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Moya D, Guilabert M, Manzanera R, Gálvez G, Torres M, López-Pineda A, Jiménez ML, Mira JJ. Differences in Perception of Healthcare Management between Patients and Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3842. [PMID: 36900854 PMCID: PMC10001773 DOI: 10.3390/ijerph20053842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Patient perception and the organizational and safety culture of health professionals are an indirect indicator of the quality of care. Both patient and health professional perceptions were evaluated, and their degree of coincidence was measured in the context of a mutual insurance company (MC Mutual). This study was based on the secondary analysis of routine data available in databases of patients' perceptions and professionals' evaluations of the quality of care provided by MC Mutual during the period 2017-2019, prior to the COVID-19 pandemic. Eight dimensions were considered: the results of care, coordination of professionals, trust-based care, clinical and administrative information, facilities and technical means, confidence in diagnosis, and confidence in treatment. The patients and professionals agreed on the dimension of confidence in treatment (good), and the dimensions of coordination and confidence in diagnosis (poor). They diverged on confidence in treatment, which was rated worse by patients than by professionals, and on results, information and infrastructure, which were rated worse by professionals only. This implies that care managers have to reinforce the training and supervision activities of the positive coincident aspects (therapy) for their maintenance, as well as the negative coincident ones (coordination and diagnostic) for the improvement of both perceptions. Reviewing patient and professional surveys is very useful for the supervision of health quality in the context of an occupational mutual insurance company.
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Affiliation(s)
- Diego Moya
- Healthcare and Prevention Services Area, MC Mutual, 08037 Barcelona, Spain
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain
| | - Rafael Manzanera
- Healthcare and Prevention Services Area, MC Mutual, 08037 Barcelona, Spain
| | | | - Marta Torres
- Healthcare and Prevention Services Area, MC Mutual, 08037 Barcelona, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University, 03550 Sant Joan d'Alacant, Spain
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan d'Alacant, Spain
| | - María Lourdes Jiménez
- Department of Emergency Medicine, College of Medicine, University of the Philippines, Manila 1500, Philippines
| | - José Joaquín Mira
- Health Psychology Department, Miguel Hernández University, 03202 Elche, Spain
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan d'Alacant, Spain
- Alicante-Sant Joan d'Alacant Health Department, 03013 Alicante, Spain
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2
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Campbell M, Hagen BNM, Gohar B, Wichtel J, Jones-Bitton A. A qualitative study exploring the perceived effects of veterinarians' mental health on provision of care. Front Vet Sci 2023; 10:1064932. [PMID: 36825229 PMCID: PMC9941564 DOI: 10.3389/fvets.2023.1064932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Veterinary medicine is a rewarding, yet demanding profession with a myriad of occupational stressors that can impact the mental health of veterinarians. Stress, mental health outcomes, and associated risk factors amongst veterinarians have been well-researched. Much less research has investigated how high stress and/or poor mental health can impact veterinarians' provision of care. Methods One-on-one research interviews were conducted with 25 veterinarians at a Canadian veterinary conference in July 2016 and verbatim transcripts were produced from the audio recordings. The research team collaboratively analyzed the interviews using thematic analysis. Results Five themes described the perceived impacts of high stress and/or poor mental health: perceived negative impacts on interactions with (1) co-workers and (2) clients; (3) reduced concentration; (4) difficulty in decision making; and (5) reduced quality of care. Discussion These results highlight the perceived impacts of self-reported high stress and/or poor mental health on veterinary team dynamics, the potential to impact case outcomes, and possibly endanger patient safety. Interventions to help mitigate the impacts of high stress and poor mental health are discussed.
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Affiliation(s)
- Megan Campbell
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada,*Correspondence: Megan Campbell ✉
| | - Briana N. M. Hagen
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada
| | - Basem Gohar
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada,Centre for Research in Occupational Safety and Health, Sudbury, ON, Canada
| | - Jeffrey Wichtel
- Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Andria Jones-Bitton
- Department of Population Medicine, The University of Guelph, Guelph, ON, Canada
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3
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Caspi I, Freund O, Pines O, Elkana O, Ablin JN, Bornstein G. Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions. World J Clin Cases 2023; 11:821-829. [PMID: 36818615 PMCID: PMC9928691 DOI: 10.12998/wjcc.v11.i4.821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/12/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in patient care worldwide. Vaccinations, which have proven efficacious in lowering the COVID-19 hospital burden, are still avoided by large populations. We, therefore, hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.
AIM To evaluate whether patient vaccine hesitancy affected the hospital care team (HCT) perceptions.
METHODS We performed a prospective clinical study using structured questionnaires. We approached physicians and nurses with previous experience caring for COVID-19 patients from 11 medical centers across Israel during the fourth COVID-19 surge (September and October 2021). The participants completed a questionnaire with the following parts: (1) Sociodemographic characteristics; (2) Assessment of anger (STAXI instrument) and chronic workplace stress (Shirom-Melamed burnout measure); and (3) Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions (the difficult doctor-patient relation questionnaire, the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire). Results were evaluated according to each part of the questionnaire and the questionnaire as a whole. Associations between HCT perceptions and their baseline characteristics, anger or chronic workplace stress were assessed.
RESULTS The HCT experienced their relationship with unvaccinated patients as more difficult (P < 0.001, Cohen’s d = 0.85), perceived unvaccinated patients as responsible for their medical condition (P < 0.001, d = 1.39) and perceived vaccinated patients as having a higher character value (P < 0.001, d = 1.03). Unvaccinated patients were considered selfish (P < 0.001), less mature (P < 0.001) and less satisfying to care for (P < 0.001). The relationship with unvaccinated patients was more difficult among HCT with higher burnout (r = 0.37, n = 66, P = 0.002). No correlations with baseline characteristics were found. All three study tools showed high internal consistency (α between 0.72 and 0.845).
CONCLUSION Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients. In order to minimize the potential negative impact on patient care, designated departments should promote specific patient-centered preparations. Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.
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Affiliation(s)
- Inbar Caspi
- Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ophir Freund
- Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Omer Pines
- Behavioral Sciences Department, Academic College of Tel Aviv-Yaffo, Tel Aviv 6818211, Israel
| | - Odelia Elkana
- Behavioral Sciences Department, Academic College of Tel Aviv-Yaffo, Tel Aviv 6818211, Israel
| | - Jacob N Ablin
- Internal Medicine Department H, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv 6423906, Israel
| | - Gil Bornstein
- Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Natafgi N, Ladeji O, Blackwell S, Hong YD, Graham G, Cort M, Mullins CD. Similar values, different expectations: How do patients and providers view 'health' and perceive the healthcare experience? Health Expect 2022; 25:1517-1528. [PMID: 35411659 PMCID: PMC9327836 DOI: 10.1111/hex.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/11/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION No one can argue on the importance of health in one's life. However, the value of health in the context of other priorities for individuals is not always as clear. Further, patients' experience with the healthcare system is rarely contrasted with the service providers' expectations. The aim of this paper is to examine and compare patients' and providers' own definitions of health and their perceptions of the healthcare delivery experience from the lens of residents and providers in West Baltimore, Maryland. METHODS This was a qualitative study with semi-structured focus groups (15 sessions) and individual in-depth interviews (21 interviews) with 94 participants. Two independent coders thematically analysed the transcripts. RESULTS Patients identified five areas where health systems can help them stay healthy or become healthier: affordability and costs of care; accessibility; clinician/patient communication; addressing social determinants; and stigma and trust. Providers acknowledged that the healthcare experience is not always perfect. While the medical team focuses on conversations that enhance medical care, patients are expecting providers to touch on subjects beyond medical care. CONCLUSIONS Patients and providers need to consider that although they have a common value towards health, there is still a gap in what users expect and what providers can offer. To further align those expectations, there is a need for increasing involvement of patient in care administration and improving dialogue between the parties about these differences. PATIENT OR PUBLIC CONTRIBUTION A Stakeholder Advisory Board (SAB)-comprised of a patient, two community leaders, a physician and two healthcare administrators-was instrumental in codeveloping the study material (e.g., interview guides), engaging patients in the research process, identifying participants and codeveloping dissemination material. Two SAB members-Gail Graham, a patient consultant/professor, and Marcia Cort, a physician-are coauthors.
