Pathway Linking Patient-Centered Communication to Emotional Well-Being: Taking into Account Patient Satisfaction and Emotion Management

Following Medical Advice of an AI or a Human Doctor? Experimental Evidence Based on Clinician-Patient Communication Pathway Model

Medical large language models are being introduced to the public in collaboration with governments, medical institutions, and artificial intelligence (AI) researchers. However, a crucial question remains: Will patients follow the medical advice provided by AI doctors? The lack of user research makes it difficult to provide definitive answers. Based on the clinician-patient communication pathway model, this study conducted a factorial experiment with a 2 (medical provider, AI vs. human) × 2 (information support, low vs. high) × 2 (response latency, slow vs. fast) between-subjects design (n = 535). The results showed that participants exhibited significantly lower adherence to AI doctors' advice than to human doctors. In addition, the interaction effect suggested that, under the slow-response latency condition, subjects perceived greater health benefits and patient-centeredness from human doctors, while the opposite was observed for AI doctors.

Turning to digital: Examining the relationship between offline healthcare barriers and U.S. older adults' emotional well-being via online patient-provider communication and perceived quality of care (2017-2020)

Purpose

To examine the association between offline healthcare barriers and emotional well-being and assess the mediation roles of online patient-provider communication (OPPC) and perceived quality of care. This study also investigates the trends in offline healthcare barriers, OPPC, perceived quality of care, and emotional well-being over four years among the old population in the U.S.

Methods

Data from the Health Information National Trends Survey (HINTS) 5 Cycles 1, 2, and 4 were used. Mediation analysis and comparison analysis were employed.

Results

The results indicated an increment in OPPC and a decline in patient's perceived quality of care between 2017 and 2020. Across the three years, offline healthcare barriers were consistently negatively associated with emotional well-being, and perceived quality of care remained a mediator in such a relationship. Moreover, the serial mediating roles of OPPC and perceived quality of care between offline healthcare barriers and emotional well-being turned from statistically non-significant (2017) to significant (2018, 2020).

Conclusion

Our results witness the growing adoption of OPPC among older adults and the evolution of OPPC as a complementary communication modality. The findings can support interventions to augment OPPC utilization and enhance the perception of quality care of older adults, contributing to their increased emotional well-being.

Pathways Linking Online Physician-Patient Communication to Health Outcomes

Online platforms have proliferated in response to the increasing demand for online medical services. However, the underlying mechanisms through which online physician‒patient communication are associated with better health outcomes are under-researched. We employed mixed focus groups and in-depth interviews to investigate the impact of online physician‒patient communication on health outcomes, including psychological and physical quality of life, as well as perceived diagnosticity. A modified pathway framework was subsequently generated to illustrate the relationship between online communication and health outcomes based on the clinician‒patient communication pathway model. Overall, we redefined the concept of perceived diagnosticity in online healthcare and identified an indirect pathway through which psychological quality of life affects physical quality of life mediated by perceived diagnosticity.

Physician's prosodic behavior and the regulation of patient anxiety: A quantitative study within the communication accommodation theory framework

OBJECTIVES

Patients commonly experience anxiety when visiting a medical provider. While regulating its level, the physician may adjust their own prosodic behavior to express different levels of affective empathy and shape the emotional outcome. The primary aim was to examine the impact of convergence and divergence with the patient's prosodic emotional cues on the patient-perceived physician's affective empathy and the emotion regulation process.

METHODS

Analog patients (n = 132) made assessments after the exposure to an audio vignette of a physician - patient conversation in the prosodic convergence or divergence condition.

RESULTS

Convergence with the prosodic cues of anxiety was associated with the physician experiencing the same as or a similar emotional state to the patient. The former type of emotional reaction was related to lower odds of anxiety alleviation. Prosodic convergence had a negative effect on anxiety alleviation through the mediation of experiencing the same emotional state as the patient.

CONCLUSIONS

Divergence from the prosodic cues of anxiety and, therefore, a low patient-perceived level of this emotion may facilitate the anxiety regulation process.

PRACTICE IMPLICATIONS

A careful use of convergence and divergence with prosodic emotional cues and adequate control of prosody in general are strongly recommended for practitioners.

How does patient-centered communication work? Trend analysis of mediation through cancer worry and health self-efficacy, 2011-2020

This study proposed and tested the cross-sectional effects of patient-centered communication (PCC) on cancer screening behaviors via an affective-cognitive sequential chain of mediation through cancer worry and health self-efficacy. Cross-sectional data were analyzed from four iterations of the Health Information National Trends Survey (2011, 2014, 2017, and 2020). The results found that lowered cancer worry following PCC does not show a cross-sectional positive effect in promoting cancer screening behaviors, while enhanced health self-efficacy as a subsequent state is a facilitator of screening behaviors. The findings further demonstrated increased PCC, a rise in cancer worry, and a sustained level of health self-efficacy. Also, our research has identified an upward trend in cancer screening behaviors from 2011 to 2017, followed by a notable decrease in 2020. These insights underscore the nuanced ways PCC can foster cancer screening behaviors, emphasizing the importance of emotional and cognitive aspects in clinical settings.

