1
|
Bhaumik D, Schlesinger MJ. How exposure to patient narratives affects stereotyped choices of primary care clinicians. PLoS One 2023; 18:e0295243. [PMID: 38060553 PMCID: PMC10703228 DOI: 10.1371/journal.pone.0295243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
In this paper, we examine whether patient narratives alter the impact of stereotyping on choice of primary care clinicians: in this case, the common presumption that female doctors will be more attentive to empathic relationships with patients. 1052 individuals were selected from a nationally representative Internet panel to participate in a survey experiment. Participants were given performance data about 12 fictitious primary care physicians, including a randomized set of narrative feedback from patients. We compared the choice of clinician made by participants who value bedside manner and were exposed to narratives in the experiment, compared to those valuing bedside manner who had not had this exposure. We estimated multivariate logistic regressions to assess whether exposure to patient comments that "disrupt" stereotypes influenced choice of physicians. Participants who saw patient comments and had previously reported caring about bedside manner had a 67% higher odds of choosing a female physician than those participants that did not see a patient comments, controlling for the content of the narratives themselves. When participants were exposed to patient comments that disrupt gendered stereotypes, they had a 40% lower odds of choosing a female physician. Simple exposure to patient narratives that do not clearly disrupt gendered stereotypes increased the likelihood of choosing a female clinician by priming attention to relational aspects of care. However, when the content of a sufficient proportion of patient comments runs counter stereotypes, even a minority of narratives is sufficient to disrupt gendered-expectations and alter choices.
Collapse
Affiliation(s)
- Deepon Bhaumik
- Department of Health Policy and Management, Yale University, New Haven, Connecticut, United States of America
| | - Mark J. Schlesinger
- Department of Health Policy and Management, Yale University, New Haven, Connecticut, United States of America
| |
Collapse
|
2
|
O'Neill J, Docherty Stewart B, Ng A, Roy Y, Yousif L, McIntyre KR. Medical student attitudes to patient involvement in healthcare decision-making and research. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109451. [PMID: 37989572 DOI: 10.1136/jme-2023-109451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Patient involvement is used to describe the inclusion of patients as active participants in healthcare decision-making and research. This study aimed to investigate incoming year 1 medical (MBChB) students' attitudes and opinions regarding patient involvement in this context. METHODS We established a staff-student partnership to formulate the design of an online research survey, which included Likert scale questions and three short vignette scenarios designed to probe student attitudes towards patient involvement linked to existing legal precedent. Incoming year 1 medical students (n=333) were invited to participate in the survey before formal teaching commenced. RESULTS Survey data (49 participants) indicate that students were broadly familiar with, and supportive of, patient involvement in medical treatment. There was least support for patient involvement in conducting (23.9%), contributing to (37.0%) or communicating research (32.6%), whereas there was unanimous support for patients choosing treatment from a selection of options (100%). CONCLUSION Incoming members of the medical profession demonstrate awareness of the need to actively involve patients in healthcare decision-making but are unfamiliar with the utility and value of such involvement in research. Further empirical studies are required to examine attitudes to patient involvement in healthcare.
Collapse
Affiliation(s)
- Jennifer O'Neill
- Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Bronwyn Docherty Stewart
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna Ng
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Yamini Roy
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Liena Yousif
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kirsty R McIntyre
- Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Sapir-Pichhadze R, Oertelt-Prigione S. P3 2: a sex- and gender-sensitive model for evidence-based precision medicine: from knowledge generation to implementation in the field of kidney transplantation. Kidney Int 2023; 103:674-685. [PMID: 36731608 DOI: 10.1016/j.kint.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023]
Abstract
Precision medicine emerged as a promising approach to identify suitable interventions for individual patients with a particular health concern and at various time points. Technology can enable the acquisition of increasing volumes of clinical and "omics" data at the individual and population levels and support advanced clinical decision making. However, to keep pace with evolving societal realities and developments, it is important to systematically include sex- and gender-specific considerations in the research process, from the acquisition of knowledge to implementation. Building on the foundations of evidence-based medicine and existing precision medicine frameworks, we propose a novel evidence-based precision medicine framework in the form of the P32model, which considers individual sex-related (predictive [P1], preventive [P2], and personalized [P3] medicine) and gender-related (participatory [P4], psychosocial [P5], and percipient [P6] medicine) domains and their intersection with ethnicity, geography, and other demographic and social variables, in addition to population, community, and public dimensions (population-informed [P7], partnered with community [P8], and public-engaging [P9] medicine, respectively). Through its ability to contextualize and reflect on societal realities and developments, our model is expected to promote consideration of diversity, equity, and inclusion principles and, thus, enrich science, increase reproducibility of research, and ensure its social impact.
Collapse
Affiliation(s)
- Ruth Sapir-Pichhadze
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; AG10 Sex- and Gender-Sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany.
| |
Collapse
|
4
|
Stanbouly D, Baron M, Pierre R, Khan OA, Fahmy R, Caraballo BA, Choi JY, Arce K, Tannyhill RJ. What explains very poor Yelp reviews of oral and maxillofacial surgeons in private practice? Oral Surg Oral Med Oral Pathol Oral Radiol 2022:S2212-4403(22)01167-1. [DOI: 10.1016/j.oooo.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 12/23/2022]
|
5
|
Javaid M, Fritz M, O'Brien M, Clark S, Mitchell S, Sanchez SE. Use and Perceptions of Shared Decision-Making by General Surgery Faculty and Trainees. J Surg Res 2022; 276:323-330. [DOI: 10.1016/j.jss.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/10/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
|
6
|
Ganguli I, Mulligan KL, Phillips RL, Basu S. How the Gender Wage Gap for Primary Care Physicians Differs by Compensation Approach : A Microsimulation Study. Ann Intern Med 2022; 175:1135-1142. [PMID: 35849829 PMCID: PMC9982701 DOI: 10.7326/m22-0664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns. OBJECTIVE To determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models. DESIGN Microsimulation. SETTING 2016 to 2019 national clinical registry of 1222 primary care practices. PARTICIPANTS Male and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked. MEASUREMENTS Net annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses. RESULTS Among 1435 matched male (n = 881) and female (n = 554) PCPs, female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58 829 (interquartile range [IQR], $39 553 to $120 353; 21%) less than male PCPs. This gap was similar under capitation ($58 723 [IQR, $42 141 to $140 192]). It was larger under capitation risk-adjusted for age alone ($74 695 [IQR, $42 884 to $152 423]), for diagnosis-based scores alone ($114 792 [IQR, $49 080 to $215 326] and $89 974 [IQR, $26 175 to $173 760]), and for age-, sex-, and diagnosis-based scores ($83 438 [IQR, $28 927 to $129 414] and $66 195 [IQR, $11 899 to $96 566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36 631 [IQR, $12 743 to $73 898]). LIMITATION Panel attribution based on office visits. CONCLUSION The gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes. PRIMARY FUNDING SOURCE None.
