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Houchens N, Engle JM, Palanjian R, Saint S, Townsend WA, Nasrallah M, Gupta A. Effect of Clinician Posture on Patient Perceptions of Communication in the Inpatient Setting: A Systematic Review. J Gen Intern Med 2024:10.1007/s11606-024-08906-4. [PMID: 39020229 DOI: 10.1007/s11606-024-08906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/17/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Nonverbal communication plays a pivotal role in the provision of effective patient care and has been associated with important patient health outcomes. Clinician posture, a nonverbal form of communication, may influence the patient experience and satisfaction. The relationship between clinician posture (i.e., standing or at the patient's eye level) and patient perceptions of clinician communication in the hospital-a setting with heightened power dynamics between patient and clinician-is currently unknown. METHODS We conducted searches of Ovid MEDLINE, EBSCO CINAHL Complete, EBSCO PsycInfo, Elsevier Embase/Embase Classic, Elsevier Scopus, and Web of Science Core Collection up to May 2023. English language studies were included if they compared clinician posture (eye-level or standing) during adult inpatient (including emergency department) interactions. Two authors independently abstracted data from included studies and assessed risk of bias or quality of evidence. A third author arbitrated any disagreements. Studies reported adherence to the posture intervention and/or patient perception outcomes. The latter included encounter duration, preferences for posture type, perceptions of interaction quality and clinician communication and compassion, and standardized assessments of patient satisfaction. RESULTS Fourteen studies (six randomized controlled trials, four quasi-experimental studies, four observational studies) assessed clinician posture at the bedside. Ten noted at least one favorable outcome for clinicians who communicated at the patient's eye level, three revealed no differences in patient perceptions between standing and sitting, and one noted higher patient ratings for standing clinicians. Findings were limited by variation in interventions and outcomes, generally high risk of bias, and relatively low adherence to assigned posture groups. DISCUSSION Compared to standing, eye-level communication by clinicians appears beneficial. The magnitude and types of benefits clinicians and patients may gain from this behavior remain unclear given heterogeneity and generally high risk of bias in available studies. With its relatively easy implementation and potential for benefit, clinicians should consider communicating with their hospitalized patients at eye level. REGISTRATION PROSPERO, CRD42020199817.
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Affiliation(s)
- Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Jason M Engle
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Rita Palanjian
- University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | - Sanjay Saint
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Whitney A Townsend
- University of Michigan Taubman Health Sciences Library, Ann Arbor, MI, USA
| | - Mariam Nasrallah
- University of Michigan Medical School, Ann Arbor, MI, USA
- Beaumont Health Family Medicine, Wayne, MI, USA
| | - Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Koppel PD, De Gagne JC, Docherty S, Smith SK, Prose NS, Thompson JA, Otero MC. Feasibility and acceptability of measuring positivity resonance in nurse-patient telehealth videoconferencing visits: A mixed-methods observational study. J Clin Nurs 2024; 33:2578-2592. [PMID: 38716789 DOI: 10.1111/jocn.17174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/23/2024] [Accepted: 04/07/2024] [Indexed: 06/14/2024]
Abstract
AIM To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. BACKGROUND Although the measurement of positivity resonance is promising, and non-participant observation is considered effective, their approaches to studying nurse-patient relationships have not been fully explored. DESIGN A mixed-methods observational study. METHODS Video recordings of 30 nurse-patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post-visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. RESULTS Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from .575 to .752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. CONCLUSIONS Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse-patient relationships. RELEVANCE TO PROFESSIONAL PRACTICE Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health-related behaviours, well-being, resilience and satisfaction. REPORTING METHOD The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. PATIENT OR PUBLIC CONTRIBUTION Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures.