Disenfranchising Talk Mediates the Relationship Between Social Determinants of Health and Wellbeing Outcomes for Women of Color Patients with Autoimmune Disease

Autoimmune disease disproportionately afflicts women of color (i.e., Black/African American, Hispanic/Latina, Multiethnic-racial) of childbearing age. Social determinants of health (SDOH) and dismissive healthcare provider (HCP) interactions exacerbate these disparities in health outcomes for women of color with autoimmune disease. Guided by the theory of communicative (dis)enfranchisement, this study assesses whether disenfranchising talk (DT) mediates the relationship between SDOH (i.e., race/ethnicity, insurance status, income, employment, education, and sexual orientation) and health outcomes including patient satisfaction, overall well-being, and tangible social support for women of color with autoimmune disease. Findings affirmed the mediating role of DT, such that Multiethnic-racial patients and those with less insurance coverage and lower household income reported less tangible social support, poorer overall well-being, and lower patient satisfaction when they experienced HCP DT. We offer theoretical and practical implications.

The Associations Between Physician-Patient Communication and Adjustment Outcomes of Patients and Physicians: A Systematic Review and Meta-Analysis of Correlations

Physician-Patient communication (PPC) has been linked to patient adjustment outcomes. However, conflicting results have been reported and previous systematic reviews showed some methodological weaknesses. It has also been suggested that PPC is related to physicians' own adjustment outcomes. This systematic review aims to explore and synthesize the associations between PPC and both patient and physician adjustment outcomes. A systematic search was conducted primarily in five databases and 11.488 non-duplicated articles were identified. Forty-five studies met the eligibility criteria and data extraction was performed for sample characteristics, PPC measurement, adjustment outcomes under examination and main outcomes. The observed results showed that the majority of the included studies were cross-sectional, assessed PPC by proxy-report and reported an overall positive association with patients' adjustment outcomes. None of the studies examined the association between PPC and physicians' adjustment outcomes. Thirty-three studies were meta-analyzed and showed a positive and significant association between PPC and patients' adjustment outcomes (r = .16). Due to the small number of studies included in the meta-analysis, the heterogeneity was high. Subgroup analysis could not identify sources for heterogeneity. Research on the associations between PPC and physicians' own adjustment outcomes is warranted. Future studies should be rigorous in defining clear PPC definitions, directionality of communication processes, and study design.

Linking patient-centered communication with cancer information avoidance: The mediating roles of patient trust and literacy

OBJECTIVES

This study, drawing on the pathway mediation model developed by Street and his colleagues (2009) that links communication to health outcomes, explores how patient-centered communication affects cancer information avoidance.

METHODS

Data was gathered through online access panel surveys, utilizing stratified sampling across Germany, Switzerland, the Netherlands, and Austria. The final sample included 4910 non-cancer and 414 cancer patients, all receiving healthcare from clinicians within the past year.

RESULTS

The results demonstrated that patient-centered communication is directly associated with reduced cancer information avoidance, especially among cancer patients. Additionally, this association is indirectly mediated through patient trust and healthcare literacy.

CONCLUSION

The findings provide empirical evidence that reveals the underlying mechanism linking clinician-patient communication to patient health information behavior.

PRACTICE IMPLICATIONS

The potential of clinician-patient communication in addressing health information avoidance is highlighted by these findings. Future interventions in healthcare settings should consider adopting patient-centered communication strategies. Additionally, improving patient trust and literacy levels could be effective in reducing cancer information avoidance.

How does patient-centered communication influence patient trust?: The roles of patient participation and patient preference

OBJECTIVE

The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China.

METHODS

A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables.

RESULTS

First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust.

CONCLUSION

The results underscore the significant effect of facilitating patient participation in linking patient-centered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process.

PRACTICE IMPLICATIONS

Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.

Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes

Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.

Health literacy, worry about unmet needs for medical care, and psychological well-being among older Chinese adults

AIM

This study aims to examine the relationship between older adults' health literacy and their psychological well-being and the role of worry about future unmet needs for medical care in mediating this relationship.

METHODS

We adopted a sample of 965 older Chinese people aged 60+ (49.74% female) from the 2021 Chinese General Social Survey. A series of structural equation models (SEMs) were performed. Health literacy was measured by three items regarding older people's ability to understand medical professionals, ask them questions, and read medical instructions. A single-item question was adopted to measure participants' worry about unmet needs for future medical care. Psychological well-being was measured by three items regarding emotional problems and depressed or anxious mood in the past 4 weeks.

RESULTS

Worry about future unmet needs for medical care mediates the relationship between lack of health literacy and Chinese older people's psychological well-being. The indirect effect accounts for 22.3% of the total effect. The SEM model has a satisfactory model fit (goodness of fit index = 1.000, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.009, standardized root mean square residual = 0.023, chi-square test = 50.96,  P = 0.321).

CONCLUSIONS

The findings of this study underscore the importance of improving communication quality between healthcare providers and older adults. Clinical interventions that promote health literacy and address worries about unmet needs for medical services may benefit older adults. Geriatr Gerontol Int 2024; 24: 202-207.

The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye

INTRODUCTION

Patient-centered communication is a type of communication that takes place between the provider and the patient.

OBJECTIVES

It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction.

METHOD

The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye.

RESULTS

More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction.

CONCLUSION

Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.