Collapse
Affiliation(s)
- Ishani Ganguli
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (I.G.)
| | | | - Robert L Phillips
- American Board of Family Medicine Center for Professionalism and Value in Health Care, Lexington, Kentucky (R.L.P.)
| | - Sanjay Basu
- Research and Development, Waymark, San Francisco, California (S.B.)
| |
Collapse
|
7
|
Bremer S, Henjum S, Sæther EM, Hovland R. Drug-related problems and satisfaction among patients receiving pharmacist-led consultations at the initiation of cardiovascular drugs. Res Social Adm Pharm 2022; 18:3939-3947. [PMID: 35750567 DOI: 10.1016/j.sapharm.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) lead to substantial morbidity and mortality and increase healthcare costs. Several interventions have been developed to reduce DRPs and improve the outcome of drug therapy. OBJECTIVE To investigate DRPs identified through a pharmacist-led intervention and to assess patient satisfaction with the intervention. METHODS Patients received two pharmacist consultations 1-2 weeks and 3-5 weeks after collecting a new cardiovascular medicine. Information about patient characteristics, beliefs about medicines (BMQ), DRPs, and patient evaluations were collected using questionnaires. RESULTS Pharmacists identified DRPs among 52.4% and 43.1% of the 633 patients at consultation 1 and 2, respectively. Of the DRPs reported in consultation 1, 43.7% were solved at consultation 2. Among patients with side effects, patients who received advice on managing these in consultation 1 where more likely to have solved problems at consultation 2 (61.2% vs. 42.6%, p = 0.008). Female gender, high BMQ concern and the number of new medicines were associated with DRPs. Patients were highly satisfied with the intervention. Predictors of satisfaction were female gender, older age, higher BMQ necessity, face-to-face consultations, longer duration of consultation 1, and solved problems in consultation 2. CONCLUSIONS The results indicate that the pharmacist-led follow-up intervention can aid early identification and solving of DRPs in patients prescribed new cardiovascular drugs. Knowledge of factors associated with DRPs and patients' satisfaction may allow further improvement of the intervention.
Collapse
Affiliation(s)
- Sara Bremer
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway.
| | - Solveig Henjum
- Norwegian Pharmacy Association, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
| | | | - Ragnar Hovland
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
| |
Collapse
|
8
|
Roselin D, Lee J, Jagsi R, Blair-Loy M, Ira K, Dahiya P, Williams J, Mangurian C. Medical Student Parental Leave Policies at U.S. Medical Schools. J Womens Health (Larchmt) 2022; 31:1403-1410. [PMID: 35704286 DOI: 10.1089/jwh.2022.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: As medical training occurs during prime childbearing years, parental leave policies may affect the career and family choices of medical students. Materials and Methods: This cross-sectional study builds on existing research by quantifying the prevalence of formal policies for parental leave in highly ranked United States Medical Degree granting institutions, and analyzing the characteristics of those policies, with the objective of identifying existing best practices for future policy adopters to consider. Results: Only 14% of the medical schools reviewed had substantive, stand-alone parental leave policies, and the majority of schools had leave of absence policies without mention of parental leave. Discussion: Leveraging the authors' legal and medical expertise, this analysis highlights existing best practices for medical school leadership to consider, as they examine and develop their policies. Best practices utilized by institutions with the most robust parental policies include adopting a formal and public parental policy, providing a parental enrolled academic adjustment option, guaranteeing approval to take and return from leave/academic adjustment, and continuing health care and financial aid benefits. Given the role of childbearing as a factor associated with gender disparities in academic medicine, and potential impact on racial disparities for students of color, medical school leadership should consider implementation of best practice parental policies to promote equity and wellness of their students. In fact, the deficit of robust parental leave policies in most highly ranked schools may contribute to existing gender and racial disparities in violation with antidiscrimination law. Strengthening policies could increase equity in medical education with positive impacts on the patient population.
Collapse
Affiliation(s)
- Danielle Roselin
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jessica Lee
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Blair-Loy
- Department of Sociology, Center for Research on Gender in STEMM, University of California, San Diego, San Diego, California, USA
| | - Kim Ira
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Priya Dahiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Joan Williams
- Center for WorkLife Law, Hastings College of the Law, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco (UCSF), California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, Center for Vulnerable Populations, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF), San Francisco, California, USA
| |
Collapse
|
9
|
Menon AV, Sariego C. Engendering connection: The embodied emotional labor of U.S. cosmetic surgeons. Soc Sci Med 2022; 306:115092. [PMID: 35717827 DOI: 10.1016/j.socscimed.2022.115092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
Emotional labor has typically been analyzed as a gendered phenomenon in managed workers like nurses. Broadening this frame, this study analyzes how a different strata of workers perform emotional labor: surgeons. Drawing on 42 in-depth interviews with U.S. cosmetic surgeons and a content analysis of online reviews by patients, we argue that cosmetic surgeons perform both intimate and professionalized strategies of emotional labor to build long-term relationships with patients. We highlight how some surgeons strategically use their gender and bodies to forge emotional connections with patients, combining physician authority and their own embodied experiences. We identify two intimate, embodied strategies of emotional labor used by cosmetic surgeons (Paternalistic and Empathic) which are highly gendered and two additional strategies that more closely resemble professional norms (Egalitarian and Technical). Cosmetic surgeons can and do switch between strategies, subject to the constraints of gender norms and expectations; embodied strategies have different payoffs for men and women. Women surgeons, in particular, may sometimes adopt professionalized strategies of emotional labor to assert their physician authority and status and resist expectations of feminized emotional labor. In commercialized medicine, emotional labor enables elite healthcare providers to negotiate power dynamics with dependent patients. In addition to making patients feel better, embodied labor can confer meaning on surgeons' work.
Collapse
Affiliation(s)
- Alka V Menon
- Department of Sociology Yale University, 493 College Street, New Haven, CT, 06511, USA.
| | - Chloe Sariego
- Department of Sociology Yale University, 493 College Street, New Haven, CT, 06511, USA.
| |
Collapse
|
10
|
Benson-Greenwald TM, Joshi MP, Diekman AB. Out of the Lab and Into the World: Analyses of Social Roles and Gender in Profiles of Scientists in The New York Times and The Scientist. Front Psychol 2022; 12:684777. [PMID: 35095632 PMCID: PMC8793918 DOI: 10.3389/fpsyg.2021.684777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Although representations of female scientists in the media have increased over time, stereotypical portrayals of science persist. In-depth, contemporary profiles of scientists’ roles have an opportunity to reflect or to challenge stereotypes of science and of gender. We employed content and linguistic analyses to examine whether publicly available profiles of scientists from New York Times and The Scientist Magazine support or challenge pervasive beliefs about science. Consistent with broader stereotypes of STEM fields, these portrayals focused more on agency than communality. However, profiles also challenged stereotypes through integrating communality, purpose, and growth. This analysis also found similar presence of communal and agentic constructs for both female and male scientists. The current findings highlight the importance of considering counterstereotypic representations of science in the media: Communicating messages to the public that challenge existing beliefs about the culture of science may be one path toward disrupting stereotypes that dissuade talented individuals from choosing science pathways.
Collapse
Affiliation(s)
- Tessa M Benson-Greenwald
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Mansi P Joshi
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Amanda B Diekman
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| |
Collapse
|
11
|
Dagostini CM, Bicca YDA, Ramos MB, Busnello S, Gionedis MC, Contini N, Falavigna A. Patients' preferences regarding physicians' gender: a clinical center cross-sectional study. SAO PAULO MED J 2022; 140:134-143. [PMID: 35043868 PMCID: PMC9623840 DOI: 10.1590/1516-3180.2021.0171.r1.08062021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.
Collapse
Affiliation(s)
- Carolina Matté Dagostini
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Yan De Assunção Bicca
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Miguel Bertelli Ramos
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Sabrina Busnello
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Murillo Cesar Gionedis
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Natália Contini
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Asdrubal Falavigna
- MD, MSc, PhD. Coordinator, Health Sciences Undergraduate Program, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| |
Collapse
|
12
|
van Rossenberg LX, Ring D, Jacobs X, Sulkers G, van Heijl M, van Hoorn BT. Patient Perceived Involvement in Their Treatment is Influenced by Factors Other Than Independently Rated Clinician Communication Effectiveness. J Patient Exp 2021; 8:23743735211065261. [PMID: 34901411 PMCID: PMC8664301 DOI: 10.1177/23743735211065261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We analyzed (1) the correspondence of patient and clinician perceived patient involvement in decision making and ratings made by independent observer's independent ratings, as well as (2), factors associated with patient-perceived involvement, among patients seeking hand specialty care. During 63 visits, the patient, their hand specialist, and 2 independent observers each rated patient involvement in decision making using the 9-item shared decision-making questionnaire for patients and clinicians, and the 5-item observing patient involvement scale (OPTION-5). We also measured health literacy (Newest Vital Sign), patient and visit characteristics (gender, age, race, years of education, occupation, marital status, and family present). There was no correlation (ρ = 0.17; P = .17) between patient (median 42, IQR 36-44.5) and clinician (38, IQR 35-43) ratings of patient involvement in decision making. Independently rated patient involvement correlated moderately with a specialist (ρ = 0.35, P <.01), but not patient (ρ = 0.22, P = .08) ratings. The finding that patient perception of their involvement in decision making has little or no relationship to independently rated clinician communication effectiveness and effort, suggests that other aspects of the encounter-such as empathy and trust-may merit investigation as mediators of the patient agency.