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Affiliation(s)
- Paula D Koppel
- School of Nursing, Duke University, Durham, North Carolina, USA
| | | | | | - Sophia K Smith
- School of Nursing, Duke University, Durham, North Carolina, USA
- Duke Health, Duke Cancer Institute, Durham, North Carolina, USA
| | - Neil S Prose
- Department of Dermatology, Duke University, Durham, North Carolina, USA
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | | | - Marcela C Otero
- Munich Research Institute on the Economics of Aging, Munich, Germany
- Max Planck Institute for Social Law and Social Policy, Munich, Germany
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Liu J, Song M, Li C, Guo S, Han J. The Effect of Characteristics of Patient Communication on Physician Feedback in Online Health Communities: An Observational Cross-Sectional Study. HEALTH COMMUNICATION 2024:1-23. [PMID: 38173084 DOI: 10.1080/10410236.2023.2300901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
With the rapid development of e-health and telemedicine, previous studies have explored the relationship between physician-patient communication and patient satisfaction; however, there is a paucity of research on the influence of the characteristics of patient communication on the characteristics of physician feedback. Based on the communication accommodation theory, as well as the computer-mediated communication theory and media richness theory, this study aimed to explore how characteristics of patient communication influence characteristics of physician feedback in online health communities. We employed a crawler software to download the communication data between 1652 physicians and 105,325 patients from the Good Doctor platform, the biggest online health community in China. We built an empirical model using this data and employed a multilevel model to test our hypotheses using Stata and Python software. The results indicate that the amount of patients' rendered information positively influences the physicians' text (α = 0.123, t = 33.147, P < .001) and voice feedback (β = 0.201, t = 40.011, P < .001). Patients' hope for help signals and the provision of their electronic health records weaken the effect of the amount of patients' rendered information on physicians' text feedback (α = -0.040, t = -24.857, P < .001; α = -0.048, t = -15.784, P < .001), whereas, it strengthened the effect of the amount of patients' rendered information on physicians' voice feedback (β = 0.033, t = 14.789, P < .001; β = 0.017, t = 4.208, P < .001). Moreover, the occurrence of high-privacy diseases strengthened the effect of the amount of patients' presented information on physicians' text and voice feedback (α = 0.023, t = 4.870, P < .001; β = 0.028, t = 4.282, P < .001). This research contributes to the development of computer-mediated communication theories and sheds light on service delivery in the online health community.
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Affiliation(s)
- Jusheng Liu
- School of Economics and Management, Shanghai University of Political Science and Law
| | - Mei Song
- School of Economics and Management, East China Normal University
| | - Chaoran Li
- School of Economics and Management, Shanghai University of Sport
| | - Shanshan Guo
- School of Business and Management, Shanghai International Studies University
| | - Jingti Han
- Fintech Research institute, Shanghai University of Finance and Economics
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Dubois H, Creutzfeldt J, Manser T. Behavioural observation tool for patient involvement and collaboration in emergency care teams (PIC-ET-tool). BMC Emerg Med 2023; 23:74. [PMID: 37393240 PMCID: PMC10314478 DOI: 10.1186/s12873-023-00841-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Patient participation is advocated in various healthcare settings. Instruments for assessment and feedback have been developed to strengthen clinician-patient interaction. In an emergency department context, such instruments are still missing. The study aimed to develop and test an observation tool for emergency teams' behaviour regarding patient involvement and collaboration. METHODS The development of the behavioural observation tool followed a systematic approach. The tool's content was based on various data sources, i.e., published literature, interview and observational data, and expert consensus. An international expert panel reviewed the content and the rating scale and rated its importance for patient involvement and collaboration in a Delphi process. The feasibility and reliability of the tool were tested by trained observers using video recordings of simulated emergencies. Intraclass correlation (ICC) and Kappa-statistics were performed to test the tool's inter-rater reliability. RESULTS The PIC-ET tool, a 22-item observation instrument was developed in which patient involvement and collaboration behaviours are rated from 'no' to 'high' using behavioural anchors. Expert agreement was obtained after three Delphi rounds on the tool content, the behavioural anchors and its importance for patient involvement and collaboration. The content validity was assessed as high, and the tool was found feasible for research. Overall inter-rater reliability was fair (Kappa 0.52). CONCLUSIONS A novel tool for assessing emergency teams' behaviour regarding patient involvement and collaboration is introduced. The tool's psychometric properties were fair to good. Further validation of the PIC-ET tool is recommended for more robust evidence. Future adaptation to different contexts and areas of use, as well as further validity testing may be of value.