A review on factors related to patient comfort experience in hospitals

The creation of a welcoming hospital atmosphere is necessary to improve patient wellbeing and encourage healing. The goal of this study was to examine the variables affecting hospitalised patients' comfort. The study procedure included a thorough search of the Web of Science and Scopus databases, as well as the use of software analytic tools to graphically map enormous literature data, providing a deeper understanding of the linkages within the literature and its changing patterns. Insights from a range of disciplines, including engineering, psychology, immunology, microbiology, and environmental science, were included into our study using content analysis and clustering approaches. The physical environment and the social environment are two crucial factors that are related to patient comfort. The study stress the need of giving patient comfort a top priority as they heal, especially by tackling indoor air pollution. Our research also emphasises how important hospital care and food guidelines are for improving patient comfort. Prioritising patients who need specialised care and attention, especially those who have suffered trauma, should be the focus of future study. Future research in important fields including trauma, communication, hospital architecture, and nursing will be built on the findings of this study. To enhance research in these crucial areas, worldwide collaboration between experts from other nations is also advised. Although many studies stress the significance of patient comfort, few have drawn conclusions from a variety of disciplines, including medicine, engineering, immunology, microbiology, and environmental science, the most crucial issue of thoroughly researching the improvement of patient comfort has not been addressed. Healthcare workers, engineers, and other professions will benefit greatly from this study's investigation of the connection between hospital indoor environments and patient comfort.

The Effect of Shared Decision-Making by Mental Health Nurses on Medication Adherence in Patients with Alcohol Use Disorders: Provider-Patient Communication Pathway Model

The involvement of patients with mental health issues in their own treatment decision-making has often been overlooked. This study aimed to investigate the impact of shared decision-making between mental health nurses and patients with alcohol use disorders (AUD) on medication adherence. The provider-patient communication pathway model was utilized to examine the ways in which therapeutic communication strategies employed by mental health nurses positively influence medication adherence. The study employed a percentile bootstrap method and pairwise comparison tests in structural equation modeling. The results revealed that shared decision-making between AUD patients and mental health nurses directly enhanced medication adherence, as well as indirectly influenced adherence through the mediating factors of therapeutic alliance and alcohol abstinence self-efficacy. These findings hold both theoretical and practical implications for involving patients with AUD in therapeutic decision-making within psychiatric and mental health nursing settings, as well as for improving medication adherence among this patient population.

Understanding the pathways linking patient-centered communication to cancer survivors' emotional health: examining the mediating roles of self-efficacy and cognitive reappraisal

PURPOSE

Many cancer survivors commonly face psychological health issues upon cancer diagnosis, both during and after treatment. Patient-centered communication can play an important role in improving health outcomes among cancer survivors across the cancer continuum. The current study examined the influence of patient-centered communication on self-efficacy in managing health, cognitive reappraisal, and emotional distress among cancer survivors.

METHODS

The analysis was conducted on a subsample of 809 cancer survivors acquired from a nationally representative 2019 Health Information National Trends Survey 5 (Cycle 3). Multivariate regression analysis was conducted to explore the pathways through which patient-centered communication can be associated with cancer survivors' emotional distress, mediated by self-efficacy and cognitive reappraisal.

RESULTS

The results indicated that effective patient-centered provider communication led to higher self-efficacy in managing health, greater involvement in cognitive reappraisal, and decreased emotional distress among cancer survivors. Additionally, the results revealed that the effect of patient-centered communication that led to decreased emotional distress was fully mediated through self-efficacy and cognitive reappraisal.

CONCLUSIONS

Although patient-centered communication positively relates to various emotional health outcomes among cancer survivors, it does not affect their emotional health directly. Self-efficacy and cognitive reappraisal play a crucial role in explaining the underlying mechanisms of such effects.

IMPLICATIONS FOR CANCER SURVIVORS

Future interventions to promote patient-centered communication in cancer care should give more emphasis to managing patients' emotions. Providers should not only recognize, elicit, and respond to patient's emotions, but also develop emotional regulation skills among patients, and improve their ability to cope with emotional distress.

The Effects of Patient-Centered Communication on Emotional Health: Examining the Roles of Self-Efficacy, Information Seeking Frustration, and Social Media Use

The existing literature on the direct association between patient-centered communication (PCC) and emotional well-being often demonstrates inconsistent results. To explain such inconsistency, it is important to explore the mediating and moderating mechanisms underlying this relationship. Built upon the communication pathways model, this study empirically analyzed the Health Information National Trends Survey 5 Cycle 3 dataset (N = 4,709) and tested a moderated mediation model that links PCC to emotional health via information-seeking self-efficacy, with an additional assessment of the moderating effects of information-seeking frustration and social media use. The findings showed that PCC was positively related to emotional health. Also, PCC was indirectly associated with emotional health through information-seeking self-efficacy. In addition, information-seeking frustration and social media use weakened the association between PCC and information-seeking self-efficacy. Furthermore, the indirect path from PCC to emotional health through information-seeking self-efficacy was conditional on both information-seeking frustration and social media use. Important theoretical and practical implications are also discussed.

The Link between Patients' Aggressive Communication and Nurses' Emotional Health Outcomes

The aggressive conduct of patients is a perennial problem that nurses face in health care. Studies have shown that such aggressiveness can be detrimental to the work and emotional wellbeing of nurses. Yet, the literature has had inconsistent findings; in some cases nurses are negatively affected by aggression, while in other cases nurses are not affected. Street and colleagues contended that such inconsistencies in research exist because social mechanisms embedded in communication are often not taken into consideration. This study adopts Street et al.'s pathways model and links patients' aggressive communication to nurses' emotional health outcomes, via the proximal outcome of communication satisfaction and the intermediate outcome of organizational identity. Results support Street et al.'s postulation and demonstrates that patients' aggressive communication does not have a direct effect on nurses' emotional health. Instead, the effect is indirect, mediated by communication satisfaction and organizational identity.

