Patient-centredness: a conceptual framework and review of the empirical literature

"Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi

BACKGROUND

The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not.

OBJECTIVE

We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi.

METHODS

Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting.

RESULTS

Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred.

CONCLUSIONS

Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.

Candid insights and overlooked facets: what medical students write about patient-centeredness in diaries on longitudinal patient contacts

Despite students' exposure to patient-centered care principles, their dedication to patient-centeredness often experiences a wane throughout their academic journey. The process of learning patient-centeredness is complex and not yet fully understood. Therefore, in our study, we sought to explore what aspects of patient-centeredness students spontaneously document in their diaries during interactions with actual patients. This investigation will help to identify gaps in the current educational practices and better prepare future clinicians to deliver patient-centered healthcare. We analyzed 92 diaries of 28 third-year undergraduate medical students at UMC Utrecht in the Netherlands who participated in an educational intervention, following four patients each as companions over a two-year period early in their clerkships. We conducted thematic analysis, using inductive and deductive coding, within a social-constructionist paradigm. We identified four key themes: communication, the person behind the patient, collaboration and organization in healthcare, and students' professional development. Within these themes, we observed that students spontaneously documented 9 of 15 dimensions of patient-centeredness as outlined in the model of Scholl : 'clinician-patient communication', 'patient as unique person', 'biopsychological perspective', 'essential characteristics of the clinician', 'clinician-patient relationship', 'involvement of family and friends', 'patient-information', 'emotional support' and 'coordination and continuity of care' (mainly principles of patient-centeredness). Conversely, we noted that students underreported six other dimensions (enablers and activities): 'access to care', 'integration of medical and non-medical care', 'teamwork and teambuilding', 'patient involvement in care', 'patient empowerment' and 'physical support'. Throughout their longitudinal journey of following patients as non-medical companions, students spontaneously documented some aspects of patient-centeredness in their diaries. Additionally, students reflected on their own professional development. Our findings suggest that incorporating education on the broadness of the concept of patient-centeredness coupled with enhanced guidance, could potentially enable students to learn about the complete spectrum of patient-centeredness within their medical education.

Patient-centric care in primary immune thrombocytopenia (ITP): shared decision-making and assessment of health-related quality of life

ABSTRACTImmune thrombocytopenia (ITP), an autoimmune disease characterized by low platelet counts and increased bleeding risk, can impair health-related quality of life (HRQoL), impacting patients' daily lives and mental health. A number of patient-reported outcome (PRO) measures (both generic and specific to ITP) can be used to understand the impact of ITP on HRQoL and generate evidence to guide disease management. As well-developed PRO tools could help in HRQoL assessment, their optimization could help to solidify a patient-centric approach to ITP management. Shared decision-making is a collaborative process between a patient and their healthcare professional in making decisions about care. Treatment decisions based on this shared process between physician and patient are recommended by clinical guidelines. The goal of this narrative review is to discuss treatment decisions with regards to patient-centric ITP management, with a focus on the impact of PRO measures and the process of shared decision-making in practice.

Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

BACKGROUND

Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored.

OBJECTIVES

This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China.

METHODS

Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders.

RESULTS

Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308-0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275-0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276-0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051-4.825).

CONCLUSION

Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Dialogued into being: Constructing knowledge about hand osteoarthritis from a polyphony of voices in healthcare encounters

PURPOSE

Multiple knowledge sources inform healthcare. In healthcare encounters, patients and health professionals' ideas intersect to understand illness and disease. Exploring what is thought of as legitimate knowledge, and where those reflections come from is central to the process of improving and developing healthcare. Within this context, we aim to explore how knowledge about hand osteoarthritis (OA) is constructed and negotiated in clinical consultations.

METHODOLOGY

The article is based on interviews with 21 patients and 14 health professionals in combination with observation in 16 clinical consultations. Reflexive thematic analysis was used to interpret the data.

RESULTS

We generated four themes from codes to tell an interpretive story about how hand OA meaning-making is "talked into being" in patient-provider encounters: from the dominant voice of health professionals, from patients as knowers in the chronic healthcare dialogue, from health professionals and patients constructing knowledge together and from the construction of knowledge in hybrid positions when patients are health professionals and health professionals have hand OA.

CONCLUSION

New knowledge about hand OA is co-constructed in the situated context of the clinical encounter through a polyphony of voices-some of which are dominant, while others occupy the periphery-within and between the interactants in dialgue.

Flipping healthcare by including the patient perspective in integrated care pathway design: A scoping review

BACKGROUND

Despite the recognized benefits of integrating patient perspectives into healthcare design and clinical decision support, theoretical approaches and standardized methods are lacking. Various strategies, such as developing pathways, have evolved to address these challenges. Previous research emphasized the need for a framework for care pathways that includes theoretical principles, extensive user involvement, and data from electronic health records to bridge the gap between different fields and disciplines. Standardizing the representation of the patient perspective could facilitate its sharing across healthcare organizations and domains and its integration into journal systems, shifting the balance of power from the provider to the patient.

OBJECTIVES

This study aims to 1) Identify research approaches taken to develop patient-centred, integrated, care pathways supported by electronic health records 2) Propose a socio-technical framework for designing patient-centred care pathways across multiple healthcare levels that integrates the voice of the patient with the knowledge of the care provider and technological perspectives.

METHODS

This study conducted a scoping review following the Joanna Briggs Institute guidelines and PRISMA-ScR protocol. The databases PubMed, Scopus, Web of Science, ProQuest, IEEE, and Google Scholar were searched using a key term search strategy including variations of patient-centred, integrated care, pathway, framework and model to identify relevant studies. Eligible articles included peer-reviewed literature documenting methodologies for mapping patient-centred, integrated care pathways in healthcare service design.

RESULTS

This review summarizes the application of care pathway modelling practices across various areas of healthcare innovation. The search resulted in 410 studies, with 16 articles included after the full review and grey literature search.

CONCLUSIONS

Our research illustrated incorporating patient perspectives into modelling care pathways and healthcare service design. Regardless of the medical domain, our methodology proposes an approach for modelling patient-centred, integrated care pathways across the care continuum, including using electronic health records to support the pathways.

Healthcare providers' psychological investment in clinical recommendations: Investigating the role of implicit racial attitudes

Racial disparities in clinical recommendations can result in racial disparities in health. While healthcare providers' implicit racial attitudes (affective component of bias) are theorized to be one major factor contributing to racial disparities in clinical recommendations, empirical evidence to support the link is lacking. This study aimed to bridge this gap by moving beyond the standard approach of operationalizing the quality of clinical recommendations as a guideline-consistent vs. -inconsistent dichotomy. The present secondary study examined the role of provider implicit racial attitudes in the quality of clinical recommendations, operationalized as behaviors reflecting providers' psychological investment in patient care (i.e., number of words used to describe clinical recommendations, and number of treatment options recommended). Two-hundred-and-ten White medical trainees reviewed a clinical vignette of either a White or Black male patient and provided clinical recommendations. Their implicit racial attitudes were evaluated using the Implicit Association Test. Participants with more biased implicit racial attitudes (i.e., stronger implicit preference for White vs. Black individuals) used fewer words to describe their clinical recommendations and provided fewer clinical recommendations for the Black (vs. White) patient, while there were no significant differences between Black and White patients among participants with less biased implicit racial attitudes. These results illustrate the insidious impact of implicit racial attitudes in healthcare provision and underscore the need for researchers to consider the complex, nuanced ways in which provider implicit racial attitudes might manifest in clinical decision-making.

Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care

Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust. We received 1,662 responses and 692 (42%) chose a VA facility. Eighty percent reported quality care was in their top three factors that influenced their decision. Respondents with the highest distrust and who lived >1 hr from the nearest VA facility had the lowest predicted probability (PP) of choosing VA (PP 15%; 95% confidence interval: 10%-20%). Veterans value quality of care. VA and other health care systems should consider patient-centered ways to improve and publicize quality and reduce distrust.

Good therapeutic connections and patient psychological safety: A qualitative survey study

BACKGROUND

Therapeutic connections (TCs) between patients and care providers are important for achieving desired patient outcomes. For patients, TC is associated with greater health self-efficacy, better health status, mental health status, and higher satisfaction with providers.

PURPOSE

The aim of the study was to examine patients' descriptions of what signals to them they have a TC with their care provider.

METHODOLOGY

We conducted an online survey of patients with a recent health care visit ( n = 1,766). This study analyzed the results of an open-ended question that asked how patients know they have a good TC with their care provider. Data were analyzed using framework analysis to determine the extent to which patient responses indicated TC dimensions. A thematic content analysis identified emergent themes.

RESULTS

Of the TC dimensions, words associated with Shared Deliberation were mentioned by 60% of respondents. Other dimension mentions ranged between 14% (Shared Mind) and 2% (Bond). Thematic content analysis revealed that patient psychological safety seems to be required for many patients to feel connected.

CONCLUSION

A majority of patients indicated that good TCs happen when they feel seen and heard by providers. However, it appears that prior to feeling a strong TC, patients need to feel safe to be fully welcome into the encounter.

PRACTICE IMPLICATIONS

Health care organizations need to give care providers the uninterrupted time and space they need to fully connect with patients. Training about how to create a psychologically safe environment for patients should be tailored for practicing providers, leaders, and students in health care fields.

Chinese expert consensus on an innovative patient-centered approach to diagnosis and treatment of cancer

Patient-centered care (PCC) is an innovative approach to the diagnosis and treatment of malignancy that aims to improve patients' experience during the management of their disease. However, despite growing interest, the concept and specifics of PCC remain unclear. This consensus document addresses this gap by providing a literature review and a clear definition of PCC and outlines its main components as observed in real-world practice. These components include daytime diagnostic and treatment procedures, in-hospital and community-based infusion centers, home-based diagnostic and treatment services, smart healthcare solutions, and integration of traditional Chinese medicine. This document delves into the implementation of PCC and explores its potential benefits.

Healthcare professionals' perspectives on the barriers and facilitators of integrated childhood obesity care

BACKGROUND

Both the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach.

METHODS

In this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart.

RESULTS

Overall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families' situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes.

CONCLUSIONS

Healthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.

Shared decision-making in post-coercion debriefing interventions in psychiatry - a scoping review

Introduction

Debriefing is recommended after any coercive measure in psychiatry, but there are no wellestablished standards, and ist effectiveness remains unclear. Incorporating shared decision-making (SDM) into post-coercion debriefing interventions has potentially beneficial effects.

Methods

This scoping review provides an overview of the general characteristics of such interventions and the extent to which SDM elements are already used in such interventions.

Results

A total of 2562 references were identified in the scholarly databases Embase, PubMed, Web of Science, and PsycINFO. In addition, 14 articles were identified through manual searches of reference lists. 42 full-text articles were screened for eligibility, 13 articles met the eligibility criteria and were further analyzed.

Discussion

No intervention tool was found that clearly included all SDM elements. However, three elements of SDM were present at least partially in all interventions: definition and explanation of the health care problem, the clarification of the patient's values and preferences, and a decision or explicit deferral of the decision. Further research is needed to systematically examine the implementation and clinical effectiveness of post-coercion debriefing interventions, particularly regarding the inclusion of shared decision-making elements.

"I've been really happy since I got that letter!": Longitudinal patient perspectives on lung cancer screening communication

OBJECTIVE

Experts recommend structured shared decision making when discussing lung cancer screening (LCS) and reporting low-dose computed tomography (LDCT) results. We examined patients' reactions to pre- and post-LDCT results communication processes at three medical centers in the US with established LCS programs.

METHODS

Multicenter, qualitative, longitudinal study of patients considering and receiving LCS using data from semi-structured interviews guided by a patient-centered communication model using conventional content analysis. We conducted 61 interviews among 32 patients (sixteen of whom had a nodule on their LDCT) at one month and 12 months after an initial LCS decision making interaction.

RESULTS

Participants were mostly satisfied with LCS communication processes pre- and post-LDCT even though guideline concordant shared decision making was rare. Most participants reported no more than mild distress even if the LDCT detected a pulmonary nodule, felt relief after getting the results, and reported the perceived benefits of LCS outweighed their distress. Nearly all participants were satisfied with recommended follow-up plans. They reported that they trusted their clinicians and health care system to provide appropriate care and recommendations. They did not appear to regret their decision since almost all participants planned to get their next LDCT. However, they were at risk of non-adherence to follow-up recommendations since they often relied on the health care system to ensure they received timely follow-up.

CONCLUSIONS

Despite receiving guideline discordant decision-making communication, patients seem very satisfied, rarely experience severe distress, and have low decisional regret after LCS decision making and receiving the results of their LDCT.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: complementary results for a controlled clinical trial

OBJECTIVE

To evaluate the effect of rapid palatal expansion (RPE) using Haas-type expanders on children's oral health-related quality of life (OHRQOL) and compare said effect with that previously reported for the use of Hyrax-type expanders.

MATERIALS AND METHODS

Forty participants aged 8-10 years with transverse maxillary deficiency were treated using Haas appliances. OHRQOL was measured using the CPQ8 - 10 before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after appliance removal (T3). Generalized mixed models were fitted to assess the effect of the Haas-type expander compared to previously collected data (a nontreated and a Hyrax-type expander-treated group).