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Affiliation(s)
- Hanna Dubois
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
| | - Tanja Manser
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32, Karolinska University Hospital, Stockholm, S-14186 Sweden
- FHNW School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, Olten, CH-4600 Switzerland
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van Dongen A, Stewart D, Garry J, McCambridge J. Measurement of person-centred consultation skills among healthcare practitioners: a systematic review of reviews of validation studies. BMC MEDICAL EDUCATION 2023; 23:211. [PMID: 37016379 PMCID: PMC10074817 DOI: 10.1186/s12909-023-04184-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Person-centred care is integral to high-quality health service provision, though concepts vary and the literature is complex. Validated instruments that measure person-centred practitioner skills, and behaviours within consultations, are needed for many reasons, including in training programmes. We aimed to provide a high-level synthesis of what was expected to be a large and diverse literature through a systematic review of existing reviews of validation studies a of instruments that measure person-centred practitioner skills and behaviours in consultations. The objectives were to undertake a critical appraisal of these reviews, and to summarise the available validated instruments and the evidence underpinning them. METHODS A systematic search of Medline, EMBASE, PsycINFO and CINAHL was conducted in September 2020. Systematic reviews of validation studies of instruments measuring individual practitioner person-centred consultation skills or behaviours which report measurement properties were included. Review quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Details of the reviews, the included validation studies, and the instruments themselves are tabulated, including psychometric data, and a narrative overview of the reviews is provided. RESULTS Four reviews were eligible for inclusion. These used different conceptualisations of person-centredness and targeted distinct, sometimes mutually exclusive, practitioners and settings. The four reviews included 68 unique validation studies examining 42 instruments, but with very few overlaps. The critical appraisal shows there is a need for improvements in the design of reviews in this area. The instruments included within these reviews have not been subject to extensive validation study. DISCUSSION There are many instruments available which measure person-centred skills in healthcare practitioners and this study offers a guide to what is available to researchers and research users. The most relevant and promising instruments that have already been developed, or items within them, should be further studied rigorously. Validation study of existing material is needed, not the development of new measures.
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Affiliation(s)
- Anne van Dongen
- Department of Psychology, Health, and Technology, University of Twente, Enschede, the Netherlands.
| | - Duncan Stewart
- School of Social Sciences and Professions, London Metropolitan University, London, UK
| | - Jack Garry
- Department of Health Sciences, University of York, York, UK
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Communication skills utilized by physicians in the pediatric outpatient setting. BMC Health Serv Res 2022; 22:993. [PMID: 35927741 PMCID: PMC9354305 DOI: 10.1186/s12913-022-08385-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Effective communication has been shown to increase patient satisfaction. The objective of this study was to describe communication strategies employed by physicians, and determine if physician communication strategies affect caregiver perception of quality or satisfaction with physician communication in a pediatric ambulatory setting. Methods This observational study was conducted at the Children’s Hospital of Philadelphia and consisted of video recordings of visits that were reviewed by research assistants for physician utilized communication strategies. Caregivers completed surveys on their preferred physician communication qualities, perception of communication quality, and satisfaction with communication. Correlation was performed between types of communication strategy and caregiver satisfaction with communication or perceived quality of communication. T-tests were run to see if there was a significant difference in patient perceived communication and satisfaction scores based on the communication strategies utilized during visits. Results There were five universally used communication strategies across the 84 clinic visits recorded, including: eye contact, good posture, speaking concisely, providing thorough explanations, and providing summary of next steps. The average number of communication strategies used was 15.95 (σ = 1.50) with physicians using at least 16 of the 18 communication strategies in 62% of the clinic visits. There was no correlation between the number of communication strategies physicians utilized and either the caregiver perception of communication quality score (CPCQ) or communication satisfaction (CS) score. Caregivers who preferred an authoritative approach but perceived a collaborative approach reported lower average CPCQ and CS scores compared to caregivers who had their communication expectations met. Discussion There are numerous tools designed to help the physician facilitate an effective working relationship with the patient. In our study, the universally used verbal communication strategies are generally recognized as components of an effective communication repertoire. Another part of effective communication is meeting communication expectations with the CS scores suggesting that caregivers felt their communication needs were being met. Dedicating clinical time to understanding this need may help improve the overall clinical experience. Conclusion Physicians utilize many of the suggested communication strategies to help facilitate an effective clinical encounter. Further studies on caregiver communication requirements and meeting caregiver communication expectations are needed.