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Affiliation(s)
- Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Olayinka Ladeji
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA
| | - Shanikque Blackwell
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Yoon Duk Hong
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA
| | - Gail Graham
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA.,Mt. Lebanon Baptist Church HIV/AIDS Outreach Services, Baltimore, Maryland, USA
| | - Marcia Cort
- University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, School of Pharmacy, The PATIENTS Program, University of Maryland, Baltimore, Maryland, USA
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5
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Blanchard MP, Pad RA, Groh C, Huprich SK. Measures of Personality Pathology, Levels of Functioning, and Physical Health in an Urban Primary Care Sample. J Clin Psychol Med Settings 2022; 29:875-885. [PMID: 35113315 DOI: 10.1007/s10880-022-09846-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
Integrative approaches in the primary care setting have grown in favor over the past few decades, with many interesting findings about the influence of personality disorders on physical health and functioning; however, less is known about how specific pathological personality traits impact patient-provider assessments of physical and mental health. Using the DSM-5 Levels of Personality Functioning Questionnaire-Short Form (DLOPFQ-SF) and Personality Inventory for DSM-5-Brief Form, these relationships were evaluated in a sample of 50 inner-city, low-income patients in a primary care clinic. Point-biserial correlations revealed significant correlations between physical and mental health morbidities, as well as personality pathology and patient response to treatment. Our findings lend further support to describing the relationships between personality pathology, medical comorbidities, and patient response to treatment.
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Affiliation(s)
- Mark P Blanchard
- Department of Psychology, University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48221-3038, USA
| | - Rachel A Pad
- Department of Psychology, University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48221-3038, USA
| | - Carla Groh
- Department of Psychology, University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48221-3038, USA
| | - Steven K Huprich
- Department of Psychology, University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48221-3038, USA.
- Michigan State University College of Human Medicine, Lansing, MI, USA.
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Harrison K. Compassion Fatigue: Understanding Empathy. Vet Clin North Am Small Anim Pract 2021; 51:1041-1051. [PMID: 34218949 DOI: 10.1016/j.cvsm.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In clinical medicine, empathy is considered a central feature of holistic caretaking and successful patient interaction. It is unclear whether characteristics of empathy are innate, learned, or a combination of both. The means to evaluate clinical empathy are ill-defined, but perception of empathy has been shown to influence patient outcomes as well as professional well-being. This article reviews what is known about empathy in a medical setting and how it relates to negative mental health outcomes, such as compassion fatigue.
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Affiliation(s)
- Kelly Harrison
- University of Florida College of Veterinary Medicine, 2015 Southwest 16(th)Avenue, Gainesville, FL 32608, USA.
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Important Aspects Influencing Delivery of Serious News in Pediatric Oncology: A Scoping Review. CHILDREN-BASEL 2021; 8:children8020166. [PMID: 33671570 PMCID: PMC7926514 DOI: 10.3390/children8020166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/10/2023]
Abstract
Delivering serious news presents a major challenge for clinical practice in pediatric oncology due to the complexity of the communication process and a number of aspects that influence how the serious news is delivered and received. This study aims to review and explore the aspects influencing the delivery of serious news in pediatric oncology from the perspective of physicians, parents, siblings and patients themselves. The MEDLINE, Embase, Scopus, Cochrane Library, PsycInfo and Medvik databases were systematically searched for relevant articles published from 1990 to 2017. Following the Preferred Reporting Items for Systematic Review and Meta-analysis extension for scoping reviews (PRISMA-ScR) guidelines, 36 original papers were included. Identified aspects of communication were categorized into six thematic groups: initial setting, physician’s approach, information exchange, parental role, illness related aspects and age of the ill child. The importance of the aspects is perceived differently by parents, patients, siblings and physicians. This scoping review highlights that delivering serious news requires an individualized approach towards the patient and the family. Ten key objectives built upon the results of the literature review offer guidance for daily clinical practice in communication with pediatric patients and their families.
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8
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Leung S, Panda M, McIntosh G, Kurbanova N, Rimer Uhelski AC, Sheikh MM, Qayyum R. Relationship Between Physician Burnout and Patient's Perception of Bedside Time Spent by Physicians. J Patient Cent Res Rev 2021; 8:58-63. [PMID: 33511254 DOI: 10.17294/2330-0698.1764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although the adverse effect of burnout on physicians has been widely documented, studies have shown an inconsistent relationship between burnout and the quality of patient care. We hypothesized that physician burnout will have an inverse relationship with the time spent at the bedside by physicians. In a cross-sectional study, we surveyed patients on their perception of the time spent by their physician on the day of the survey (4 categories: 0-5, 6-10, 11-15, >15 minutes). Oldenburg Burnout Inventory was used to assess physician burnout; burnout was defined as high levels of both exhaustion (≥2.25) and disengagement (≥2.10). Among the 1374 patients, the most commonly reported time spent at bedside category was 6-10 minutes (n=614, 45%). Among the 95 physicians who saw these patients, burnout was present in 44 (46%), with a higher prevalence in women (61% vs 39%; P=0.04). Using ordered logistic regression, we found no relationship between physician burnout and patient's perception of bedside time spent, without adjustment (odds ratio: 0.86, 95% CI: 0.65-1.16) or with adjustment (odds ratio: 0.85, 95% CI: 0.64-1.12) for potential confounders. Although physician burnout is not associated with patient perception of time spent at bedside, it may be associated with other patient outcomes that require further research.
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Affiliation(s)
- Shannon Leung
- Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Mukta Panda
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Georgia McIntosh
- Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Nargiza Kurbanova
- Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Anna-Carson Rimer Uhelski
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN.,Johns Hopkins Hospital, Baltimore, MD
| | | | - Rehan Qayyum
- Division of Hospital Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
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9
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Röttele N, Schöpf-Lazzarino AC, Becker S, Körner M, Boeker M, Wirtz MA. Agreement of physician and patient ratings of communication in medical encounters: A systematic review and meta-analysis of interrater agreement. PATIENT EDUCATION AND COUNSELING 2020; 103:1873-1882. [PMID: 32376141 DOI: 10.1016/j.pec.2020.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine the agreement of physician and patient ratings of communication in medical face-to-face consultations. METHODS A systematic search of twelve databases was conducted. Studies investigating agreement between physician and patient ratings of communication in medical face-to-face encounters and reporting interrater agreement were included. Methodological quality was assessed, and study characteristics and physician-patient agreement were narratively summarized. Meta-analysis was conducted for a subsample of the included studies investigating shared decision making. RESULTS Of the 17 included studies, ten studies did not demonstrate any correspondence between physician and patient ratings. The remaining seven studies revealed poor to fair absolute agreement (κ between .13 and .42; κw between .31 and .49; 95% CI 0.13 - 0.76) and poor to moderate consistency (r = .17 and .06; rpolyc between .39 and .63; p < .05). Meta-analysis of six studies yielded small association (rpolyc = .15). CONCLUSION Physicians and patients evaluate communication differently and at best, only slightly agree in their ratings, indicating that the construct of communication is not measurable in a stable manner. PRACTICE IMPLICATIONS Decision makers and researchers should be aware that they assess different aspects of communication, depending on the perspective examined. PROSPERO registration number: CRD42019120065.
