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Haverfield MC, Carrillo Y, Itliong JN, Ahmed A, Nash A, Singer A, Lorenz KA. Cultivating Relationship-Centered Care: Patient, Caregiver, and Provider Communication Preferences for and Experiences with Prognostic Conversations. HEALTH COMMUNICATION 2024; 39:1256-1267. [PMID: 37165555 DOI: 10.1080/10410236.2023.2210383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Prognostic conversations present many challenges for patients, caregivers, and providers alike. Most research examining the context of prognostic conversations have used a more siloed approach to gather the range of perspectives of those involved, typically through the lens of patient-centered care. However, the mutual influence evident in prognostic conversations suggests a relationship-centered care model may be useful in cancer communication research. Similarities and differences in preferences for and experiences with prognostic conversations among oncology patients, caregivers, and providers (N = 32) were explored. Identified themes were then mapped to the principles of the relationship-centered care framework to extend our understanding of prognostic conversations and contribute to a new direction in the application of relationship-centered care. Findings suggest fewer similarities than differences, point to important discrepancies among participant perspectives, and reinforce the utility of relationship-centered care in identifying communication practices that enhance the prognostic conversation experience.
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Affiliation(s)
| | | | | | - Anum Ahmed
- Communication Studies, San José State University
| | - Amia Nash
- School of Public Health, University of California
| | - Adam Singer
- School of Medicine, University of California Los Angeles
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Department of Primary Care and Population Health, Stanford University School of Medicine
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Therapeutic alliance impact on analgesic outcomes in a real-world clinical setting: An observational study. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2022; 72:529-545. [PMID: 36651362 DOI: 10.2478/acph-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 01/20/2023]
Abstract
A good therapeutic alliance is relevant for healthcare providers exposed to patients' suffering, especially since patients and physicians may understand the painful experience differently. Our aim was to explore the impact of therapeutic alliance on analgesic outcomes in a real-world interdisciplinary pain unit (PU). A cross-sectional observational study was conducted on outpatients (n = 69) using opioids on a long-term basis for the treatment of chronic non-cancer pain, where clinical pharmacologists and pharmacists advised patients about their opioid treatment. Responses to the patient-doctor relationship questionnaire (PDRQ), sociodemographic and clinical information (pain level, quality of life and hospital use) were collected, whereas pharmacology data (analgesic prescription, adverse events, and compliance) were obtained from electronic health records. Patients were predominantly middle-aged (75 % women, 72 % retired), experiencing moderate pain (VAS 40-70 mm) on average, and under a high morphine equianalgesic dosage (95 ± 88 mg per day, mainly tapentadol or fentanyl). Patients with better PDRQ outcomes, and therefore better therapeutic alliance, showed lower pain intensity than patients with worse PDRQ outcomes (pain intensity: high scores 60 ± 47 mm and medium scores 60 ± 45 mm vs. low scores 80 ± 75 mm, p < 0.01). Along with this, pain intensity was lower when patients affirmed that, thanks to the health-care providers, they "gained new insight", "felt better", or "felt content with their doctor's treatment". What´s more, patients who affirmed "I benefit from the treatment" experienced increased pain relief (benefit 40 ± 30 vs. non-benefit 19 ± 26 mm, p = 0.010) and improved quality of life (benefit 33 ± 25 vs. non-benefit 18 ± 16 mm, p = 0.031). However, there was a percentage of patients who did not fully understand the provided information, which is something to be taken into account to improve in clinical routine. Therapeutic alliance supported by pharmacist experts on pain management can be an effective strategy to improve analgesic outcomes. Further efforts are needed to improve communication strategies for pain management. Future directions of research should include the analysis of the role of the pharmacist in poly-professional consultations as related to the advice of patients about their medication, and the mutual trust with the patients.
