Factors associated with patient trust in their clinicians: Results from the Healthy Work Place Study

A qualitative exploration of migraine in students attending Irish Universities

INTRODUCTION

The complex neurological disorder of migraine is prevalent (19%) and burdensome in university students. Qualitative research exploring the lived experience of migraine in students has yet to be conducted.

METHODS

Students clinically diagnosed with migraine were recruited (purposive sampling) from a sample of Irish third-level institutions for a one-time anonymized Zoom focus group or individual interview. Focus group questions were sent to participants in advance. Interviews were iterative. Participants were also invited to submit a drawing. The interviews were audio-recorded, transcribed, and sent to participants for triangulation. Reflexive thematic content analysis was undertaken, data was imported to Microsoft Excel, initial codes were generated, and themes and sub-themes were derived from the codes. The Standards for Reporting Qualitative Studies Checklist (S1 File) ensured study rigour.

RESULTS

Twenty students from three Irish universities participated (mean age 23.8 years). The four key themes identified were (i) Migraine Characteristics, (ii) Migraine Self-Management, (iii) Migraine Clinical Management, and (iii) Migraine Impacts. Migraine was described as not just a headache but a debilitating sensory experience. A notable high level of self-management satisfaction indicated hopeful coping strategies. However, many participants said medications were ineffective and had side effects, and clinical management could be improved. Additionally, there was a marked academic and social impact of migraine, psychological issues abounded, and several participants worried about finances.

CONCLUSIONS

Migraine is impactful in a cohort of students attending Irish third-level institutions, with students carrying a wide range of debilitating migraine burdens. Students demonstrate an attitude of resilience and determination despite these challenges. Migraine awareness and education campaigns on university campuses are warranted.

Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care

Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust. We received 1,662 responses and 692 (42%) chose a VA facility. Eighty percent reported quality care was in their top three factors that influenced their decision. Respondents with the highest distrust and who lived >1 hr from the nearest VA facility had the lowest predicted probability (PP) of choosing VA (PP 15%; 95% confidence interval: 10%-20%). Veterans value quality of care. VA and other health care systems should consider patient-centered ways to improve and publicize quality and reduce distrust.

Body work and body meanings in patient-centered care: Health care professionals and patients with disabilities in Italian hospitals

BACKGROUND

This study integrates patient-centered care (PCC) research and body work studies to understand how a focus on physical and sensorial aspects in the relationship between health care professionals (HPs) and patients contribute to the implementation of PCC.

PURPOSE

To understand how HPs' body work practices contribute to the implementation of PCC, we investigate the meanings HPs ascribe to their and to patients' bodies. The goal is to grasp how these practices and meanings, rooted in unexplored sensorial perceptions, account for the emergence of a relationship of mutual acknowledgment between HPs and patients.

METHODOLOGY

Thirty-nine in-depth interviews were carried out with HPs, who interact with patients with disabilities in Italian hospitals.

RESULTS

HPs engage in different body work practices: adopting a diagnostic gaze and an empathetic gaze, touching, and playing. The diagnostic gaze concurs to create a feeling of promptness between HPs and patients, but also a stronger distance with respect to other practices. The empathetic gaze, touching, and playing are associated with feelings of shared vulnerability and resilience. These shared perceptions and emotions build a common ground and shape a relationship focused on patients' involvement.

PRACTICE IMPLICATIONS

Voicing and feedback sessions can be arranged to listen to how HPs interpret their own and patients' bodies. An organizational culture acknowledging emotions should be promoted to sponsor among HPs the consideration of the sensorial aspects of their connection with patients. The value of bricolage should be observed, where the HPs feel free to readjust tools, spaces, and routines. Sensitivity training exercises should be arranged to understand the interactions with patients with disabilities.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

Objective

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

Methods

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

Results

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

Conclusion

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

Diabetes and Depression: Strategies to Address a Common Comorbidity Within the Primary Care Context

Diabetes and depression represent a prevalent, bidirectional, and impactful comorbidity that affects patient and family quality of life, glycemic self-management, long-term diabetes complications, usage of medical services, medical costs, and early mortality. Primary care providers (PCPs) are frequently the first medical providers to observe changes in mood and diabetes management, as well as the primary point of contact for making referrals to specialty providers (e.g. endocrinology, psychiatry). PCPs play a critical role in screening, evaluating, and treating these conditions. Critical to fostering and maintaining a position of trust and patient engagement in medication recommendations is the use of person-centered, nonjudgmental language used by the provider within the clinical encounter. Key strategies for the management of these conditions include the following: routine screening for depressive symptoms, securing access to behavioral health professionals, either within or beyond the primary care setting, collaboration with diabetes care and education specialists to support problem-solving of diabetes self-management, and monitoring the use and effectiveness of antidepressant medications.