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Affiliation(s)
- Nicole Röttele
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Andrea C Schöpf-Lazzarino
- Division of General Practice/Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sonja Becker
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus A Wirtz
- Department of Research Methods, Freiburg University of Education, Freiburg, Germany
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Coylewright M, Keevil JG, Xu K, Dodge SE, Frosch D, Field ME. Pragmatic Study of Clinician Use of a Personalized Patient Decision Aid Integrated into the Electronic Health Record: An 8-Year Experience. Telemed J E Health 2020; 26:597-602. [DOI: 10.1089/tmj.2019.0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan Coylewright
- Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Clinical Practice and Health Policy, Lebanon, New Hampshire, USA
| | - Jon G. Keevil
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Keren Xu
- Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shayne E. Dodge
- Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Dominick Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Michael E. Field
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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11
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Mitchell KAR, Brassil KJ, Fujimoto K, Fellman BM, Shay LA, Springer AE. Exploratory Factor Analysis of a Patient-Centered Cancer Care Measure to Support Improved Assessment of Patients' Experiences. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:351-361. [PMID: 32197731 PMCID: PMC7086403 DOI: 10.1016/j.jval.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/26/2019] [Accepted: 10/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To increase the understanding of patient-centered care (PCC) and address the need for cross-cutting quality cancer care measures that are relevant to both patients and providers. METHODS An exploratory factor analysis (EFA) was performed on a short version of the Patients and the Cancer Care Experience Survey, a patient-reported measure of perceived importance of social, emotional, physical, and informational aspects of care, administered to adult patients (n = 104) at a National Cancer Institute-designated comprehensive cancer center. Relationships between PCC dimensions and patient characteristics were also assessed. Principal axis factoring was applied and bivariate analyses were performed using Wilcoxon rank-sum tests. RESULTS Most of our sample was over 60 years old (63.4%), female (57.4%), and white (74.2%), with either breast (41.2%) or prostate cancer (27.5%). A 5-factor model was identified: (1) quality of life (α = .91), (2) provider social support (α = .83), (3) psychosocial needs (α = .91), (4) nonprovider social support (α = .79), and (5) health information and decision-making support (α = .88). No statistically significant associations were found between these factors and patients' characteristics. CONCLUSIONS A preliminary factor structure for a cancer PCC measure was identified. Our findings reinforce the interrelated nature of PCC dimensions. The lessons learned from this study may be used to develop a single PCC measure that identifies patient priorities across the cancer care continuum. Data collected from such a measure can be used to support patient engagement in treatment planning and decision-making.
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Affiliation(s)
- Kerri-Anne R Mitchell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA; Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laura Aubree Shay
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
| | - Andrew E Springer
- Department of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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13
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Nelson SM, Huprich SK, Meehan KB, Siefert C, Haggerty G, Sexton J, Dauphin VB, Macaluso M, Zackula R, Baade L, Jackson J. Convergent and Discriminant Validity and Utility of the DSM–5 Levels of Personality Functioning Questionnaire (DLOPFQ): Associations with Medical Health Care Provider Ratings and Measures of Physical Health. J Pers Assess 2019; 100:671-679. [DOI: 10.1080/00223891.2018.1492415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | | | - James Sexton
- Professional Psychology Department, George Washington University, USA
| | | | - Matthew Macaluso
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, USA
| | - Rosalee Zackula
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, USA
| | - Lyle Baade
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, USA
| | - Jennifer Jackson
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, USA
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Klumb PL, Wicki C, Rauers A. Physicians' Interactions with Peers: Empathic Accuracy during Shift Handovers on Intensive-Care Units. Appl Psychol Health Well Being 2018; 11:102-125. [DOI: 10.1111/aphw.12146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Antje Rauers
- Max-Planck-Institute for Human Development; Berlin Germany
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15
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Patients' perceived needs of health care providers for low back pain management: a systematic scoping review. Spine J 2018; 18:691-711. [PMID: 29373836 DOI: 10.1016/j.spinee.2018.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/19/2017] [Accepted: 01/10/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Optimal management of low back pain (LBP) involves patients' active participation in care, facilitated by positive interactions with their health care provider(s) (HCP). An understanding of patients' perceived needs regarding their HCP is, therefore, necessary to achieve such outcomes. Therefore, the aim of the present study is to review the existing literature regarding patients' perceived needs of HCP managing LBP. METHODS A systematic scoping review of publications in MEDLINE, EMBASE, CINAHL, and PsycINFO (1990-2016) was performed. Descriptive data regarding study design and methodology were extracted, and risk of bias was assessed. Aggregates of patients' perceived needs of HCP for LBP were categorized. RESULTS Forty-three studies (30 qualitative, 12 quantitative, and 1 mixed methods) from 1,829 were relevant. Four areas of perceived need emerged: (1) there are several characteristics of HCP that patients desire, such as good communication and shared decision-making; (2) patients wanted HCP to provide information, including a cause of their LBP and legitimization of their symptoms; (3) patients' valued holistic, individualized care, and continuity of care; and (4) patients perceived long waiting times, difficulties with access to treatment, cost, and personal effort to be obstacles to care. CONCLUSIONS Patients with LBP want patient-centered care, to be actively involved, and they have identified characteristics of HCP that foster a good provider-patient relationship. They noted areas of dissatisfaction with HCP and perceived obstacles to care. Given limited health care resources, HCP and policy makers need to implement novel methods of health care delivery that address these issues to facilitate improved patient satisfaction and achieve better patient and health system outcomes.
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Breaking bad news in the emergency department: a comparative analysis among residents, patients and family members’ perceptions. Eur J Emerg Med 2018; 25:71-76. [DOI: 10.1097/mej.0000000000000404] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Federman AD, Sanchez-Munoz A, Jandorf L, Salmon C, Wolf MS, Kannry J. Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design. J Am Med Inform Assoc 2018; 24:e61-e68. [PMID: 27497793 DOI: 10.1093/jamia/ocw106] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/29/2016] [Indexed: 11/13/2022] Open
Abstract
Objective We explored patients' and clinicians' perspectives on electronic health record (EHR)-generated outpatient after-visit summaries (AVSs) to inform efforts to maximize the document's utility. Materials and Methods This qualitative study involved focus groups and semistructured interviews with patients ( n = 39) and clinicians ( n = 56) in adult primary care practices serving socioeconomically diverse communities in New York City; Long Island, New York; and Chicago, Illinois. Focus group and interview transcripts were coded and analyzed following standard qualitative methods. Results Core themes included the use and purpose of the AVS, content modification and prioritization, formatting improvements, customization, privacy and accuracy concerns, and clinician workflow concerns. While most patients valued the document as a visit summary, others considered it a general summary of their health and health care issues, useful for sharing with family or clinicians even if they had access to their health records via web portals. Patients expressed a preference for the order of content items, and many wanted the reasons for medications and referrals stated. Additionally, some patients were confused by multiple medication lists indicating started, stopped, and modified medications, and a single "current" medication list was preferred by both patients and doctors. Concerns were raised about the risk of violating patient privacy and challenges to clinician workflow. Discussion The AVS is valued by patients and clinicians. Both groups have identified numerous ways it can be improved, but also several obstacles to improvement and effective use. Conclusion EHR vendors should work with stakeholder groups to improve the AVS to ensure that this important communication device achieves its patient-centered potential.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Angela Sanchez-Munoz
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Lina Jandorf
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | | | - Michael S Wolf
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joseph Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York
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Zhang K, Day C, Iorio ML. Concordance of Patient and Physician Perceptions of Care in an Orthopedic Clinic. Orthopedics 2017; 40:242-246. [PMID: 28437547 DOI: 10.3928/01477447-20170418-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023]
Abstract
It is essential to study whether physicians' perceptions align with their patients' views, as understanding patient perception leads to superior satisfaction and health outcomes. Previous studies have established differences in physician-patient perceptions, but no studies have been conducted in orthopedic clinics. The authors' primary goal was to evaluate differences in physician and patient perceptions of an orthopedic clinic visit. Their secondary objective was to determine the influence of visit length, demographics, and depression risk-level on patient satisfaction. The authors surveyed 143 new patients being seen by orthopedic surgeons at a level I trauma center. After their appointment, these patients completed surveys on satisfaction and likelihood of depression. The authors recorded wait times and visit lengths. Simultaneously, the physicians completed a self-evaluative satisfaction survey. Patients' and physicians' answers were compared using a Wilcoxon signed-rank test. Mann-Whitney and Spearman correlation analyses were used to assess factors that impact satisfaction. Physicians and patients showed no significant differences on most questions of the satisfaction survey, except that physicians reported feeling less satisfied with their own explanations (P<.001). Length of visit was positively correlated with patient satisfaction (R=0.276, P=.001), while waiting times had no effect. Patients at risk for depression were less satisfied with physicians' effort to include them in decision-making (P=.044). Age was a predictor of greater satisfaction with explanations (P=.032) and instructions (P=.009) from the physician. Thus, orthopedic clinics may not exhibit the same physician-patient perception patterns as primary care clinics, potentially because of differences in patient populations, conditions, or expectations. [Orthopedics. 2017; 40(4):242-246.].