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Tarbi EC, Blanch-Hartigan D, van Vliet LM, Gramling R, Tulsky JA, Sanders JJ. Toward a basic science of communication in serious illness. PATIENT EDUCATION AND COUNSELING 2022; 105:1963-1969. [PMID: 35410737 DOI: 10.1016/j.pec.2022.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
High-quality communication can mitigate suffering during serious illness. Innovations in theory and technology present the opportunity to advance serious illness communication research, moving beyond inquiry that links broad communication constructs to health outcomes toward operationalizing and understanding the impact of discrete communication functions on human experience. Given the high stakes of communication during serious illness, we see a critical need to develop a basic science approach to serious illness communication research. Such an approach seeks to link "what actually happens during a conversation" - the lexical and non-lexical communication content elements, as well as contextual factors - with the emotional and cognitive experiences of patients, caregivers, and clinicians. This paper defines and justifies a basic science approach to serious illness communication research and outlines investigative and methodological opportunities in this area. A systematic understanding of the building blocks of serious illness communication can help identify evidence-informed communication strategies that promote positive patient outcomes, shape more targeted communication skills training for clinicians, and lead to more tailored and meaningful serious illness care.
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Affiliation(s)
- Elise C Tarbi
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA.
| | | | | | - Robert Gramling
- University of Vermont. Department of Family Medicine, Burlington, USA.
| | - James A Tulsky
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA; Brigham and Women's Hospital, Division of Palliative Medicine, Department of Medicine, Boston, USA.
| | - Justin J Sanders
- McGill University, Division of Palliative Care, Department of Family Medicine, Montreal, Canada.
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Ekman N, Moons P, Taft C, Boström E, Fors A. Observable indicators of person-centred care: an interview study with patients, relatives and professionals. BMJ Open 2022; 12:e059308. [PMID: 35443963 PMCID: PMC9021806 DOI: 10.1136/bmjopen-2021-059308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To identify key observable indicators of person-centred care (PCC) from interviews with patients, relatives and professionals with experience of receiving or working with PCC. DESIGN A qualitative interview study using deductive content analysis. SETTING Primary and hospital care settings in Western Sweden. PARTICIPANTS Twelve participants with extensive experience of receiving or working with PCC were interviewed: two patients, two patients representative with long-term conditions, one relative and informal carer, three registered nurses, one physician, two occupational therapists and one social worker/researcher. RESULTS Nine observable indicators were identified and subsumed under three predetermined categories: initiating, working and safeguarding the partnership. The first category comprised three subcategories: welcoming, interested and courteous reception; agreeing on structure and aims of the conversation; and eliciting patients' wishes for involvement of significant others. The second category comprised four subcategories: attentive, empathic and encouraging manner; promoting mutual understanding; promoting patient engagement; and encouraging and friendly body language. The last category consisted of two subcategories: collaboration and transparency in documentation and verifying that patient's and professional's views, goals and wants are correctly documented. CONCLUSION Our results underline the need for health professionals to actively and conscientiously convey to patients their interest in and respect for the patient as a person and their willingness to collaborate as partners in their care from the very outset of the interaction. Non-verbal behaviours were seen to play a major role in shaping patients' impressions of health professionals. Given that patients' first impressions were considered to impact the content, course and outcomes of the interaction, more research attention should be given to their implications for the effective delivery of PCC.