Linking Nonverbal Rapport to Health Outcome: Testing an Organizational Pathway Model

A growing body of research on medical communication indicates that nonverbal rapport (e.g., smiling, eye contact, closer proximity) is central to productive health care delivery. However, mechanisms integral to the process by which nonverbal rapport influences health improvement remain under-researched. This study breaks new grounds in proposing and testing mediation pathways that take into account organizational factors. We conducted a cross-sectional survey in a private hospital in Singapore among 417 patients to examine their communication with physicians and nurses. Results indicated that nonverbal rapport did not have a significant direct relationship with perceived health outcome in both the patient-physician dyad and the patient-nurse dyad. Instead, communication satisfaction and organizational identity completely mediated this relationship. In addition, respect positively moderated the relationship between nonverbal rapport and communication satisfaction in both dyads, while health literacy was not a significant moderator. The findings suggest that the organizational context should be considered in pathways research.

The Psychosocial Impact of the Decision to Undergo Risk-Reducing Salpingo-Oophorectomy Surgery in BRCA Mutation Carriers and the Role of Physician-Patient Communication

Risk-reducing bilateral salpingo-oophorectomy (RRSO) is an effective prophylactic surgery provided to premenopausal women carrying BRCA1 or BRCA2 mutations and presenting an increased risk of developing breast or ovarian cancer. This procedure is related to physiological, sexual, and psychosocial distress, which altogether increase uncertainty and complexity in the clinical decision-making process and post-surgery adaptation. Physician-patient communication (PPC) has been pointed out as a determinant factor in the decision-making to undergo RRSO, and the subsequent adjustment of women. However, studies examining the psychosocial impact of the decision-making process have been scarce and often lack clear theoretical frameworks. While the role of PPC in such processes has been highlighted in a few qualitative studies, there is a paucity of quantitative research addressing this question. Therefore, this narrative review, conducted using a multidisciplinary approach, was planned to: (1) present an updated medical background for RRSO; (2) analyze the psychosocial impact of the decision-making process within a theoretical framework of the Health Belief Model; and (3) discuss the role of PPC in such a decision-making process and in post-surgery. The collected research also enabled the recommendation of some additions to the existing clinical guidelines and the outlining of future research directions.

How Do Team-Level and Individual-Level Linguistic Styles Affect Patients' Emotional Well-Being-Evidence from Online Doctor Teams

BACKGROUND

In the post-epidemic era, online medical care is developing rapidly, and online doctor teams are attracting attention as a high-quality online medical service model that can provide more social support for patients.

METHODS

Using online doctor teams on the Haodf.com platform as the research subject, this study investigates the key factors in the process of doctor-patient communication, which affects patients' emotional well-being. We also explore the different roles played by doctors as leaders and non-leaders in doctor-patient communication. From the perspective of language style, we select representative factors in the process of doctor-patient communication, namely the richness of health vocabulary, the expression of emotions, and the use of health-related terms (including perceptual words and biological words). We extract both team-level and individual-level linguistic communication styles through textual and sentiment analysis methods and empirically analyze their effects on patients' emotional well-being using multiple linear regression models.

RESULTS

The results show that the expression of positive emotions by the team and attention to patients' perceptions and biological conditions benefit patients' emotional well-being. Leaders should focus on the emotional expression, whereas non-leaders should focus on the use of perceptual and biological words.

CONCLUSIONS

This study expands the application of linguistic styles in the medical field and provides a practical basis for improving patients' emotional well-being.

What Satisfies Parents of Pediatric Patients in China: A Grounded Theory Building Analysis of Online Physician Reviews

Patient satisfaction is an important intermediate outcome of patient-provider encounters, linking face-to-face interactions between patients and medical professionals with patients' well-being after consultations. Today, physician review websites provide a new venue for the study of patient satisfaction, as patients are utilizing such websites to evaluate their encounters with physicians. This study examined how parents of pediatric patients in China evaluated their pediatricians and factors associated with patient satisfaction through a qualitative content analysis of reviews (n = 7230) on the "Good Doctor Website" (haodf.com), China's largest physician review platform. Reviews were chosen from all reviews of pediatricians in eight top-tier hospitals in four major cities. Three dimensions of patient satisfaction were identified: pediatricians' interpersonal manners (including friendliness, listening to patients, heartfelt encouragement, and clear explanation), ethics (including rejecting red envelopes and kickbacks and cost awareness), and medical competence/overall health outcome. This study contributes to a culturally sensitive understanding of patient satisfaction and further explains the tense physician-patient relationship in China. Practically, our findings can inform the training of pediatricians in China.

The effect of a relationship-centered communication program on patient experience and provider wellness

OBJECTIVES

Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness.

METHODS

636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019.

RESULTS

104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTR CP significantly increased and persisted more than 7 months following program completion.

CONCLUSIONS

The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience.

PRACTICE IMPLICATIONS

Implementing a RCC course for providers may improve patient experience and provider wellness.

