with patients. The Medicines and Alcohol Consultation aims to increase the capacity of pharmacists to conduct person-centred reviews in which alcohol is regarded as another drug to be discussed alongside medications. This paper explores sensitivities in discussing alcohol and views on the legitimacy of the Medicines and Alcohol Consultation intervention concept at a pharmacy-user intervention co-design workshop. METHODS A co-design workshop was held with 14 people recruited from UK community pharmacies who regularly drank alcohol and took medications for long-term conditions. This formed one element of a broader, iterative, intervention co-production process. Workshop discussions were audio-recorded and analysed thematically. RESULTS The basic intervention concept resonated well, though not entirely unproblematically. Participants were interested in receiving information on how medications interact with alcohol and how this might affect their own conditions, with which to make their own informed choices. Linking alcohol use to medicines gave legitimacy to pharmacists to raise alcohol in medicines reviews. Sensitivity in talking about alcohol was linked to vulnerability to negative judgement. DISCUSSION AND CONCLUSIONS Changing the framing of alcohol in medicines reviews, away from being regarded as a 'lifestyle issue' to being considered a drug directly linked to medicines use, safety and effectiveness, was welcomed by participants in this study.
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Affiliation(s)
- Mary Madden
- Department of Health Sciences, University of York, York, UK
| | | | - Margaret Ogden
- Department of Health Sciences, University of York, York, UK
| | - David Lewis
- Department of Health Sciences, University of York, York, UK
| | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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