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Affiliation(s)
- Nina Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Deparment of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Philip Moons
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Deparment of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Eva Boström
- Department of Nursing, University of Umeå, Umeå, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
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Siddiqui S. A Wider Understanding of a Patient’s Relational Autonomy at the Time of Death. THE JOURNAL OF CLINICAL ETHICS 2022. [DOI: 10.1086/jce2022331058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Hamel LM, Moulder R, Ramseyer FT, Penner LA, Albrecht TL, Boker S, Eggly S. Nonverbal Synchrony: An Indicator of Clinical Communication Quality in Racially-Concordant and Racially-Discordant Oncology Interactions. Cancer Control 2022; 29:10732748221113905. [PMID: 35801386 PMCID: PMC9272474 DOI: 10.1177/10732748221113905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this cross-sectional study was to apply a novel software to
measure and compare levels of nonverbal synchrony, as a potential indicator
of communication quality, in video recordings of racially-concordant and
racially-discordant oncology interactions. Predictions include that the
levels of nonverbal synchrony will be greater during racially-concordant
interactions than racially-discordant interactions, and that levels of
nonverbal synchrony will be associated with traditional measures of
communication quality in both racially-concordant and racially-discordant
interactions. Design This is a secondary observational analysis of video-recorded oncology
treatment discussions collected from 2 previous studies. Setting Two National Cancer Institute-designated Comprehensive Cancer Centers and
another large urban cancer center. Participants Participants from Study 1 include 161 White patients with cancer and 11 White
medical oncologists. Participants from Study 2 include 66
Black/African-American patients with cancer and 17 non-Black medical
oncologists. In both studies inclusion criteria for patients was a recent
cancer diagnosis; in Study 2 inclusion criteria was identifying as
Black/African American. Main outcome measures Nonverbal synchrony and communication quality. Results Greater levels of nonverbal synchrony were observed in racially-discordant
interactions than in racially-concordant interactions. Levels of nonverbal
synchrony were associated with indicators of communication quality, and
these associations were more consistently found in racially-discordant
interactions. Conclusion This study advances clinical communication and disparities research by
successfully applying a novel approach capturing the unconscious nature of
communication, and revealing differences in communication in
racially-discordant and racially-concordant oncology interactions. This
study highlights the need for further exploration of nonverbal aspects
relevant to patient-physician interactions.
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Affiliation(s)
- Lauren M Hamel
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | | | | | - Louis A Penner
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | | | - Steven Boker
- 2358University of Virginia, Charlottesville, VA, USA
| | - Susan Eggly
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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Hamel LM, Moulder R, Harper FWK, Penner LA, Albrecht TL, Eggly S. Examining the dynamic nature of nonverbal communication between Black patients with cancer and their oncologists. Cancer 2020; 127:1080-1090. [PMID: 33290592 DOI: 10.1002/cncr.33352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although communication quality is associated with patient outcomes, racial disparities in communication exist, disproportionately burdening Black patients. However, most communication research focuses on verbal behaviors in predominantly White patient populations. We used a newly developed and theory-guided network analysis that examines the dynamic interplay and behavioral convergence and divergence between Black patients with cancer and their oncologists during cancer treatment discussions. METHODS We applied a nonverbal behavioral coding system to thin slices of video recordings of Black patients and their oncologists discussing treatment. We then estimated 3 networks: 1) a temporal network to determine whether a nonverbal behavior predicts another nonverbal behavior at the next time point in an interaction, and how much each nonverbal behavior influences other nonverbal behaviors and is influenced by other nonverbal behaviors; 2) a contemporaneous network to determine whether a nonverbal behavior co-occurs with other nonverbal behaviors at the same time point in an interaction; and 3) a between-dyads network to examine the covariation between nonverbal behaviors across all dyads. RESULTS Black patients (n = 74) and their non-Black physicians (n = 15) showed a mix of convergence and divergence in their nonverbal behaviors at the same points in time, from one time point to the next, and across dyads. Across analyses, convergence was most likely to occur when physicians matched their behaviors to their patients; especially with smiling, gaze, leaning, and laughter behaviors. CONCLUSION Our findings reveal patterns of modifiable behaviors that can potentially inform interventions to reduce disparities in clinical communication and, in turn, treatment and mortality disparities.