Patient Expectation in China: Exploring Patient Satisfaction in Online and Offline Patient-Provider Communication

Introduction

Online patient-provider communication (OPPC) has become an alternative approach to seek medical advice and contact health professionals. However, its penetration rate remains low, and the underlying mechanisms of patient satisfaction with OPPC are underexamined. This study investigates the role of patient expectancy and the expectancy violation of patient-centered communication (PCC) in patient satisfaction in emerging OPPC scenarios by integrating the concepts of PCC and expectancy violation theory (EVT).

Method

An online survey was conducted in October 2019 among Chinese respondents who experienced OPPC and offline medical services.

Results

The 471 qualified participants reported high satisfaction with OPPC (mean [M] = 3.63, standard deviation [SD] = 0.81). However, patient satisfaction with OPPC was lower than that in offline medical encounters (M = 3.75, SD = 0.80), and patients suffered a higher expectancy violation of PCC in OPPC scenarios (M = 0.45, SD = 0.76) than in offline medical encounters (M = 0.27, SD = 0.69). Nevertheless, patients' satisfaction with OPPC significantly increased as the frequency of OPPC usage increased (β = 0.209, p < 0.001). This positive relationship was partially mediated by the decrease in the expectancy violation of PCC in OPPC scenarios.

Discussion

The study can contribute to increasing the adoption of OPPC and reducing the burden of offline medical resources.

Exploring the value of using patient-oriented MRI reports in clinical practice - a pilot study

PURPOSE

Standard radiology reports (SRR) are designed to communicate information between doctors. With many patients having instantaneous access to SRRs on patient portals, interpretation without guidance from doctors can cause anxiety and panic. In this pilot study, we designed a patient-centred prostate MRI template report (PACERR) to address some of these challenges and tested whether PACERRs improve patient knowledge and experience.

MATERIALS AND METHODS

Patients booked for clinical prostate MRI were randomly assigned to SRR or SRR + PACERR. Questionnaires included multiple-choice that targeted 4 domains (understanding, usefulness, next steps, emotional experience) hypothesized to improve with patient-centred reports and short answer questions, testing knowledge regarding MRI results. Clinical encounters were observed and recorded to explore whether adding PACERR improved communication. Likert scaled-responses and short-answer questions were compared using Mann-Whitney U test and Kruskal-Wallis test.

RESULTS

Of the 40 participants, the majority were MRI naïve (70%). Patients receiving a PACERR had higher scores in the categories of patient understanding (mean: 4.17 vs. 3.39, p=0.006), usefulness (mean: 4.58 vs. 3.07, p<0.001), and identifying next steps (mean: 1.89 vs. 3.03, p=0.003) but not emotional experience (mean: 4.18 vs. 3.79, p=0.22). PACERR participants found the layout and design more patient friendly (mean: 4.47 vs. 2.61, p<0.001) and easier to understand (mean: 4.37 vs. 2.38, p<0.001). In the knowledge section, overall, the PACERR arm scored better (87% vs. 56%, p=0.004).

CONCLUSION

With the addition of prostate MRI PACERR, participants had better understanding of their results and felt more prepared to involve themselves in discussions with their doctor.

Effect of Patient-Centered Communication on Physician-Patient Conflicts from the Physicians' Perspective: A Moderated Mediation Model

Physician-patient conflicts are detrimental to doctor-patient relationship and sustainable healthcare delivery. In China, the status quo of the doctor-patient relationship is in great tension. Based on the uncertainty reduction theory (URT), the present study examined the relationship between patient-centered communication (PCC) and medical conflict, as well as the roles of perceived patients' trust, doctors' empathy, and expertise from physicians' perspectives. In March 2020, 509 physicians in China were recruited to participate in an online survey. The results revealed that PCC was negatively associated with physician-patient conflicts and that patient trust mediated the relationship. Additionally, doctors' empathy moderated PCC on patient trust, while expertise positively predicted physician-patient conflicts. Theoretical and practical implications for improving doctor-patient relationships were discussed.

Virtual environments to study emotional responses to clinical communication: A scoping review

OBJECTIVE

This scoping review explores the potential for virtual environments (VE) to evaluate emotional outcomes in clinical communication research. Authors representing multiple disciplines use review results to propose potential research opportunities and considerations.

METHODS

We utilized a structured framework for scoping reviews. We searched four literature databases for relevant articles. We applied multidisciplinary perspectives to synthesize relevant potential opportunities for emotion-focused communications research using VE.

RESULTS

Twenty-one articles met inclusion criteria. They applied different methodological approaches, including a range of VE technologies and diverse emotional outcome measures, such as psychophysiological arousal, emotional valence, or empathy. Major research topics included use of virtual reality to provoke and measure emotional responses, train clinicians in communication skills, and increase clinician empathy.

CONCLUSION

Researchers may leverage VE technologies to ethically and systematically examine how characteristics of clinical interactions, environments, and communication impact emotional reactions and responses among patients and clinicians. Variability exists in how VE technologies are employed and reported in published literature, and this may limit the internal and external validity of the research. However, virtual reality can provide a low-cost, low-risk, experimentally controlled, and ecologically valid approach for studying clinician-patient communication.

PRACTICE IMPLICATIONS

Future research should leverage psychophysiological measures to further examine emotional responses during clinical communication scenarios and clearly report virtual environment characteristics to support evaluation of study conclusions, study replicability, and meta-analyses.

Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care

Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study examined the relationship between clinician PPC skills and patient satisfaction with care among virally unsuppressed adult HIV patients in Busia County, Kenya. This cross-sectional study was conducted among 360 HIV patients on first line antiretroviral regimen and having a recent viral load ≥400 copies HIV RNA/ml. We conducted logistic regression analysis. The mean age of participants was 48.2 years [standard deviation (SD): 12.05]. Overall, the mean score on clinician PPC skills was 33.3 (SD: 9.0). A high proportion (85%) of participants reported satisfaction with the HIV care services. After adjusting for covariates, the odds of being satisfied with care increased by 19% (adjusted odds ratio: 1.19, 95% CI: 1.11-1.30) for every one unit increase in the clinician PPC skills score. Promoting good PPC skills may be key to improving patient satisfaction with HIV care.

Patient-Centered Communication to Address Young Adult Breast Cancer Survivors' Reproductive and Sexual Health Concerns

Women faced with a diagnosis of breast cancer as young adults commonly experience negative effects of cancer and cancer treatment on their reproductive and sexual health (RSH) that are inadequately addressed by their healthcare providers (HCPs). The objectives of this study were to 1) identify approaches to improving RSH communication from YA breast cancer survivors' perspectives, 2) identify facilitators and barriers to the approaches identified, and 3) identify specific strategies to improve patient-centered RSH communication. We conducted individual telephone interviews with 29 women who were diagnosed with breast cancer under age 40 years. We used a grounded theory approach to identify themes, and explored how the themes related to the PCC framework to elucidate specific strategies for improving communication. Three main themes emerged: 1) Normalizing and integrating assessment of RSH concerns; 2) HCP conveying genuine caring and investment; and 3) Improving accessibility of comprehensive RSH services after cancer. Results revealed concrete strategies for improving patient-centered RSH communication at the patient-provider and health system levels. These included reminding patients that RSH concerns are common, routinely asking about RSH, using active listening, and connecting patients to HCP who can address their RSH concerns.

Can You Hear Me Now? Effects of Patient-Centered Communication With Young Adults Aged 26 to 39

Patient-centered communication (PCC) is critical to the delivery of quality health care services. Although numerous health outcomes have been connected to patient–provider communication, there is limited research that has explored the processes and pathways between communication and health. Research among young adults (ages 26-39 years) is even more scarce, despite findings that health communication does vary with age. This cross-sectional study used data from the 2014 Health Interview National Trends Survey to explore the relationship between PCC, patient trust, patient satisfaction, social support, self-care skills, and emotional well-being among young adults aged 26 to 39 years. Our results showed that income, history of depression diagnosis, PCC, patient trust, social support, and patient self-efficacy (self-care skills) were all significantly related to emotional well-being. These findings suggest the need to explore the means through which communication can impact emotional well-being, specifically among young adults who are in poor health or have a history of depression. Future research should also include longitudinal studies, in order to determine causality and directionality among constructs.

The participatory development of a national core set of person-centred diabetes outcome constructs for use in routine diabetes care across healthcare sectors

BACKGROUND

This study sought to utilise participatory research methods to identify the perspectives of people with diabetes regarding which diabetes outcomes were most important to them. These findings were then used to support an expert working group representing multiple health sectors and healthcare disciplines and people with diabetes to establish a core set of patient-important outcome constructs for use in routine diabetes care.

METHODS

26 people with diabetes and family members were recruited through purposive sampling to participate in interviews, focus groups, voting and plenary activities in order to be part of identifying outcome constructs. Content and qualitative analysis methods were used with literature reviews to inform a national multi-stakeholder consensus process for a core set of person-centred diabetes outcome constructs to be used in routine diabetes care across health care settings.

RESULTS

21 people with diabetes and 5 family members representing type 1 and 2 diabetes and a range of age groups, treatment regimens and disease burden identified the following patient-reported outcome constructs as an important supplement to clinical indicators for outcome assessment in routine diabetes care: self-rated health, psychological well-being, diabetes related emotional distress and quality of life, symptom distress, treatment burden, blood sugar regulation and hypoglycemia burden, confidence in self-management and confidence in access to person-centred care and support. Consensus was reached by a national multi-stakeholder expert group to adopt measures of these constructs as a national core diabetes outcome set for use in routine value-based diabetes care.

CONCLUSIONS

We found that patient-reported outcome (PRO) constructs and clinical indicators are needed in core diabetes outcome sets to evaluate outcomes of diabetes care which reflect key needs and priorities of people with diabetes. The incorporation of patient-reported outcome constructs should be considered complementary to clinical indicators in multi-stakeholder value-based health care strategies. We found participatory research methods were useful in facilitating the identification of a core prioritised set of diabetes outcome constructs for routine value-based diabetes care. The use of our method for involving patients may be useful for similar efforts in other disease areas aimed at defining suitable outcomes of person-centred value-based care. Future research should focus on developing acceptable and psychometrically valid measurement instruments to evaluate these outcome constructs as part of routine diabetes care.

Patient-centered communication and emotional well-being in the era of medical violence in China

The past decade has witnessed an increasing number of patient assaults on doctors in China. Patient-centered communication (PCC) may be one way to mitigate this problem. This study examined the effects of PCC and patient trust on emotional health outcome, especially how patients' attitude toward medical violence affected this relationship. Data were drawn from the China Governance and Public Policy Survey administered in 2017 with a sample size of 3784. The results showed that PCC had no direct effect on emotional well-being. Instead, patient trust completely mediated this path. Also, patients' attitude toward medical violence increased the indirect effect of PCC on emotional well-being, suggesting a moderated mediation model. We call for education programs to promote PCC for both providers and patients, mass media campaigns to condemn violence against doctors and stricter law enforcement to stop medical violence.