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O'Hanlon CE, Giannitrapani KF, Lindvall C, Gamboa RC, Canning M, Asch SM, Garrido MM, Walling AM, Lorenz KA. Patient and Caregiver Prioritization of Palliative and End-of-Life Cancer Care Quality Measures. J Gen Intern Med 2022; 37:1429-1435. [PMID: 34405352 PMCID: PMC9086093 DOI: 10.1007/s11606-021-07041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Development and prioritization of quality measures typically relies on experts in clinical medicine, but patients and their caregivers may have different perspectives on quality measurement priorities. OBJECTIVE To inform priorities for health system implementation of palliative cancer and end-of-life care quality measures by eliciting perspectives of patients and caregivers. DESIGN Using modified RAND-UCLA Appropriateness Panel methods and materials tailored for knowledgeable lay participants, we convened a panel to rate cancer palliative care process quality measure concepts before and after a 1-day, in-person meeting. PARTICIPANTS Nine patients and caregivers with experience living with or caring for patients with cancer. MAIN MEASURES Panelists rated each concept on importance for providing patient- and family-centered care on a nine-point scale and each panelist nominated five highest priority measure concepts ("top 5"). KEY RESULTS Cancer patient and caregiver panelists rated all measure concepts presented as highly important to patient- and family- centered care (median rating ≥ 7) in pre-panel (mean rating range, 6.9-8.8) and post-panel ratings (mean rating range, 7.2-8.9). Forced choice nominations of the "top 5" helped distinguish similarly rated measure concepts. Measure concepts nominated into the "top 5" by three or more panelists included two measure concepts of communication (goals of care discussions and discussion of prognosis), one measure concept on providing comprehensive assessments of patients, and three on symptoms including pain management plans, improvement in pain, and depression management plans. Patients and caregivers nominated one additional measure concept (pain screening) back into consideration, bringing the total number of measure concepts under consideration to 21. CONCLUSIONS Input from cancer patients and caregivers helped identify quality measurement priorities for health system implementation. Forced choice nominations were useful to discriminate concepts with the highest perceived importance. Our approach serves as a model for incorporating patient and caregiver priorities in quality measure development and implementation.
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Affiliation(s)
- Claire E O'Hanlon
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA. Claire.O'
| | - Karleen F Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care (POPC), Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raziel C Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mark Canning
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa M Garrido
- Partnered Evidence-Based Policy Resource Center (PEPReC), VA Boston Healthcare System Research & Development, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, USA
| | | | - Anne M Walling
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Mathew A, McQuinn H, Flynn DM, Ransom JC, Doorenbos AZ. Experiences of Military Primary Care Providers during Chronic Pain Visits: A Qualitative Descriptive Study. PAIN MEDICINE 2021; 23:1095-1105. [PMID: 34542638 DOI: 10.1093/pm/pnab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 07/30/2021] [Accepted: 09/18/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic pain complaints are the second most common reason for outpatient primary care visits, yet a comprehensive assessment of the processes and experiences of providers during a chronic pain visit is still lacking. This qualitative descriptive study aimed to conceptualize the processes and experiences that military primary care providers go through while they assess and manage chronic pain. SETTING Single US Army medical center. METHODS Semi-structured interviews with 12 military primary care providers. Interviews were audio-recorded, transcribed, and coded using qualitative software. Transcripts were analyzed using thematic analysis to identify emergent themes. RESULTS Three broad themes with associated sub-themes captured the processes and providers' experiences: 1) comprehending the pain story - asking the right questions regarding pain impact, navigating through complexities of the pain story, and conveying understanding of pain story back to the patient; 2) optimizing the pain story - perception of provider-patient disconnect on pain management goals, re-setting realistic goals, creating optimal individualized treatment plan, and evaluating treatment effectiveness; and 3) empathetic and therapeutic engagement with patients - trusting patients and fostering patient-provider relationship. A thematic map illustrates these provider experiences. CONCLUSIONS During chronic pain visits, the provider-patient disconnect on goals of chronic pain treatment presents a considerable challenge. Further in-depth studies on addressing provider-patient disconnect are warranted to identify solutions, which would help providers communicate realistic chronic pain management expectations to patients. The themes and sub-themes described in this study could serve as a guide for directing strategies to improve chronic pain visits in primary care.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago, USA.,College of Nursing, Christian Medical College, Vellore, India
| | | | | | | | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
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