RESULTS

RPE with Haas-type appliances had a negative impact on overall OHRQOL at T1 and T2 (P = 0.001), and a positive impact at T3 (P = 0.001). The Haas-type expander had a significantly greater negative impact on OHRQOL than the Hyrax-type appliance during RPE. At T1, overall scores using the Haas-type expander were 1.08 times the scores using the Hyrax-type expander (i.e., 8% increase; 95% CI, 1.01-1.17; P = 0.033). Patients using the Haas appliance had 1.24 times the scores of those using Hyrax-type devices for the oral symptoms domain at T1 (i.e., 24% increase; 95% CI, 1.06-1.46; P = 0.009).

CONCLUSIONS

Correction of the transverse maxillary deficiency by RPE using the Haas appliance in children 8-10 years improves OHRQOL. The Haas- and Hyrax-type devices temporarily worsen OHRQOL during treatment, however, the negative impact is less with the Hyrax-type expander than with the Haas-type expander, because it causes fewer negative oral symptoms.

CLINICAL RELEVANCE

From a patient-centered perspective, the use of the Hyrax over the Haas appliance may be suggested as it causes less negative oral symptoms during use.

Haptic Resources in Pain Communication: New Amputees Redirecting Doctors' Professional Touch at the Prosthetic Clinic

Pain assessment is key in deciding whether amputee patients are fit to receive a prosthesis, but its interactional accomplishment is still underexplored. This study adopts multimodal conversation analysis to investigate how pain assessment is carried out during medical visits at an Italian prosthetic clinic involving 77 patients and 24 health professionals. In the analyzed data, doctors carry out pain assessment by asking patients whether they feel pain during palpation of the stump, and patients respond by elaborating on their sensations and using touch in turn. The analysis focuses on a collection of 10 cases in which patients use response expansions and self-touch to reorient doctors' ongoing inquiry by specifying the type of sensation they experience and its location or to correct doctors' previous inquiry. The analysis illuminates how the patient's body becomes a resource for tactile practices that are shared between doctors and patients in the service of a common understanding of patients' pain. This analysis provides new knowledge of a practice patients use to redirect doctors' attention and understandings.

Advancing Patient-Centered Care: An International Survey of Adolescent Perspectives on Insomnia

OBJECTIVE

The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia.

METHOD

A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis.

RESULTS

Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia.

CONCLUSIONS

Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.

Patient autonomy in an East-Asian cultural milieu: a critique of the individualism-collectivism model

The practice of medicine-and especially the patient-doctor relationship-has seen exceptional shifts in ethical standards of care over the past few years, which by and large originate in occidental countries and are then extrapolated worldwide. However, this phenomenon is blind to the fact that an ethical practice of medicine remains hugely dependent on prevailing cultural and societal expectations of the community in which it serves. One model aiming to conceptualise the dichotomous efforts for global standardisation of medical care against differing sociocultural expectations is the individualism-collectivism model, with the 'West' being seen as individualistic and the 'East' being seen as collectivistic. This has been used by many academics to explain differences in approach towards ethical practice on key concepts such as informed consent and patient autonomy. However, I argue that this characterisation is incomplete and lacks nuance into the complexities surrounding cross-cultural ethics in practice, and I propose an alternative model based on the ethics of clinical care in Hong Kong, China. Core ethical principles need not be culture-bound-indeed, their very existence mandates for them to be universal and non-derogable-but instead cultural alignment occurs in the particular implementation of these principles, insofar as they respect the general spirit of contemporary ethical standards.

Design and validation of an instrument to evaluate Person-Centered care in health services

BACKGROUND

The concept of quality in health care has evolved, placing greater importance on the patient's needs, culture, and social context, as well as their participation in clinical decision-making, as highlighted by Mead and Bower's Person-Centered Care Model. The aim of the present study was to design and validate an instrument to assess the extent to which healthcare services provided by PEMEX (Petróleos Mexicanos) offer person-centered care according to user perceptions.

METHODS

The first phase comprised the development of 57 items based on the analysis of responses from an open-ended questionnaire administered to 30 users of Pemex healthcare services. This questionnaire was designed considering the four factors of the person-centered care model, however, the high correlation between the 4 factors (i.e., r ≥ .80) indicated an overfactoring effect and consequently an increase in the risk of overfitting. Therefore, an exhaustive analysis of the instrument was performed, starting with the review of the individual behavior of each item, and carrying out exploratory and confirmatory factor analysis. Using a sample of 330 individuals, an exploratory factor analysis was perfomed. Afterward, a confirmatory factorial analysis was carried out with 335 participants. Finally, a new confirmatory factorial analysis included 130 participants due to the refinements made in the previous phase. Internal consistency was assessed using Cronbach's α and McDonald's ω at every phase.

RESULTS

The exploratory factor analysis retained 35 items in a single factor that accounted for 49% of the variance with an internal consistency of Cronbach's α and McDonald's ω = 0.97. Because the factorial structure by confirmatory factorial analysis was unsatisfactory, the initial model was refined, leading to the retention of 11 items and a final model with adjustment index of χ2 = 127.53, χ2/gl = 2.89, RMSEA = 0.07, IC RMSEA 0.06 to 0.09, TLI = 0.95 and CFI = 0.96, with an internal consistency of Cronbach's α and McDonald's ω = 0.93. Due to the refinements, a new confirmatory factorial analysis was conducted with suitable goodness-of-fit criteria in most items (χ2 = 151.44, χ2/gl = 3.43, RMSEA = 0.13, IC RMSEA 0.11 to 0.16, TLI = 0.93 and CFI = 0.94), resulting in a Cronbach's α and McDonald's ω = 0.98.

CONCLUSIONS

The instrument exhibits suitable psychometric properties to be employed to measure the degree to which medical care is patient centered. This instrument represents a strategy for promoting an innovative healthcare model.

Development and validation of a patient-centered communication scale for nurses

BACKGROUND

Patient-centered care aims to prevent disease and promote well-being by actively involving patients in treatment and decision-making that is based on respecting the patients and their families. However, no scales have been developed to assess patient-centered care from the nurse's perspective. This study aimed to develop a scale to measure nurses' level of patient-centered communication and confirm its validity and reliability.

METHODS

A methodological cross-sectional study was adopted to develop and validate the Patient-Centered Communication Scale (PCCS). The items were developed through a literature review and online interviews with nurses. Content validity was assessed by experts and the content validity index was calculated. A pretest of the questionnaire was conducted with 10 clinical nurses. To evaluate the factor structure and internal consistency reliability, the PCCS was administered online to 325 nurses in South Korea. Data were analyzed using descriptive statistics, explanatory factor analysis (EFA), and confirmatory factor analysis (CFA).

RESULTS

The final instrument consisted of 12 items and three factors: (1) information sharing, (2) patient-as-person, and (3) therapeutic alliance. EFA revealed a distinct three-factor structure, explaining 59.0% of the total variance. CFA confirmed the adequacy of the model fit and validated the inclusion of the final items. The Cronbach's alpha values ranged from 0.60 to 0.77, indicating acceptable internal consistency. Convergent validity was evidenced by the correlation between the PCCS and a measure of interpersonal communication competence.

