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Wang YF, Lee YH, Lee CW, Lu JY, Shih YZ, Lee YK. The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting. HEALTH COMMUNICATION 2024; 39:1235-1245. [PMID: 37161370 DOI: 10.1080/10410236.2023.2210379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Chen-Wei Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University
| | - Jing-Yi Lu
- Department of Healthcare Administration, Asia University
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Yi-Kung Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Medicine, Tzu Chi University
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Wang YF, Lee YH, Lee CW, Shih YZ, Lee YK. Differences in patient-physician communication between the emergency department and other departments in a hospital setting in Taiwan. BMC Health Serv Res 2023; 23:1279. [PMID: 37986078 PMCID: PMC10662510 DOI: 10.1186/s12913-023-10311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Communication fosters trust and understanding between patients and physicians, and specific communication steps help to build relationships. Communication in the emergency department may be different from that in other departments due to differences in medical purposes and treatments. However, the characteristics of communication in the clinical settings of various departments have not been explored nor compared. OBJECTIVES This study aimed to construct the steps in patient-physician communication based on the Roter Communication Model and compare communication performance between the emergency department and three other clinical settings-internal medicine, surgery, and family medicine departments. METHODS Both qualitative and quantitative approaches were adopted. First, in-depth interviews were used to analyze clinical communication steps and meanings. Then, a quantitative questionnaire was designed based on the interview results to investigate differences in communication between the emergency department and the other three departments. Qualitative and quantitative data were analyzed from 20 interviews and 98 valid questionnaires. RESULTS Patient-physician communication consists of four steps and ten factors. The four steps-greeting and data gathering, patient education and counseling, facilitation and patient activation, and building a relationship-had significant progressive effects. Patient education and counseling had an additional significant effect on building a relationship. The emergency department performed less well in the facilitation and patient activation, building a relationship step and the evaluation method, enhancement method, and attitude factors than the other departments. CONCLUSIONS To improve the quality of patient-physician communication in the emergency department, physicians should strengthen the steps of facilitation and patient activation to encourage patients' active engagement in their health care.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Chen-Wei Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Yi-Kung Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Gettel CJ, Serina PT, Uzamere I, Hernandez‐Bigos K, Venkatesh AK, Cohen AB, Monin JK, Feder SL, Fried TR, Hwang U. Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12355. [PMID: 36204349 PMCID: PMC9518973 DOI: 10.1002/trc2.12355] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner-completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi-structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS Care partners' mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: (1) unique care considerations while in the ED setting impact the perceived success of the care transition, (2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, (3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and (4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner-reported outcome measures as well as ED discharge care transition interventions targeting care partners.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Outcomes Research and EvaluationYale School of MedicineNew HavenConnecticutUSA
| | - Peter T. Serina
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ivie Uzamere
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Kizzy Hernandez‐Bigos
- Section of GeriatricsDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Arjun K. Venkatesh
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Outcomes Research and EvaluationYale School of MedicineNew HavenConnecticutUSA
| | - Andrew B. Cohen
- Section of GeriatricsDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Joan K. Monin
- Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Shelli L. Feder
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of NursingOrangeConnecticutUSA
| | - Terri R. Fried
- Section of GeriatricsDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Ula Hwang
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Geriatrics ResearchEducation and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA
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Wang YF, Lee YH, Lee CW, Hsieh CH, Lee YK. Patient-physician communication in the emergency department in Taiwan: physicians’ perspectives. BMC Health Serv Res 2022; 22:152. [PMID: 35123459 PMCID: PMC8817560 DOI: 10.1186/s12913-022-07533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background Effective patient-physician communication promotes trust and understanding between physicians and patients and reduces medical disputes. In this study, the Roter Interaction Analysis System was used to explore physician-patient communication behaviors in the emergency departments of Taiwanese hospitals. Method Data was collected from the dialogues between 8 emergency physicians and 54 patients through nonparticipant observation, and 675 pieces of data were quantitatively and qualitatively analyzed. Results The results showed that: 1. Emergency physicians’ communication behaviors are task-focused. They usually ask closed-ended questions to collect data to identify the symptoms quickly and provide medical treatment. 2. Socioemotion-oriented physician-patient communication behaviors are less common in the emergency department and only serve as an aid for health education and follow-up. Due to time constraints, it is difficult to establish relationships with patients and evoke their positivity. Conclusions It is suggested that future education programs on physician-patient communication in the emergency department should focus on strengthening physicians’ ability to communicate with patients in a more open way. They should adopt socioemotional-oriented communication skills, expressing respect and kindness, and allowing patients to briefly describe their symptoms and participate in the treatment process to achieve physician-patient consensus.