Treatment satisfaction mediates the association between perceived physician empathy and psychological distress in a community sample of individuals with chronic pain

OBJECTIVE

While the benefits of patient-centered care have been consistently demonstrated in the health literature, there exists a dearth of pathway research within health outcome research, especially within the chronic pain context. This study examined the relationship between perceived physician empathy and patient psychological distress and its underlying mechanism.

METHODS

A community sample of 259 adults with chronic pain completed online questionnaires measuring patient-perceived physician empathy, treatment satisfaction, depressive and anxiety symptoms. Analyses were conducted using correlational and mediation analyses.

RESULTS

Results revealed perceived empathy to be positively and strongly correlated with treatment satisfaction (r = .72, p < .001). A significant negative correlation was also demonstrated between perceived empathy and depressive symptoms (r = -.13, p < .05), but not between perceived empathy and anxious symptoms (r = .03, p = .65). Results revealed significant mediation models between perceived empathy and patient depressive symptoms (indirect effect: B = -.19, SE =.06, 95 % CI [-.31, -.09]) and anxious symptoms (indirect effect: B = -.24, SE = .06, 95 % CI [-.35, -.14]), via treatment satisfaction as mediator and including covariates.

CONCLUSION

Chronic pain patients who perceive greater levels of physician empathy experience fewer depressive and anxious symptoms, as mediated by treatment satisfaction.

PRACTICE IMPLICATIONS

Clinical training and practice should promote empathetic components of health communication within chronic pain treatment.

Self-Management of Chronic Diseases: A Descriptive Phenomenological Study

Chronic diseases are a priority for health-care systems and patient-centered care. They cause long-term issues and have a number of physical, psychological, and social effects. Patients with chronic diseases require ongoing care and support in order to manage them. The aim of this study was to understand the experiences of patients with chronic conditions who were able to practice self-management. The study was conducted in Izmir province, Turkey with 10 patients with a chronic disease (e.g., hypertension, diabetes, arthritis) who attended two family health-care centers. A phenomenological approach was used and three main themes were identified: social support, disease management, and self-awareness and empowerment. It was determined that the subthemes of "definition of a chronic disease," "perceived barriers," "emotional and spiritual state," "self-monitoring," and "diet and medication management" had a significant influence on self-management. The results demonstrated that patients' health outcomes can be affected by their experiences and behaviors. Health-care professionals should design and implement self-care programs that take into account all the variables that affect patients' self-management of their disease.

Impact of Patients' Companions on Clinical Encounters Between Black Patients and Their Non-Black Oncologists

PURPOSE

The presence of caregivers or companions during clinical encounters influences the dynamics and outcomes of the encounters. Most prior studies of companions in clinical encounters focus on non-Hispanic White patients. However, there is generally lower-quality patient-physician communication during encounters with Black patients; these communication differences may contribute to racial health disparities. The purpose of the present study was to examine effects of the presence and active participation of companions on encounters between Black patients with cancer and non-Black oncologists.

METHODS

This was a secondary analysis of data collected during a larger intervention study. Participants were Black patients with breast, colon, or lung cancer who had a treatment-discussion encounter with a participating non-Black medical oncologist. Video recordings of encounters were coded for patient, companion, and oncologist communication. After the encounter, patients reported perceptions of the recommended treatment; patients and oncologists reported perceptions of each other.

RESULTS

Data from 114 patients and 19 oncologists were included in analyses. Only 47% of patients brought a companion to the encounter. Oncologists spent more time with accompanied Black patients, used more patient-centered communication with them, and perceived them as having more social support compared with unaccompanied Black patients. Oncologists reported that accompanied patients asked more questions. When companions participated more actively in the encounter, oncologists used more patient-centered communication.

DISCUSSION

Bringing a companion to oncology appointments may be beneficial to Black patients because oncologists spend more time with patients, use more patient-centered communication, and perceive patients more positively, all of which may ultimately improve patient health and well-being outcomes.

Prevalence and Influencing Factors of Medical Dissatisfaction Experiences in Chinese Hospitals: A Cross-Sectional Study

PURPOSE

To explore the influencing factors of medical dissatisfaction experiences from the perspectives of patients, and provide corresponding strategies for its prevention.

PATIENTS AND METHODS

Using multistage random sampling, 43 hospitals in three provinces of China were surveyed using a self-designed questionnaire. There were 2065 valid questionnaires analyzed in our study.

RESULTS

46.9% (n = 934) of participants had experienced medical dissatisfaction in the past year, mainly due to poor service quality, cumbersome procedures and high medical costs. There were statistically significant differences in the medical dissatisfaction experiences for these patients with different ages, marital status and levels of education (P<0.05). According to structural equation modelling, health education and media reports had a positive and indirect influence (standardized coefficient = 0.046) on medical dissatisfaction experiences, while there was a negative correlation (standardized coefficient = -0.399) between patients' social recognition and medical dissatisfaction experiences. Also, our results also found that social relationships had a negative and indirect impact (standardized coefficient = -0.166) on medical dissatisfaction experiences. Besides, health education and media reports had a negative impact (standardized coefficient = -0.115) on patients' social recognition, while social relationships have a positive effect (standardized coefficient = 0.416) on patients' social recognition.

