Predictors of physicians' attitudes toward sharing information with patients and addressing psychosocial needs: a cross-sectional study in Greece

Breaking bad news in oncology practice: experience and challenges of oncology health professionals in Ethiopia - an exploratory qualitative study

OBJECTIVE

To explore the experience and challenges health professionals face during breaking bad news (BBN) to patients with cancer in the oncology centre of Black Lion Specialized Hospital (BLSH), Addis Ababa, Ethiopia 2019.

DESIGN

An exploratory qualitative phenominological study using in-depth interviews was carried out in the only radiotherapy integrated oncology centre in Ethiopia during March 2019. Purposeful maximum variation sampling was used to select participants. OpenCode (V.4.02) assisted thematic analysis approach was employed to analyse the data.

PARTICIPANTS

Eleven oncology health practitioners (oncologists, residents and nurses) working at the oncology centre were interviewed. Repeated interviews and analysis were done until theoretical saturation.

RESULTS

All participants were cognisant of the positive outcome of proper and effective practice of BBN. However, they were practicing it empirically, no standardised protocols or guidelines were in place. Four dimensions of challenges were mentioned: (1) setup centric: unconducive environment, lack of protocols or guidelines, inaccessible treatment, and psychotherapy or counselling services; (2) health care centric, such as inadequate expertise, inadequate time due to patient load,treatment backlog, and referral system; (3) patients/family centric: poor medical literacy level, poor compliance, and family interference; and (4) sociocultural: wrong perception of families on BBN and treatment modalities, and opposition from religious leaders.

CONCLUSION

BBN is challenging for professionals caring for patients in the oncology centre of BLSH. Hence, there is a critical need to improve practices. Change efforts may focus on the development of contextualised, content and context specific practice oriented training programmes and curriculum interventions. Raising awareness of the community and religious leaders regarding the nature and treatment of cancer may also be a helpful adjunct.

An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes

Introduction

The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information".

Methods

A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time.

Results

A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3).

Conclusion

Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

Multi-generational labour markets: Data-driven discovery of multi-perspective system parameters using machine learning

The impact of aggressive capitalist approaches on social, economic and planet sustainability is significant. Economic issues such as inflation, energy costs, taxes and interest rates persist and are further exacerbated by global events such as wars, pandemics and environmental disasters. A sustained history of financial crises exposes weaknesses in modern economies. The Great Attrition, with many quitting jobs, adds to concerns. The diversity of the workforce poses new challenges. Transformative approaches are essential to safeguard societies, economies and the planet. In this work, we use big data and machine learning methods to discover multi-perspective parameters for multi-generational labour markets. The parameters for the academic perspective are discovered using 35,000 article abstracts from the Web of Science for the period 1958-2022 and for the professionals' perspective using 57,000 LinkedIn posts from 2022. We discover a total of 28 parameters and categorized them into five macro-parameters, Learning & Skills, Employment Sectors, Consumer Industries, Learning & Employment Issues and Generations-specific Issues. A complete machine learning software tool is developed for data-driven parameter discovery. A variety of quantitative and visualization methods are applied and multiple taxonomies are extracted to explore multi-generational labour markets. A knowledge structure and literature review of multi-generational labour markets using over 100 research articles is provided. It is expected that this work will enhance the theory and practice of artificial intelligence-based methods for knowledge discovery and system parameter discovery to develop autonomous capabilities and systems and promote novel approaches to labour economics and markets, leading to the development of sustainable societies and economies.

Psychosocial adaptation of families with children newly diagnosed with cancer in the Greek population amidst the socioeconomic crisis

OBJECTIVE

To present the initial assessment of psychosocial adaptation among Greek parents whose children were newly diagnosed with cancer amidst the turmoil of an ongoing financial crisis.

STUDY DESIGN

This prospective observational study used a quantitative approach.

PARTICIPANTS

Sixty-one parents of children with cancer treated at a large urban tertiary-care children's hospital were prospectively recruited to participate in our study during the first week of their child's diagnosis (2013-2016).

METHODS

The parents were asked to complete the psychosocial assessment tool (PAT 2.0), Zung Depression Scale, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, and World Health Organization Quality of Life-Bref Instrument; Moreover, three female healthcare providers (the physician oncologist, the head nurse and a senior nurse) completed the relevant PAT 2.0 -Staff Perceptions questionnaire the results of which were then compared to those of the child's parent.

FINDINGS

The majority of parents had PAT 2.0 scores indicative of increased psychosocial risk :54% were stratified into the "Targeted" (moderate risk) and 15% into the "Clinical" (highest risk) categories, whereas healthcare providers underestimated psychosocial risk in 57%-59% of the cases. The subscales that most contributed to the increased scores were Parental Stress Reaction, Family Structure and Resources, and Family Social Support. The PAT 2.0 had statistically significant correlations with most of the anxiety and depression scales, with Zung having the strongest correlation (r-value: +0.5, p-value <0.01). Our cohort presented more anxiety and depression compared to the general Greek population (14% for depression versus 2,9% for the general population and 46% for anxiety compared to 4,1%) in the years of financial recession in Greece.