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Affiliation(s)
- Lauren M Hamel
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Robert Moulder
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Felicity W K Harper
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Louis A Penner
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Terrance L Albrecht
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
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Agarwal V. Patient Communication of Chronic Pain in the Complementary and Alternative Medicine Therapeutic Relationship. J Patient Exp 2020; 7:238-244. [PMID: 32851146 PMCID: PMC7427370 DOI: 10.1177/2374373519826137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Patient descriptions of pain shape the pain experience, yet there is insufficient understanding of how patient communication can help providers lessen pain’s psychological and physical impact. Objective: To examine how individuals communicate their pain experience in the complementary and alternative medicine (CAM) provider-patient relationship. Method: Qualitative thematic framing examining semistructured interviews of a purposive and snowball sample of CAM patients (N = 13; 850 double-spaced pages) recruited from the mid-Atlantic region of the United States. Results: Complementary and alternative medicine patients communicate the pain experience through an awareness of their interdependence with: (a) relational spaces as attention to the self, the healing practices, and the provider; (b) physical spaces as openness to surroundings and the spatiality and temporality of self; and (c) physiological spaces as breathing and neurological and immune system functioning. Conclusion: A therapeutic relationship cultivating interdependence through awareness of relational, physical, and physiological spaces supports patients’ ability to open up to, know, and accept their body. The CAM provider’s work connects their practice with patient awareness of control over their environment, relationships, and physiology to redefine their pain experience.
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Affiliation(s)
- Vinita Agarwal
- Department of Communication Arts, Fulton School of Liberal Arts, Salisbury University, Salisbury, MD, USA
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Villar R(R. Missing body language. J Hip Preserv Surg 2020; 7:355-356. [PMID: 33948192 PMCID: PMC8081408 DOI: 10.1093/jhps/hnaa066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oakley S, Grealish L, Coyne E. Telling their story: A qualitative descriptive study of the lived experience of expatriate palliative care nurses in the United Arab Emirates. Eur J Oncol Nurs 2020; 48:101793. [PMID: 32791462 DOI: 10.1016/j.ejon.2020.101793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore the experiences of expatriate nurses caring for Muslim patients near end-of-life in a palliative care unit in the United Arab Emirates. METHODS A qualitative descriptive study, with data collected through semi structured individual interviews with nine expatriate nurses working in a palliative care unit in one hospital in the United Arab Emirates. Thematic analysis of the data transcripts used a structured inductive approach. RESULTS Analysis of the interview transcripts yielded three themes. First, language was a significant barrier in end-of-life care but was transcended when nurses practiced authentically, using presence, empathetic touch and spiritual care. Secondly, relationships between nurses, patients and families were strengthened over time, which was not always possible due to late presentation in the palliative care unit. Finally, nurses were continually in discussions with physicians, families and other nurses, co-creating the meaning of new information and experiences within the hospital policy context. CONCLUSION For expatriate nurses, palliative nursing in a Muslim middle eastern country is complex, requiring nurses to be creative in their communication to co-create meaning in an emotionally intensive environment. Like other palliative care settings, time can strengthen relationships with patients and their families, but local cultural norms often meant that patients came to palliative care late in their disease trajectory. Preparing expatriate nurses for work in specialist palliative care settings requires skill development in advanced communication and spiritual practices, as well as principles of palliative care and tenets of Muslim culture.
