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Harris M, Lau-Bogaardt T, Shifaza F, Attrill S. The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10359-7. [PMID: 39037662 DOI: 10.1007/s10459-024-10359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.
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Affiliation(s)
- Mikaela Harris
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Timothea Lau-Bogaardt
- School of Allied Health Science and Practice, The University of Adelaide, Level 4, Engineering Maths and Science Building North Terrace Campus, Adelaide, SA, 5005, Australia
| | - Fathimath Shifaza
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Stacie Attrill
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia.
- School of Allied Health Science and Practice, The University of Adelaide, Level 4, Engineering Maths and Science Building North Terrace Campus, Adelaide, SA, 5005, Australia.
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Tsukahara Y, Novak M, Takei S, Asif IM, Yamasawa F, Torii S, Akama T, Matsumoto H, Day C. International study of physicians' opinion on physician-patient sex concordance when treating athletes. PM R 2024; 16:331-338. [PMID: 37850371 DOI: 10.1002/pmrj.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The effect of physician-patient sex concordance in medicine has been reported in many studies. Whether physicians believe that the sex concordance between physician and athlete influences treatment has not been investigated. OBJECTIVE To determine whether physicians believe that the sex concordance between physician and athlete influences treatment. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS One thousand one hundred ninety-three sports medicine physicians in 51 countries. Participants were sports medicine physicians trained in orthopedics (n = 443 [37.1%]) and nonorthopedics (n = 750 [62.9%]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were asked to decide whether sex of the physician made them better suited to care for athletes of concordant or different sexes along with their personal background. RESULTS Orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians regarding the statement "MALE sports medicine physicians are better suited than their female counterparts to care for MALE athletes" (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.91, p = .02), and compared to sports medicine physicians based in Europe, those based in Asia agreed more to this statement (OR 7.91, 95% CI 4.60-13.60, p < .01). In addition, regarding the statement "FEMALE sports medicine physicians are better suited than their male counterparts to care for FEMALE athletes," compared to sports medicine physicians based in Europe, those based in Asia (OR 9.12, 95% CI 5.63-14.79, p < .01) and North America (OR 2.18, 95% CI 1.46-3.25, p < .01) agreed more and orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians (OR 0.61, 95% CI 0.39-0.93, p = .02) to this statement. CONCLUSIONS Sports medicine physicians trained in orthopedics felt sex concordance was less important than physicians trained in other specialties. Asian sports medicine physicians believed sex concordance was more important compared to physicians in other regions.
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Affiliation(s)
- Yuka Tsukahara
- Waseda Institute for Sport Sciences, Waseda University, Tokorozawa, Japan
- Faculty of Physical Education, Tokyo Women's College of Physical Education, Tokyo, Japan
| | - Melissa Novak
- Department of Family Medicine, Oregon Health and Science University, Portland, USA
| | - Seira Takei
- Waseda Institute of Human Growth and Development, Waseda University, Tokorozawa, Japan
| | - Irfan M Asif
- Department of Family and Community Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | | | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Takao Akama
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Hideo Matsumoto
- Public Interest Incorporated Foundation, Japan Sports Medicine Foundation, Tokyo, Japan
| | - Carly Day
- Department of Health and Kinesiology, Purdue University, West Lafayette, USA
- Franciscan Physician Network, West Lafayette, USA
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Rodin R, Stukel TA, Chung H, Bell CM, Detsky AS, Isenberg S, Quinn KL. Attending physicians' annual service volume and use of virtual end-of-life care: A population-based cohort study in Ontario, Canada. PLoS One 2024; 19:e0299826. [PMID: 38457383 PMCID: PMC10923452 DOI: 10.1371/journal.pone.0299826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/15/2024] [Indexed: 03/10/2024] Open
Abstract
IMPORTANCE Physicians and their practice behaviors influence access to healthcare and may represent potentially modifiable targets for practice-changing interventions. Use of virtual care at the end-of-life significantly increased during the COVID-19 pandemic, but its association with physician practice behaviors, (e.g., annual service volume) is unknown. OBJECTIVE Measure the association of physicians' annual service volume with their use of virtual end-of-life care (EOLC) and the magnitude of physician-attributable variation in its use, before and during the pandemic. DESIGN, SETTING AND PARTICIPANTS Population-based cohort study using administrative data of all physicians in Ontario, Canada who cared for adults in the last 90 days of life between 01/25/2018-12/31/2021. Multivariable modified Poisson regression models measured the association between attending physicians' use of virtual EOLC and their annual service volume. We calculated the variance partition coefficients for each regression and stratified by time period before and during the pandemic. EXPOSURE Annual service volume of a person's attending physician in the preceding year. MAIN OUTCOMES AND MEASURES Delivery of ≥1 virtual EOLC visit by a person's attending physician and the proportion of variation in its use attributable to physicians. RESULTS Among the 35,825 unique attending physicians caring for 315,494 adults, use of virtual EOLC was associated with receiving care from a high compared to low service volume attending physician; the magnitude of this association diminished during the pandemic (adjusted RR 1.25 [95% CI 1.14, 1.37] pre-pandemic;1.10 (95% CI 1.08, 1.12) during the pandemic). Physicians accounted for 36% of the variation in virtual EOLC use pre-pandemic and 12% of this variation during the pandemic. CONCLUSIONS AND RELEVANCE Physicians' annual service volume was associated with use of virtual EOLC and physicians accounted for a substantial proportion of the variation in its use. Physicians may be appropriate and potentially modifiable targets for interventions to modulate use of EOLC delivery.
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Affiliation(s)
- Rebecca Rodin
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thérèse A. Stukel
- ICES, Toronto and Ottawa, ON, Canada
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | | | - Chaim M. Bell
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allan S. Detsky
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sarina Isenberg
- Division of Palliative Care, Dept of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kieran L. Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto and Ottawa, ON, Canada
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Pakravan P, Lai J, Cavuoto KM. Demographics, Practice Analysis, and Geographic Distribution of Neuro-Ophthalmologists in the United States in 2023. Ophthalmology 2024; 131:333-340. [PMID: 37739230 DOI: 10.1016/j.ophtha.2023.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE To assess the demographic characteristics and geographic distribution of neuro-ophthalmologists practicing in the United States. DESIGN A cross-sectional study. PARTICIPANTS Neuro-ophthalmologists across the United States. METHODS In this cross-sectional study, public databases from the American Academy of Ophthalmology, North American Neuro-ophthalmology Society, American Neurological Association, and American Academy of Neurology were used to identify neuro-ophthalmologists in the United States as of April 2023. Providers' office locations were geocoded using ArcGIS pro, version 2.9 (Esri). Data on age, sex, and residency and fellowship training were collected. Analysis was performed using SPSS 28.0 (IBM Corp.). MAIN OUTCOME MEASURES Neuro-ophthalmologists' demographics, and information about their medical education, postgraduate education, residency training, fellowship training, years in practice, practice environment, and geographic distribution of neuro-ophthalmologists across the United States. RESULTS A total of 635 neuro-ophthalmologists (436 male, 68.7%) were identified. The majority (599, 94.3%) graduated from an allopathic medical school. Most of the 85 physicians who held a secondary graduate degree had a PhD (54, 63.5%). Although approximately three-quarters (429, 67.6%) completed their residency in ophthalmology, 159 (25%) had residency positions in neurology and 47 (7.4%) had residency positions in both. Approximately one-third (191, 30.0%) were trained in more than 1 fellowship, including oculoplastics (78, 12.3%) or pediatric ophthalmology (53, 8.3%). The average post-fellowship years of experience was 23.7±13.7 years, with 134 (21.1%) in their early career (< 10 years), 120 (18.9%) in their mid-careers (10-19 years), and 381 (60.0%) in their late careers (> 20 years). Male neuro-ophthalmologists had 10.5±1.1 more years of experience than female neuro-ophthalmologists (P < 0.001). Three states (Maine, South Dakota, Wyoming) and 2897 counties (93.2%) had no neuro-ophthalmologists. Counties without a neuro-ophthalmologist had lower median income (P < 0.001), lower access to a vehicle (P = 0.024), and lower rates of health insurance (P = 0.012). CONCLUSIONS Practicing neuro-ophthalmologists are mostly male and often are trained in more than 1 subspecialty. More than half of the practicing neuro-ophthalmologists are in their late careers, which may further exacerbate the existing geographic and socioeconomic disparities in access to neuro-ophthalmology. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Parastou Pakravan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - James Lai
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kara M Cavuoto
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Tan X, He Y, Ning N, Peng J, Wiley J, Fan F, Wang J, Sun M. Shared decision-making in the treatment of adolescents diagnosed with depression: A cross-sectional survey of mental health professionals in China. J Psychiatr Ment Health Nurs 2023. [PMID: 37882490 DOI: 10.1111/jpm.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
WHAT IS ALREADY KNOWN?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression. SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services. Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression. The positive preferences for providing information and family involvement in treatment decision-making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision-making actively. A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression. SDM-related training should be encouraged for MHPs to promote widespread SDM. ABSTRACT INTRODUCTION: Shared decision-making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well-documented. AIM This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. METHOD In this cross-sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision-Making Questionnaire-Physician Version (SDM-Q-Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. RESULTS The mean SDM-Q-Doc was 80.47 (±16.31). Within the six specific decision-making situations, most MHPs selected non-SDM (52.7%-71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision-making, working in an outpatient clinic and receiving SDM training (F = 23.582; p = .000; R2 = .198; adjusted R2 = .189). DISCUSSION Although the MHPs' self-rated score of SDM-Q-Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM-related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer-practitioner relationship. IMPLICATIONS FOR PRACTICE MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high-quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families.