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English W, Gott M, Robinson J. The meaning of rapport for patients, families, and healthcare professionals: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2-14. [PMID: 34154861 DOI: 10.1016/j.pec.2021.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Rapport is considered fundamental to clinical relationships but is a concept which is rarely defined. This review explores how rapport is defined, characterised, and operationalised in healthcare. METHODS A scoping review methodology was used. Data were synthesised using thematic analysis. The review process adhered to the Preferred Reporting System for Meta-Analysis for Scoping reviews (PRISMA-ScR). RESULTS Medline, CINAHL, and psychINFO were searched with thirty-four studies meeting inclusion criteria. Results were presented in two themes: The meanings of rapport and the implications for building rapport. CONCLUSIONS This scoping review found rapport has no commonly shared definition or conceptualisation in the reviewed research. At the same time rapport is operationalised and characterised. Factors that facilitate, and hinder rapport-building were identified. Having a consistently used definition and conceptualisation will benefit the research that is needed into patient and family experiences and outcomes of rapport. PRACTICE IMPLICATIONS It is crucial for health professionals to incorporate simple kind gestures into practice to facilitate rapport. Equally it is necessary for health professionals to review their practice for dismissive, avoiding behaviours that impede rapport-building and consider how they spend their time with patients.
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Affiliation(s)
- Wendy English
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand.
| | - Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand.
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Tay DL, Ellington L, Towsley GL, Supiano K, Berg CA. Emotional expression in conversations about advance care planning among older adult home health patients and their caregivers. PATIENT EDUCATION AND COUNSELING 2021; 104:2232-2239. [PMID: 33658140 DOI: 10.1016/j.pec.2021.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To examine patient and caregivers' differences in emotional expression and explore topics associated with emotional expression during advance care planning (ACP) discussions. METHODS Older adult home health patient-caregiver dyads participated in video-recorded ACP conversations as part of a collaboration-focused intervention study. Recordings were coded in Noldus Observer XT, analyzed with descriptive statistics, Cochran-Mantel-Haenszel and Breslow-Day test, and integrated with qualitative content analysis. RESULTS Eighteen patient-caregiver dyads were purposively recruited. Participants were mostly female (11 patients; 13 caregivers). Mean ages were 68.22 (SD = 9.64) for patients and 61.28 (SD = 13.60) for caregivers. Emotional expression (depth of emotion, positive and negative valence) was similar across patients and caregivers. Conversations centered on positive and negative decisional, relational, and existential topics. CONCLUSIONS This study explored emotional expression and identified topics associated with emotion for patients and caregivers during collaborative ACP. Findings suggest that collaboration in ACP can have positive relational aspects for patient-caregiver dyads, while negative emotions can also be distressing. PRACTICE IMPLICATIONS This study describes the range of emotions that are common during patient and caregiver ACP discussions. Clinical implications for the assessment of caregiver support and awareness of the interdependent nature of decision making is discussed.
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Affiliation(s)
- Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Gail L Towsley
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Katherine Supiano
- College of Nursing, University of Utah, Salt Lake City, UT, 84112, USA.
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA.
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Goldstein P, Losin EAR, Anderson SR, Schelkun VR, Wager TD. Clinician-Patient Movement Synchrony Mediates Social Group Effects on Interpersonal Trust and Perceived Pain. THE JOURNAL OF PAIN 2020; 21:1160-1174. [PMID: 32544602 PMCID: PMC7722052 DOI: 10.1016/j.jpain.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022]
Abstract
Pain is an unfortunate consequence of many medical procedures, which in some patients becomes chronic and debilitating. Among the factors affecting medical pain, clinician-patient (C-P) similarity and nonverbal communication are particularly important for pain diagnosis and treatment. Participants (N = 66) were randomly assigned to clinician and patient roles and were grouped into C-P dyads. Clinicians administered painful stimuli to patients as an analogue of a painful medical procedure. We manipulated the perceived C-P similarity of each dyad using groups ostensibly based on shared beliefs and values, and each patient was tested twice: Once with a same group clinician (concordant, CC) and once with a clinician from the other group (discordant, DC). Movement synchrony was calculated as a marker of nonverbal communication. We tested whether movement synchrony mediated the effects of group concordance on patients' pain and trust in the clinician. Movement synchrony was higher in CC than DC dyads. Higher movement synchrony predicted reduced pain and increased trust in the clinician. Movement synchrony also formally mediated the group concordance effects on pain and trust. These findings increase our understanding of the role of nonverbal C-P communication on pain and related outcomes. Interpersonal synchrony may be associated with better pain outcomes, independent of the specific treatment provided. PERSPECTIVE: This article demonstrates that movement synchrony in C-P interactions is an unobtrusive measure related to their relationship quality, trust toward the clinician, and pain. These findings suggest that interpersonal synchrony may be associated with better patient outcomes, independent of the specific treatment provided.