CONCLUSIONS

The 12-item PCCS showed good reliability, construct validity, and convergent validity. The scale has utility for measuring the level of patient-centered communication skills in nurses.

Patient-Centered Care in Action: How Clinicians Respond to Patient Dissatisfaction with Contraceptive Side Effects

Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.

Person-centered care for common mental disorders in Ontario's primary care patient-centered medical homes: a qualitative study of provider perspectives

BACKGROUND

For more than a decade, the Patient-Centered Medical Home model has been a guiding vision for the modernization of primary care systems. In Canada, Ontario's Family Health Teams (FHTs) were designed in the mid-2000s with the medical home model in mind. These primary care clinics aim to provide accessible, comprehensive, and person-centered primary care services to communities across Ontario. Their services typically include mental health care for people experiencing common mental disorders, such as depression and anxiety disorders. It remains unclear, however, whether the mental health care delivered within FHTs is consistent with person-centered care approaches. In the current study, we aimed to explore the perspectives of FHT providers on the care delivered to people with common mental disorders to determine whether, and to what extent, they believed this care was person-centered.

METHODS

We conducted a qualitative grounded theory study involving interviews with 65 health professionals and administrators from 18 FHTs across Ontario. Transcripts were coded using a three-step process of initial, focused, and axial coding that mixed inductive and deductive approaches informed by sensitizing concepts on person-centeredness.

RESULTS

Practices and challenges associated with the delivery of mental health care in a person-centered way were captured by several themes regrouped into five domains: (1) patient as unique person, (2) patient-provider relationship, (3) sharing power and responsibility, (4) connecting to family and community, and (5) creating person-centered care environments. FHT providers perceived that they delivered person-centered care by delivering mental health care that was responsive, flexible, and consistent with biopsychosocial approaches. They emphasized the importance of creating long-lasting relationships with patients grounded in empathy and trust. Their challenges included being able to ensure continuity of care, adequately prioritizing patients' mental health issues, and meaningfully engaging patients and families as partners in care.

CONCLUSIONS

Our findings suggest that FHT providers have adopted a range of person-centered practices for people with common mental disorders. However, greater attention to practices such as shared decision making, supporting self-management, and involving families in care would strengthen person-centeredness and bring teams closer to the Patient-Centered Medical Home vision.

The Influence of Perceived Provider Empathic Communication on Disclosure Decision-Making

Provider empathy is a crucial component in establishing therapeutic provider-patient relationships. The benefits of increased perceptions of empathy can support patient psychological adjustment to their cancer as well as patients' comfort and confidence in disclosing to providers, ultimately promoting patient engagement. Guided by the disclosure decision-making model, this manuscript explores how perceptions of empathy influence patient psychological adjustment and how those variables influence patient disclosure efficacy. The model ultimately predicts patient sharing and withholding of information during the medical interaction. This study tested a mediation model to investigate how current (n = 111) and former (n = 174) breast cancer patients' psychological adjustment mediates the relationship between patient perceptions of oncologist empathic communication and efficacy to disclose health information to their oncologist and their disclosure enactment in sharing and withholding. Overall, former patients compared to current patients had more positive perceptions of their oncologist's empathic communication, had better psychological adjustment, felt more self-efficacy to disclose to their oncologist, and shared more and withheld less information from their oncologist (p < .05 in all cases). Structural equation modeling revealed good fit to the data for both current and former patients such that more perceived empathic communication was associated with more efficacy for disclosure, which was associated with more sharing and less withholding. Additionally, there was an indirect relationship from perceptions of empathic communication to disclosure efficacy through patients' psychological adjustment to the diagnosis. Results reinforce the importance of providers' empathic communication for cancer patients' psychological adjustment because patient sharing and withholding of information remain crucially important to achieving holistic care across the cancer trajectory.

Exploring the Clinical Usefulness of Undergraduate Medical Research: A Mixed-Methods Study

A significant amount of published clinical research has no measurable impact on health and disease outcomes, and research in undergraduate medical education is viewed as especially susceptible. The aims of this mixed methods study were to (a) to use group concept mapping (GCM) to explore key features identified by hospital physicians, medical educators, and medical students as central to clinical usefulness in an undergraduate medical research context, and (b) review a sample of undergraduate medical research projects based on usefulness criteria described by Ioannidis (2016). In the GCM procedure, 54 respondents (39 students, 15 physicians) from an Irish medical school participated across each of three phases: brainstorming, sorting, and rating. Data was analysed using multidimensional scaling and hierarchical clustering. A retrospective analysis of 252 student projects was also completed using a rubric based on Ioannidis's (2016) six domains of "clinical usefulness": problem base, context placement and information gain, pragmatism, patient-centredness, feasibility, and transparency. Projects were scored for each domain by three assessors. Results were analysed and presented using descriptive analysis.GCM analysis revealed the following "clinically useful" research characteristics: optimal design and methodology, practicality, research skills development, translational impact, patient-centredness, and asking a clinical question. Following a rubric-based analysis of projects, the highest scoring categories (mean rating; range of 1-4) were feasibility (3.57), transparency (3.32), and problem base (3.05). The lowest scoring areas were context placement and information gain (2.73), pragmatism (2.68), and patient-centredness (212). We identified considerable conceptual overlap between stakeholder consensus views on "clinical usefulness" as applied to undergraduate research and Ioannidis's criteria. Patient-centredness was identified as a domain requiring greater emphasis during the design of undergraduate medical research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02035-7.

Does Medical Curriculum Impact on Empathy? A Longitudinal Study in a Sample of Undergraduate Medical Students

Empathy in medical students is receiving increasing attention as it is fundamental to build and develop a functional patient-physician relationship. When looking at its determinants, demographic and academic factors seem to concur in shaping empathy in this population. Although data show strong gender differences and changes in empathy throughout medical school, it is not clear the direction of these changes and whether gender and curriculum features modulate them. This longitudinal study examined changes in empathy and explored gender differences throughout the medical school. Four consecutive cohorts of Italian medical students (N = 336) completed the Jefferson Scale of Empathy - Student (JSE-S) and the Interpersonal Reactivity Index (IRI) in their second year of study (before any clinical clerkship and communication skills courses) and fifth year of study (after a 2-year clinical clerkship and communication skills courses). Analysis of variance for repeated-measures revealed that, beyond the effect of gender, JSE-S total score and IRI Perspective Taking increased, whereas IRI Personal Distress and IRI Fantasy significantly decreased throughout medical school. No significant change in IRI Empathic Concern emerged over time. Student's t-tests showed that female students displayed significantly higher mean scores than their male counterparts for all empathy measures in both their second and fifth years of medical training. The findings suggest that the medical curriculum affects self-reported empathy dimensions among undergraduate medical students. Further research is needed to deepen the understanding of the educational factors that promote the changes in empathy levels during medical training.