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Affiliation(s)
- Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Yuqing He
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ni Ning
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Jiayuan Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - James Wiley
- School of Nursing, University of California, San Francisco, California, USA
| | - Fangxiu Fan
- Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, Hunan, China
| | - Jianjian Wang
- Clinical Nursing Teaching and Research Section, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- School of Nursing, Changsha Medical University, Changsha, Hunan, China
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Bernard L, Wang AR, Menez S, Henderson JM, Dighe A, Roberts GV, Stutzke C, Tuttle KR, Miller RT. Kidney Biopsy Utility: Patient and Clinician Perspectives from the Kidney Precision Medicine Project. Kidney Med 2023; 5:100707. [PMID: 37771916 PMCID: PMC10522985 DOI: 10.1016/j.xkme.2023.100707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Rationale & Objective Limited data exist on patient perspectives of the implications of kidney biopsies. We explored patients' perspectives alongside those of clinicians to better understand how kidney biopsies affect patients' viewpoints and the clinical utility of biopsies. Study Design Prospective Cohort Study. Setting & Participants Patient participants and clinicians in the Kidney Precision Medicine Project, a prospective cohort study of patients who undergo a research protocol biopsy, at 9 recruitment sites across the United States. Surveys were completed at enrollment before biopsy and additional timepoints after biopsy (participants: 28 days, 6 months; clinicians: 2 weeks). Analytical Approach Kappa statistics assessed prebiopsy etiology concordance between clinicians and participants. Participant perspectives after biopsy were analyzed using a thematic approach. Clinician ratings of clinical management value were compared to prebiopsy ratings with Wilcoxon matched-pairs signed-rank tests and paired t tests. Results A total of 167 participants undergoing biopsy (124 participants with chronic kidney disease [CKD], 43 participants with acute kidney injury [AKI]) and 58 clinicians were included in this study. CKD participants and clinicians had low etiology concordance for the 2 leading causes of CKD: diabetes (k = 0.358) and hypertension (k = 0.081). At 28 days postbiopsy, 46 (84%) participants reported that the biopsy affected their understanding of their diagnosis, and 21 (38%) participants reported that the results of the biopsy affected their medications. Participants also shared biopsy impressions in free-text responses, including impacts on lifestyle and concurrent condition management. The biopsy positively shifted clinician perceptions of the procedure's clinical management benefits, while perceptions of prognostic value decreased and diagnostic ratings remained unchanged. Limitations Our study did not have demographic data of clinicians and could not provide insight into postbiopsy experiences for participants who did not respond to follow-up surveys. Conclusions Participant perspectives of the personal implications of kidney biopsy can be integrated into shared decision-making between clinicians and patients. Enhanced biopsy reports and interactions between nephrologists and pathologists could augment the management and prognostic value of kidney biopsies. Plain-Language Summary The utility of kidney biopsy is debated among clinicians, and patients' perspectives are even less explored. To address these gaps, we synthesized perspectives from clinicians and patient participants of the Kidney Precision Medicine Project (KPMP). Both before and after biopsy, clinicians were surveyed on how the procedure affected their clinical management, diagnosis, and prognosis. After biopsy, participants shared how the procedure affected their diagnosis, medication, and lifestyle changes. Clinicians and patients shared an appreciation for the biopsy's impact on medical management but diverged in their takeaways on diagnosis and prognosis. These findings highlight the need for greater collaboration between patients and clinicians, particularly as they navigate shared decision-making when considering kidney biopsy.
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Affiliation(s)
- Lauren Bernard
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ashley R. Wang
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Menez
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joel M. Henderson
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Ashveena Dighe
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - Glenda V. Roberts
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
- Kidney Precision Medicine Project Patient Partner, Seattle, WA
| | - Christine Stutzke
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
- Kidney Precision Medicine Project Patient Partner, Seattle, WA
| | - Katherine R. Tuttle
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - R. Tyler Miller
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
| | - Kidney Precision Medicine Project
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
- Kidney Precision Medicine Project Patient Partner, Seattle, WA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
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Holmes CT, Huggins C, Knowles H, Swoboda TK, Kirby R, Alanis N, Bulga A, Schrader CD, Dunn C, Wang H. The Association of Name Recognition, Empathy Perception, and Satisfaction With Resident Physicians' Care Amongst Patients in an Academic Emergency Department. J Clin Med Res 2023; 15:225-232. [PMID: 37187709 PMCID: PMC10181348 DOI: 10.14740/jocmr4901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Background Recognition of the provider's name, provider empathy, and the patient's satisfaction with their care are patient-provider rapport measures. This study aimed to determine: 1) resident physicians' name recognition by patients in the emergency department; and 2) name recognition in association with patient perception of the resident's empathy and their satisfaction with the resident's care. Methods This was a prospective observational study. A patient recognizing a resident physician was defined as the patient remembering a resident's name, understanding the level of training, and understanding a resident's role in patient care. A patient's perception of resident physician empathy was measured by the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE). Patient satisfaction of the resident was measured utilizing a real-time satisfaction survey. Multivariate logistic regressions were performed to determine the association amongst patient recognition of resident physicians, JSPPPE, and patient satisfaction after adjustments were made for demographics and resident training level. Results We enrolled 30 emergency medicine resident physicians and 191 patients. Only 26% of studied patients recognized resident physicians. High JSPPPE scores were given by 39% of patients recognizing resident physicians compared to 5% of those who were not recognized (P = 0.013). High patient satisfaction scores were recorded in 31% of patients who recognized resident physicians compared to 7% who did not (P = 0.008). The adjusted odds ratios of patient recognition of resident physicians to high JSPPPE and high satisfaction scores were 5.29 (95% confidence interval (CI): 1.33 - 21.02, P = 0.018) and 6.12 (1.84 - 20.38, P = 0.003) respectively. Conclusions Patient recognition of resident physicians is low in our study. However, patient recognition of resident physicians is associated with a higher patient perception of physician empathy and higher patient satisfaction. Our study suggests that resident education advocating for patient recognition of their healthcare provider's status needs to be emphasized as part of patient-centered health care.
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Affiliation(s)
- Chad T. Holmes
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Charles Huggins
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Heidi Knowles
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Thomas K. Swoboda
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, Las Vegas, NV 89144, USA
| | - Ryan Kirby
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Naomi Alanis
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Alexandra Bulga
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Chet D. Schrader
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Cita Dunn
- TCU and UNTHSC School of Medicine, Fort Worth, TX 76107, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, Las Vegas, NV 89144, USA
- Corresponding Author: Hao Wang, Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA.