Collapse
Affiliation(s)
- Luke X van Rossenberg
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Xander Jacobs
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - George Sulkers
- Department of Plastic Surgery, Hand Service, Diakonessenhuis Utrecht, Utrecht, the Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| | - Bastiaan T van Hoorn
- Department of Surgery, Hand Service, Utrecht Medical Center, Medical University of Utrecht, Utrecht, the Netherlands
| |
Collapse
|
13
|
Bajpai J, Mailankody S, Nair R, T Surappa S, Gupta S, Prabhash K, Banavali SS, Malhotra H, Bhattacharyya GS, Bk S, Babu G. Gender climate in Indian oncology: national survey report. ESMO Open 2021; 5:S2059-7029(20)30066-1. [PMID: 32354723 PMCID: PMC7213870 DOI: 10.1136/esmoopen-2020-000671] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction There is evidence of under-representation of women in leadership roles and publications in oncology. However, there is little knowledge about their perceptions of professional environment, unique challenges and opportunities compared with male counterparts. The problem is more prominent in lower-income and middle-income countries like India and merits exploration. Materials and methods A survey, ‘Exploratory Study on the Challenges of Female Oncologists in India’, was conducted among oncology professionals. We included questions on demography, working team details, role at work, perceived challenges for advancement of career, gender-related values brought into the team and the measures for improvement of gender disparity. Lead authorship data were collected from two Indian oncology journals. Results Of the 324 respondents, 198 (61.1%) were women. Majority of the respondents were medical oncologists (46.3%), ≤45 years old (69.4%) and working in universities and corporate hospitals (71.6%). One hundred eighty-nine (58.3%) respondents worked in teams with male majority, 50 (15.4%) in women-majority teams, while 85 (26.2%) worked in teams with gender equality. Of the 324 respondents, 218 (67.3%) had men managers, while 106 (32.7%) had women managers. Men led 160 (84.7%) male-majority teams; 45 (52.9%) gender-equal teams; and 13 (26%) female-majority teams (p<0.00001). Age >45 years was found to be associated with a leadership role (43% vs 25%, p=0.0012). The most significant barrier perceived for advancement of career for women was finding a work–life balance. Most respondents suggested provision of flexible training programmes to improve the disparity. Of the 558 journal publications inspected, 145 (26%) articles had a female first or corresponding author. Conclusions The study brought out the current figures regarding gender climate in oncology practice and academia across India. We identified lead thrust areas and schemes to improve the gender bias. There needs to be action at international, national and personal levels to bring about an efficient gender-neutral workforce.
Collapse
Affiliation(s)
- Jyoti Bajpai
- Medical Oncology, Tata Memorial Centre, Mumbai, India .,Medical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sharada Mailankody
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Reena Nair
- Clinical Hematology, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Sudeep Gupta
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shripad S Banavali
- Medical Oncology, Tata Memorial Centre, Mumbai, India.,Medical Oncology, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | - Hemant Malhotra
- Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
| | | | - Smruti Bk
- Medical Oncology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Govind Babu
- Medical Oncology, HCG Cancer Centre, Bengaluru, India
| |
Collapse
|
14
|
Al-Busaidi AS, Ganesh A, Al-Adawi S, Al-Farsi YM, Al-Rawahi MK, Al-Mawali NA, Al-Kharousi NS, Al-Alawi M, Al-Mujaini AS. Development and validation of an instrument to measure physician awareness of bioethics and medical law in Oman. BMC Med Ethics 2021; 22:65. [PMID: 34022852 PMCID: PMC8140473 DOI: 10.1186/s12910-021-00619-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
Background A different ethos with respect to the perception of medical ethics prevails in societies in transition such as those in the Arabian Peninsula, which makes it difficult to apply international principles of bioethics in medical practice. This study aimed to develop and psychometrically test an instrument that measures physicians’ awareness of bioethics and medical law and their attitudes towards the practice of medical ethics. Additionally, it examined physician correlates influencing the awareness of bioethics. Methods Following a rigorous review of relevant literature by a panel of experts, a 13-item instrument, the Omani physicians’ bioethics and medical law awareness (OBMLA) questionnaire was developed with the aim of assessing physicians’ awareness of bioethics and medical law. The study tool’s construct validity and internal consistency reliability were examined by exploratory factor analysis (EFA) and Cronbach’s alpha. In a cross-sectional study, the questionnaire was distributed among a random sample of 200 physicians at a tertiary hospital in Muscat, Oman. Participant characteristics that may influence awareness of bioethics and medical law were explored. Results The EFA of the OBMLA questionnaire resulted in three well-loading factors: (1) Physicians’ bioethics practice subscale (2) incentive related bioethics subscale and (3) medical law awareness subscale. Internal consistency reliability ranged between Cronbach’s α: 0.73–0.8. Of the total 200 participants, 52% reported that teaching medical ethics during medical school was inadequate. The overall mean (standard deviation, SD) of the bioethics awareness score and Omani medical law awareness were 27.6 (3.5) and 10.1 (2.1) respectively. The majority of physicians (73%) reported that they frequently encountered ethical dilemmas in their practice and 24.5% endorsed the view that unethical decisions tended to occur in their practice. Conclusion The study provides an insight into the practice of bioethics, and the awareness of bioethics and medical law among physicians in a teaching hospital in Oman. The OBMLA questionnaire appears to be a valid and reliable tool to assess a physician’s awareness of bioethics and medical law. In this preliminary study, it appears that participants have suboptimal scores on the indices which measure practice and awareness of bioethics and medical law. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00619-1.
Collapse
Affiliation(s)
- Ahmed S Al-Busaidi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Sultanate of Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Yahya M Al-Farsi
- Department of Family Medicine and Public Health, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Maryam K Al-Rawahi
- Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Nusaiba A Al-Mawali
- Medical Student, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Nadiya S Al-Kharousi
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mohammed Al-Alawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Muscat, Sultanate of Oman
| | - Abdullah S Al-Mujaini
- Department of Ophthalmology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| |
Collapse
|
15
|
Dwyer R, Kalin M. Significance of the physician's and the patient's sex in hospitalized patients with community-acquired pneumonia. Infect Dis (Lond) 2021; 53:538-545. [PMID: 33750259 DOI: 10.1080/23744235.2021.1900906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Numerous studies have revealed that the sex of the patient or of the attending physician have impact on patient care, treatment, morbidity and mortality. Community-acquired pneumonia (CAP) is a common cause of hospitalization, antibiotic treatment and intensive care unit (ICU) admission. The purpose of this study was to examine if the patient's or the attending physicians' sex may influence the management of hospitalized patients with CAP. METHODS Our study included 826 consecutive inpatients with CAP (404 females, and 422 male patients, 429 patients initially treated by a female physician and 397 patients initially treated by a male physician). We examined if the patient's, or the initial attending physician's sex, affected treatment and outcome in patients with CAP. RESULTS Patients mean age was 69 years, 30-day mortality 9%. By use of the pneumonia severity index, male patients were found to be more severely ill at admission (p = .0008). Fewer female physicians' patients were admitted from the emergency department (ED) to the ICU when compared to male physicians' patients, 5% versus 10% (p = .006), and female physicians' patients received their first intravenous (IV) antibiotic dose later than male physicians' patients in the ED (p = .003). CONCLUSION Our study indicates that the sex of the attending physician may affect the chosen level of care and antibiotic treatment, and that admitted male patients with CAP were more seriously ill than admitted female patients with CAP.