CONCLUSIONS

The parents of children newly diagnosed with cancer in Greece are at increased risk for developing anxiety and depression in the years of financial recession in Greece compared to general population.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Parental stress reaction to diagnosis as well as lack of family resources and social support may contribute to this difference. Screening for psychosocial risk factors is essential for the early identification of these families and for the optimal utilization of the limited available resources in times of economic hardship.

"Nobody's Ever Told Me That:" Women's Experiences with Shared Decision-making when Accessing Contraception

Half of all pregnancies in the United States are unintended. Contraceptive methods are effective in reducing unintended pregnancy burden. The shared decision-making model serves as best practice when choosing among healthcare options, and may be appropriate when considering contraceptive options. This study examined women's experiences with shared decision-making in contraceptive use dynamics. Researchers analyzed 38 interviews with women of reproductive age (range: 19-50 years) living in South Carolina (May-November 2016). Researchers completed a constant comparative method of data analysis using HyperRESEARCH 3.7.3 to explore reproductive-aged women's contraceptive decision-making. Shared decision-making provided a conceptual framework for analysis. Gaps in contraceptive knowledge, especially method effectiveness, impacted participants' experiences with contraception. Although participants believed they had adequate information, findings suggest they may not be fully informed about existing contraceptive options. Participants wanted options; however, results indicated women may not be actively involved in choosing contraception. Nuanced beliefs about contraception demonstrated preferences for patient-provider communication within the broader context of reproductive health and individual lifestyle needs. Findings from this study offer theoretical and practical recommendations to guide shared decision-making during contraceptive consultations to empower women in making informed and lifestyle-appropriate contraceptive choices.

Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain

BACKGROUND

In recent decades, many self-report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person-centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) using a sample of primary care health-care professionals in Spain.

METHODS

Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item-to-scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2-factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA).

RESULTS

Low inter-item correlations were observed, and the CFA 2-factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10-item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3-factor structure. Participants showed a patient-oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing.

CONCLUSION

Although the 2-factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health-care professionals overall show a patient-oriented attitude, although less marked in issues such as patients' need for and management of medical information.

The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management

Objectives

The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver's patient-centered and empathetic behaviours in chronic pain context.

Methods

A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer's assessment using a video of real patients with chronic pain.

Results

The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler–Danlos syndrome and fibromyalgia) (p < 0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience.

Discussion

The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.

Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece

There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.

Enhancing clinical communication in dermatologists: a personalized educational intervention

OBJECTIVES

Effective communication is a vital component of patient-centered consultations with favorable treatment outcomes. This study aimed in testing the effectiveness of a personalized, communication training program for dermatologists in their practices.

METHODS

Fifteen dermatologists were offered the educational intervention NO.TE.S. (Non-Technical Skills). Depending on the dermatologists' needs, seven to nine sessions with a 60-min duration were performed, focusing on: patient-centered care, principles of Neurolinguistic Programming, a guide to the medical interview, principles of motivational interviewing and self-care. After the program's completion, participants completed anonymously an 18-item evaluation questionnaire.

RESULTS

All 14 participants would suggest NO.TE.S to a colleague. According to the main themes identified, their participation led to (i) re-consideration of the physician-patient relationship, (ii) more conscious application of the patient-centered model, (iii) improvement in communication skills, (iv) awareness of medical interview guides, (v) increase in self-confidence, and (vi) techniques of self-care. Eleven physicians (78.6%) declared improvement in patients' satisfaction, 14 (100%) in their own satisfaction, seven (50%) in adherence to therapeutic plan and seven (50%) in treatment outcomes.

CONCLUSION

The one-to-one coaching is a convenient and well-received personalized means of enhancing clinical communication in dermatologists, leading to more patient-centered medical encounters with better treatment outcomes.

Determinants of patients' attitudes toward patient-centered care: a cross-sectional study in Greece

OBJECTIVE

The aim of this study was to investigate - for the first time in Greece - patients' attitudes toward patient-centered care, by identifying the impact of socio-demographic factors, health condition, social support and religious beliefs.

METHODS

454 Hospitalized patients were interviewed on the first day of their scheduled admission, answering demographic questions and the following questionnaires: Patient-Practitioner Orientation Scale (PPOS), Autonomy Preference Index (API), Short Form SF-12v2 Health Survey, God Locus of Health Control (GLHC) and Perceived Available Support (PAS).