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Alameddine M, Otaki F, Bou-Karroum K, Du Preez L, Loubser P, AlGurg R, Alsheikh-Ali A. Patients’ and physicians’ gender and perspective on shared decision-making: A cross-sectional study from Dubai. PLoS One 2022; 17:e0270700. [PMID: 36048748 PMCID: PMC9436052 DOI: 10.1371/journal.pone.0270700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Delivering patient-centered care is a declared objective of many health delivery systems globally, especially in an era of value-based health care. It entails the active engagement of the patients in healthcare decisions related to their health, also known as shared decision making (SDM). Little is known about the role of gender in shaping the perspective of patients on their opportunity for engaging in SDM in the Arabian Gulf Region. The aim of this study is to investigate the role of gender in shaping patients’ perspectives toward their opportunity for SDM in Dubai, UAE. Methods This study utilized a cross-sectional survey consisting of sociodemographic questions and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). A total of 50 physicians (25 females and 25 males), practicing at a large private healthcare delivery network in Dubai, were recruited using convenience sampling. Ten patients of every recruited physician (5 male and 5 female) were surveyed (i.e., a total of 500 patients). Statistical analysis assessed the differences in patients’ perceptions of physician SDM attitude scores by physicians’ and patients’ gender using independent t-test, ANOVA-test, and Chi-square analyses. Findings A total of 50 physicians and 500 patients (250 male patients and 250 female patients) participated in this study. The odd of patients agreement was significantly lower for male physicians, compared to their female counterparts, on the following elements of SDM: the doctor precisely explaining the advantages and disadvantages of the treatment (OR = 0.55, 95%CI: 0.34–0.88, p = 0.012); the doctor helping them understand the information (OR = 0.47, 95%CI: 0.23–0.97, p = 0.038), the doctor asking about preferred treatment option (OR = 0.52, 95%CI: 0.35–0.77, p = 0.001), and the doctor thoroughly weighting the different treatment options (OR = 0.60, 95%CI: 0.41–0.90, p = 0.013). No significant associations were observed between patients’ gender and their perception of their opportunity for SDM. Likewise, no significant associations were observed between the same or different physician-patient gender and patients’ perception of physicians’ SDM attitudes. Statistically significant associations were observed between physician-patient gender and preferred treatment option for patients (p = 0.012). Conclusion Study findings suggest that while there were no differences in patients’ perspective on SDM by the gender of patients, significant differences were observed by the gender of physicians. Female physicians, compared to their male counterparts, were more engaged in SDM, with both male and female patients. Male physician-female patient dyad received the lowest scores on SDM. This could be explained by the cultural, social, and religious sensitivities that infiltrate the physician-patient relationship in the Arab contexts. Despite the multi-cultural nature of the country, some female patients may still experience some discomfort in opening up and in discussion preferences with male physicians. For physicians, striking the right balance between assertiveness and SDM is necessary within the cultural context, especially among male providers. Offering targeted learning and development programs on the importance and practice of SDM is also necessary to ensure equitable opportunity for engagement in SDM for all patients irrespective of the gender of their provider.
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Affiliation(s)
- Mohamad Alameddine
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Karen Bou-Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leon Du Preez
- Cardiac Anesthesiology, The City Hospital, Dubai Health Care City, Dubai, United Arab Emirates
| | | | - Reem AlGurg
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- * E-mail:
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Sugisawa H, Shimizu Y, Kumagai T, Shinoda T, Shishido K, Koda Y. Discordance between hemodialysis patients' reports and their physicians' estimates of adherence to dietary restrictions in Japan. Ther Apher Dial 2022; 26:1156-1165. [PMID: 35419948 DOI: 10.1111/1744-9987.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study examined the discordance between hemodialysis patients' reports and their physicians' estimates of dietary restriction adherence and related factors in Japan. METHODS In a cross-sectional survey of 6,644 outpatients, physicians who estimated higher and lower adherence than their patients' self-reported were categorized as overestimation and underestimation in terms of discordance, respectively. Possible factors included clinical indicators, patient characteristics related to negative stereotypes, and health beliefs related to statistical discrimination. RESULTS The concordance rate was .069 based on the weighted kappa coefficient. The coefficients of acceptable serum potassium, prevalence of diabetes, and self-efficacy on overestimates were .663 , -.126, and -.132, respectively. The coefficients of these factors on underestimates were -.589, .338, and .145, respectively. All these coefficients were significant. CONCLUSIONS The discordance may be high and is related to physicians' clinical data reliance, negative stereotypes about patient characteristics, and a lack of understanding of patients' health beliefs.
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Affiliation(s)
- Hidehiro Sugisawa
- International Graduate School for Advanced Studies, J. F. Oberlin University, Machida-city, Tokyo, Japan
| | - Yumiko Shimizu
- The Jikei University School of Nursing, Chofu-city, Tokyo, Japan
| | - Tamaki Kumagai
- Graduate School of Health Sciences at Odawara, International University of Health and Welfare, Odawara-city, Kanagawa, Japan
| | - Toshio Shinoda
- Faculty of Medical and Health Sciences, Tsukuba International University, Tsuchiura-city, Ibaraki, Japan
| | | | - Yutaka Koda
- Koda Medical and Dialysis Clinic, Tsubame-city, Niigata, Japan
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11
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Ashrafzadeh S, Peters GA, Buzney EA, Lee H, Asgari MM. Gender differences in dermatologist practice locations in the United States: A cross-sectional analysis of current gender gaps. Int J Womens Dermatol 2021; 7:435-440. [PMID: 34621956 PMCID: PMC8484981 DOI: 10.1016/j.ijwd.2021.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/02/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background The percentage of female dermatologists has increased from 6.9% in 1970 to 48.9% in 2017. Despite the changing gender composition of the dermatologist workforce, it is unknown whether there are gender-based differences in dermatology practice locations. Objective This study aimed to characterize gender-based differences in dermatology practice locations across the United States. Methods A cross-sectional study of all dermatologists in the 2020 Centers for Medicare and Medicaid Services Physician Compare Database was performed. The number of self-identified female dermatologists and total dermatologists in each county and state was tabulated, and Spearman's correlation coefficients between county-level demographic and socioeconomic characteristics and female practices were calculated. Results Among 11,911 dermatologists, 5945 (49.9%) self-identified as female and 5966 (50.1%) as male. Of the 1052 counties with a dermatologist, 291 (27.7%) had no female dermatologist and 149 (14.2%) had no male dermatologist. The percentage of female dermatologists in each state ranged from 18.4% to 62.2%. Female dermatologists practiced more in areas with a higher percentage of democratic voters (r = +0.22) and higher median household income (r = +0.18), and less in rural counties (r = -0.18) or counties with higher uninsured rates (r = -0.11). Conclusion Female dermatologists remain significantly underrepresented in some regions in the United States, particularly in the Mountain states and rural counties. As women continue entering the dermatologist workforce, these results can inform workforce planning strategies to improve the distribution and accessibility of dermatologists across the United States.
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Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Gregory A Peters
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth A Buzney
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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12
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Duong DK, Samuels EA, Boatright D, Wilson T. Association Between Emergency Medicine Clerkship Diversity Scholarships and Residency Diversity. AEM EDUCATION AND TRAINING 2021; 5:e10547. [PMID: 34099994 PMCID: PMC8166303 DOI: 10.1002/aet2.10547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To improve resident diversity, emergency medicine (EM) residencies across the United States have implemented financial scholarships to attract visiting medical students underrepresented in medicine (URiM). The impact of these scholarships on changes in residency racial and ethnic diversity is currently unknown. In this study, we describe characteristics of these visiting elective scholarships for underrepresented students and evaluate changes in residency racial and ethnic diversity after program implementation. METHODS From 2018 to 2019, we conducted a cross-sectional survey of EM residency programs with a visiting clerkship rotation scholarship for medical students URiM. Programs were identified for study inclusion using the Society for Academic Emergency Medicine's online directory of Visiting Elective Scholarship Programs for Underrepresented Minorities. Program characteristics were analyzed descriptively. Changes in residency racial and ethnic diversity were evaluated using an interrupted time series analysis. RESULTS Of 34 programs contacted, 20 responded. While there was some variability in funding sources, scholarship amounts, and application review, most scholarships were similar in implementation practices. Of the 20 program respondents, nine were able to provide complete data on residency race and ethnicity and were included in the time series analysis. After program implementation, the time series analysis showed a significant increase in both underrepresented minority EM residents overall and Black and Latinx EM residents in particular. CONCLUSION Emergency medicine visiting clerkship scholarship programs for medical students URiM vary in funding type and application review but had similar implementation practices. Residency programs increased their racial and ethnic diversity after program implementation. Future investigations are needed to determine specific factors contributing to the successful implementation of scholarship programs.