Collapse
Affiliation(s)
- Richard Dwyer
- Department of Infectious Diseases/Venhälsan, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mats Kalin
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Gong Y, Wang H, Xia Q, Zheng L, Shi Y. Factors that determine a Patient's willingness to physician selection in online healthcare communities: A trust theory perspective. TECHNOLOGY IN SOCIETY 2021; 64:101510. [PMID: 36033357 PMCID: PMC9398493 DOI: 10.1016/j.techsoc.2020.101510] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/21/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
Health care users and patients are increasingly using online health communities to seek medical service, especially during the COVID-19 epidemic. The factors that determine the online trust between physicians and patients perplex the stakeholders for a long time. Based on the trust theory, this study explored the influence of physicians' personal quality and online reputation on patients' selection. A longitudinal panel data collection exercise, covering 11905 physicians on haodf. com, was conducted on May 20, 2018, May 22, 2019 and May 25, 2020. The random effect models are used to test our hypothesis. Results show that physicians' quality (competence, benevolence, and integrity) and online reputation (online reviews and online rating) can significantly affect patients' selection. Moreover, the physician's gender can enhance the influence of online reputation on patients' selection. As online healthcare community becomes an increasingly appealing channel for health, the frequency of the physician's quality information updating and the quality of online service are equally important to online physician-patient trust.
Collapse
Affiliation(s)
- Yingli Gong
- School of Economics and Management, Tongji University, China
| | - Hongwei Wang
- School of Economics and Management, Tongji University, China
| | - Qiangwei Xia
- School of Economics and Management, Tongji University, China
| | | | - Yunxiang Shi
- School of Economics and Management, Tongji University, China
| |
Collapse
|
17
|
Chaitoff A, Volovetz J, Mitchell-Handley B, Cobb K. The Effects of Student Demographic Characteristics in a Primary Care Encounter: a Randomized Experiment. J Gen Intern Med 2021; 36:552-554. [PMID: 32076970 PMCID: PMC7878620 DOI: 10.1007/s11606-020-05681-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 12/24/2019] [Accepted: 01/23/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander Chaitoff
- Department of Internal Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, 02115, USA.
| | | | - Blair Mitchell-Handley
- Department of Obstetrics and Gynecology, Mercy Hospital and Health System, Chicago, IL, 60616, USA
| | - Kendalle Cobb
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA.,Department of Family Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| |
Collapse
|
18
|
Coe JB, O'Connor R, Pizzolon CN, Hester KA, Nogueira Borden LJ, Haley D. Investigation of the effects of veterinarians' attire on ratings of trust, confidence, and comfort in a sample of pet owners in Canada. J Am Vet Med Assoc 2020; 256:1268-1276. [PMID: 32412872 DOI: 10.2460/javma.256.11.1268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine companion animal owners' perceptions of appropriate veterinarian attire and investigate potential associations between a veterinarian's attire and clients' ratings of trust in, confidence in, and comfort with a veterinarian. SAMPLE 449 pet owners. PROCEDURES Participants were randomly assigned to complete a questionnaire containing photos of a male or female model veterinarian photographed in 8 attire types (formal attire, white dress shirt with black pants, white casual shirt with khaki pants, surgical scrubs, white casual shirt with jeans, surgical scrub top with jeans, surgical scrub top with khaki pants, and white laboratory coat with khaki pants). Participants were asked to rate their trust in, confidence in, and comfort with the pictured individual on a response scale of 1 (low) to 7 (high), rank photos according to their preferences for attire, and provide input on the importance of attire and other appearance-related subjects. Attire and gender of photographed individual and participant demographics were investigated for associations with trust, confidence, and comfort scores. RESULTS Most (317/445 [71%]) respondents indicated veterinarians' attire was important. Attire type was significantly associated with respondents' trust, confidence, and comfort scores. Model veterinarian gender and participant education level were also associated with trust and comfort scores. CONCLUSIONS AND CLINICAL RELEVANCE Veterinarians' attire is a form of nonverbal communication that is likely to inform clients' first impressions and may influence clients' trust in, confidence in, and comfort with a veterinarian. Veterinary personnel and veterinary management should consider how attire and general appearance represent staff members or their practice.
Collapse
|
19
|
Lamb CC, Wang Y. PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY. PATIENT EDUCATION AND COUNSELING 2020; 103:2280-2289. [PMID: 32475713 DOI: 10.1016/j.pec.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation. METHODS A multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender. RESULTS A patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians. CONCLUSION A patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions. Practice Implications Future SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.
Collapse
Affiliation(s)
- Christopher C Lamb
- BioSolutions Services, Englewood Cliffs, New Jersey, United States; Department of Management and Entrepreneurship, Silberman College of Business, Fairleigh Dickinson University, Teaneck, New Jersey, United States; Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106, USA
| |
Collapse
|
20
|
Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal MB, Neprash H. Physician Work Hours and the Gender Pay Gap - Evidence from Primary Care. N Engl J Med 2020; 383:1349-1357. [PMID: 32997909 PMCID: PMC10854207 DOI: 10.1056/nejmsa2013804] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The gender gap in physician pay is often attributed in part to women working fewer hours than men, but evidence to date is limited by self-report and a lack of detail regarding clinical revenue and gender differences in practice style. METHODS Using national all-payer claims and data from electronic health records, we conducted a cross-sectional analysis of 24.4 million primary care office visits in 2017 and performed comparisons between female and male physicians in the same practices. Our primary independent variable was physician gender; outcomes included visit revenue, visit counts, days worked, and observed visit time (interval between the initiation and the termination of a visit). We created multivariable regression models at the year, day, and visit level after adjustment for characteristics of the primary care physicians (PCPs), patients, and types of visit and for practice fixed effects. RESULTS In 2017, female PCPs generated 10.9% less revenue from office visits than their male counterparts (-$39,143.2; 95% confidence interval [CI], -53,523.0 to -24,763.4) and conducted 10.8% fewer visits (-330.5 visits; 95% CI, -406.6 to -254.3) over 2.6% fewer clinical days (-5.3 days; 95% CI, -7.7 to -3.0), after adjustment for age, academic degree, specialty, and number of sessions worked per week, yet spent 2.6% more observed time in visits that year than their male counterparts (1201.3 minutes; 95% CI, 184.7 to 2218.0). Per visit, after adjustment for PCP, patient, and visit characteristics, female PCPs generated equal revenue but spent 15.7% more time with a patient (2.4 minutes; 95% CI, 2.1 to 2.6). These results were consistent in subgroup analyses according to the gender and health status of the patients and the type and complexity of the visits. CONCLUSIONS Female PCPs generated less visit revenue than male colleagues in the same practices owing to a lower volume of visits, yet spent more time in direct patient care per visit, per day, and per year. (Funded in part by the Robert Wood Johnson Foundation.).