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Shim EJ, Park JE, Yi M, Jung D, Lee KM, Hahm BJ. Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients. BMC WOMENS HEALTH 2016; 16:65. [PMID: 27756287 PMCID: PMC5069888 DOI: 10.1186/s12905-016-0347-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/11/2016] [Indexed: 12/04/2022]
Abstract
Background Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum. Methods In-depth interviews with seven breast cancer patients were carried out. Results Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as ‘a disease of the mind’, which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important. Conclusion Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questions. Electronic supplementary material The online version of this article (doi:10.1186/s12905-016-0347-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Korea
| | - Jee Eun Park
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Myungsun Yi
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Dooyoung Jung
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kwang-Min Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Bong-Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Integrated Cancer Care Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Using tablets in medical consultations: Single loop and double loop learning processes. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Characteristics of outpatient clinical summaries in the United States. Int J Med Inform 2016; 94:75-80. [PMID: 27573314 DOI: 10.1016/j.ijmedinf.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/20/2022]
Abstract
In the United States, federal regulations require that outpatient practices provide a clinical summary to ensure that patients understand what transpired during their appointment and what to do before the next visit. To determine whether clinical summaries are appropriately designed to achieve these objectives, we examined their content and formatting and their usability. We obtained a convenience sample of clinical summaries from 13 diverse practices across the U.S. and assessed their characteristics using validated measures. We also interviewed key informants at these practices to assess their views of the documents. The summaries were generated by seven different electronic health record platforms. They had small font sizes (median, 10 point) and high reading grade levels (median, 10). Suitability, measured with the Suitability Assessment of Materials was low (median score, 61%) and understandability and actionability, measured with the Patient Education Materials Assessment Test, were fair to moderate (65% and 78%, respectively). Content and order of content were inconsistent across the summaries. Among physicians, 46% found the summaries helpful for clarifying medications while 38% found them helpful for conveying follow-up information. Results suggest that clinical summaries in the U.S. may often be suboptimally designed for communicating important information with patients. A patient-centered approach to designing them is warranted.
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Concordance between patient satisfaction and the dentist's view: findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2016; 145:355-62. [PMID: 24686969 DOI: 10.14219/jada.2013.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction. METHODS Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction. RESULTS Most dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which dentists were not aware of this dissatisfaction. CONCLUSION For improved patient-centered care, dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed. PRACTICAL IMPLICATIONS By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.
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Goh JX, Rad A, Hall JA. Bias and accuracy in judging sexism in mixed-gender social interactions. GROUP PROCESSES & INTERGROUP RELATIONS 2016. [DOI: 10.1177/1368430216638530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This research examined bias and accuracy in judging hostile and benevolent sexism during mixed-gender interactions. Bias is defined as underestimation or overestimation of a partner’s sexism. Accuracy is defined as covariation in two different ways, as (a) the strength of the association between a dyad member’s judgment and their partner’s sexism, across dyads, and (b) the ability to differentiate sexism between multiple targets. In Studies 1 and 2, members of mixed-gender dyads rated their own and their partners’ benevolent and hostile sexism. Overall, there was no covariation, across dyads, between perceptions and the partner’s self-reported sexism. However, women overestimated men’s hostile sexism; there was no evidence of biases for women judging men’s benevolent sexism. Men underestimated women’s hostile sexism and overestimated benevolent sexism. In Study 3, participants watched brief videos of male or female students (targets) from Study 1 and completed benevolent or hostile sexism items for each target as they thought the target would fill them out. Accuracy for detecting sexism across multiple targets (using sensitivity correlations) was significantly above chance for both forms of sexism. Male and female participants were more accurate at detecting hostile sexism in male targets than female targets. Participants were more accurate at detecting benevolent sexism of same-gender targets than opposite-gender targets. When judging targets of opposite gender, women’s judgments were significantly above chance for both forms of sexism, but men were not accurate for either forms of sexism. These studies suggest that there is bias and accuracy in first impression judgments of sexism.
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Nawaz H, Via CM, Ali A, Rosenberger LD. Project ASPIRE: Incorporating Integrative Medicine Into Residency Training. Am J Prev Med 2015; 49:S296-301. [PMID: 26477907 PMCID: PMC4718078 DOI: 10.1016/j.amepre.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/05/2015] [Accepted: 07/21/2015] [Indexed: 11/27/2022]
Abstract
Griffin Hospital, a community hospital affiliated with Yale School of Public Health and Yale School of Medicine, received Health Resources and Services Administration funding to strengthen and improve its combined internal medicine and general preventive medicine residency program by incorporating an integrative medicine curriculum. The purpose of project ASPIRE (Advancing Skills of Preventive medicine residents through Integrative medicine Education, Research and Evaluation) was to create, implement, and evaluate a needs-based, innovative training curriculum in integrative medicine. Through this robust new training, the authors aimed to produce preventive medicine-trained physicians with competencies in integrative medicine to collaboratively work with other integrative medicine practitioners in interdisciplinary teams to provide holistic, patient-centered care. The multifaceted collaborative curriculum was composed of didactics, grand rounds, journal club, objective structured clinical examinations, and two new practicum rotations in integrative medicine. The new practicum rotations included block rotations at the Integrative Medicine Center at Griffin Hospital and the Yale Stress Center. Between 2012 and 2014, three cohorts participated in the curriculum; two of these cohorts included three advanced preventive medicine residents each and the fourth included four residents. Project faculty conducted 14 lectures and journal clubs, and two grand rounds. Six of the ten participating residents (60%) completed integrative medicine clinical rotations. Residents' attitudes toward integrative medicine were evaluated through self-assessment using the Complementary, Alternative, and Integrative Medicine Attitudes Questionnaire; data were analyzed in 2015. This article describes the results of this prospective observational study based on single-institution experience over the course of the 2-year project period.
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Affiliation(s)
- Haq Nawaz
- Department of Preventive Medicine, Griffin Hospital, Derby, Connecticut.
| | - Christina M Via
- Department of Preventive Medicine, Griffin Hospital, Derby, Connecticut
| | - Ather Ali
- Department of Pediatrics, Yale Stress Center, Yale School of Medicine, New Haven, Connecticut
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Sebo P, Herrmann FR, Haller DM. How do GPs in Switzerland perceive their patients' satisfaction and expectations? An observational study. BMJ Open 2015; 5:e007085. [PMID: 26063565 PMCID: PMC4466691 DOI: 10.1136/bmjopen-2014-007085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess doctors' perceptions of their patients' satisfaction and expectations in primary care. STUDY DESIGN Cross-sectional study using questionnaires completed by general practitioners (GPs) and their patients. SETTING Primary care practices in Geneva, Switzerland. PARTICIPANTS 23 GPs from a random list of 75 GPs practising in the canton of Geneva (participation rate 31%), who each recruited between 50 and 100 consecutive patients coming to the practice for a scheduled medical consultation, leading to a total of 1637 patients (participation rate: 97%, women: 63%, mean age: 54 years). Patient exclusion criteria were: new patients, those consulting in an emergency situation or suffering from disorders affecting their ability to consent, and those who did not speak French. MAIN OUTCOME MEASURES Patients satisfaction with and expectations from the care they received in this practice; GPs perceptions of their patient's satisfaction and expectations. RESULTS GPs underestimated all patient satisfaction items (p<0.001 for all items) whereas they overestimated their expectations, except for equipment (laboratory and X-ray) and some accessibility items. In a multivariate analysis to assess which GP factors were associated with correct assessment of their patients' views, only GPs' certification status was a significant factor. CONCLUSIONS GPs tend to underestimate patients' satisfaction but overestimate their expectations in primary care. These findings may help GPs to understand patients' views in order to adequately meet their expectations and concerns.