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Affiliation(s)
- David K. Duong
- From theDepartment of Emergency MedicineHighland HospitalAlameda Health SystemOaklandCAUSA
| | - Elizabeth A. Samuels
- theDepartment of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRIUSA
| | - Dowin Boatright
- and theDepartment of Emergency MedicineYale School of MedicineNew HavenCTUSA
| | - Taneisha Wilson
- theDepartment of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRIUSA
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13
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Kalavar M, Watane A, Sridhar J, Cavuoto KM. Surgeon demographic and surgical volume trends in adult strabismus surgery in the United States. J AAPOS 2021; 25:78.e1-78.e5. [PMID: 33711430 DOI: 10.1016/j.jaapos.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/18/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore the influence of career stage, gender, and age on procedural trends of surgeons performing strabismus surgery. METHODS Data on ophthalmologists who performed strabismus surgery and on the Medicare beneficiaries who underwent surgery between 2012 and 2017 was retrieved from Medicare Provider Utilization and Payment Data. RESULTS A total of 133 strabismus surgeons (78.9% male and 21.1% female) were reimbursed by Centers for Medicare and Medicaid Services for 10,598 strabismus procedures during the study period. The overall number of strabismus surgeries increased (P = 0.039) over time. Most surgeons were 50-59 years of age (n = 45 [33.8%]), with an average age of 54.5 ± 9.5 years. The number of services per physician did not differ by gender (85 ± 97 procedures/male surgeon and 60 ± 149 procedures/female surgeon [P = 0.13]). There was no difference in the gender proportion of physicians, with 0-9 post-fellowship years of experience (P = 0.32), but there were significantly more men with 10-19 (P = 0.003), 20-29 (P < 0.001), and 30-39 (P < 0.001) years of post-fellowship experience. There was no difference in the number of procedures performed between women and men 30-39 (P = 0.83) or 60-69 (P = 0.48) years of age; however, women 40-49 (P = 0.009) and 50-59 (P < 0.001) years of age performed significantly fewer procedures per surgeon than men. CONCLUSIONS Women performed significantly fewer surgeries midcareer compared to their male counterparts.
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Affiliation(s)
- Meghana Kalavar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Arjun Watane
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida
| | - Kara M Cavuoto
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida.
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14
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Soffer M, Cohen M, Azaiza F. The Moderating Role of Clinical Experience in the Relationship Between Patient Characteristics, Attributed Barriers to Mammography, Beliefs About Cancer, and Clinical Decisions: a Study of Israeli Arab Physicians. J Racial Ethn Health Disparities 2021; 9:731-737. [PMID: 33666896 DOI: 10.1007/s40615-021-01008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
This study examined whether clinical experience moderates the relationship between three potential physician biases (patient characteristics; cancer-related beliefs, i.e., traditional and fatalistic beliefs; and attributed barriers to mammogram performance) and clinical decisions (recommending and discussing mammography with Arab women patients). A survey was conducted among 146 randomly sampled (cluster sampling) Arab physicians who serve the Arab population in Israel. We found that the least experienced physicians recommended and discussed mammography to a lesser extent than experienced doctors. Less experienced physicians were also less inclined to discuss and recommend mammography to women with specific characteristics (religious women, women with lower education levels, and women who expressed high fatalistic beliefs) and held significantly higher traditional beliefs concerning cancer. The correlation between patient characteristics and clinical decision making was both direct and moderated by clinical experience (stronger for the least experienced and moderately experienced physicians). Cancer-related beliefs had a direct negative effect on recommending and discussing mammography. The findings suggest that greater clinical experience with Arab women patients might reduce physician bias pertaining to patient characteristics among less experienced doctors who serve patients of the same ethnicity. Nonetheless, the findings imply that anti-stigma interventions should not rely on prolonged contact and should be implemented among all physicians, regardless of their clinical experience.
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Affiliation(s)
- Michal Soffer
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.
| | - Miri Cohen
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
| | - Faisal Azaiza
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
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15
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Benedict K, Li Y, Molinari NAM, Jackson BR. Health Care Providers' Testing Practices for Coccidioidomycosis and Histoplasmosis in Patients With Community-Acquired Pneumonia-United States, 2020. Open Forum Infect Dis 2021; 8:ofab020. [PMID: 33575429 DOI: 10.1093/ofid/ofab020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/13/2021] [Indexed: 11/12/2022] Open
Abstract
Laboratory testing is required to distinguish coccidioidomycosis and histoplasmosis from other types of community-acquired pneumonia (CAP). In this nationwide survey of 1258 health care providers, only 3.7% reported frequently testing CAP patients for coccidioidomycosis and 2.8% for histoplasmosis. These diseases are likely underdiagnosed, and increased awareness is needed.
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Affiliation(s)
- Kaitlin Benedict
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yiman Li
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Noelle Angelique M Molinari
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Schumm MA, Ohev-Shalom R, Nguyen DT, Kim J, Tseng CH, Zanocco KA. Measuring patient perceptions of surgeon communication performance in the treatment of thyroid nodules and thyroid cancer using the communication assessment tool. Surgery 2020; 169:282-288. [PMID: 32980166 DOI: 10.1016/j.surg.2020.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thyroid surgeons are offering their patients less aggressive diagnostic and therapeutic management strategies for thyroid nodules and low-risk thyroid cancer in an effort to decrease overdiagnosis and overtreatment of indolent disease. Explaining the rationale for less aggressive management plans requires physicians to be effective communicators. We aimed to assess the communication skills of thyroid surgeons with the Makoul Communication Assessment Tool and to identify risk factors for poor communication. METHODS New adult patients with thyroid nodules or thyroid cancer presenting to a single tertiary-referral endocrine surgery clinic were enrolled from July 2018 through December 2019. Patients were administered the Communication Assessment Tool immediately after their clinical encounter. Outlier communication scores were identified, and clinical characteristics were compared between outlier and nonoutlier groups. RESULTS A total of 107 patients completed the Communication Assessment Tool. Mean (standard deviation) total and top box scores were 67 (6) and 86% (29%), respectively. Twenty-five patients (23%) were in the low-outlier group, defined by a total score below 67.5/70 or top box score below 82.25%. Other race and non-Hispanic patients (versus white race) were more likely low outliers (odds ratio 3.58, P = .048). The lowest scoring Communication Assessment Tool item overall was "the doctor encouraged me to ask questions" (78.5% top box). CONCLUSION We found communication to be perceived as excellent in the majority of patients; however, an opportunity for improvement was identified in 29% of participants. Significant differences in race and ethnicity between low outlier and nonoutlier communication score patients were observed, which warrants additional investigation. These findings support the utility of the Communication Assessment Tool in studying the effectiveness of communication improvement initiatives.
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Affiliation(s)
- Max A Schumm
- Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - Roben Ohev-Shalom
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Dalena T Nguyen
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jiyoon Kim
- Department of Biostatistics, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA
| | - Chi-Hong Tseng
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Kyle A Zanocco
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Saha S, Beach MC. Impact of Physician Race on Patient Decision-Making and Ratings of Physicians: a Randomized Experiment Using Video Vignettes. J Gen Intern Med 2020; 35:1084-1091. [PMID: 31965527 PMCID: PMC7174451 DOI: 10.1007/s11606-020-05646-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/26/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies suggest that black patients have better interactions, on average, with physicians of their own race. Whether this reflects greater "cultural competence" in race-concordant relationships, or other effects of race unrelated to physician behavior, is unclear. It is also unclear if physician race influences patient decision-making. OBJECTIVE To determine whether physician race affects patients' ratings of physicians and decision-making, independent of physician behavior. DESIGN Randomized study using standardized video vignettes. PARTICIPANTS Primary care patients with coronary risk factors or disease. INTERVENTIONS Each participant viewed one of 16 vignettes depicting a physician reviewing cardiac catheterization results and recommending coronary artery bypass graft (CABG) surgery. Vignettes varied only in terms of physicians' race, gender, age, and communication style (high vs. low patient-centeredness). MAIN MEASURES Participants rated the video physician's communication, interpersonal style, competence, trustworthiness, likability, and overall performance (0-4 Likert scales). They also rated the necessity of CABG (0-5 scale) and whether they would undergo CABG or obtain a second opinion if they were the video patient (0-3 scales). KEY RESULTS Participants included 107 black and 131 white patients (72% participation rate). Black participants viewing a black (vs. white) video physician gave higher ratings on all physician attributes (e.g., overall rating 3.22 vs. 2.34, p < 0.001) and were more likely to perceive CABG as necessary (4.05 vs. 3.72, p = 0.03) and say they would undergo CABG if they were the video patient (2.43 vs. 2.09, p = 0.004). Patient-centered communication style reduced, but did not eliminate, the impact of race concordance. Physician race was not associated with any outcomes among white patients. CONCLUSIONS Black patients viewed the doctor in a scripted vignette more positively, and were more receptive to the same recommendation, communicated in the same way, with a black vs. white physician. Patient-centered communication reduced but did not eliminate the effect of physician race.