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Affiliation(s)
- Pavel Goldstein
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado; The School of Public Health, University of Haifa, Israel
| | | | | | - Victoria R Schelkun
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire; Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado.
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Afriyie D. Effective communication between nurses and patients: an evolutionary concept analysis. Br J Community Nurs 2020; 25:438-445. [PMID: 32881615 DOI: 10.12968/bjcn.2020.25.9.438] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Communication can be considered as the basis of the nurse-patient relationship and is an essential element in building trust and comfort in nursing care. Effective communication is a fundamental but complex concept in nursing practice. This concept analysis aims to clarify effective communication and its impact on patient care using Rodgers's (1989) evolutionary framework of concept analysis. Effective communication between nurses and patients is presented along with surrogate terms, attributes, antecedents, consequences, related concepts and a model case. Effective communication was identified to be a multifactorial concept and defines as a mutual agreement between nurses and patients. This influences the nursing process, clinical reasoning and decision-making. Consequently, promotes high-quality nursing care, positive patient outcome and patient's and nurse's satisfaction of care.
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Lambert K, Lau TK, Davison S, Mitchell H, Harman A, Carrie M. Does a renal diet question prompt sheet increase the patient centeredness of renal dietitian outpatient consultations? PATIENT EDUCATION AND COUNSELING 2020; 103:1645-1649. [PMID: 32199691 DOI: 10.1016/j.pec.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Effective communication is fundamental to helping patients change behaviour. Few studies have operationalised how to quantify and improve the patient centeredness of communication during the dietitian outpatient consultation. We sought to evaluate the impact of a renal diet question prompt sheet (QPS) on patient centeredness (PC) in dietitian outpatient clinics and describe the impact of a renal diet QPS on the volume and pattern of communication between dietitians (n = 4) and patients/carers (n = 24, n = 11). METHODS The Roter Interaction Analysis System was used to compute a PC index, the volume communication (number of questions and utterances) and categorise dietitian communication. RESULTS The QPS was associated with significant improvements in the PC of communication (p = 0.004 and p = 0.001), without increasing the volume of communication. The QPS was also associated with an increase in the total number of questions asked (p < 0.0001) especially from patients (p = 0.0009); and an increase in the volume of communication devoted to education and counselling (p < 0.0001). CONCLUSIONS This study describes a promising intervention to increase the patient centeredness of dietetic consultations in an outpatient setting. PRACTICE IMPLICATIONS Whilst simple in design, the use of a QPS had a large effect on how patients and carers interact with the dietitian in the outpatient setting.
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Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
| | - Tsz Kwan Lau
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
| | - Sarah Davison
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| | - Holly Mitchell
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| | - Alex Harman
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| | - Mandy Carrie
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
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Vatandost S, Cheraghi F, Oshvandi K. Facilitators of Professional Communication Between Nurse and Opposite Gender Patient: A Content Analysis. MAEDICA 2020; 15:45-52. [PMID: 32419860 PMCID: PMC7221273 DOI: 10.26574/maedica.2020.15.1.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Caring for a patient of the opposite gender is followed by many challenges. Hence, making an appropriate professional communication between the patient and the nurse is of great importance in order to provide a high-quality care to the patient and reduce tensions. Identifying positive factors in the formation of an appropriate professional communication can play an important role in preventing such challenges. Materials and methodology: The current study aimed to identify the facilitators of professional communication between nurse and opposite gender patient in Iran. A qualitative method and a conventional content analysis approach were used. A total of 25 nurses were included in the study by purposive sampling. Data were collected through unstructured and semi-structured interviews in hospitals of three provinces of Northwestern Iran, and were analyzed by Graneheim and Lundman method. Results: The results included seven categories and three main themes: prevention of misunderstanding, non-violation of therapeutic relationship boundaries, and observance of the socio-individual context. Discussion: Despite accepting the difficulties of nursing care for an opposite gender patient, the results of the present study showed that paying more attention to, and carefully watching, the mentioned factors could enhance the chance to establish a proper professional communication between a nurse and an opposite gender patient, which is crucial in providing a high quality care, also improving nurses' comfort in their work environment. Therefore, it is recommended to consider these factors in academic and in-service training of nurses.