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Affiliation(s)
- Paul Sebo
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, 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
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Moret L, Anthoine E, Gillet N, Fouquereau E, Colombat P. Organisation du travail, démarche participative et satisfaction des patients hospitalisés : une évaluation dans 47 services d’oncohématologie. PSYCHO-ONCOLOGIE 2014. [DOI: 10.1007/s11839-014-0466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ekberg K, Grenness C, Hickson L. Addressing patients' psychosocial concerns regarding hearing aids within audiology appointments for older adults. Am J Audiol 2014; 23:337-50. [PMID: 25036799 DOI: 10.1044/2014_aja-14-0011] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/27/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE It has long been documented that patients may experience emotional reactions to a diagnosis of hearing impairment and recommendation of hearing aids. Because of this, patients may raise psychosocial concerns regarding their hearing rehabilitation during audiology appointments, particularly in relation to getting hearing aids. However, thus far there has been little systematic research exploring how patients' concerns about hearing aids are addressed by audiologists within appointments. METHOD This study used conversation analysis to examine a corpus of 63 video-recorded initial audiology appointments with older adults with hearing impairment. RESULTS The findings demonstrated that when patients expressed concerns regarding hearing aids, these concerns were typically psychosocial in nature and expressed in a way that carried a negative emotional stance. These types of turns thus invited an empathic response. However, patients' concerns were not typically addressed by audiologists during the appointment. As a consequence, patients persistently re-raised their concerns in subsequent turns, leading to expanded sequences of interaction during the management phase of the appointment. CONCLUSIONS Older adults' psychosocial concerns regarding hearing aids may not always be sufficiently addressed within audiology appointments. A greater emphasis on emotionally focused communication within audiology could result in improved outcomes from hearing health care services.
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Affiliation(s)
- Katie Ekberg
- University of Queensland, St. Lucia, Queensland, Australia
| | - Caitlin Grenness
- HEARing Cooperative Research Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Louise Hickson
- University of Queensland, St. Lucia, Queensland, Australia
- HEARing Cooperative Research Centre, Melbourne, Victoria, Australia
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Powell AA, White KM, Partin MR, Halek K, Hysong SJ, Zarling E, Kirsh SR, Bloomfield HE. More than a score: a qualitative study of ancillary benefits of performance measurement. BMJ Qual Saf 2014; 23:651-8. [PMID: 24522176 DOI: 10.1136/bmjqs-2013-002149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prior research has examined clinical effects of performance measurement systems. To the extent that non-clinical effects have been researched, the focus has been on negative unintended consequences. Yet, these same systems may also have ancillary benefits for patients and providers--that is, benefits that extend beyond improvements on clinical measures. The purpose of this study is to identify and describe potential ancillary benefits of performance measures as perceived by primary care staff and facility leaders in a large US healthcare system. METHODS In-person individual semistructured interviews were conducted with 59 primary care staff and facility leaders at four Veterans Health Administration facilities. Transcribed interviews were coded and organised into thematic categories. RESULTS Interviewed staff observed that local performance measurement implementation practices can result in increased patient knowledge and motivation. These effects on patients can lead to improved performance scores and additional ancillary benefits. Performance measurement implementation can also directly result in ancillary benefits for the patients and providers. Patients may experience greater satisfaction with care and psychosocial benefits associated with increased provider-patient communication. Ancillary benefits of performance measurement for providers include increased pride in individual or organisational performance and greater confidence that one's practice is grounded in evidence-based medicine. CONCLUSIONS A comprehensive understanding of the effects of performance measurement systems needs to incorporate ancillary benefits as well as effects on clinical performance scores and negative unintended consequences. Although clinical performance has been the focus of most evaluations of performance measurement to date, both patient care and provider satisfaction may improve more rapidly if all three categories of effects are considered when designing and evaluating performance measurement systems.
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Affiliation(s)
- Adam A Powell
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katie M White
- School of Public Health Center for Care Organization Research and Development (CCORD), University of Minnesota, Minneapolis, Minnesota, USA
| | - Melissa R Partin
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Krysten Halek
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Sylvia J Hysong
- Houston Center for Quality of Care and Utilization Studies, Michael E DeBakey VA Medical Center, Houston, Texas, USA Baylor College of Medicine, Houston, Texas, USA
| | - Edwin Zarling
- Rosalind Franklin School of Medicine, North Chicago, Illinois, USA
| | - Susan R Kirsh
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hanna E Bloomfield
- Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Farin E, Gramm L, Schmidt E. Predictors of communication preferences in patients with chronic low back pain. Patient Prefer Adherence 2013; 7:1117-27. [PMID: 24187489 PMCID: PMC3810494 DOI: 10.2147/ppa.s50695] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances). METHODS Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics). The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed. RESULTS On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%-19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs), extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician's communicative behavior. CONCLUSION Providers should take into consideration the fact that patients with back pain have a strong need for effective, open, and patient-centered communication. A flexible approach to communication needs appears to be especially important for communication about emotional and personal circumstances, because the patients differ most clearly in this respect. Personal characteristics provided only initial clues to possible preferences; for more precision, an individual assessment (by means of questionnaires or discussion) is needed.
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Affiliation(s)
- Erik Farin
- University Freiburg, Medical Center, Department of Quality Management and Social Medicine, Freiburg, Germany
- Correspondence: Erik Farin, University Freiburg Medical Center, Department of Quality Management and Social Medicine, Engelbergerstrasse 21, D-79106 Freiburg, Germany, Fax +49 76 1270 73310, Tel +49 761 2707 4430, Email
| | - Lukas Gramm
- University Freiburg, Medical Center, Department of Quality Management and Social Medicine, Freiburg, Germany
| | - Erika Schmidt
- University Freiburg, Medical Center, Department of Quality Management and Social Medicine, Freiburg, Germany
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Bradford L, Roedl SJ, Christopher SA, Farrell MH. Use of social support during communication about sickle cell carrier status. PATIENT EDUCATION AND COUNSELING 2012; 88:203-8. [PMID: 22658247 PMCID: PMC3409326 DOI: 10.1016/j.pec.2012.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/28/2012] [Accepted: 03/28/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine the use of social support behaviors by primary care providers during delivery of positive newborn screening results for Sickle Cell Anemia carrier status. METHODS Transcripts from 125 primary care providers who conveyed Sickle Cell Anemia carrier status to standardized parents were content analyzed using categories derived from Cutrona and Suhr's social support taxonomy. Frequencies and cross-tabulation matrices were calculated to study providers' social support utilization. RESULTS Results showed most primary care providers (80%) incorporate social support behaviors into delivery of Sickle Cell Anemia carrier results and most frequently employed social network (61.6%) and informational support (38.4%) behaviors. Providers used tangible aid (8%), esteem (1.6%), and emotional support (9.6%) behaviors less frequently. CONCLUSION Cutrona and Suhr's taxonomy may be a useful tool for assessing supportive communication during the delivery of Sickle Cell Anemia carrier status and could be incorporated into population scale assessments of communication quality assurance. PRACTICE IMPLICATIONS Primary care providers may need training in how to adapt supportive behaviors to parents' needs during communication of Sickle Cell Anemia carrier status. They also may benefit from specific training about how to use esteem and emotional support.
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Affiliation(s)
- Lisa Bradford
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee 53226, USA.
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The congruence of patient communication preferences and physician communication behavior in cardiac patients. J Cardiopulm Rehabil Prev 2012; 31:349-57. [PMID: 21826015 DOI: 10.1097/hcr.0b013e318228a341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to examine the communication preferences of patients with chronic ischemic heart disease (CIHD) and matching between the preferences and physician communication behavior. Prior to this, psychometric testing was performed on a questionnaire on the perceived communication behavior of the physician (KOVA Questionnaire). METHODS Patients with CIHD undergoing rehabilitation (N = 342) in Germany were questioned. At the beginning of rehabilitation, patients answered questions about their communication preferences (KOPRA Questionnaire), and at the end of rehabilitation, they answered questions regarding the perceived communication behavior of the physician. Preference-matching values were determined by combining the KOPRA and KOVA items. RESULTS The KOVA Questionnaire psychometric properties proved to be good. Patients with CIHD indicated clear and open communication and patient participation were especially important. This was followed by emotionally supportive communication and, finally, communication about personal things. Overall, the behavior of physicians corresponded quite closely with the patients' communication preferences. However, preference matching was low (the physicians demonstrated too little of the desired behavior) regarding the open communication of bad news and explanation of treatments. There was relatively high fulfillment of expectations on the part of patients in terms of seeking information from the physician, the physician's explanation of the diagnosis, and regarding aspects of shared decision making. We observed no gender differences, but did identify age-group differences. CONCLUSIONS The instruments developed (KOPRA and KOVA questionnaires) can be used for communication studies of patients with chronic conditions. However, some patient communication needs seem to require greater consideration from physicians.