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Affiliation(s)
- Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd. (P3HSRD), Portland, OR, USA.
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA.
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Berger JT, Miller DR. Denial and Dyads: Patients Whose Surrogates and Physicians Are Unrealistically Optimistic. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:29-31. [PMID: 30235103 DOI: 10.1080/15265161.2018.1498939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
AIM Recently, a growing awareness has developed of the extraordinary complexity of factors that influence the clinical reasoning underpinning the diagnostic process. The aim of the present report is to delineate these factors and suggest strategies for dealing more effectively with this complexity. METHOD Six major clusters of factors are described here: (A) individual characteristics of the decision maker, (B) individual intellectual and cognitive styles, (C) ambient and homeostatic factors, (D) factors in the work environment including team factors, (E) characteristics of the medical condition, and (F) factors associated with the patient. Additional factors, such as health care systems, culture, politics, and others are also important. RESULTS A review of the literature suggests that most clinicians trained under existing methods achieve a level of expertise presently referred to as "routine" or "classic." The results of studies of diagnostic failure, however, suggest that this level of expertise has proved insufficient. A growing literature suggests that more effective clinical decision might be achieved through adaptive reasoning, leading to enhanced levels of expertise and mastery. CONCLUSIONS It is proposed here that adaptive expertise may be achieved through emphasizing additional features of the reasoning process: being aware of the inhibitors and facilitators of rationality; pursuing the standards of critical thinking; developing a comprehensive awareness of cognitive and affective biases and how to mitigate them; developing a similar depth and understanding of logic and its fallacies; engaging metacognitive processes such as reflection and mindfulness; and through approaches embracing creativity, lateral thinking, and innovation.
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Affiliation(s)
- Pat Croskerry
- a Continuing Professional Development and Department of Emergency Medicine, Faculty of Medicine , Dalhousie University , Halifax , Canada
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Kelly-Blake K, Garrison NA, Fletcher FE, Ajegba B, Smith N, Brafford M, Bogdan-Lovis E. Rationales for expanding minority physician representation in the workforce: a scoping review. MEDICAL EDUCATION 2018; 52:925-935. [PMID: 29932213 DOI: 10.1111/medu.13618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 05/21/2023]
Abstract
OBJECTIVES The purpose of this study was to conduct a scoping review of the literature and to categorically map a 15-year trajectory of US undergraduate medical education rationales for and approaches to expanding under-represented minority (URM) physician representation in the medical workforce. Further aims were to comparatively examine related justifications and to consider international implications. METHODS From 1 June to 31 July 2015, the authors searched the Cochrane Library, ERIC, PsycINFO, PubMed, Scopus, Web of Science and Google Scholar for articles published between 2000 and 2015 reporting rationales for and approaches to increasing the numbers of members of URMs in undergraduate medical school. RESULTS A total of 137 articles were included in the scoping review. Of these, 114 (83%) mentioned workforce diversity and 73 (53%) mentioned concordance. The patient-physician relationship (n = 52, 38%) and service commitment (n = 52, 38%) were the most commonly cited rationales. The most frequently mentioned approaches to increasing minority representation were pipeline programmes (n = 59, 43%), changes in affirmative action laws (n = 32, 23%) and changes in admission policies (n = 29, 21%). CONCLUSIONS This scoping review of the 2000-2015 literature on strategies for and approaches to expanding URM representation in medicine reveals a repetitive, amplifying message of URM physician service commitment to vulnerable populations in medically underserved communities. Such message repetition reinforces policies and practices that might limit the full scope of URM practice, research and leadership opportunities in medicine. Cross-nationally, service commitment and patient-physician concordance benefits admittedly respond to recognised societal need, yet there is an associated risk for instrumentally singling out members of URMs to fulfil that need. The proceedings of a 2001 US Institute of Medicine symposium warned against creating a deterministic expectation that URM physicians provide care to minority populations. Our findings suggest that the expanding emphasis on URM service commitment and patient-physician concordance benefits warrants ongoing scrutiny and, more broadly, represent a cautionary tale of unintended consequences for medical educators globally.
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Affiliation(s)
- Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nanibaa' A Garrison
- Division of Bioethics, Department of Paediatrics, University of Washington, Seattle, Washington, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Faith E Fletcher
- Department of Health Behaviour, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Brittany Ajegba
- College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nichole Smith
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Morgann Brafford
- Department of Forensic Psychology, Walden University, Minneapolis, Minnesota, USA
| | - Elizabeth Bogdan-Lovis
- Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Attrill S, Lincoln M, McAllister S. Culturally and linguistically diverse students in speech-language pathology courses: A platform for culturally responsive services. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:309-321. [PMID: 28264593 DOI: 10.1080/17549507.2017.1292548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/04/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE Increasing the proportion of culturally and linguistically diverse (CALD) students and providing intercultural learning opportunities for all students are two strategies identified to facilitate greater access to culturally responsive speech-language pathology services. To enact these strategies, more information is needed about student diversity. This study collected descriptive information about CALD speech-language pathology students in Australia. METHOD Cultural and linguistic background information was collected through surveying 854 domestic and international speech-language pathology students from three Australian universities. Students were categorised according to defined or perceived CALD status, international student status, speaking English as an Additional Language (EAL), or speaking a Language Other than English at Home (LOTEH). RESULT Overall, 32.1% of students were either defined or perceived CALD. A total of 14.9% spoke EAL and 25.7% identified speaking a LOTEH. CALD students were more likely to speak EAL or a LOTEH than non-CALD students, were prominently from Southern and South-Eastern Asian backgrounds and spoke related languages. CONCLUSION Many students reported direct or indirect connections with their cultural heritage and/or contributed linguistic diversity. These students may represent broader acculturative experiences in communities. The sociocultural knowledge and experience of these students may provide intercultural learning opportunities for all students and promote culturally responsive practices.
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Affiliation(s)
- Stacie Attrill
- a Speech Pathology, School of Health Sciences, Flinders University , Adelaide , Australia and
| | - Michelle Lincoln
- b Faculty of Health Sciences, The University of Sydney , Australia
| | - Sue McAllister
- a Speech Pathology, School of Health Sciences, Flinders University , Adelaide , Australia and
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Gampa V, Smith C, Muskett O, King C, Sehn H, Malone J, Curley C, Brown C, Begay MG, Shin S, Nelson AK. Cultural elements underlying the community health representative - client relationship on Navajo Nation. BMC Health Serv Res 2017; 17:19. [PMID: 28069014 PMCID: PMC5223387 DOI: 10.1186/s12913-016-1956-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families. The success of the CHRs’ interventions depends on the interactions between the CHRs and their clients. This research investigates the culturally specific factors that build and sustain the CHR-client interaction. Methods In-depth interviews were conducted with 16 CHRs on Navajo Nation. Interviews were transcribed and coded according to relevant themes. Code summaries were organized into a narrative using grounded theory techniques. Results The analysis revealed four findings critical to the development of a CHR-client relationship. Trust is essential to this relationship and provides a basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture. CHRs must be respectful of the diverse traditional and social practices. Lastly, the passing of clients brings together the CHR, the client’s family, and the community. Conclusion Understanding the cultural elements of the CHR-client relationship will inform the work of community partners, clinical providers, and other indigenous communities working to strengthen CHR programs and obtain positive health outcomes among marginalized communities. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1956-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vikas Gampa
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Casey Smith
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Olivia Muskett
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline King
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Hannah Sehn
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Partners in Health, Boston, MA, USA
| | - Jamy Malone
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Partners in Health, Boston, MA, USA
| | - Cameron Curley
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Brown
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sonya Shin
- Community Outreach and Patient Empowerment Program, 210 East Aztec Ave, Gallup, NM, 87301, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Partners in Health, Boston, MA, USA.