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Affiliation(s)
- Salam Vatandost
- School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Cheraghi
- School of Nursing and Midwifery, Chronic disease (home care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- School of Nursing and Midwifery, Child & Maternity Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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A Prospective Examination of Racial Microaggressions in the Medical Encounter. J Racial Ethn Health Disparities 2019; 7:519-527. [PMID: 31845288 DOI: 10.1007/s40615-019-00680-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/16/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
Disparities in healthcare and health outcomes between whites and non-whites continue to plague the US healthcare system. A large literature suggests that people of color face obstacles at various points in the healthcare system. This article examines one such obstacle: whether patients of color experience microaggressions from physicians during primary care medical visits. A majority of microaggression studies are qualitative and retrospective in nature. In the current study, we use a prospective approach to broaden how microaggressions are measured, as well as understand differential treatment of racial minorities within healthcare. Using data derived from audio recordings of medical visits (n = 224), we utilize a quantitative measure to examine microaggressions in the medical encounter. We find that when race status differences are present between patient and physician, patients of color are more likely to experience microaggressions from their physician. The results suggest that medical encounters differ depending on characteristics of the parties involved. These differences may not only perpetuate the differential treatment of people of color but also contribute to health disparities for people of color.
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Leone D, Borghi L, Del Negro S, Becattini C, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Giuffrida G, Livi C, Luehwink A, Palermo R, Revelli A, Tomasi G, Tomei F, Filippini C, Vegni E. Doctor-couple communication during assisted reproductive technology visits. Hum Reprod 2019; 33:877-886. [PMID: 29635461 DOI: 10.1093/humrep/dey069] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/12/2018] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the characteristics of doctor-couple communication content during actual ART visits? SUMMARY ANSWER Physicians were mainly focused on providing biomedical information, while communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. WHAT IS KNOWN ALREADY Communication aspects in ART seem crucial for clinical decision-making, retention in care and critical conversations with couples due to low treatment success rates. However, no studies have been carried out on the actual interaction between the doctor and the couple in this context. STUDY DESIGN, SIZE, DURATION This observational study involved 28 clinicians and 160 patients referred to eight Italian ART clinics during a one-year recruitment period. PARTICIPANTS/MATERIALS, SETTING, METHODS ART visits at eight Italian clinics were videotaped. The visits were coded using the Roter Interaction Analysis System (RIAS), particularly focusing on RIAS composite categories, verbal dominance and patient-centeredness score. MAIN RESULTS AND THE ROLE OF CHANCE A total of 85 visits were eligible for analysis (62% acceptance rate), involving 28 clinicians and 160 patients (including 75 couples). The average visit duration was 37 ± 17.7 min. The mean verbal dominance was 1.9 ± 0.86 (range: 0.72-5.74). Physicians mainly focused on providing biomedical information. Communication content from couples had a 2-fold focus on providing biomedical information and on positive talk. The mean of patient centeredness index (PCI) was 0.51 (SD = 0.28; range 0.08-1.77); visits in which the doctor was a woman or the treatment indication was for heterologous fertilization showed higher PCI scores. Overall, females accounted for 67% of all patient talk. Taking this imbalance into account as expected frequencies for each composite category, males reported significantly more utterances in almost all of the socioemotional categories. LIMITATIONS, REASONS FOR CAUTION These results are preliminary and observational and only regard Italy. Communication during visits may have been biased since the professionals who agreed to participate showed an interest in communication issues. Another limitation is a possible Hawthorne effect due to the fact that participants were aware of being videotaped. WIDER IMPLICATIONS OF THE FINDINGS Our study showed that ART physicians mainly adopted an informative model of communication and a more disease-oriented approach. Findings revealed the complexity of communication content during ART consultations, given its triadic characteristic in which the third party is also a patient; clinicians should be aware of this complex aspect and of the specific male and female perspectives to be taken into account. The results could be useful for training ART professionals. STUDY FUNDING/COMPETING INTEREST(S) This study was possible thanks to an unconditional grant from Ferring Spa to the Department of Health Sciences, University of Milan. There are no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- D Leone