Collapse
Affiliation(s)
- Ishani Ganguli
- From Harvard Medical School (I.G., M.C.), Brigham and Women's Hospital (I.G.), and Harvard T.H. Chan School of Public Health (M.B.R.), Boston, athenahealth, Watertown (B.S.), and Health Data Analytics Institute, Dedham (J.G.) - all in Massachusetts; and the University of Minnesota, Minneapolis (H.N.)
| | - Bethany Sheridan
- From Harvard Medical School (I.G., M.C.), Brigham and Women's Hospital (I.G.), and Harvard T.H. Chan School of Public Health (M.B.R.), Boston, athenahealth, Watertown (B.S.), and Health Data Analytics Institute, Dedham (J.G.) - all in Massachusetts; and the University of Minnesota, Minneapolis (H.N.)
| | - Joshua Gray
- From Harvard Medical School (I.G., M.C.), Brigham and Women's Hospital (I.G.), and Harvard T.H. Chan School of Public Health (M.B.R.), Boston, athenahealth, Watertown (B.S.), and Health Data Analytics Institute, Dedham (J.G.) - all in Massachusetts; and the University of Minnesota, Minneapolis (H.N.)
| | - Michael Chernew
- From Harvard Medical School (I.G., M.C.), Brigham and Women's Hospital (I.G.), and Harvard T.H. Chan School of Public Health (M.B.R.), Boston, athenahealth, Watertown (B.S.), and Health Data Analytics Institute, Dedham (J.G.) - all in Massachusetts; and the University of Minnesota, Minneapolis (H.N.)
| | - Meredith B Rosenthal
- From Harvard Medical School (I.G., M.C.), Brigham and Women's Hospital (I.G.), and Harvard T.H. Chan School of Public Health (M.B.R.), Boston, athenahealth, Watertown (B.S.), and Health Data Analytics Institute, Dedham (J.G.) - all in Massachusetts; and the University of Minnesota, Minneapolis (H.N.)
| | - Hannah Neprash
- From Harvard Medical School (I.G., M.C.), Brigham and Women's Hospital (I.G.), and Harvard T.H. Chan School of Public Health (M.B.R.), Boston, athenahealth, Watertown (B.S.), and Health Data Analytics Institute, Dedham (J.G.) - all in Massachusetts; and the University of Minnesota, Minneapolis (H.N.)
| |
Collapse
|
21
|
Chen H, Pierson E, Schmer-Galunder S, Altamirano J, Jurafsky D, Leskovec J, Fassiotto M, Kothary N. Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations. J Womens Health (Larchmt) 2020; 30:551-556. [PMID: 32857642 DOI: 10.1089/jwh.2019.8233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.
Collapse
Affiliation(s)
- Heidi Chen
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Emma Pierson
- Department of Computer Science, Stanford University, Stanford, California, USA
| | | | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Dan Jurafsky
- Department of Computer Science, Stanford University, Stanford, California, USA.,Department of Linguistics, Stanford University, Stanford, California, USA
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Nishita Kothary
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| |
Collapse
|
22
|
Abstract
Racial disparities in health care have been extensively documented. Although race is a recognized determinant of the incidence and outcome of disease, few studies have examined the role of race in the delivery of pediatric perianesthesia care. Whereas racial differences in health outcomes may not be easy to modify, disparities in health care delivery are modifiable. The authors examined literature to determine whether racial disparities exist in the delivery of pediatric anesthesia. They explored putative contributors to disparities at the provider, patient, and systems level and propose ideas to address potential causes of disparities in the practice of pediatric anesthesia.
Collapse
Affiliation(s)
- Anne Elizabeth Baetzel
- University of Michigan, CS Mott Children's Hospital, 4-911, 1540 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Ashlee Holman
- University of Michigan, CS Mott Children's Hospital, 4-911, 1540 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Nicole Dobija
- University of Michigan, CS Mott Children's Hospital, 4-911, 1540 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Paul Irvin Reynolds
- University of Michigan, CS Mott Children's Hospital, 4-911, 1540 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | | |
Collapse
|
23
|
Lamb CC, Wang Y, Lyytinen K. Shared decision making: Does a physician's decision-making style affect patient participation in treatment choices for primary immunodeficiency? J Eval Clin Pract 2019; 25:1102-1110. [PMID: 31115958 PMCID: PMC6900116 DOI: 10.1111/jep.13162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient-physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire-based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision-making styles and SDM as mediated by patient-centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.
Collapse
Affiliation(s)
- Christopher C Lamb
- BioSolutions Services LLC, Cambridge, Massachusetts.,Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kalle Lyytinen
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
24
|
Kovács N, Varga O, Nagy A, Pálinkás A, Sipos V, Kőrösi L, Ádány R, Sándor J. The impact of general practitioners' gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study. BMJ Open 2019; 9:e027296. [PMID: 31494598 PMCID: PMC6731795 DOI: 10.1136/bmjopen-2018-027296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact. STUDY DESIGN A nation-wide cross-sectional study was performed in 2016. SETTING AND PARTICIPANTS The study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners. MAIN OUTCOME MEASURES Multilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated. RESULTS 48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations. CONCLUSION Female GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.
Collapse
Affiliation(s)
- Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Orsolya Varga
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kőrösi
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
- WHO Collaborating Centre on Vulnerability and Health, Debrecen, Hungary
- MTA-DE Public Health Research Group, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
25
|
Koper I, Pasman HRW, Onwuteaka-Philipsen BD. Experiences of Dutch general practitioners and district nurses with involving care services and facilities in palliative care: a mixed methods study. BMC Health Serv Res 2018; 18:841. [PMID: 30409204 PMCID: PMC6225713 DOI: 10.1186/s12913-018-3644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Generals practitioners (GPs) and district nurses (DNs) play a leading role in providing palliative care at home. Many services and facilities are available to support them in providing this complex care. This study aimed to examine the extent to which GPs and DNs involve these services, what their experiences are, and how involvement of these services and facilities can be improved. Methods Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 108 GPs and 258 DNs, followed by three homogenous online focus groups with 8 GPs and 19 DNs, analyzed through open coding. Results Most GPs reported that they sometimes or often involved palliative home care teams (99%), hospices (94%), and palliative care consultation services (93%). Most DNs reported sometimes or often involving volunteers (90%), hospices (88%), and spiritual caregivers (80%). The least involved services and facilities were psychologists and psychiatrists (51% and 50%) and social welfare (44% and 57%). Main reason for not involving services and facilities was ‘not needing’ them. If they had used them, most GPs and DNs (68–93%) reported solely positive experiences. Hardly anyone (0–3%) reported solely negative experiences with any of the services and the facilities. GPs and DNs suggested improvements in three areas: (1) establishment of local centers giving information on available services and facilities, (2) presentation of services and facilities in local multidisciplinary meetings, and (3) support organizations to proactively offer their facilities and services. Conclusion Psychological, social, and spiritual services are involved less often, suggesting that the classic care model, which focuses strongly on somatic issues, is still well entrenched. More familiarity with services that can provide additional care in these areas, regarding their availability and their added value, could improve the quality of life for patients and relatives at the end of life.
Collapse
Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
| |
Collapse
|
26
|
Hwong AR, Sah S, Lehmann LS. The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment. J Gen Intern Med 2017; 32:1186-1192. [PMID: 28717899 PMCID: PMC5653550 DOI: 10.1007/s11606-017-4122-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/28/2017] [Accepted: 06/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Financial ties between physicians and the pharmaceutical and medical device industry are common, but little is known about how patient trust is affected by these ties. OBJECTIVE The purpose of this study was to evaluate how viewing online public disclosure of industry payments affects patients' trust ratings for physicians, the medical profession, and the pharmaceutical and medical device industry. DESIGN This was a randomized experimental evaluation. PARTICIPANTS There were 278 English-speaking participants over age 18 who had seen a healthcare provider in the previous 12 months who took part in the study. INTERVENTIONS Participants searched for physicians on an online disclosure database, viewed payments from industry to the physicians, and assigned trust ratings. Participants were randomized to view physicians who received no payment ($0), low payment ($250-300), or high payment (>$13,000) from industry, or to a control arm in which they did not view the disclosure website. They also were asked to search for and then rate trust in their own physician. MAIN MEASURES Primary outcomes were trust in individual physician, medical profession, and industry. These scales measure trust as a composite of honesty, fidelity, competence, and global trust. KEY RESULTS Compared to physicians who received no payments, physicians who received payments over $13,000 received lower ratings for honesty [mean (SD): 3.36 (0.86) vs. 2.75 (0.95), p < 0.001] and fidelity [3.19 (0.65) vs. 2.89 (0.68), p = 0.01]. Among the 7.9% of participants who found their own physician on the website, ratings for honesty and fidelity decreased as the industry payment to the physician increased (honesty: Spearman's ρ = -0.52, p = 0.02; fidelity: Spearman's ρ = -0.55, p = 0.01). Viewing the disclosure website did not affect trust ratings for the medical profession or industry. CONCLUSIONS Disclosure of industry payments to physicians affected perceptions of individual physician honesty and fidelity, but not perceptions of competence. Disclosure did not affect trust ratings for the medical profession or the pharmaceutical and medical device industry. ClinicalTrials.gov identifier: NCT02179632 ( https://clinicaltrials.gov/ct2/show/NCT02179632 ).