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Sy A, Kim W, Chen J, Shen Y, Tao C, Lee J. Acculturation levels and personalizing orthognathic surgery for the Asian American patient. Int J Oral Maxillofac Surg 2016; 45:1201-8. [DOI: 10.1016/j.ijom.2016.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/19/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
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Fredericks E, Harbin A, Baker K. Being (in)visible in the clinic: A qualitative study of queer, lesbian, and bisexual women's health care experiences in Eastern Canada. Health Care Women Int 2016; 38:394-408. [PMID: 27428268 DOI: 10.1080/07399332.2016.1213264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this article, we examine the ways in which 18 queer, lesbian, and bisexual (QLB) women in Eastern Canada negotiated their visibility in interactions with primary care providers. QLB women patients used a number of strategies to determine risk and to be visible or invisible to their health care providers. We describe participants' disclosure decisions and strategies, and we argue that being visible and invisible requires work on the part of QLB patients in the context of institutionalized heteronormativity. Conceptualizing (in)visibility as work is required in efforts to account for and improve health care interactions across differences.
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Affiliation(s)
- Erin Fredericks
- a Department of Sociology , St. Thomas University , Fredericton , New Brunswick , Canada
| | - Ami Harbin
- b Departments of Philosophy and Women & Gender Studies , Oakland University , Rochester , Michigan , USA
| | - Kelly Baker
- c Department of Global Studies , Wilfrid Laurier University , Waterloo , Ontario , Canada
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Díaz E, Armah T, Linse CT, Fiskin A, Jordan A, Hafler J. Novel Brief Cultural Psychiatry Training for Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:366-368. [PMID: 25636254 DOI: 10.1007/s40596-015-0279-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/13/2015] [Indexed: 06/04/2023]
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Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners. Br J Gen Pract 2015; 64:e313-20. [PMID: 24868068 DOI: 10.3399/bjgp14x680077] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. AIM To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response. DESIGN AND SETTING Qualitative study using individual interviews among primary care practitioners working in Lebanon. METHOD Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. RESULTS Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV. CONCLUSION Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV.
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Chow ALP, Lye DC, Arah OA. Patient and physician predictors of patient receipt of therapies recommended by a computerized decision support system when initially prescribed broad-spectrum antibiotics: a cohort study. J Am Med Inform Assoc 2015; 23:e58-70. [PMID: 26342216 DOI: 10.1093/jamia/ocv120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/06/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Antibiotic computerized decision support systems (CDSSs) were developed to guide antibiotic decisions, yet prescriptions of CDSS-recommended antibiotics have remained low. Our aim was to identify predictors of patients' receipt of empiric antibiotic therapies recommended by a CDSS when the prescribing physician had an initial preference for using broad-spectrum antibiotics. METHODS We conducted a prospective cohort study in a 1 500-bed tertiary-care hospital in Singapore. We included all patients admitted from October 1, 2011 through September 30, 2012, who were prescribed piperacillin-tazobactam or carbapenem for empiric therapy and auto-triggered to receive antibiotic recommendations by the in-house antibiotic CDSS. Relevant data on the patient, prescribing and attending physicians were collected via electronic linkages of medical records and administrative databases. To account for clustering, we used multilevel logistic regression models to explore factors associated with receipt of CDSS-recommended antibiotic therapy. RESULTS One-quarter of the 1 886 patients received CDSS-recommended antibiotics. More patients treated for pneumonia (33.2%) than sepsis (12.1%) and urinary tract infections (7.1%) received CDSS-recommended antibiotic therapies. The prescribing physician - but not the attending physician or clinical specialty - accounted for some (13.3%) of the variation. Prior hospitalization (odds ratio [OR] 1.32, 95% CI, 1.01-1.71), presumed pneumonia (OR 6.77, 95% CI, 3.28-13.99), intensive care unit (ICU) admission (OR 0.38, 95% CI, 0.21-0.66), and renal impairment (OR 0.70, 95% CI, 0.52-0.93) were factors associated with patients' receipt of CDSS-recommended antibiotic therapies. CONCLUSIONS We observed that ICU admission and renal impairment were negative predictors of patients' receipt of CDSS-recommended antibiotic therapies. Patients admitted to ICU and those with renal impairment might have more complex clinical conditions that require a physician's assessment in addition to antibiotic CDSS.
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Affiliation(s)
- Angela L P Chow
- Department of Clinical Epidemiology, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, United States
| | - David C Lye
- Department of Infectious Diseases, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, United States Center for Health Policy Research, University of California, Los Angeles (UCLA), Los Angeles, United States
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Hardeman RR, Burgess D, Phelan S, Yeazel M, Nelson D, van Ryn M. Medical student socio-demographic characteristics and attitudes toward patient centered care: do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study. PATIENT EDUCATION AND COUNSELING 2015; 98:350-5. [PMID: 25499003 PMCID: PMC4433154 DOI: 10.1016/j.pec.2014.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/16/2014] [Accepted: 11/08/2014] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To determine whether attitudes toward patient-centered care differed by socio-demographic characteristics (race, gender, socioeconomic status) among a cohort of 3191 first year Black and White medical students attending a stratified random sample of US medical schools. METHODS This study used baseline data from Medical Student CHANGES, a large national longitudinal cohort study of medical students. Multiple logistic regression was used to assess the association of race, gender and SES with attitudes toward patient-centered care. RESULTS Female gender and low SES were significant predictors of positive attitudes toward patient-centered care. Age was also a significant predictor of positive attitudes toward patient-centered care such that students older than the average age of US medical students had more positive attitudes. Black versus white race was not associated with attitudes toward patient-centered care. CONCLUSIONS New medical students' attitudes toward patient-centered care may shape their response to curricula and the quality and style of care that they provide as physicians. Some students may be predisposed to attitudes that lead to both greater receptivity to curricula and the provision of higher-quality, more patient-centered care. PRACTICE IMPLICATIONS Medical school curricula with targeted messages about the benefits and value of patient-centered care, framed in ways that are consistent with the beliefs and world-view of medical students and the recruitment of a socioeconomically diverse sample of students into medical schools are vital for improved care.
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Affiliation(s)
- Rachel R Hardeman
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, USA; University of Minnesota Medical School, Department of Medicine, Minneapolis, USA.
| | - Diana Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, USA; University of Minnesota Medical School, Department of Medicine, Minneapolis, USA.
| | - Sean Phelan
- Division of Health Care Policy Research Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
| | - Mark Yeazel
- University of Minnesota, Department of Family Medicine and Community Health, Minneapolis, USA.
| | - David Nelson
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, USA; University of Minnesota Medical School, Department of Medicine, Minneapolis, USA.
| | - Michelle van Ryn
- Division of Health Care Policy Research Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
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Ghahramani N, Sanati-Mehrizy A, Wang C. Perceptions of patient candidacy for kidney transplant in the United States: a qualitative study comparing rural and urban nephrologists. EXP CLIN TRANSPLANT 2015; 12:9-14. [PMID: 24471717 DOI: 10.6002/ect.2013.0183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore different perceptions of urban and rural nephrologists regarding patient suitability for transplant. MATERIALS AND METHODS We conducted 4 focus groups, each consisting of 4 to 6 nephrologists practicing in either a rural (n=9) or an urban setting (n=11). A topic guide was developed and modified according to pilot testing. Broadly stated, open ended queries probed perceptions about the ideal or suboptimal candidates for transplant, perceived barriers to transplant, views regarding providing information to patients, and strategies that could improve transplant rates. At the sessions, all audio was recorded and professionally transcribed. Responses were pooled, de-identified, and analyzed using qualitative thematic content analysis. RESULTS In considering candidacy, urban participants mentioned "age, " "compliance, " and "functional status "; "support " was a more-prevalent theme among rural nephrologists. Urban physicians discussed the expected effect of a transplant on a subject 's quality of life. As barriers to transplant, "evaluation time " was mentioned by urban groups only, and "distance to transplant center " was suggested by rural nephrologists only. To improve transplant rates, urban nephrologists suggested strategies that would increase the donor pool. Rural nephrologists, on the other hand, suggested a collaboration between nephrologists and the transplant center, "limiting listing eligibility " and "financial assistance. " Rural nephrologists suggested providing comparisons of modalities and information about selecting subjects. CONCLUSIONS This qualitative study underscores geographic differences in perceptions of nephrologists regarding patient candidacy for kidney transplant, perceived barriers to kidney transplant, and proposed strategies to increase rates of kidney transplant. These differences are potential contributors to geographic variations in referring patients for kidney transplant.