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Miller KH, Ziegler C, Greenberg R, Patel PD, Carter MB. Why physicians should share PDA/smartphone findings with their patients: a brief report. JOURNAL OF HEALTH COMMUNICATION 2012; 17 Suppl 1:54-61. [PMID: 22548599 DOI: 10.1080/10810730.2011.649102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many physicians use PDAs/smartphones in the presence of their patients. But how do patients perceive this behavior? This study tested the hypothesis that participants with increased knowledge about medical applications of PDAs/smartphones have more positive perceptions of physicians using them. The authors assigned 250 patients and/or family members in medical or pharmacy waiting rooms at 2 universities to either the control group or the treatment group. The treatment group viewed a brief presentation about how and why physicians use PDAs/smartphones, whereas the control group received no new information. All participants completed a survey about their knowledge (7 items) and perceptions (13 items) of physician use of PDAs/smartphones. The treatment group showed more favorable perceptions (p < .05) on 5 out of 13 survey items. In addition, in the control group, those who showed "high knowledge" had more favorable perceptions (p < .05) on 8 out of 13 survey items compared with control group participants with "low/moderate knowledge" levels. The authors concluded that even a small amount of information increases measurable perceptions. This study suggests that perhaps physicians should take time to share their PDA/smartphone findings with their patients to improve patients' perceptions of their use.
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Affiliation(s)
- Karen Hughes Miller
- University of Louisville School of Medicine, Louisville, Kentucky 40202, USA.
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Ratanawongsa N, Wright SM, Vargo EM, Carrese JA. Challenges in primary care relationships: seeing it from both sides. PATIENT EDUCATION AND COUNSELING 2011; 85:40-45. [PMID: 20828976 DOI: 10.1016/j.pec.2010.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 07/26/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This qualitative study explored perspectives of primary care providers and patients in challenging relationships. METHODS In 2007, we conducted semi-structured interviews with providers recruited from 12 clinics affiliated with a U.S. academic center. Providers identified patients with whom they had ongoing "challenging relationships," and we interviewed the first consenting patient for each provider. We compared numeric ratings of relationship quality statistically. Using an editing analysis style, ≥2 investigators coded transcripts to identify themes. RESULTS Seventeen dyads participated. Providers averaged 14 years in practice. Most were Caucasian (88%) and female (59%). The mean patient age was 49 years, 59% were Caucasian, and 71% female. Relationships averaged 4.6 years. On a 1-10 scale, patients' ratings of the relationship quality (median 9) significantly exceeded providers' ratings (median 5, p=0.002). Three major themes emerged: patients view relationships more positively than providers, the challenges of guarding emotions, and trust matters in challenging relationships. CONCLUSION Patients felt more positively about these relationships than providers perceived. Both sought ways to achieve mutual trust, despite barriers arising from guarded emotions. PRACTICE IMPLICATIONS Providers in challenging relationships should consider exploring their patients' views, as they may feel reassured that patients appreciate their efforts and have trust in them.
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Affiliation(s)
- Neda Ratanawongsa
- Division of General Internal Medicine, San Francisco General Hospital, Center for Vulnerable Populations, University of California, San Francisco 94110, USA.
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Hall JA. Clinicians' accuracy in perceiving patients: its relevance for clinical practice and a narrative review of methods and correlates. PATIENT EDUCATION AND COUNSELING 2011; 84:319-324. [PMID: 21592718 DOI: 10.1016/j.pec.2011.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE A relatively unexplored aspect of clinicians' communication skill is their interpersonal sensitivity, or ability to perceive their patients accurately with regard to patients' feelings, desires, intentions, needs, physical states, personality, attitudes, beliefs, and values. The present article argues for the importance of this skill in clinical interactions and summarizes supportive research. METHODS Reviews approaches to measuring interpersonal sensitivity and research on correlates of clinicians' and laypersons' interpersonal sensitivity. RESULTS Studies on clinicians' interpersonal sensitivity suggest that this skill could be improved. Furthermore, there are important correlates of clinicians' interpersonal sensitivity, including, on the patient's side, satisfaction, appointment-keeping adherence, and learning of conveyed information, and, on the clinician's side, awareness of patients' cues of anxiety and distress, commitment to patient-centered values, self-reported awareness of own emotions, and female gender. Furthermore, a very large non-clinical literature points to many other correlates of interpersonal sensitivity that are relevant to the clinical situation, including empathy, prosocial behavior, skill in negotiating, selling, teaching, and managing, better personal adjustment, and better interpersonal relationships. Research also suggests that interpersonal sensitivity is a trainable skill that could realistically be included in clinical education. CONCLUSION Clinicians' interpersonal sensitivity is an important component of quality of care and deserves further research. PRACTICE IMPLICATIONS This important skill should be incorporated into training programs to improve clinician-patient communication.
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Affiliation(s)
- Judith A Hall
- Department of Psychology, Northeastern University, Boston, MA, USA.
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Aarts JWM, Faber MJ, van Empel IWH, Scheenjes E, Nelen WLDM, Kremer JAM. Professionals' perceptions of their patients' experiences with fertility care. Hum Reprod 2011; 26:1119-27. [PMID: 21393300 DOI: 10.1093/humrep/der054] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-centredness is one of the core dimensions of quality of care. It can be monitored with surveys measuring patients' experiences with care. The objective of the present study was to determine to what extent gynaecologists, physicians specializing in infertility and nurses can estimate the level of patient-centredness of their clinic. METHODS A random sample of 1189 couples with fertility problems and 194 physicians and nurses from 29 Dutch fertility clinics participated in this cross-sectional study. Differences between patients' experiences with fertility care and professionals' perceptions of these experiences as measured with the patient-centredness questionnaire-infertility (PCQ-infertility) were calculated. The questionnaire's structure, comprising one total scale (level 1), seven subscales (level 2) and 46 single items (level 3), was used as a framework. RESULTS Response rates were 75% (n = 888) in the patient sample and 83% (n = 160) in the professional sample. Independent sample t-tests, corrected for multiple comparisons with the Bonferroni correction method (P < 0.05), showed no significant differences in mean scores on the total scale of patient-centredness for either professionals or patients. At level 2, professionals underestimated most subscales, namely, 'Accessibility', 'Communication', 'Patient involvement' and 'Competence', whereas 'Continuity of care' was overestimated. Professionals significantly and clinically relevantly misjudged 29 care aspects. CONCLUSIONS Professionals within fertility care cannot adequately evaluate their performance regarding patient-centredness, and specifically the care aspects to which their own patients attribute the greatest improvement potential. Providing detailed feedback might start improvement of patient-centredness and quality of care.
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Affiliation(s)
- J W M Aarts
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, HB Nijmegen, The Netherlands.
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Shapiro J. Perspective: Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2011; 86:326-32. [PMID: 21248595 DOI: 10.1097/acm.0b013e3182088833] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Emotions--one's own and others'--play a large role in the lives of medical students. Students must deal with their emotional reactions to intellectual and physical stress, the demanding clinical situations to which they are witness, as well as patients' and patients' family members' often intense feelings. Yet, currently few components in formal medical training--in either direct curricular instruction or physician role modeling--focus on the emotional lives of students. In this article, the author examines patients', medical students', and physician role models' emotions in the clinical context, highlighting challenges in all three of these arenas. Next, the author asserts that the preponderance of medical education continues to address the emotional realm through ignoring, detaching from, and distancing from emotions. Finally, she presents not only possible theoretical and conceptual models for developing ways of understanding, attending to, and ultimately "working with" emotions in medical education but also examples of innovative curricular efforts to incorporate emotional awareness into medical student training. The author concludes with the hope that medical educators will consider making a concerted effort to acknowledge emotions and their importance in medicine and medical training.