Collapse
Affiliation(s)
- Alison R Hwong
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
- Harvard PhD Program in Health Policy and Harvard Medical School, Boston, MA, USA.
| | - Sunita Sah
- Johnson Graduate School of Management, Cornell University, Ithaca, NY, USA
| | - Lisa Soleymani Lehmann
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA
| |
Collapse
|
27
|
Sebo P, Herrmann FR, Haller DM. Is patient satisfaction with organizational aspects of their general practitioner's practice associated with patient and doctor gender? An observational study. BMC FAMILY PRACTICE 2016; 17:120. [PMID: 27729018 PMCID: PMC5057478 DOI: 10.1186/s12875-016-0513-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND No study has assessed the association between patients' and doctors' gender and patient satisfaction with organizational aspects of health care in primary care. However, just like satisfaction regarding communication styles or technical skills, satisfaction towards organization of the general practitioner (GP) practice could also depend on doctors' and/or patients' gender. Different expectations between female and male patients regarding the organization of the practice or different ways of organizing care delivery between female and male GPs could act on this satisfaction. We aimed to compare female and male patients' satisfaction towards their GP overall, and according to GPs' gender. METHODS In a cross-sectional study in Geneva, 23 randomly selected GPs (participation rate: 31 %) were asked to recruit up to 100 consecutive patients coming to the practice for a scheduled medical consultation. The patients completed an anonymous questionnaire about their satisfaction with their GP. Patient satisfaction was assessed using the six questions from the Europep questionnaire regarding organizational aspects of health care in terms of accessibility and availability, and presented in two different ways: % of patients very satisfied and mean score (SD). Multivariate analyses adjusting for patient and GP characteristics were conducted to compare outcomes between genders. RESULTS One thousand six hundred thirty-seven patients agreed to participate (participation rate: 97 %, women: 63 %, mean age: 54 years). The majority of patients were very satisfied (women 96.2 %, men 95.3 %, p = 0.38). Mean satisfaction scores were slightly higher in women (for overall satisfaction: women 4.7/5 (SD 0.6), men 4.6/5 (SD 0.6), p = 0.02) and in women visiting male GPs (women 4.6 (SD 0.6), men 4.5 (SD 0.6), p = 0.01), and the gender differences showed consistency across satisfaction items. These differences were small and no longer statistically significant in multivariate analyses. CONCLUSIONS These findings suggest that patients are highly satisfied with the organization of their GP's practice, regardless of patients' and GPs' gender. As patients' and GPs' gender are known to influence patient satisfaction towards primary care delivery and as the current study is the first to explore this aspect in relation to organizational aspects of GP practice, further studies are needed in various primary care settings to confirm our results.
Collapse
Affiliation(s)
- Paul Sebo
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland. .,Centre médico-chirurgical des Trois Chêne, 97-99, rue de Genève, 1226, Thônex, GE, Switzerland.
| | - François R Herrmann
- Geriatrics Division, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of medicine, University of Geneva, Geneva, Switzerland.,Department of Community, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
28
|
Shim HY, Chang YJ, Kawk KS, Mai TTX, Choi JY, Ahn EM, Jho HJ, Park SJ. Do Korean Doctors Think a Palliative Consultation Team Would Be Helpful to Their Terminal Cancer Patients? Cancer Res Treat 2016; 49:437-445. [PMID: 27506213 PMCID: PMC5398399 DOI: 10.4143/crt.2015.495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/22/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Hospice and palliative care services (HPC) are not commonly utilized in Korea; however, palliative care teams (PCTs) have been found to be effective at addressing the shortcomings in HPC. In this study, we attempted to outline unmet palliative care needs of terminal cancer patients and the potential benefits of PCTs as perceived by doctors in Korea. MATERIALS AND METHODS We surveyed 474 doctors at 10 cancer-related academic conferences from June to November 2014 with a self-report questionnaire to assess their perceptions of end-of-life care needs and the expected effects of PCTs on caring for terminal cancer patients. Among those surveyed, 440 respondents who completed the entire questionnaire were analyzed. RESULTS In all domains, fewer participants reported satisfaction with palliative care services than those reporting needs (p < 0.001). The surveyed participants also reported difficulties with a shortage of time for treatment, psychological burden, lack of knowledge regarding hospice care, lengths of stay, and palliative ward availability. Multivariate logistic regression analysis revealed that female doctors (odds ratio [OR], 2.672; 95% confidence interval [CI], 1.035 to 6.892), doctors who agreed that referring my patients to a HPC means I must give up on my patient (OR, 3.075; 95% CI, 1.324 to 7.127), and doctors who had no experience with HPC education (OR, 3.337; 95% CI, 1.600 to 7.125) were associated with higher expected effectiveness of PCT activities. CONCLUSION The PCT activities were expected to fill the doctor's perceived unmet HPC needs of terminal cancer patients and difficulties in communications.
Collapse
Affiliation(s)
- Hye-Young Shim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Yoon Jung Chang
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kiu-Sang Kawk
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Tran Thi Xuan Mai
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Young Choi
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Mi Ahn
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun Jung Jho
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So-Jung Park
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| |
Collapse
|
29
|
De Valck C, Bruynooghe R, Bensing JM, Kerssens JJ, Hulsman RL. Cue-responding in a Simulated Bad News Situation: Exploring a Stress Hypothesis. J Health Psychol 2016; 6:585-96. [DOI: 10.1177/135910530100600514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The stress-coping paradigm of Folkman and Lazarus (1984) was applied to investigate if the communicative reactions of the physician in a bad news transaction are related to the stressfulness of the situation. A standardized video bad news consultation was presented to 88 medical students. To examine their communicative reactions we selected 10 patient cues with different levels of expressed emotion to which the participants responded from the physician’s point of view. A strongly positive relationship between expressed emotion and perceived difficulty of the cues and a gender effect occurred, confirming that handling emotions is stressful for physicians. The reluctance of physicians to address the emotionally laden issues of the consultation can be understood as a lack of a frame of reference. The problem-solving strategies, which they apply in the instrumental domain of the consultation, are ineffective when dealing with psychosocial suffering.