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Affiliation(s)
- Nasrollah Ghahramani
- Department of Medicine, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033,USA
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Burgess DJ, Phelan S, Workman M, Hagel E, Nelson DB, Fu SS, Widome R, van Ryn M. The effect of cognitive load and patient race on physicians' decisions to prescribe opioids for chronic low back pain: a randomized trial. PAIN MEDICINE 2014; 15:965-74. [PMID: 24506332 DOI: 10.1111/pme.12378] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To test the hypothesis that racial biases in opioid prescribing would be more likely under high levels of cognitive load, defined as the amount of mental activity imposed on working memory, which may come from environmental factors such as stressful conditions, chaotic workplace, staffing insufficiency, and competing demands, one's own psychological or physiological state, as well as from demands inherent in the task at hand. DESIGN Two (patient race: White vs Black) by two (cognitive load: low vs high) between-subjects factorial design. SETTING AND PARTICIPANTS Ninety-eight primary care physicians from the Veterans Affairs Healthcare System. METHODS Web-based experimental study. Physicians were randomly assigned to read vignettes about either a Black or White patient, under low vs high cognitive load, and to indicate their likelihood of prescribing opioids. High cognitive load was induced by having physicians perform a concurrent task under time pressure. RESULTS There was a three-way interaction between patient race, cognitive load, and physician gender on prescribing decisions (P = 0.034). Hypotheses were partially confirmed. Male physicians were less likely to prescribe opioids for Black than White patients under high cognitive load (12.5% vs 30.0%) and were more likely to prescribe opioids for Black than White patients under low cognitive load (30.8% vs 10.5%). By contrast, female physicians were more likely to prescribe opioids for Black than White patients in both conditions, with greater racial differences under high (39.1% vs 15.8%) vs low cognitive load (28.6% vs 21.7%). CONCLUSIONS Physician gender affected the way in which patient race and cognitive load influenced decisions to prescribe opioids for chronic pain. Future research is needed to further explore the potential effects of physician gender on racial biases in pain treatment, and the effects of physician cognitive load on pain treatment.
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Affiliation(s)
- Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Joynt M, Train MK, Robbins BW, Halterman JS, Caiola E, Fortuna RJ. The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. J Gen Intern Med 2013; 28:1604-10. [PMID: 23797920 PMCID: PMC3832731 DOI: 10.1007/s11606-013-2516-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/12/2013] [Accepted: 05/15/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. DESIGN We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. MAIN MEASURES Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. RESULTS Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P<0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66–0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68–0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. CONCLUSIONS Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.
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Affiliation(s)
- Michael Joynt
- />Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY 14609 USA
- />Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Meghan K. Train
- />Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY 14609 USA
- />Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Brett W. Robbins
- />Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY 14609 USA
- />Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
- />Strong Children’s Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Jill S. Halterman
- />Strong Children’s Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Enrico Caiola
- />Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY 14609 USA
- />Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Robert J. Fortuna
- />Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY 14609 USA
- />Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
- />Strong Children’s Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY USA
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Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making. Pediatrics 2013; 132:e1105-16. [PMID: 24081998 DOI: 10.1542/peds.2013-2268] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This policy statement serves to combine and update 2 previously independent but overlapping statements from the American Academy of Pediatrics (AAP) on culturally effective health care (CEHC) and workforce diversity. The AAP has long recognized that with the ever-increasing diversity of the pediatric population in the United States, the health of all children depends on the ability of all pediatricians to practice culturally effective care. CEHC can be defined as the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of all cultural distinctions, leading to optimal health outcomes. The AAP believes that CEHC is a critical social value and that the knowledge and skills necessary for providing CEHC can be taught and acquired through focused curricula across the spectrum of lifelong learning. This statement also addresses workforce diversity, health disparities, and affirmative action. The discussion of diversity is broadened to include not only race, ethnicity, and language but also cultural attributes such as gender, religious beliefs, sexual orientation, and disability, which may affect the quality of health care. The AAP believes that efforts must be supported through health policy and advocacy initiatives to promote the delivery of CEHC and to overcome educational, organizational, and other barriers to improving workforce diversity.
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Sivananthan SN, Puyat JH, McGrail KM. Variations in self-reported practice of physicians providing clinical care to individuals with dementia: a systematic review. J Am Geriatr Soc 2013; 61:1277-85. [PMID: 23889524 DOI: 10.1111/jgs.12368] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine to what extent actual practice as reported in the literature is consistent with clinical guidelines for dementia care. DESIGN A systematic review of empirical studies of clinical services provided by physicians to older adults with a diagnosis of dementia. SETTING All settings involving primary care physicians in which a diagnosis of dementia is provided. PARTICIPANTS Physicians providing care to individuals aged 60 and older with a primary or secondary diagnosis of dementia. INTERVENTION Seven dementia care processes recommended by guidelines: formal memory testing, imaging, laboratory testing, interventions, counseling, community service, and specialist referrals. MEASUREMENTS Web of Knowledge, PubMed, Science Direct, MedLine, PsychINFO, EMBASE, and Google Scholar databases were searched for articles in English published before March 1, 2012. RESULTS Twelve studies met the final inclusion criteria, all of which were self-reported cross-sectional surveys. There was broad variation in the proportion of physicians who reported conducting each dementia care process, with the widest variation in formal memory testing (4-96%). Recently published studies reflected a shift in scope of care, reporting that high proportions of physicians provided interventions, counseling, and referrals to specialist. CONCLUSION Despite the availability and dissemination of established best practice guidelines, there is still wide variation in physician practice patterns in dementia care. The quality of currently available studies limits the ability to draw strong conclusions. Better information on practice patterns and their relationship to outcomes for individuals with dementia and their caregivers using more-robust study designs is needed to address the needs of the increasing number of individuals who will require dementia care.
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Affiliation(s)
- Saskia N Sivananthan
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
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Tofan G, Bodolica V, Spraggon M. Governance mechanisms in the physician-patient relationship: a literature review and conceptual framework. Health Expect 2013; 16:14-31. [PMID: 22882293 PMCID: PMC5060640 DOI: 10.1111/j.1369-7625.2012.00807.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The physician-patient relationship is a critical component of the integrated approach to excellence in health-care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent-principal interaction, there exists only a sparse understanding about the most effective ways of governing it. OBJECTIVE This article undertakes a selective review of the growing body of research on the governance of the physician-patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration. FINDINGS On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust-based (i.e. trust and ethical oversight) and distrust-based (i.e. patient information-empowerment and decision-making authority) governance mechanisms of the physician-patient relationship and discuss the key findings within each stream. DISCUSSION To conciliate the on-going scholarly debate concerning the efficacy of trust- and distrust-based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician-patient relationship.
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Affiliation(s)
- Gabriela Tofan
- School of Public HealthState University of Medicine and Pharmacy “Nicolae Testemitanu”ChisinauRepublic of Moldova
| | - Virginia Bodolica
- Department of ManagementSchool of Business and ManagementAmerican University of SharjahSharjahUnited Arab Emirates
| | - Martin Spraggon
- Department of ManagementSchool of Business and ManagementAmerican University of SharjahSharjahUnited Arab Emirates
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Forte DN, Vincent JL, Velasco IT, Park M. Association between education in EOL care and variability in EOL practice: a survey of ICU physicians. Intensive Care Med 2012; 38:404-12. [PMID: 22222566 DOI: 10.1007/s00134-011-2400-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 08/29/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. METHODS Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. RESULTS The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. CONCLUSIONS Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.
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Affiliation(s)
- Daniel Neves Forte
- Intensive Care Unit, Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil.
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Affiliation(s)
- J T Berger
- Department of Medicine, Stony Brook University School of Medicine, Stony Brook and Section of Hospice and Palliative Medicine, Division of Geriatric Medicine, Winthrop University Hospital, Mineola, NY, USA.
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Lee L, Jun J, Danganan M, Pogrel M, Kushner H, Lee J. Orthognathic surgery for the Asian patient and the influence of the surgeon's background on treatment. Int J Oral Maxillofac Surg 2011; 40:458-63. [DOI: 10.1016/j.ijom.2010.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 10/27/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
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Mitchell AJ, Crowfoot D, Leaver J, Hughes S. Does the academic performance of psychiatrists influence success in the NHS Clinical Excellence Award Scheme? JRSM SHORT REPORTS 2011; 2:21. [PMID: 21541089 PMCID: PMC3086332 DOI: 10.1258/shorts.2011.011008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Given the uncertainty about factors that influence receipt of Clinical Excellence Awards (CEA) and recent availability of advanced research metrics, we examined the factors that predict CEA success using a convenience sample of English psychiatrists. Design Observational study examining region, subspecialty, H-index, M-index, number of publications, years since registration and years in specialty. Setting ACCEA Nominal Roll, cross-referenced with data from the GMC's list of registered medical practitioners and Thompson's Web of Science database. Participants A total of 494 psychiatrists including 245 with national levels awards and a random sample with local level awards. Main outcome measures Receipt of local or national CEA awards in 2008 and 2009. Results Of those with national awards, 126 had university contracts and 119 NHS contracts. Across all staff, years since qualification in medicine and H-index were the dominant influences. For local awards we found that years worked in the specialty was the main predictor of a CEA award with a smaller contribution from H-index. For national awards to university staff (academics) years on the medical register and publication rate were significant predictors. For national awards to NHS staff (non-academics) H-index and total cites were predictive, but these were themselves related to age. Conclusions Progression in CEAs among psychiatrists is strongly influenced by age (years spent in specialty and years on the medical register) with an additional contribution from research productivity. Currently, research impact is crudely assessed in the CEA process. We suggest that CEA committees formally assess the impact of NHS-related research using standardized research metrics which are openly available. We also suggest that supporting organizations and local trusts adhere to the rules mandated by the ACCEA.