Adapting standardized patient training to improve patients' understanding and preparedness for health care encounters

OBJECTIVE

To examine the impact of standardized patient (SP) training on SPs' real-life healthcare encounters and explore whether SP training elements can be adapted to increase actual patients' understanding, communication and participation in a patient-centered care model.

METHODS

Data were collected from surveys and focus groups with standardized patients and a survey of primary care physicians. Findings were used to create an educational video with pre- and post-viewing surveys of patients' understanding of engagement strategies and plans to use them in future encounters.

RESULTS

SPs reported medical visits were more productive because of their ability to understand the visit's framework; crediting their SP training. Patients reported the video will help in planning future medical visits by providing information that increases their understanding of their role in the care process.

CONCLUSIONS

SPs' understanding of the visit and its impact on knowledge, skills and affective domains can be transferred to patients in the form of specific strategies that enhance communication and patient participation during medical visits.

PRACTICE IMPLICATIONS

A brief educational intervention for patients using SPs' understanding of the medical visit may contribute to enhanced patient participation in future health care encounters and could increase patient engagement in patient-centered models of care.

The experiences of patients attending the emergency department who were managed by physiotherapists: a person-centred perspective

PURPOSE

The expectation for all clinicians to deliver person-centred practices extends to the growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED). Research on ED patients' experience of this physiotherapy role has yet to consider this through the lens of person-centredness. A qualitative exploration of person-centredness among ED physiotherapists through the experiences of attending patients targeted this knowledge gap to inform future clinical practice.

METHODS

Semi-structured interviews with thematic analysis.

RESULTS

13 interviews were completed with four overarching themes generated: (1) patient experience of the ED; (2) the importance of connection, competence, and time; (3) recognising the benefits of being seen by a physiotherapist in ED; and (4) patient experience of the ED physical environment.

CONCLUSION

Novel contributions from the patient perspective, here, reflected a cognisance of certain environment limitations to PCP, as well as institutional challenges to their personhood, with a suggestion that ED patients anticipated a validation of their visit and valued the educational aspects that the physiotherapists provided. Considering this new knowledge can help ED physiotherapists to be more person-centred.

Meaningful contributions of rehabilitation for people with persistent pain; a reflexive thematic analysis

PURPOSE

This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain.

MATERIALS AND METHODS

A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses.

RESULTS

Participants included three men and ten women, age ranging from 22-69 years, pain duration was 2-30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants' perspective.

CONCLUSIONS

The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.

Patient-centered care in diabetes care-concepts, relationships and practice

We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.

Shared decision-making in the management of pulmonary nodules: a systematic review of quantitative and qualitative studies

OBJECTIVE

The objective of this systematic review was to explore the evidence regarding shared decision-making (SDM) in the management of pulmonary nodules.

DESIGN

Systematic review of quantitative and qualitative studies.

DATA SOURCE

Studies published in English or Chinese up to April 2022 were extracted from nine databases: PubMed, PsycINFO, EMBASE, Cochrane Library, Web of Science and CINAHL, China National Knowledge Infrastructure, Wanfang Data and SinoMed Data.

ELIGIBILITY CRITERIA

Studies were eligible if patients or healthcare providers are faced with pulmonary nodule management options or the interventions or experiences were focused on the patient-healthcare provider relationship or health education to make, increase or support shared decisions. All types of studies were included, including quantitative and qualitative studies. Grey literature and literature that had not been peer reviewed were excluded. Poster abstracts and non-empirical publications such as editorials, letters, opinion papers and review articles were excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened abstracts and full texts, assessed quality using Joanna Briggs Institute's critical appraisal tools, and extracted data from included studies. Thematic syntheses were used to identify prominent themes emerging from the data.

RESULTS

A total of 12 studies met the inclusion criteria, 11 of which were conducted in USA. These included six qualitative studies and six quantitative studies (including both survey and quasi-experimental designs). Three major themes with specific subthemes emerged: (1) Opportunity (uncertainty in the diagnosis and treatment of pulmonary nodules, willingness to participate in decision-making); (2) Ability (patient's lack of knowledge, physician's experience); and (3) Different worldview (misconception, distress among patients, preference for diagnosis and treatment).

CONCLUSIONS

Uncertainty in the management of pulmonary nodules is the opportunity to implement SDM. Patients' lack of knowledge, distress, and misunderstandings between healthcare providers and patients are both the main obstacles and the causes of the application of SDM.

What matters to you? An observational field study of patient and care provider expectations for health care relationships

Therapeutic connections (TC) between patients and providers are foundational to patient-centered care, which is co-produced between patients and care providers. This necessitates that we understand what patients expect from TCs, the extent to which providers know what patients expect, and what providers expect. The purpose of this study was to examine nine TC dimensions and determine which are most important to patients, which dimensions providers believe are most important to patients, and which are most important to providers. An online survey of patients (n = 388) and care providers (n = 433) was conducted in the USA in March 2021. Respondents rated the extent to which the nine TC dimensions were important to them, followed by open-ended questions to expand upon what matters. The quantitative responses were rank-ordered and rankings were compared across groups. All groups ranked "having the patient's best interest in mind no matter what" as the top expectation. Patients also ranked "caring commitment" and being "on the same page" as highly important. Providers were relatively accurate in ranking what they believed was most important to patients. Respondents affirmed the TC dimensions in the qualitative results, adding nuance and context, such as patients feeling "heard" and noting providers that go "above and beyond." Providers ranked dimensions differently for themselves, prioritizing "full presence" and "emotional support" of patients. This study is among the first to examine expectations for TC. TC could play an explanatory role in understanding variation in patient experience ratings and other outcomes.

Social support from the physiotherapist and the therapeutic relationship in physiotherapy: bridging theory to practice

BACKGROUND/PURPOSE

Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice.

METHODS

This is a perspective paper drawing on examples from existing research.

KEY RESULTS

Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual's social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body - which is the main point of contact with patients - and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship's trajectory.

CONCLUSION

Social support and therapeutic relationships are complementary aspects of one's health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.