Collapse
Affiliation(s)
| | | | | | - J. J. Kerssens
- Netherlands Institute for Primary Health Care, Utrecht, The Netherlands
| | | |
Collapse
|
30
|
Lambers NM, Bolton JE. Perceptions of the quality of the therapeutic alliance in chiropractic care in The Netherlands: a cross-sectional survey. Chiropr Man Therap 2016; 24:18. [PMID: 27280015 PMCID: PMC4897913 DOI: 10.1186/s12998-016-0100-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/06/2016] [Indexed: 02/08/2023] Open
Abstract
Background Research in various medical fields demonstrates a consistent and positive association between clinical outcomes and the quality of the therapeutic alliance between the patient and clinician. The aim of this study was to explore how well chiropractors and their patients in The Netherlands perceive the quality of their working relationship. Methods A nationwide survey of chiropractors and their patients was conducted in The Netherlands, using a validated Dutch translation of the Working Alliance Inventory (WAV-12). Data were collected over a 5-week period in September-October 2014. Both patients and chiropractors were requested to reflect on 12 statements about to how well they perceived their collaboration in reaching consensus on treatment goals and treatment strategies, and how well they perceived the existence of an affective bond in their working relationship. A 5-point Likert scale was used to answer each question. Higher ratings reflected a more positive perception of the therapeutic alliance. Furthermore, levels of agreement between patients’ and chiropractors’ perceptions of the quality of their therapeutic alliance were determined. Results In total, 207 working relationships between patients and their chiropractor were analysed. The quality of the therapeutic alliance was perceived as being very positive for both patients (n = 183, mean 49.14 ± 7.12) and chiropractors (n = 202, mean 50.48 ± 4.97). There was no difference in patients’ perceptions whether treated by a male or female chiropractor, nor in relation to the chiropractor’s years of experience. Nevertheless, poor agreement was found between perceptions of patients and chiropractors in the same relationship (ICC = 0.13). Conclusions Both patients and chiropractors perceived the quality of the therapeutic alliance as being very positive. Despite these positive results, patient and chiropractor pairs perceived the level of collaboration in order to reach agreement on treatment goals and strategies and the quality of their affective bond very differently. Clinically, these results suggest that chiropractors should, during the course of treatment, continue to collaborate with their patient and frequently verify whether their patient continues to agree with the treatment goals and treatment plan applied to further develop, improve and maintain a positive therapeutic alliance. Electronic supplementary material The online version of this article (doi:10.1186/s12998-016-0100-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicoline M Lambers
- Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF UK
| | - Jennifer E Bolton
- Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF UK
| |
Collapse
|
31
|
Barber A, Puryer J, Leary S, McNally L, O'Sullivan D. Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists. Dent J (Basel) 2016; 4:dj4020012. [PMID: 29563454 PMCID: PMC5851257 DOI: 10.3390/dj4020012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.
Collapse
Affiliation(s)
- Andrew Barber
- Cambridge University Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - James Puryer
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Sam Leary
- Bristol Nutrition (Biomedical Research Unit), School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Lisa McNally
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| | - Dominic O'Sullivan
- School of Oral and Dental Sciences, Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.
| |
Collapse
|
32
|
Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns. J Racial Ethn Health Disparities 2015; 2:256-66. [PMID: 26863341 DOI: 10.1007/s40615-015-0088-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. OBJECTIVE To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. METHOD A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. RESULTS African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. CONCLUSION It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.
Collapse
|
33
|
Bartley EJ, Boissoneault J, Vargovich AM, Wandner PhD LD, Hirsh AT, Lok BC, Heft MW, Robinson ME. The influence of health care professional characteristics on pain management decisions. PAIN MEDICINE (MALDEN, MASS.) 2015; 16:99-111. [PMID: 25339248 PMCID: PMC5555370 DOI: 10.1111/pme.12591] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evidence suggests that patient characteristics such as sex, race, and age influence the pain management decisions of health care providers. Although this signifies that patient demographics may be important determinants of health care decisions, pain-related care also may be impacted by the personal characteristics of the health care practitioner. However, the extent to which health care provider characteristics affect pain management decisions is unclear, underscoring the need for further research in this area. METHODS A total of 154 health care providers (77 physicians, 77 dentists) viewed video vignettes of virtual human (VH) patients varying in sex, race, and age. Practitioners provided computerized ratings of VH patients' pain intensity and unpleasantness, and also reported their willingness to prescribe non-opioid and opioid analgesics for each patient. Practitioner sex, race, age, and duration of professional experience were included as predictors to determine their impact on pain management decisions. RESULTS When assessing and treating pain, practitioner sex, race, age, and duration of experience were all significantly associated with pain management decisions. Further, the role of these characteristics differed across VH patient sex, race, and age. CONCLUSIONS These findings suggest that pain assessment and treatment decisions may be impacted by the health care providers' demographic characteristics, effects which may contribute to pain management disparities. Future research is warranted to determine whether findings replicate in other health care disciplines and medical conditions, and identify other practitioner characteristics (e.g., culture) that may affect pain management decisions.
Collapse
Affiliation(s)
- Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Jeff Boissoneault
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Alison M. Vargovich
- Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Laura D. Wandner PhD
- Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Adam T. Hirsh
- Oral and Maxillofacial Surgery, University of Florida, Gainesville, Florida, USA
| | - Benjamin C. Lok
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Marc W. Heft
- Computer and Information Science and Engineering, University of Florida, Gainesville, Florida, USA
| | - Michael E. Robinson
- Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
34
|
Roter DL, Erby LH, Adams A, Buckingham CD, Vail L, Realpe A, Larson S, Hall JA. Talking about depression: an analogue study of physician gender and communication style on patient disclosures. PATIENT EDUCATION AND COUNSELING 2014; 96:339-45. [PMID: 24882087 PMCID: PMC4145035 DOI: 10.1016/j.pec.2014.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/26/2014] [Accepted: 05/01/2014] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To disentangle the effects of physician gender and patient-centered communication style on patients' oral engagement in depression care. METHODS Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS). RESULTS Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p<.05). APs were more willing to continue treatment with gender-discordant HPC physicians (p<.05). No effects were evident in the LPC condition. CONCLUSIONS Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender. PRACTICE IMPLICATIONS High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.
Collapse
Affiliation(s)
- Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Lori H Erby
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | - Susan Larson
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | |
Collapse
|
35
|
Franconi F, Campesi I. Sex and gender influences on pharmacological response: an overview. Expert Rev Clin Pharmacol 2014; 7:469-85. [DOI: 10.1586/17512433.2014.922866] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
36
|
Kirby E, Broom A, Good P, Wootton J, Adams J. Families and the transition to specialist palliative care. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/13576275.2014.916258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
37
|
Hirsh AT, Hollingshead NA, Matthias MS, Bair MJ, Kroenke K. The Influence of Patient Sex, Provider Sex, and Sexist Attitudes on Pain Treatment Decisions. THE JOURNAL OF PAIN 2014; 15:551-9. [DOI: 10.1016/j.jpain.2014.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
|
38
|
Alotaibi M, Alazemi T, Alazemi F, Bakir Y. Patient satisfaction with primary health-care services in Kuwait. Int J Nurs Pract 2014; 21:249-57. [PMID: 24621410 DOI: 10.1111/ijn.12257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The study aims to evaluate patient satisfaction with respect to primary health-care services in Kuwait.A total of 245 patients completed the General Practice Assessment Questionnaire postconsultation version 2.0. Two statistically significant differences of patients' satisfaction with sex and level of education were found. Overall satisfaction was higher among men than women (P = 0.002), and it was also higher among those with university degree of education than the other levels of education (P = 0.049). We also found statistically significant differences of patients' responses over sex for three themes, namely: satisfaction with receptionists, satisfaction with access and satisfaction with communication; and over the age for one theme: satisfaction with access. There was no statistically significant differences of patients' responses over nationality for all themes. Satisfaction is a multifactorial and no one factor alone could provide satisfaction with primary health services in Kuwait.
Collapse
Affiliation(s)
- Muhammad Alotaibi
- Health Information Administration Department, Faculty of Allied Health Sciences, Kuwait University, Sulaibikhat, Kuwait, Kuwait
| | - Talal Alazemi
- Fahaheel Specialty Clinic, Ministry of Health, Kuwait, Fahaheel, Kuwait
| | - Fahad Alazemi
- South Sabahiya Clinic, Ministry of Health, Kuwait, Sabahiya, Kuwait
| | - Yusif Bakir
- Radiologic Sciences Department, Faculty of Allied Health Sciences, Kuwait University, Sulaibikhat, Kuwait, Kuwait
| |
Collapse
|
39
|
Bernardes SF, Costa M, Carvalho H. Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions. THE JOURNAL OF PAIN 2013; 14:931-40. [DOI: 10.1016/j.jpain.2013.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022]
|
40
|
Abstract
BACKGROUND Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician. OBJECTIVE The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application. DESIGN A cross-sectional study was conducted. METHODS Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes. RESULTS In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more "history/background probes," more "advice/suggestion," and less "restatement" than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%). LIMITATIONS Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded. CONCLUSION This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (i.e., Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience.