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Affiliation(s)
- Suzanne Oakley
- Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates.
| | - Laurie Grealish
- School of Nursing & Midwifery & Menzies Health Institute, Griffith University, Gold Coast Health, Queensland, Australia. https://twitter.com/GrealishLaurie
| | - Elisabeth Coyne
- Griffith University, Australia. https://twitter.com/Elisabethcoyne1
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Ekman N, Taft C, Moons P, Mäkitalo Å, Boström E, Fors A. A state-of-the-art review of direct observation tools for assessing competency in person-centred care. Int J Nurs Stud 2020; 109:103634. [PMID: 32531569 DOI: 10.1016/j.ijnurstu.2020.103634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists. OBJECTIVE To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC. DESIGN State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017. REVIEW METHODS Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles. RESULT 16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed. CONCLUSION Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.
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Affiliation(s)
- Nina Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Åsa Mäkitalo
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
| | - Eva Boström
- Department of Nursing, University of Umeå, Umeå, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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16
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James S, Desborough J, McInnes S, Halcomb EJ. Nonverbal communication between registered nurses and patients during chronic disease management consultations: Observations from general practice. J Clin Nurs 2020; 29:2378-2387. [DOI: 10.1111/jocn.15249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Sharon James
- School of Nursing University of Wollongong BEGA NSW Australia
| | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population Health College of Medicine, Biology and the Environment Australian National University ACTON ACT Australia
| | - Susan McInnes
- School of Nursing University of Wollongong WOLLONGONG NSW Australia
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Cheshire WP, Barrett KM, Eidelman BH, Mauricio EA, Huang JF, Freeman WD, Robinson MT, Salomon GR, Ball CT, Gamble DM, Melton VS, Meschia JF. Patient perception of physician empathy in stroke telemedicine. J Telemed Telecare 2020; 27:572-581. [PMID: 31986965 DOI: 10.1177/1357633x19899237] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We assessed patients' perceptions of physician empathy during telemedicine consultations as compared to in-person consultations during clinical encounters for acute stroke. METHODS This prospective cohort study was undertaken at a comprehensive stroke centre hub in collaboration with a distant community hospital spoke site. Eligible participants presented to hub or spoke emergency departments with suspected acute stroke within three hours of symptom onset. Participants were evaluated at the hub site in person or at the remote site via telemedicine by the same group of neurologists. Following acute care decisions, single-visit data including participant-reported assessments of physician empathy were collected within 24 h. The primary outcome was the Consultation and Relational Empathy score. The secondary outcome for the telemedicine cohort was the Telemedicine Patient Satisfaction Measure score. RESULTS Between 31 May 2013-13 March 2019, 70 patients completed the study. Fifty patients were seen by telemedicine and 20 patients were seen in person. Median Consultation and Relational Empathy scores (with a possible score of 10-50) were 49 (range 27-50) for telemedicine and 45 (range 26-50) for in-person consultations (Wilcoxon rank sum p = 0.18). Each item of the Consultation and Relational Empathy questionnaire was rated very good or excellent by at least 87% of participants in the telemedicine group. The median Telemedicine Patient Satisfaction Measure score was 54 (range 12-60), with each item rated agree or strongly agree by at least 84% of participants. DISCUSSION We found no difference between telemedicine and in-person visits in patient perception of physician empathy in acute stroke care. Therefore, we conclude that empathy can be conveyed by facial expression, voice and attentiveness in a telemedicine encounter and, in the setting of acute stroke care, does not require physical touch or proximity.
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Affiliation(s)
- William P Cheshire
- Department of Neurology, Mayo Clinic, USA.,Program in Professionalism and Values, Mayo Clinic, USA
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James S, Desborough J, McInnes S, Halcomb E. Strategies for using non-participatory video research methods in general practice. Nurse Res 2019; 27:32-37. [PMID: 31468886 DOI: 10.7748/nr.2019.e1667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Non-participatory video research is useful for observing and analysing interactions between clinicians, patients and technology. However, few clinical nursing studies have used non-participatory video observation and there is limited literature describing the approach. AIM To describe a study that used non-participatory video observation in general practice. DISCUSSION The authors' experience of non-participatory video research methods indicates that the acceptability of the technique, workplace organisation and consultation space have implications for preparation and data collection. Strategies for success include engaging stakeholders early on, obtaining contextual knowledge and piloting the approach. CONCLUSION Non-participatory video observation is valuable in understanding interactions between nurses and patients in a naturalistic setting. Careful planning is essential to ensure alignment between research aims, context and technology. The methods for analysing data must be chosen carefully to ensure the research question is answered. IMPLICATIONS FOR PRACTICE Video observation provides rich data. Careful planning and engagement of participants is required for successful conduct of studies that use the technique.