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Eliason MJ, Dibble SL, Robertson PA. Lesbian, gay, bisexual, and transgender (LGBT) physicians' experiences in the workplace. JOURNAL OF HOMOSEXUALITY 2011; 58:1355-71. [PMID: 22029561 DOI: 10.1080/00918369.2011.614902] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Little is known about the experiences of lesbian, gay, bisexual, and transgender (LGBT) physicians in the workplace. There is little formal education in medical school about LGBT issues, and some heterosexual physicians have negative attitudes about caring for LGBT patients or working with LGBT coworkers, setting the stage for an exclusive and unwelcoming workplace. The current study used an online survey to assess a convenience sample of 427 LGBT physicians from a database of a national LGBT healthcare organization, as well as a snowball sample generated from the members of the database. Although rates of discriminatory behaviors had decreased since earlier reports, 10% reported that they were denied referrals from heterosexual colleagues, 15% had been harassed by a colleague, 22% had been socially ostracized, 65% had heard derogatory comments about LGBT individuals, 34% had witnessed discriminatory care of an LGBT patient, 36% had witnessed disrespect toward an LGBT patient's partner, and 27% had witnessed discriminatory treatment of an LGBT coworker. Few had received any formal education on LGBT issues in medical school or residency. It appears that medical schools and health care workplaces continue to ignore LGBT issues and operate in discriminatory fashion far too often.
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Affiliation(s)
- Michele J Eliason
- Department of Health Education, San Francisco State University, San Francisco, California 94132, USA.
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McCloskey J, Tollestrup K, Sanders M. A community integration approach to social determinants of health in New Mexico. FAMILY & COMMUNITY HEALTH 2011; 34 Suppl 1:S79-S91. [PMID: 21160334 DOI: 10.1097/fch.0b013e318202a852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Lifestyle and Values Impacting Diabetes Awareness (LA VIDA), a community-based diabetes intervention program targeting Hispanics in southwestern New Mexico, addresses social determinants of health by utilizing promotores and collaborating with community partners and health care providers. Using a mixed-methods approach, a program evaluation documented the promotores' crucial role in providing social support, contributing to social cohesion, and accessing health care, community resources, and LA VIDA's educational and healthy lifestyle activities. Findings suggest that patients with diabetes who participated in the LA VIDA program significantly increased the number of days they checked their feet and took their diabetes medications and significantly lowered their glycated hemoglobin levels.
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Affiliation(s)
- Joanne McCloskey
- Department of Family and Community Medicine, Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
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Simon Bell J, Klaukka T, Ahonen J, Hartikainen S. National utilization of transdermal fentanyl among community-dwelling older people in Finland. ACTA ACUST UNITED AC 2009; 7:355-61. [DOI: 10.1016/j.amjopharm.2009.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2009] [Indexed: 10/19/2022]
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Sharp HM, Shega JW. Feeding tube placement in patients with advanced dementia: the beliefs and practice patterns of speech-language pathologists. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2009; 18:222-230. [PMID: 19106205 DOI: 10.1044/1058-0360(2008/08-0013)] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To describe the beliefs and practices of speech-language pathologists (SLPs) about the use of percutaneous endoscopic gastrostomy (PEG) among patients with advanced dementia and dysphagia. METHOD A survey was mailed to a geographically stratified random sample of 1,050 medical SLPs. RESULTS The response rate was 57%, and 326 surveys met inclusion criteria. Fifty-six percent of SLPs recommended PEG for a patient with advanced dementia and dysphagia. Contrary to the evidence, many respondents believed that PEG improves nutritional status and increases survival. Relatively few SLPs believed that PEG improved patients' functional status or quality of life. Patient factors (e.g., age or prognosis) were more often identified as influences on recommendations for PEG than were extrinsic factors (e.g., cost). Nearly 40% believed that PEG was the standard of care, while 15% believed it should be. Very few SLPs (11%) would want a PEG themselves. Perceived standard of care was significantly related to both geographic region and population density (p < .05), but self-reported practices were not. CONCLUSIONS Discrepancies between SLPs' beliefs, the literature, and self-reported practices were observed. The findings suggest the need to connect the evidence base to clinical practice and to include SLPs in local and national discussions about end-of-life care protocols.
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Lee KB, Vaishnavi SN, Lau SK, Andriole DA, Jeffe DB. Cultural Competency in Medical Education: Demographic Differences Associated With Medical Student Communication Styles and Clinical Clerkship Feedback. J Natl Med Assoc 2009; 101:116-26. [DOI: 10.1016/s0027-9684(15)30823-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Padela AI, Punekar IRA. Emergency medical practice: advancing cultural competence and reducing health care disparities. Acad Emerg Med 2009; 16:69-75. [PMID: 19055674 DOI: 10.1111/j.1553-2712.2008.00305.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In an increasingly diverse patient population, language differences, socioeconomic circumstances, religious values, and cultural practices may present barriers to the delivery of quality care. These obstacles contribute to the health care disparities observed in all areas of medical care. Increasing cultural competence has been cited as part of the solution to reduce disparities. The emergency department (ED) is an environment where cultural sensitivity is particularly needed, as it is often a primary source of health care for the underserved and ethnic and racial minorities and a place where high patient volume and acuity place the provider under demanding time pressures, yet the emergency medicine (EM) literature on health care disparities and cultural competence is limited. The authors present three clinical scenarios highlighting challenges in providing equitable emergency care to minority populations. Using these cases as illustrations, three processes are proposed that may improve the quality of care delivered to minority populations: 1) increase cultural awareness and reduce provider biases, enabling providers to interact more effectively with different patient populations; 2) accommodate patient preferences and needs in medical settings through practice adjustments and cultural modifications; and 3) increase provider diversity to raise levels of tolerance, awareness, and understanding for other cultures and create more racially and/or ethnically concordant patient-physician relationships.
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Affiliation(s)
- Aasim I Padela
- Department of Emergency Medicine, Robert Wood Clinical Scholars Program University of Michigan, Ann Arbor, MI, USA.
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Wear D, Kuczewski MG. Perspective: medical students' perceptions of the poor: what impact can medical education have? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:639-45. [PMID: 18580079 DOI: 10.1097/acm.0b013e3181782d67] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
There is currently little knowledge or understanding of medical students' knowledge and attitudes toward the poor. Teaching hospitals bring students face-to-face with poor and uninsured patients on a regular basis. However, an overview of the research available suggests that this contact does not result in students' greater understanding and empathy for the plight of the poor and may, in fact, lead to an erosion of positive attitudes toward the poor. A basic understanding of justice suggests that as the poor are disproportionately the subjects of medical training, this population should enjoy a proportionate benefit for this service. Furthermore, medicine's social contract with the public is often thought to include an ideal of service to the underserved and a duty to help educate the general public regarding the health needs of our nation. In their discussion, the authors situate medical students' attitudes toward the poor within larger cultural perspectives, including attitudes toward the poor and attributions for poverty. They provide three suggestions for improving trainees' knowledge of and attitudes toward the poor-namely, increasing the socioeconomic diversity of students, promoting empathy through curricular efforts, and focusing more directly on role modeling. The authors argue that service learning, especially efforts that include gaining detailed knowledge of a particular person or persons, coupled with critical reflection, presents a very promising direction toward achieving these goals. Finally, they posit an agenda for future educational research that might contribute to the increased efficacy of medical education in this important formative domain.
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Affiliation(s)
- Delese Wear
- Northeastern Ohio Universities College of Medicine, Rootstown, Ohio, USA
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