Evolving roles and structures of triadic engagement in healthcare

Communicating decisions about care with patients and companions in emergency department consultations

INTRODUCTION

This paper explores doctor-patient and companion communication about care decisions in a UK emergency department (ED). Doctors interface between patients and healthcare systems and facilitate access to care across a range of encounters, drawing on information and authority to make and communicate clinical care decisions.

MATERIALS AND METHODS

We explored characteristics of communication through ethnographic observation of 16 video-recorded case studies of ED consultations (average length: 1 h) collected over 6 months. Companions were present in 10 cases. We conducted a framework analysis to understand the roles of doctors, consultants, patients and companions in relaying ED care decisions.

FINDINGS

We present two cases to reflect companion roles and their effect on the consultation. The urgency for care and scarcity of resources means clinicians justify decisions and strategize to move patients along ED pathways.

DISCUSSION

Everyday care interactions between patients and doctors are goal-oriented and companions participate by providing case information, querying decisions and advocating for care. Our findings reflect how doctors justify decisions made in communicating the next steps in ways that characterize the clinical encounter.

CONCLUSION

By exploring everyday interactions our study contributes to a growing understanding of patient-clinician and companion communication in the ED.

PATIENT OR PUBLIC CONTRIBUTION

Patients and caregivers voluntarily participated in data collection and consented to video recordings being conducted of ED consultations between them and junior doctors. There was extensive consultation with all grades of staff about the acceptability of the work and the best way to conduct it to minimize the impact on patients and staff. Through this manuscript, we have demonstrated the presence and important role of companions. On reflection it would have been valuable to have included patients and companions in discussions about the work; however, this project was conducted with very limited funding and no resources were committed to patient and public involvement. Given the setting and scope of the study, it was not feasible to involve patients or members of the public in other stages of the research or preparation of the manuscript. We recognize this as a potential limitation of the work.

Communicating with Companions. The Impact of Companion Empowerment and Companion Literacy on the Well-being of Elderly Patients

The complexity of the current healthcare ecosystem justifies the convenience of targeting patients' companions in health communication strategies. Designing successful interventions requires taking into account which keys should be pressed in companions in order to generate positive outcomes in the accompanied patients. In particular, this paper explores how companion health empowerment and companion health literacy affect the well-being of chronically-ill elderly patients. Data for this research come from a cross-sectional quantitative study including 1,814 individuals (907 chronically-ill elderly patients and their 907 companions). Data were collected through two online questionnaires, one for patients and one for companions. The findings suggest that companion health empowerment is defined by the dimensions information search empowerment and knowledge development and decision participation empowerment. Furthermore, the distinction between functional, interactive and critical health literacy has revealed to be useful for comprehending companion health literacy. A structural equation model shows that critical health literacy sets the threshold above which companion health literacy improves accompanied patient well-being, even more so when it is backed up by companion information search empowerment and by companion knowledge development and decision participation empowerment.

Accompanying Patients Aged 65 or Over: How Companions' Health Literacy Affects Value Co-Creation During Medical Encounters

Objectives: The recent health crisis has led to a tightening of visitor policies during medical consultations. This work studies the relationship between the companion's health literacy (functional, interactive, and critical) and the companion's co-creation of value (co-production and value in use). Methods: Six hypotheses are tested by means of a sample of companions of chronically ill patients over the age of 65, using structural equation modeling. Results: Functional literacy does not predict the co-creation of value through either of its dimensions (co-production and value in use). Interactive literacy has a positive influence on co-production and a negative influence on value in use. Critical literacy only positively influences value in use. Discussion: Merely understanding the health information is not sufficient for the companion to be recognized as a collaborator or "ally" of the doctor. It is necessary to encourage the companion's communication and critical evaluation skills.

Is public healthcare healthy? The role of emotional exhaustion

Purpose

This study analyzes the mediating effect of emotional exhaustion between certain job demands (workload, role conflict, and influence at work) and employees' work attitudes (affective commitment and turnover intention) in public healthcare. Furthermore, it analyzes the moderating effect of possibilities for development and the degree of freedom at work between the above-mentioned job demands and emotional exhaustion.

Design/methodology/approach

A total of 512 healthcare professionals participated in the study. The data were analyzed using structural equation modeling and a hierarchical multiple regression analysis.

Findings

The results show that emotional exhaustion fully mediates the relationship between job demands (workload and role conflict) and work attitudes (affective commitment and turnover intention). Moreover, the possibilities for development and degree of freedom at work moderate the relationship between role conflict and emotional exhaustion.

Practical implications

Strategies should be designed to prevent employees from becoming emotionally exhausted and lead them to feel more motivated, which results in a more effective public healthcare service.

Originality/value

This study stresses the importance of analyzing the role of emotional exhaustion in the public healthcare context. It demonstrates the mediating role of this variable between several antecedents and consequences, and it analyzes whether other relevant variables can moderate the negative effects of emotional exhaustion.