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Affiliation(s)
- Sharon James
- University of Wollongong, Bega, New South Wales, Australia
| | - Jane Desborough
- Australian National University, Australian Capital Territory, Australia
| | - Susan McInnes
- University of Wollongong, Wollongong, New South Wales, Australia
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Freud D, Ezrati-Vinacour R, Amir O. Speech rate adjustment of adults during conversation. JOURNAL OF FLUENCY DISORDERS 2018; 57:1-10. [PMID: 29960136 DOI: 10.1016/j.jfludis.2018.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 05/14/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Speech rate convergence has been reported previously as a phenomenon in which one's speech rate is influenced by his/her partner's speech rate. This phenomenon has been demonstrated in artificial settings, and to some extent, in mother-child interactions. The purpose of this study was to explore speech rate adjustment in a quasi-natural adult-adult conversation. METHODS An A-B-A-B paradigm was used, in which ten adults conversed on a given topic with two experimenters. Speech rates of both communication partners were measured. RESULTS Participants significantly reduced their speech rate, in response to the experimenters' reduction in speech rate. However, the participants' reduction in speech rate was significantly smaller than the experimenters' reduction in speech rate. In addition, during the controlled slow speech rate, the participants' speech rate correlated negatively with that of the experimenters'. CONCLUSION Results suggest that speech rate convergence is a non-linear phenomenon, and may be affected by various linguistic as well as communicational factors. From a clinical perspective, the results support the use of the modeling strategy in speech therapy, as a means to facilitate a reduction in clients' speech rate.
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Affiliation(s)
- Debora Freud
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Ruth Ezrati-Vinacour
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ofer Amir
- Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Hale AJ, Freed J, Ricotta D, Farris G, Smith CC. Twelve tips for effective body language for medical educators. MEDICAL TEACHER 2017; 39:914-919. [PMID: 28504023 DOI: 10.1080/0142159x.2017.1324140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND A significant proportion of human communication is nonverbal. Although the fields of business and psychology have significant literature on effectively using body language in a variety of situations, there is limited literature on effective body language for medical educators. AIM To provide 12 tips to highlight effective body language strategies and techniques for medical educators. METHOD The tips provided are based on our experiences and reflections as clinician-educators and the available literature. RESULTS The 12 tips presented offer specific strategies to engage learners, balance learner participation, and bring energy and passion to teaching. CONCLUSIONS Medical educators seeking to maximize their effectiveness would benefit from an understanding of how body language affects a learning environment and how body language techniques can be used to engage audiences, maintain attention, control challenging learners, and convey passion for a topic. Understanding and using body language effectively is an important instructional skill.
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Affiliation(s)
- Andrew J Hale
- a Beth Israel Deaconess Medical Center, Infectious Disease , Boston , MA , USA
| | - Jason Freed
- b Beth Israel Deaconess Medical Center, Medicine , Boston , MA , USA
| | - Daniel Ricotta
- b Beth Israel Deaconess Medical Center, Medicine , Boston , MA , USA
| | - Grace Farris
- b Beth Israel Deaconess Medical Center, Medicine , Boston , MA , USA
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Asan O, Young HN, Chewning B, Montague E. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care. PATIENT EDUCATION AND COUNSELING 2015; 98:310-6. [PMID: 25534022 PMCID: PMC4319541 DOI: 10.1016/j.pec.2014.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/21/2014] [Accepted: 11/30/2014] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. METHODS Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. RESULTS Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. CONCLUSION Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. PRACTICE IMPLICATIONS Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
| | - Henry N Young
- College of Pharmacy, University of Georgia, Athens, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin-Madison, Madison, USA
| | - Enid Montague
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
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