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Affiliation(s)
- Johanna Shapiro
- Program in Medical Humanities & Arts, University of California, Irvine, School of Medicine, Irvine, California, USA.
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Farin E, Gramm L, Kosiol D. Development of a questionnaire to assess communication preferences of patients with chronic illness. PATIENT EDUCATION AND COUNSELING 2011; 82:81-88. [PMID: 20219317 DOI: 10.1016/j.pec.2010.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 02/08/2010] [Accepted: 02/10/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE the objectives of the study are to develop a patient-oriented and theory-based questionnaire on the communication preferences of chronically ill patients (KOPRA questionnaire) and to carry out psychometric testing of the instrument. METHODS following two preliminary studies (focus groups, cognitive interviews), a total of 472 patients with chronic back pain or chronic ischemic heart disease were surveyed. In the main sample (N=333), communication preferences regarding the physician were assessed; for N=89 (or N=50) patients, preferences regarding nursing staff (or therapists) were analyzed. Psychometric testing was done with respect to unidimensionality, fit to an item response theory (IRT) model, and for reliability. The questionnaire was developed and validated in German. RESULTS In the physician version with a total of 32 items, there are four scales ("Patient participation and patient orientation", "Effective and open communication", "Emotionally supportive communication", and "Communication about personal circumstances") that are unidimensional, fulfill the demands for a 1-parameter IRT model, and are reliable (Cronbach's alpha between .80 and .92). The psychometric properties with respect to nursing staff and therapists are slightly worse. CONCLUSION the KOPRA questionnaire has good psychometric properties. PRACTICE IMPLICATIONS clinical use of the questionnaire appears useful to determine patients' communication preferences.
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Affiliation(s)
- Erik Farin
- University Medical Center Freiburg, Dept. of Quality Management and Social Medicine, Engelbergerstr. 21, D-79106 Freiburg, Germany.
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How well do doctors know their patients? Factors affecting physician understanding of patients' health beliefs. J Gen Intern Med 2011; 26:21-7. [PMID: 20652759 PMCID: PMC3024116 DOI: 10.1007/s11606-010-1453-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/11/2010] [Accepted: 06/29/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND An important feature of patient-centered care is physician understanding of their patients' health beliefs and values. OBJECTIVE Determine physicians' awareness of patients' health beliefs as well as communication, relationship, and demographic factors associated with better physician understanding of patients' illness perspectives. DESIGN Cross-sectional, observational study. RESEARCH PARTICIPANTS: A convenience sample of 207 patients and 29 primary care physicians from 10 outpatient clinics. APPROACH AND MEASURES: After their consultation, patients and physicians independently completed the CONNECT instrument, a measure that assesses beliefs about the degree to which the patient's condition has a biological cause, is the patient's fault, is one the patient can control, has meaning for the patient, can be treated with natural remedies, and patient preferences for a partnership with the physician. Physicians completed the measure again on how they thought the patient responded. Active patient participation (frequency of questions, concerns, acts of assertiveness) was coded from audio-recordings of the consultations. Physicians' answers for how they thought the patient responded to the health belief measure were compared to their patients' actual responses. Degree of physician understanding of patients' health beliefs was computed as the absolute difference between patients' health beliefs and physicians' perception of patients' health beliefs. KEY RESULTS Physicians' perceptions of their patients' health beliefs differed significantly (P<0.001) from patients' actual beliefs. Physicians also thought patients' beliefs were more aligned with their own. Physicians had a better understanding of the degree to which patients believed their health conditions had personal meaning (p=0.001), would benefit from natural remedies (p=0.049), were conditions the patient could control (p=0.001), and wanted a partnership with the doctor (p=0.014) when patients more often asked questions, expressed concerns, and stated their opinions. Physicians were poorer judges of patients' beliefs when patients were African-American (desire for partnership) (p=0.013), Hispanic (meaning) (p=0.075), or of a different race (sense of control) (p=0.024). CONCLUSIONS Physicians were not good judges of patient's health beliefs, but had a substantially better understanding when patients more actively participated in the consultation. Strategies for increasing physicians' awareness of patients' health beliefs include preconsultation assessment of patients' beliefs, implementing culturally appropriate patient activation programs, and greater use of partnership-building to encourage active patient participation.
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Park JS, Ryu JS, Lee SM, Yim JJ, Yoo CG, Kim YW, Han SK, Shim YS, Yang SC. Influence of additional post-bronchoscopy visit on patient satisfaction after flexible bronchoscopy. Korean J Intern Med 2010; 25:392-8. [PMID: 21179277 PMCID: PMC2997968 DOI: 10.3904/kjim.2010.25.4.392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 05/03/2010] [Accepted: 05/04/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Many patients undergoing a flexible bronchoscopy (FB) experience anxiety and discomfort during the procedure. We assessed whether an additional patient visit after a FB would improve patient satisfaction. METHODS The study patients were randomly assigned to a control and post-visit groups. The physicians who were scheduled to perform the FB visited the study patients. The control group had one visit before the FB and the post-visit group had a before and after FB visit. The post-visit group received additional information and support during the second visit. Twenty-four hours after the FB, the participants completed questionnaires about discomfort and satisfaction with the procedure. RESULTS The control and post-visit groups included 151 and 153 patients, respectively. The post-visit group reported having more information after the FB than the control group. The additional post-bronchoscopy visit improved the general patient tolerability of the procedure. The willingness to return for another FB was not affected by the post-bronchoscopy patient visit. CONCLUSIONS The post-bronchoscopy visit improved patient satisfaction and general tolerability to the procedure. Subjective patient tolerability with the FB may be improved through a post-bronchoscopy visit by providing more information and emotional support to patients.
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Affiliation(s)
- Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Seon Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Soo Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Lee YY, Lin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient-physician relationships and health outcomes. Soc Sci Med 2010; 71:1811-8. [PMID: 20933316 DOI: 10.1016/j.socscimed.2010.08.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 06/02/2010] [Accepted: 08/16/2010] [Indexed: 11/26/2022]
Abstract
As health care systems seek to provide patient-centered care as a cornerstone of quality, the link between patient-centeredness and patient outcomes is a concern. Past research reveals inconsistent findings regarding the impact of patient-centeredness on patient outcomes, and few studies have investigated the factors that moderate this relationship. Most studies have used self-rated outcomes on a cross-sectional basis, even though most patient care is inherently longitudinal. The current study extends past research by examining the theoretical and empirical relationships between patients' perceptions of autonomy support and autonomy preferences with regard to their health outcomes. We hypothesized that autonomy preferences moderate the positive relationships between perceived autonomy support and patient-physician relationships, and on self-rated and objective health outcomes such that the relationships are more positive when patient autonomy preferences are high. Data were collected 3 times over a one-year period from a sample of 614 patients with type 2 diabetes in Taiwan. The results revealed strong support for the hypothesized relationships between perceived autonomy support and patient trust, satisfaction, and mental health-related quality of life (HRQoL) after adjusting for baseline scores; however, the direct link between autonomy support and patients' glycemic control was not significant. Specifically, patients with high decisional preference experienced a greater increase in subsequent trust and satisfaction than patients with low decisional preference. Further, patients with high information preference had a higher level of satisfaction over time than patients with low information preference. In addition, it was found that perceived autonomy support improved both physical and mental HRQoL but only if combined with high levels of information preference. This study provides evidence of a contingency perspective of the relationship between patient autonomy support and outcomes. By recognizing the uniqueness of each patient's autonomy preferences, healthcare practitioners can increase the efficiency of patient-centered care and improve patient outcomes.
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Affiliation(s)
- Yin-Yang Lee
- Department of Health Management, I-Shou University, No1, Sec 1, Syuecheng Rd, Dashu Township, Kaohsiung County 840, Taiwan.