Is Lung Cancer Screening Knowledge Associated with Patient-Centered Outcomes? A Multi-institutional Cohort Study

Introduction. The Centers for Medicare and Medicaid Services mandate that clinicians use a shared decision-making interaction to provide information about the harms and benefits of lung cancer screening (LCS). Methods. We enrolled patients from 3 geographically diverse medical centers after a decision-making interaction about undergoing LCS but before receiving a low-dose computed tomography (CT) scan. We performed the primary analysis based on the primary knowledge question, "Which of these conditions do you think that the CT scan screens for?" We used the knowledge summary score in secondary analyses. We evaluated LCS care experience by using validated instruments to measure participant-reported communication quality (Consultation Care Measure), perception of the primary LCS clinician (Consumer Assessment of Health Care Providers and Systems), and decision conflict (Decisional Conflict Scale). Results. Of the 409 participants, 44% correctly answered the primary LCS knowledge question. Clinician communication quality was rated positively by 93% of participants. Most (93%) participants rated their LCS clinician as good. Only 14% reported decision conflict. Correctly answering the primary LCS knowledge question was associated with higher patient-clinician communication quality scores (b = 0.4; 95% confidence interval [CI] [0.1, 0.7]; R 2 change = 0.03) and higher LCS clinician ratings (b = 0.4; 95% CI [0.0, 0.7]; R 2 change = 0.02) but not with decision conflict. In secondary analyses, higher total LCS knowledge score was associated with lower Decisional Conflict Scale scores (b = -2.2; 95% CI [-3.4, -0.9]; R 2 change = 0.24), indicating lower decision conflict. Conclusions. After an LCS decision-making interaction, many patients do not retain basic knowledge about LCS but nevertheless had low levels of decision conflict. Primary LCS knowledge may be important but insufficient to ensure high-quality, patient-centered LCS care.

Highlights

Survey of patients with a lung cancer screening (LCS) decision-making interaction.Only 44% of patients correctly answered the knowledge question about LCS.Primary LCS knowledge was not associated with decision conflict.Patient knowledge about LCS may not equate to high-quality patient-centered care.

Strategies for Effective Dentist-Patient Communication: A Literature Review

The effectiveness of high-quality dental care predominantly lies on the communication between dentist and patient. However, little literature has reported the importance of these "soft skills" in dental practice. The aim of this literature review is to explore strategies for effective dentist-patient communication. Dentist-patient communication is a bidirectional process involving the exchange of ideas that should be clear (easy to understand), correct (accurate), concise (to the point), complete (with essential information), and cohesive (well-organized). Effective communication empowers patients with the knowledge required to make an informed decision about their own oral health. It not only improves the dentist's efficiency and boosts patient confidence, but also alleviates patients' dental anxiety and fear, addresses patients' needs and preferences, increases patients' adherence, and enhances patient satisfaction. To enhance dentist-patient communication, dentists should take the patient-centered approach as a premise. The approach comprises understanding patients' illnesses, shared decision-making, and mindful intervention at the patient's own pace. In addition, dentists should use simple, succinct language, proper body posture, gestures, facial expressions, and eye contact when interacting with patients. Dentists should show empathy, encourage questions and feedback, employ visual aids, and give ample time to patients. Nowadays, dentists and their patients use messaging applications in their communication. This form of telecommunication is not only a convenient way of communication but also reduces the costs associated with a dentist visit. In conclusion, effective dentist-patient communication is vital for the success of dental practice. Dentists who prioritize communication and build positive relationships with their patients are more likely to achieve positive outcomes and foster the expansion of their dental practice.

Are the content and usability of a new direct observation tool adequate for assessing competency in delivering person-centred care: a think-aloud study with patients and healthcare professionals in Sweden

OBJECTIVE

To evaluate the content and usability of a new direct observation tool for assessing competency in delivering person-centred care based on the Gothenburg Centre for Person-Centred Care (gPCC) framework.

DESIGN

This is a qualitative study using think-aloud techniques and retrospective probing interviews and analyzed using deductive content analysis.

SETTING

Sessions were conducted remotely via Zoom with participants in their homes or offices.

PARTICIPANTS

11 participants with lengthy experience of receiving, delivering and/or implementing gPCC were recruited using purposeful sampling and selected to represent a broad variety of stakeholders and potential end-users.

RESULTS

Participants generally considered the content of the four main domains of the tool, that is, person-centred care activities, clinician manner, clinician skills and person-centred care goals, to be comprehensive and relevant for assessing person-centred care in general and gPCC in particular. Some participants pointed to the need to expand person-centred care activities to better reflect the emphasis on eliciting patient resources/capabilities and psychosocial needs in the gPCC framework. Think-aloud analyses revealed some usability issues primarily regarding difficulties or uncertainties in understanding several words and in using the rating scale. Probing interviews indicated that these problems could be mitigated by improving written instructions regarding response options and by replacing some words. Participants generally were satisfied with the layout and structure of the tool, but some suggested enlarging font size and text spacing to improve readability.

CONCLUSION

The tool appears to satisfactorily cover major person-centred care activities outlined in the gPCC framework. The inclusion of content concerning clinician manner and skills was seen as a relevant embellishment of the framework and as contributing to a more comprehensive assessment of clinician performance in the delivery of person-centred care. A revised version addressing observed content and usability issues will be tested for inter-rater and intra-rater reliability and for feasibility of use in healthcare education and quality improvement efforts.

Public perceptions of artificial intelligence in healthcare: ethical concerns and opportunities for patient-centered care

BACKGROUND

In an effort to improve the quality of medical care, the philosophy of patient-centered care has become integrated into almost every aspect of the medical community. Despite its widespread acceptance, among patients and practitioners, there are concerns that rapid advancements in artificial intelligence may threaten elements of patient-centered care, such as personal relationships with care providers and patient-driven choices. This study explores the extent to which patients are confident in and comfortable with the use of these technologies when it comes to their own individual care and identifies areas that may align with or threaten elements of patient-centered care.

METHODS

An exploratory, mixed-method approach was used to analyze survey data from 600 US-based adults in the State of Florida. The survey was administered through a leading market research provider (August 10-21, 2023), and responses were collected to be representative of the state's population based on age, gender, race/ethnicity, and political affiliation.

RESULTS

Respondents were more comfortable with the use of AI in health-related tasks that were not associated with doctor-patient relationships, such as scheduling patient appointments or follow-ups (84.2%). Fear of losing the 'human touch' associated with doctors was a common theme within qualitative coding, suggesting a potential conflict between the implementation of AI and patient-centered care. In addition, decision self-efficacy was associated with higher levels of comfort with AI, but there were also concerns about losing decision-making control, workforce changes, and cost concerns. A small majority of participants mentioned that AI could be useful for doctors and lead to more equitable care but only when used within limits.

CONCLUSION

The application of AI in medical care is rapidly advancing, but oversight, regulation, and guidance addressing critical aspects of patient-centered care are lacking. While there is no evidence that AI will undermine patient-physician relationships at this time, there is concern on the part of patients regarding the application of AI within medical care and specifically as it relates to their interaction with physicians. Medical guidance on incorporating AI while adhering to the principles of patient-centered care is needed to clarify how AI will augment medical care.