RESULTS

Mean PPOS and API scores were: PPOS Sharing 3.4 (sd=0.69), Caring 3.99 (sd=0.76), API Information-Seeking 88.32 (sd=9.35) and Decision-Making 51.19 (sd=9.27). Higher desire for information was associated with younger age, more years of education, weaker spiritual faith in healing and worse subjective health status. Higher expectations for caring physicians were correlated with older age, more years of education, higher perceived social support and weaker spiritual faith in healing.

CONCLUSION

Age, years of education, health status, social support and religious beliefs are determinants of patient-centered attitudes.

PRACTICE IMPLICATIONS

Patients expect to be informed, although they do not equally want to be involved in decision-making. Religious faith and perceived social support should be taken into consideration to further understand patients' needs.

Audiologists' preferences for patient-centredness: a cross-sectional questionnaire study of cross-cultural differences and similarities among professionals in Portugal, India and Iran

OBJECTIVE

Patient-centredness has become an important aspect of health service delivery; however, there are a limited number of studies that focus on this concept in the domain of hearing healthcare. The objective of this study was to examine and compare audiologists' preferences for patient-centredness in Portugal, India and Iran.

DESIGN

The study used a cross-sectional survey design with audiologists recruited from three different countries.

PARTICIPANTS

A total of 191 fully-completed responses were included in the analysis (55 from Portugal, 78 from India and 58 from Iran).

MAIN OUTCOME MEASURE

The Patient-Practitioner Orientation Scale (PPOS).

RESULTS

PPOS mean scores suggest that audiologists have a preference for patient-centredness (ie, mean of 3.6 in a 5-point scale). However, marked differences were observed between specific PPOS items suggesting these preferences vary across clinical situations. A significant level of difference (p<0.001) was found between audiologists' preferences for patient-centredness in three countries. Audiologists in Portugal had a greater preference for patient-centredness when compared to audiologists in India and Iran, although no significant differences were found in terms of age and duration of experience among these sample populations.

CONCLUSIONS

There are differences and similarities in audiologists' preferences for patient-centredness among countries. These findings may have implications for the training of professionals and also for clinical practice in terms of optimising hearing healthcare across countries.

An Australian survey of audiologists' preferences for patient-centredness

OBJECTIVE

Patient-centredness is becoming a core value of health services worldwide, however it remains largely unexplored in audiology. This study investigated audiologists' preferences for patient-centredness and identified factors that explain audiologists' preferences for patient-centredness.

DESIGN

All members of the Audiological Society of Australia received two questionnaires: (1) a descriptive questionnaire (e.g. age, gender, place of residence, years in practice, employment characteristics), and (2) a modified patient-practitioner orientation scale (PPOS; Krupat et al, 2000) which measures preferences for two aspects of patient-centredness, sharing and caring.

STUDY SAMPLE

In total 663 (46%) audiologists returned both questionnaires fully completed.

RESULTS

Mean PPOS scores indicated that audiologists prefer patient-centredness. Linear regression modelling identified that older audiologists, that had practiced longer, and who worked in community education, industrial audiology, or teaching had a significantly greater preference for patient-centredness than their peers. In contrast, audiologists who practiced in a private environment and who worked in the area of assessment of adults had a significantly lesser preference for patient-centredness than their peers.

CONCLUSIONS

Audiologists prefer client-centredness and age, years of experience, and employment characteristics can partly explain preferences for patient-centredness. Future research should explore the relationships between patient-centredness and intervention outcomes in audiology.

Psychometric properties of the Greek version of the Toronto Composite Empathy Scale in Greek dental students

INTRODUCTION

Empathy levels of health practitioners are related to patient satisfaction and treatment outcomes. The Toronto Composite Empathy Scale (TCES) was recently developed to assess cognitive and emotional empathy levels in both professional and personal spheres, and tested in an English-speaking sample of dental students. The aim of this study was to examine the psychometrics of the Greek version of the TCES.

MATERIALS AND METHODS

The TCES was translated into Greek and administered to all of the dental students at Aristotle University of Thessaloniki. A random subset of students completed the questionnaire twice for test-retest analysis.

RESULTS

Nearly all (96.5%) of the students completed the questionnaire. The internal consistencies of each of the four subscales were generally acceptable (Cronbach's alphas: 0.676-0.805), and the scale showed good discriminant and convergent validities (r's for discriminant validity: 0.217 and 0.103; r's for convergent validity: 0.595 and 0.700). Test-retest reliabilities ranged from 0.478 to 0.779. After eliminating items that fell on both cognitive and emotional factors, a rotated factor analysis indicated that the items loaded on two cognitive and three emotional factors.

DISCUSSION

Our results indicate that the Greek version of the TCES has good psychometric properties. The factor analysis indicates that the emotional and cognitive aspects of empathy are distinct, supporting the need to address both aspects in studies of empathy.

CONCLUSIONS

The Greek version of the TCES is a reliable and valid tool for the measurement of cognitive and emotional empathy, in both professional and personal life, in Greek dental students.