CONCLUSION

Health education and media reports and social relationships, as antecedent variables, have an indirect effect on inducing the medical dissatisfaction experiences of patients. In addition, patients' social recognition was an intermediate variable in inducing the medical dissatisfaction of patients.

Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology

Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.

Patient loyalty to HIV care in an HIV facility in Eldoret, Kenya: A mediated mediation

Patient loyalty is the continuous commitment and engagement in care where patients can improve and sustain quality of life through continuous use of medical care. Identifying strengths and weaknesses in providing excellent quality care is a key measure of success of healthcare professionals and hospital management. However, few studies have examined patient loyalty from a strategic leadership perspective within HIV health care systems. The purpose of this study is to determine how patient loyalty to HIV care is influenced by multiple factors in a healthcare system environment. The study employs a mixed-methods approach guided by the complexity theory and the theory of planned behavior. A total of 444 surveys with (50 healthcare providers and 394 adult HIV-infected patients) currently on antiretroviral drugs, as well as 22 in-depth interviews with healthcare providers will be conducted. The study will be done at AMPATH Eldoret Kenya. We will use stratified proportionate and census sampling methods to select study participants for the survey while purposive and convenient sampling techniques will be used for in-depth interviews. Structured questionnaires and interviewer guides will guide data collection. Quantitative data analysis will entail hierarchical regression to test direct effects while multiple regression will test the mediation effects using the Hayes PROCESS Model No.6 in SPSS. Qualitative data analysis will be conducted using a thematic analytical method.

Nursing Communication as a Tool for Patient Satisfaction. A Single Hospital Survey

Background:

Communication is an essential tool for health promotion. Effective healthcare communication has great therapeutic value.

Objective:

The aim of the study is to assess the degree of patient satisfaction related to nursing communication in the various stages of hospital stay.

Methods:

Patients admitted to General University Hospital in medical and surgical department were subjected to this survey using a questionnaire, structured in four sections (acceptance, hospital stay, discharge, pain and new drugs management). Chi-square and multivariate logistic regression models were used to test the association between the outcome of interest defined as the satisfaction of nursing communication and the independent variables.

Results:

One thousand three hundred seventy questionnaires were administered. In acceptance, among patients satisfied with nursing skills related to explaining the department's functioning, most were satisfied with nursing communication (972 vs 87 p <0.005). Also during the hospital stay, among patients satisfied with nursing Skills and Manner relating to communication most were significantly satisfied with the nursing communication (849 vs 74 p <0.005 and 987 vs 55 p <0.001). At the discharge, the number of patients satisfied with nursing communication was greater among patients who considered the length of hospital stay adequate (1020 vs 65 p <0.001). Data are confirmed by the multiple logistic regression analysis.

Conclusion:

Our study shows how nursing communication is the key to establishing a good therapeutic care relationship and how it can be associated with patient satisfaction in various phases of hospital stay.

How Does Online Patient-Provider Communication Heal? Examining the Role of Patient Satisfaction and Communication Experience in China

China is facing the problem of having health care that is difficult to access. Online patient-provider communication (OPPC) may bring a new option to deliver health services. However, online communication with doctors is still novel to many people in China. Little research has been conducted to examine how OPPC could improve health outcomes. With an integrated model that incorporates social cognitive theory into the three-stage model of health promotion using interactive media, this study tested the social mechanism underlying the impact of OPPC. Results indicated that self-efficacy, behavioral capability, and outcome expectation positively predicted OPPC at Stage 1, which in turn increased patient satisfaction at Stage 2, which finally improved three types of health outcomes (general, emotional, and physical) at Stage 3. In addition, quality of users' experience in OPPC positively moderated this mediation pathway. Theoretical and practical implications of this study were also discussed.

Pathways Linking Patient-Centered Communication to Health Improvement: A Longitudinal Study in China

The Chinese health care system has suffered from severe tension between patients and doctors during the past decade. Patient-centered communication (PCC) may play a significant role in mitigating this problem. With a general basis of the pathway model linking communication to health, this paper illustrates social mechanisms that underlie how PCC improves health outcomes in China. Using three-wave panel data collected in China, the results showed that PCC failed to directly influence health. Instead, PCC at Wave 1 predicted patient satisfaction and patient trust at Wave 2, which in turn enhanced self-reported health outcomes at Wave 3. In addition, bonding social capital positively moderated the effect of PCC on patient trust.

The effects of patient-centered communication, social capital, and internet use on patient empowerment: a cross-sectional study in China

Patient empowerment is a relatively new concept in the context of the Chinese health care system. Based on Street’s ecological framework of communication in healthcare settings, this study examined the social, clinical and media factors that could empower patients. Results from a survey of 401 Chinese adults (response rate, 34%) showed that respondents felt more empowered as health care consumers when they reported having more social capital bonding and bridging, and used the Internet for health purposes more often. Importantly, having had more positive patient-centered communicative experiences with health care providers not only predicted patient empowerment, it also moderated the effects of bridging social capital and Internet use on empowerment. Specifically, the more positive the experience of interacting with health care providers, the weaker the effects of bridging social capital and Internet use on patient empowerment. The findings have important implications for patient empowerment in health care, particularly within the context of China.