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Nonverbal sensitivity in medical students: implications for clinical interactions. J Gen Intern Med 2009; 24:1217-22. [PMID: 19771481 PMCID: PMC2771239 DOI: 10.1007/s11606-009-1107-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 05/21/2009] [Accepted: 08/21/2009] [Indexed: 12/30/2022]
Abstract
BACKGROUND Clinicians' accuracy in perceiving nonverbal cues has potentially important consequences, but has received insufficient research. OBJECTIVE To examine the relation of medical students' nonverbal sensitivity to their gender and personal traits, as well as to their communication and impressions made during a standardized patient (SP) visit. DESIGN Psychometric testing, questionnaire, and observation. SETTING One US medical school. PARTICIPANTS Two-hundred seventy-five third-year medical students. MEASUREMENTS Nonverbal sensitivity and attitudes were measured using standard instruments. Communication during the SP visit was measured using trained coders and analogue patients who viewed the videotapes and rated the favorability of their impressions of the student. RESULTS Nonverbal sensitivity was higher in female than male students (P < 0.001) and was positively correlated with self-reported patient-centered attitudes (P < 0.01) and ability to name one's own emotions (P < 0.05). It was also associated with less distressed (P < 0.05), more dominant (P < 0.001), and more engaged (P < 0.01) behavior by the SP, and with more liking of the medical student (P < 0.05) and higher ratings of compassion (P < 0.05) by the analogue patients. Correlations between nonverbal sensitivity and other variables were generally stronger and different for male than female students, but nonverbal sensitivity predicted analogue patients' impressions similarly for male and female students. CONCLUSION Medical students' nonverbal sensitivity was related to clinically relevant attitudes and behavioral style in a clinical simulation.
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Physician burnout and patient-physician communication during primary care encounters. J Gen Intern Med 2008; 23:1581-8. [PMID: 18618195 PMCID: PMC2533387 DOI: 10.1007/s11606-008-0702-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 05/27/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors. OBJECTIVE To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters. DESIGN Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment. SETTING Fifteen urban community-based clinics in Baltimore, MD. PARTICIPANTS Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured. MEASUREMENTS Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician. RESULTS The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust. CONCLUSIONS Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.
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Tang TS, Stansfield RB, Oh M, Anderson RM, Fitzgerald JT. Patient-provider perceptions of diabetes and its impact on self-management: a comparison of African-American and White patients. Diabet Med 2008; 25:341-8. [PMID: 18307461 DOI: 10.1111/j.1464-5491.2007.02371.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To compare patient-provider differences in diabetes-related perceptions between African-American and White patients and to examine its association with self-care behaviours. METHODS One hundred and thirty patient-provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes-related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes-related perceptions. Patients also reported the frequency of performing self-care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. RESULTS There were a greater number of patient-provider differences in diabetes-related perceptions for the African-American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients' semantic differential scores to be significantly associated with five self-care behaviours for African-American patients and two self-care behaviours for White patients. Providers' semantic differential scores emerged as predictors of self-care behaviours for African-American patients, but not for White patients. CONCLUSIONS Our findings suggest that compared with White patients, African-Americans differ in a greater number of diabetes-related perceptions than their providers. Patients' and providers' perceptions of diabetes care concepts have a significant impact on a greater number of self-care behaviours for African-American patients than White patients.
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Affiliation(s)
- T S Tang
- University of Michigan Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA.
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Moret L, Rochedreux A, Chevalier S, Lombrail P, Gasquet I. Medical information delivered to patients: discrepancies concerning roles as perceived by physicians and nurses set against patient satisfaction. PATIENT EDUCATION AND COUNSELING 2008; 70:94-101. [PMID: 17988822 DOI: 10.1016/j.pec.2007.09.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 08/09/2007] [Accepted: 09/23/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess and to compare roles as perceived by physicians and nurses regarding medical information delivered to patients and to set this against patients' opinions on the quality of the medical information delivered to them. METHODS A questionnaire administered to 302 physicians (MDs) and 533 nurses (NUs), and an inpatient satisfaction survey administered to 1246 patients the day before discharge, as a part of a quality improvement program on patient information in a university hospital. RESULTS MDs and NUs reported that diagnosis and prognosis announcements were made by MDs alone. Concerning explanations about diagnosis, information on investigations, and benefits and risks of treatment, NUs considered that they provided information in addition to MDs, while MDs considered that it was generally they alone who delivered the information. Patients were generally very satisfied with information delivered, but more than 20% were not satisfied with information on benefits and risks of investigations and treatments. The most important problem underlined by NUs was that they lacked knowledge of the medical information delivered to patients by MDs (55%). CONCLUSION Perceived roles in the transmission of medical information to patients were very different between MDs and NUs. Patient satisfaction seemed to be greater where professional roles were clear-cut. Physicians did not recognise the primary role of the NUs. Lack of MD-NU collaboration affects the quality of patient care. PRACTICE IMPLICATIONS A better definition of the specific roles of MDs and NUs, their training in effective methods of asserting opinions and knowledge and in conducting collaborative ward rounds would be of benefit to patients.
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Frantsve LME, Kerns RD. Patient-provider interactions in the management of chronic pain: current findings within the context of shared medical decision making. PAIN MEDICINE 2007; 8:25-35. [PMID: 17244101 DOI: 10.1111/j.1526-4637.2007.00250.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article reviews the literature on patient-provider interactions among patients with chronic pain conditions with an emphasis on shared medical decision making. RESULTS Key findings suggest that: 1) patients with chronic pain and health care providers are likely to have opposing attitudes and goals, with patients seeking "to be understood as individuals" and struggling to have their pain concerns legitimized while their health care providers may place a greater focus on diagnosis and treatment than quality of life concerns; and 2) female patients may face additional challenges when communicating their pain concerns with providers. Increased emphasis on communication training and efforts to promote a shared decision making process are proposed as possible mechanisms to improve patient-provider interactions. CONCLUSIONS Treatment of chronic pain is often complex and may be further complicated when patients and health care providers have differing goals and attitudes concerning treatment. Difficulties in engaging in collaborative treatment decision making may result. Efforts to enhance patient-provider communication as well as to systematically examine nonspecific treatment factors are likely to promote effective management of chronic pain.
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Affiliation(s)
- Lisa Maria E Frantsve
- Psychology Service, VA Connecticut Healthcare System, Yale University School of Medicine, West Haven, Connecticut 06516, USA.
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Sierpina V, Levine R, Astin J, Tan A. Use of mind-body therapies in psychiatry and family medicine faculty and residents: attitudes, barriers, and gender differences. Explore (NY) 2007; 3:129-35. [PMID: 17362848 DOI: 10.1016/j.explore.2006.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mind-body medicine (MBM) approaches to many health problems have been well documented in the literature, including through multiple meta-analyses. Efficacy has been well demonstrated in conditions such as headache, irritable bowel syndrome, anxiety, fibromyalgia, hypertension, low back pain, depression, cancer symptoms, and postmyocardial infarction. However, an apparent disconnect (ie, translational block) prevents more widespread adoption of such therapies into practice. Biofeedback, relaxation therapy, hypnosis, guided imagery, cognitive behavioral therapy, and psychoeducational approaches are the domain of MBM we examined in assessing physician attitudes, beliefs, and practices. METHODS Using a Web-based survey, we obtained responses from 74 faculty and resident physicians in the Department of Family Medicine and the Department of Psychiatry. Our response rate was 69%. We conducted descriptive statistics, bivariate analysis, and multivariate analysis using a logistic regression model. Various statistics were chosen depending on the nature of analyzed variables. Synoptic tables are presented. RESULTS Comparing these cohorts, we found little difference between physicians in the two specialties, but substantial reports that barriers to the use of MBM were largely based on lack of training, inadequate expertise, and insufficient clinic time. Lack of expertise and insufficient clinic time were higher among family physicians than among psychiatrists. There was a high interest in both groups in learning relaxation techniques and meditation and lower interest in biofeedback and hypnosis. Female physicians were significantly more likely to use MBM, both with patients and for their own self-care, and were less likely to be concerned that recommending these therapies would make patients feel that their symptoms were being discounted. Female physicians also had significantly higher beliefs about the benefits of MBM on health disorders in several of the conditions examined, with a consistent though nonsignificant trend in others.
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Affiliation(s)
- Victor Sierpina
- University of Texas Medical Branch, Galveston, TX 77555-1123, USA.
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