Attention to the Values, Wishes and Needs of Patients With Advanced Cancer by Hospital Clinicians, an Exploratory Qualitative Study

Context: Insight into patients' personal values, wishes, and needs (VWN) by clinicians is essential to guide appropriate palliative care. Objective: To gain insight into the exploration and monitoring of the VWN of patients with advanced cancer during the illness trajectory by hospital oncology clinicians. Method: A generic qualitative study was conducted from February 2022 to July 2022. Specialized nurses, nurse practitioners and medical specialists (in training) providing care to adult patients with advanced cancer were recruited at an outpatient clinic in a Dutch academic hospital. Data were collected using in-depth semi-structured interviews and participatory observations of outpatient clinic consultations. Data were analyzed collaboratively by two researchers using thematic analysis. Results: Eleven clinicians, aged 33-64, 8 females, participated; 7 interviews and 13 observations were conducted. How clinicians explored and monitored patients' VWN was based on their opinions, originating from the clinicians' personal values and work experiences. These were influenced by the local collaboration. Three key opinions were identified: (1) providing safety, (2) supporting medical decision-making, and (3) ensuring alignment. Individual clinicians' approaches varied. The alignment of care and treatment with the patient's VWN was observed to be limited. Conclusion: Clinicians acknowledged the importance of exploring and monitoring patients' VWN but lacked a systematic approach in discussing these topics. Patients should be actively engaged in communication regarding their VWN rather than primarily being provided with medical information. Patient-Reported Outcome Measures may be beneficial in facilitating communication regarding the patient's VWN and could improve appropriate palliative care in hospital cancer care.

Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants

BACKGROUND

Patients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients' experiences with cancer care.

OBJECTIVE

To examine whether patients' experiences with cancer care differ according to their economic status and health literacy.

METHODS

Secondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients' economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors.

RESULTS

Adjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of 'respect for patients' preferences' and 'physical comfort' where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of 'respect for patients' preferences', 'physical comfort' and 'emotional support' were associated with health literacy.

DISCUSSION

This study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.

Costs saved and avoided from pharmacist interventions to address drug-related problems identified from outpatient clinics in Jordan

BACKGROUND

The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems.

RESEARCH DESIGN AND METHODS

Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective.

RESULTS

A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852).

CONCLUSIONS

The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.

"We're On The Same Team": A Qualitative Study On Communication And Care Coordination Surrounding The Requirement To Quit Smoking Prior To Elective Orthopaedic Surgery

INTRODUCTION

Many surgeons require patients to quit smoking prior to elective surgeries to reduce the risk of postoperative complications. Our aim was to qualitatively evaluate the communication and care experiences of patients and clinicians involved in conversations about quitting smoking prior to elective orthopaedic surgery.

METHODS

A qualitative interview study of rural-residing Veterans, primary care providers (PCPs), and Veterans Administration (VA) orthopaedic surgery staff and pharmacists, who care for rural Veterans. We performed a combination of deductive and inductive approaches to support conventional content analysis using a Patient-Centered Care framework.

RESULTS

Patients appreciated a shared approach with their PCP on the plan and reasons for cessation. Despite not knowing if the motivation for elective surgeries served as a teachable moment to facilitate long-term abstinence, almost all clinicians believed it typically helped in the short-term. There was a lack of standardized workflow between primary care and surgery, especially when patients used care delivered outside of VA.

CONCLUSIONS

While clinician-provided information about the reasons behind the requirement to quit smoking preoperatively was beneficial, patients appreciated the opportunity to collaborate with their care teams on developing a plan for cessation and abstinence. Other aspects of patient-centered care need to be leveraged, such as the therapeutic alliance or patient-as-person, to build trust and improve communication surrounding tobacco use treatment. System-level changes may need to be made to improve coordination and connection of clinicians within and across disciplines.

IMPLICATIONS

This study included perspectives from patients, primary care teams, and surgical teams and found that, in addition to providing information, clinicians need to address other aspects of patient-centered care such as the therapeutic alliance and patient-as-person domains to promote patient engagement in tobacco use treatment. This, in turn, could enhance the potential of surgery as a teachable moment and patient success in quitting smoking.

An ethical assessment of compounded bioidentical hormone therapy

The use of compounded bioidentical hormone therapy (cBHT) continues to grow in popularity despite the availability of many US Food and Drug Administration-approved hormone products produced in different formulations and dosages. Numerous claims made by proponents of cBHT are not substantiated by properly designed studies. Valid concerns about purity, efficacy, bioavailability and safety of cBHT have been raised. Since patient welfare is the first duty of health professionals, promoting and prescribing cBHT as first-line therapy violates a number of ethical tenets of medical and pharmacy practice and should be discouraged without a compelling reason.

The content and characteristics of face-to-face interventions to encourage patients' enrollment in cardiac rehabilitation; a scoping review

PURPOSE

To provide an overview of the content and characteristics of face-to-face interventions to encourage enrollment in exercise-based cardiac rehabilitation (CR).

METHODS

Following a published protocol describing the methods, six databases were searched. The search was limited to studies published from January 2000 to December 2021. Two reviewers independently performed study selection and data extraction.

RESULTS

5583 studies were identified and 20 studies with a variety of study designs met the inclusion criteria. Eight studies specified important content in face-to-face interventions to be: Education, problem-solving, support of autonomy, exploring reasons for change, emotional and cognitive support while showing understanding. Studies targeting patients' experiences used motivational interviewing and addressed worries and anticipated difficulties. Intention to attend, CR barriers, practical barriers, exercise self-efficacy, and patients asking questions supported enrollment. Reassurance could lead to nonattendance if patients had a high degree of worry and distress.

CONCLUSION

Face-to-face interventions are important to support patients' enrollment in CR and should integrate a person-centered dialogue exploring reasons for change and providing support to overcome barriers. Focus on the patients' perspectives, the mechanisms of change, and the evaluation of the intervention to inform implementation should be further explored.Implications for RehabilitationIn-hospital face-to-face interventions support enrollment in cardiac rehabilitation (CR) in patients with ischemic heart disease.This study suggests that individual worries and barriers toward CR should be jointly explored while considering patients' capacity for making choices as well as their vulnerability.Patients should be encouraged to ask questions.A too strong focus on reassurance and problem-solving can impede enrollment.

When pharmacy and theater collide: How diversity can develop inclusive communication skills

BACKGROUND

Effective communication with patients and colleagues is key to a pharmacist's ability to provide effective person-centered care. Neurodivergent patients face many barriers when interacting with health professionals; increased awareness and understanding are therefore paramount to the pharmacist's role. This paper describes an innovative teaching partnership between a school of pharmacy and an inclusive theater company which aims to develop awareness and skills of undergraduate pharmacy students in relation to communicating with patients with autism and/or learning disabilities.

EDUCATIONAL ACTIVITY

Forum theater and role-plays were used to complement existing communication skills teaching in Years two and four of the undergraduate MPharm (Master of Pharmacy) program. The sessions were designed and delivered in partnership between academic teaching staff and a theater company of neurodivergent actors. An online evaluation form was used to obtain student feedback on these sessions (two Likert-style questions and three open format questions).

CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY

Of the 241 students who attended a session in 2021, 70 (29%) provided feedback. Feedback was positive, with 99% of respondents finding the session useful. Students spoke about how they found the sessions supportive and enlightening, helping them to reflect on their own communication skills. As a result, the teaching has been developed and now expanded through all years of the undergraduate program. While conscious of challenges such as funding and finding the right partner, the authors recommend this rewarding initiative to fellow academics.

When the Patient is Absent in Patient-Centered Communication Training: A Discursive Analysis of How Medical Students Learn to Interact with Patients

Phenomenon: Patient-centered communication is an ideal for undergraduate medical education and has been for decades. However, medical students often find the patient-centered approach challenging. The present study finds a possible discordance between formal intentions of a medical curriculum and the corresponding learning environment. The objective of our study was to explore how medical curriculum resonates with the purpose of patient-centered medicine, including how a possible dynamic may have helped maintain this discordance in undergraduate medical education. Approach: The study took a qualitative approach exploring the medical curriculum via a structured communication course. The educational context for the course was considered a discursive environment, partially constructed through documents. The concept of textual agency was used to analyze curriculum and course documents. This was to explore how competencies were presented in the medical curriculum and course descriptions and how they were translated through the practices of the communication course. Inductive thematic analysis was used to analyze observations made during the course. Findings: Our analysis suggested that the medical curriculum content and structure still emphasize bio-medical disciplines and knowledge domains in students learning. This connected well with the socialization of medical students toward the role as medical experts whose primary task is to provide information, while patients are defined as passive subjects, who received information. The course description also operationalized complexities of patient-centered communication to a measurable, instrumental structure of skills. This focus on one-directional communication frames the students' understanding of the courses and their performance in it. They learn that: (1) meeting a real patient is a rare opportunity, (2) engaging patients' thoughts and feelings in the conversation is challenging, and (3) the biomedical aspect should be prioritized in the conversation. Insights: These findings suggested that the medical curriculum we studied gave limited room for patient-centered medicine, even in communication training. The power of macro-level documents framed and focused micro-level learning activities and could help explain observed disharmonies in patient-medical student encounters. We see how patient-centered medicine - in both texts and practice - is represented and enacted as a peripheral activity and patients are given a marginal position in encounters with students. The findings suggested that there are challenges for progress and change toward a more patient-centered communication training and curriculum. However, empirical findings also offered points of departure for course leaders and curriculum planners wishing to take steps toward a stronger and more reflective patient-centered approach in medical education, supported through the document structure and the translation of the curriculum through relevant learning activities.

Exploring the Inclusion of Person-Centered Care Domains in Stroke Transitions of Care Interventions: A Scientific Statement From the American Heart Association

BACKGROUND

Health care teams along the stroke recovery continuum have a responsibility to support care transitions and return to the community. Ideally, individualized care will consider patient and family preferences, best available evidence, and health care professional input. Person-centered care can improve patient-practitioner interactions through shared decision-making in which health professionals and institutions are sensitive to those for whom they provide care. However, it is unclear how the concepts of person-centered care have been described in reports of stroke transitional care interventions.

METHODS

A secondary analysis of a systematic review and meta-analysis was undertaken. We retrieved all included articles (n=17) and evaluated the extent to which each intervention explicitly addressed 7 domains of person-centered care: alignment of care with patients' values, preferences, and needs; coordination of care; information and education; physical comfort; emotional support; family and friend involvement; and smooth transition and continuity of care.

RESULTS

Most of the articles included some aspects of person-centeredness; we found that certain domains were not addressed in the descriptions of transitional care interventions, and no articles mentioned all 7 domains of person-centered care. We identified 3 implications for practice and research: (1) delineating person-centered care components when reporting interventions, (2) elucidating social and cultural factors relevant to the study sample and intervention, and (3) clearly describing the role of family and nonmedical support in the intervention.

CONCLUSIONS

There is still room for greater consistency in the reporting of person-centeredness in stroke transitions of care interventions, despite a long-standing definition and conceptualization of person-centered care in academic and clinically focused literature.

Size, shape, alignment, and arrangement-4 steps to optimize dentofacial composition in smile design by using the patient-centered concept: A dental technique

A technique derived from patient-based outcomes is described for planning and determination of dental morphology in esthetic rehabilitation by direct evaluation in the mouth, with the help of the patient, and based on the definitive simulation results. The technique is focused on identification of a tooth arrangement to provide the most harmonious dentofacial composition based on size, shape, alignment, and arrangement, with input from the patient. A clinical treatment is presented to illustrate the use of the technique. Dental selection before smile design provided a comprehensive approach to the complex art of giving each patient's smile individuality and personality.

Quality of health care for patients with coronary heart disease and comorbid mental disorders: a prospective cohort study

BACKGROUND

Coronary heart disease (CHD) is often associated with mental disorders (MDs). Comorbid MDs reduce the quality of life and increase cardiac morbidity and mortality. Nevertheless, there is little and inconsistent research on the management of MDs in CHD patients. To bridge this gap, this study aims to gain insight into the long-term course of MD-related health care for patients with CHD, in order to identify opportunities for care improvement.

METHODS

In this prospective cohort study, we investigated whether CHD patients with or without expert-rated MD at baseline (N = 364) received different MD-related health care from either their general practitioner (GP) or cardiologist at follow-up, M = 2.7 [2.0-4.0] years later. In the follow-up assessment, N = 131 CHD patients participated and received questionnaires capturing sociodemographic, mental health, and MD-related health care characteristics. Descriptive statistics, t-tests and chi-squared tests were used for analyses.

RESULTS

We found significant differences in MD-related health care. CHD patients with MD were more likely to be examined psychologically/psychiatrically (MD 55.9%, non-MD 16.7%, p = < .001) and diagnosed with MD (MD 55.9%, non-MD 13.5%, p = .020) by their GP or cardiologist. Recommendations for and responses to requests for psychotherapy were more likely in MD patients compared to non-MD patients (MD 38.7%, non-MD 11.8%, p = .012 and MD 38.5%, non-MD 11.8%, p = .031, respectively). No significant differences were found concerning physicians' active demand for patients' mental health, referral to a specialist for additional diagnostics, provision of information about the diagnosed MD and further treatment options, response to the patients' request for psychopharmacotherapy, help received in finding psychotherapy or psychopharmacotherapy, and actual receipt of these treatments.

CONCLUSIONS

The results indicate differences in MD-related health care of CHD patients with and without comorbid MD. However, they still highlight the need to further encourage primary care physicians treating CHD to adequately address MDs, provide further diagnostics, support, and information to affected patients. To address this, physicians may benefit from awareness training on the association between CHD and MDs and on appropriate communication with MD patients.

TRIAL REGISTRATION

German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: ID DRKS00022154, date of registration: 02.11.2021.