Collapse
Affiliation(s)
- Lisa C Roberts
- Faculty of Health Sciences, University of Southampton, Building 45, Highfield, Southampton, Hampshire, SO17 1BJ, UK.
| | | | | | | |
Collapse
|
41
|
Abstract
Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.
Collapse
Affiliation(s)
- Rupinder K Legha
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
42
|
Kaphingst KA, Goodman M, Pandya C, Garg P, Stafford J, Lachance C. Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population. PATIENT EDUCATION AND COUNSELING 2012; 88:291-7. [PMID: 22197261 PMCID: PMC3443406 DOI: 10.1016/j.pec.2011.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 11/07/2011] [Accepted: 11/27/2011] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information. METHODS 1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors. RESULTS Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p =.012) and heart disease (p < .001), seek health information frequently in newspapers (p < .001) and in general (p < .001), and be female (p < .001). Patients who talked frequently with doctors about FHH were more likely to report a family history of heart disease (p = .011), meet physical activity recommendations (p = .022), seek health information frequently in newspapers (p < .001) and in general (p < .001), be female (p < .001), and not have experienced racial discrimination in healthcare (p < .001). CONCLUSION Patients with a family history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions. PRACTICE IMPLICATIONS Interventions are needed to encourage providers to update patients' family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control.
Collapse
Affiliation(s)
- Kimberly A Kaphingst
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
| | | | | | | | | | | |
Collapse
|
43
|
Degni F, Suominen S, Essén B, El Ansari W, Vehviläinen-Julkunen K. Communication and cultural issues in providing reproductive health care to immigrant women: health care providers' experiences in meeting the needs of [corrected] Somali women living in Finland. J Immigr Minor Health 2012; 14:330-43. [PMID: 21465142 DOI: 10.1007/s10903-011-9465-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Communication problems due to language and cultural differences between health care professionals and patients are widely recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as more open in their communication. The aim of the study was to explore physicians-nurses/midwives' communication when providing reproductive and maternity health care to Somali women in Finland. Four individual and three focus group interviews were carried out with 10 gynecologists/obstetricians and 15 nurses/midwives from five selected clinics. The health care providers considered communication (including linguistic difficulties), cultural traditions, and religious beliefs to be problems when working with Somali women. Male and female physicians were generally more similar in communication style, interpersonal contacts, and cultural awareness than the nurses/midwives who were engaged in more partnership-building with the Somali women in the clinics. Despite the communication and cultural problems, there was a tentative mutual understanding between the Finnish reproductive health care professionals and the Somali women in the clinics.
Collapse
Affiliation(s)
- Filio Degni
- Department of Public Health, University of Turku, 20014, Turku, Finland.
| | | | | | | | | |
Collapse
|
44
|
Djurkov A, Sertsou L. Comparison of patients' and clinicians' views of the therapeutic relationship: a pilot project. Australas Psychiatry 2012; 20:228-30. [PMID: 22508652 DOI: 10.1177/1039856212437253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our aim was to find out whether psychiatrists' views of the quality of the therapeutic relationship were shared by their patients, and to ascertain a feasible way to explore these relationships routinely. METHOD Sixty-one outpatients selected by two receptionists completed the Helping Alliance Scale (HAS), client version and the Relationship Questionnaire. The two participating psychiatrists were not involved in patient selection and were blind to patients' responses. They recorded their view of the relationships using the clinician version of HAS. The Big Five Inventory and Relationship Questionnaire were also utilized. Without identifying patients, each psychiatrist analysed the data of the other clinician. RESULTS Both clinicians had an agreement rate above 75%. The differences in the details reflected gender and personality differences. There was no benchmark with which to compare these results. CONCLUSIONS Assessing and recording the therapeutic relationship in community practice is feasible and provides invaluable knowledge. The next challenge is to consider whether and how this could be done routinely.
Collapse
Affiliation(s)
- Anthony Djurkov
- Community Mental Health and Drug and Alcohol Service, Broken Hill Hospital, NSW, Australia.
| | | |
Collapse
|
45
|
Nor NAM, Yusof ZY, Shahidan MNF. University of Malaya Dental Students’ Attitudes Towards Communication Skills Learning: Implications for Dental Education. J Dent Educ 2011. [DOI: 10.1002/j.0022-0337.2011.75.12.tb05222.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
46
|
Portnoy DB, Han PKJ, Ferrer RA, Klein WMP, Clauser SB. Physicians' attitudes about communicating and managing scientific uncertainty differ by perceived ambiguity aversion of their patients. Health Expect 2011; 16:362-72. [PMID: 21838835 DOI: 10.1111/j.1369-7625.2011.00717.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical interventions are often characterized by substantial scientific uncertainty regarding their benefits and harms. Physicians must communicate to their patients as part of the process of shared decision making, yet they may not always communicate scientific uncertainty for several reasons. One suggested by past research is individual differences in physicians' tolerance of uncertainty. Relatedly, an unexplored explanation is physicians' beliefs about their patients' tolerance of uncertainty. DESIGN To test this possibility, we surveyed a sample of primary care physicians (N = 1500) and examined the association between their attitudes about communicating and managing scientific uncertainty and their perceptions of negative reactions to uncertainty by their patients. Physician perceptions were measured by their propensity towards pessimistic appraisals of risk information and avoidance of decision making when risk information is ambiguous--of uncertain reliability, credibility or adequacy, known as 'ambiguity aversion'. RESULTS Confirming past studies, physician demographics (e.g. medical specialty) predicted attitudes toward communicating scientific uncertainty. Additionally, physicians' beliefs about their patients' ambiguity aversion significantly predicted these preferences. Physicians who thought that more of their patients would have negative reactions to ambiguous information were more likely to think that they should decide what is best for their patients (β = 0.065, P = 0.013), and to withhold an intervention that had uncertainty associated with it (β = 0.170, P < 0.001). DISCUSSION When faced with the task of communicating scientific uncertainty about medical tests and treatments, physicians' perceptions of their patients' ambiguity aversion may be related to their attitudes towards communicating uncertainty.
Collapse
Affiliation(s)
- David B Portnoy
- Cancer Prevention Fellow, Cancer Prevention Fellowship Program, Center for Cancer Training, National Cancer Institute, Bethesda, MDBehavioral Research Program, National Cancer Institute, Bethesda, MDClinician Investigator, Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, MEProgram Director, Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute, Bethesda, MDDirector, Behavioral Research Program, National Cancer Institute, Bethesda, MD andChief, Outcomes Research Branch, Applied Research Program, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | |
Collapse
|
47
|
Noori K, Weseley AJ. Beyond Credentials: The Effect of Physician Sex and Specialty on How Physicians Are Perceived. CURRENT PSYCHOLOGY 2011. [DOI: 10.1007/s12144-011-9116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient's perspective. Ther Clin Risk Manag 2011; 4:269-86. [PMID: 18728716 PMCID: PMC2503662 DOI: 10.2147/tcrm.s1458] [Citation(s) in RCA: 616] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To explore and evaluate the most common factors causing therapeutic non-compliance. Methods A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance. Results A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory. Conclusion There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.
Collapse
Affiliation(s)
- Jing Jin
- Department of Pharmacy, National University of Singapore Republic of Singapore
| | | | | | | |
Collapse
|
49
|
Hale S, Grogan S, Willott S. Male GPs' views on men seeking medical help: A qualitative study. Br J Health Psychol 2010; 15:697-713. [DOI: 10.1348/135910709x479113] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
50
|
Wunderlich T, Cooper G, Divine G, Flocke S, Oja-Tebbe N, Stange K, Lafata JE. Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening. PATIENT EDUCATION AND COUNSELING 2010; 80:358-63. [PMID: 20667678 PMCID: PMC2971658 DOI: 10.1016/j.pec.2010.06.034] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 06/24/2010] [Accepted: 06/25/2010] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions. METHODS Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations. RESULTS 70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication. CONCLUSION Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening. PRACTICE IMPLICATIONS Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions.
Collapse
|