- Department of Health Science, University of Milan, Milan 20142, Italy
| | - L Borghi
- Department of Health Science, University of Milan, Milan 20142, Italy
| | - S Del Negro
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Milan 20142, Italy
| | - C Becattini
- Assisted Reproductive Center, Futura Diagnostica Medica, Florence 50129, Italy
| | - E Chelo
- Demetra Assisted Reproductive Center, Florence 50141, Italy
| | - M Costa
- Assisted Reproductive Unit, Ospedale Evangelico Internazionale, Genoa 16122, Italy
| | - L De Lauretis
- Assisted Reproductive Center, Istituto Clinico Città Studi, Milan 20131, Italy
| | - A P Ferraretti
- Reproductive Medicine Unit, S.I.S.Me.R., Bologna 40138, Italy
| | - G Giuffrida
- CRA, Assisted Reproductive Center, Catania 95128, Italy
| | - C Livi
- Demetra Assisted Reproductive Center, Florence 50141, Italy
| | - A Luehwink
- Assisted Reproductive Unit, Azienda Provinciale per i Servizi Sanitari-Provincia Autonoma di Trento, Arco 38123, Italy
| | - R Palermo
- Ambra Assisted Reproductive Center, Palermo 90138, Italy
| | - A Revelli
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Torino 10126, Italy
| | - G Tomasi
- CRA, Assisted Reproductive Center, Catania 95128, Italy
| | - F Tomei
- Assisted Reproductive Unit, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone 33170, Italy
| | - C Filippini
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - E Vegni
- Department of Health Science, University of Milan, Milan 20142, Italy.,Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Milan 20142, Italy
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Salminen-Tuomaala M, Mikkola R, Paavilainen E, Leikkola P. Emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations. Scand J Caring Sci 2018; 32:1371-1378. [PMID: 30113717 DOI: 10.1111/scs.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Not much research has been conducted on emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations. This knowledge is required to develop the quality and safety of emergency care. AIM The aim of the study was to describe patients' and family members' experiences concerning encounters with emergency care providers and the patient's care in nonconveyance situations. METHODS The study is a descriptive, cross-sectional survey carried out using quantitative methods. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open question were analysed using inductive content analysis. RESULTS Patients and family members found that emergency care providers had acted in a professional and friendly manner. They would have expected more psychological support. Family members were less satisfied with the emergency care than patients, especially as regards psychological support and the amount of time given to the patient. CONCLUSIONS Emergency care providers should take the whole family's situation into consideration and seek to promote the family's coping by providing comprehensible counselling and support.
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Affiliation(s)
- Mari Salminen-Tuomaala
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Riitta Mikkola
- School of Nursing Science, Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland
| | - Eija Paavilainen
- School of Nursing Science, Faculty of Social Sciences/Health Sciences, University of Tampere, Tampere, Finland.,The Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Päivi Leikkola
- The Hospital District of South Ostrobothnia, Seinäjoki, Finland
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Pun JKH, Chan EA, Wang S, Slade D. Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China. PATIENT EDUCATION AND COUNSELING 2018; 101:1193-1206. [PMID: 29422231 DOI: 10.1016/j.pec.2018.01.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide an integrative review of literature on health communication in East Asia and detail culturally-specific influences. METHODS Using PRISMA model, search of PubMed, PsychInfo, Web of Knowledge, ERIC and CINAHL databases were conducted for studies between January 2000 and March 2017, using the terms 'clinician/health professional-patient', 'nurse/doctor-patient, 'communication' and 'Asia'. RESULTS 38 studies were included: Mainland China, Hong Kong, Japan, South Korea, and Taiwan. The existing body of research on clinician patient communication in East Asia can be classified: 1) understanding the roles and expectations of the nurse, clinician, patient, and family in clinician-patient consultations: a) nurse-patient communication; b) doctor-patient communication; c) the role of family member; and 2) factors affecting quality of care: d) cultural attitudes towards death and terminal illnesses; e) communication preferences affecting trust, decision-making and patient satisfaction; f) the extent to which patient centred care is being implemented in practice; and g) communication practices in multilingual/multi-disciplinary environments. CONCLUSION The review detailed the complexity and heterogeneity of clinician-patient communication across East Asia. The studies reviewed indicate that research in East Asia is starting to move beyond a preference for Western-based communication practices. PRACTICE IMPLICATIONS There is a need to consider local culture in understanding and interpreting medical encounters in East Asia. The paper highlights the need for a specific culturally-appropriate model of health communication in East Asia which may significantly improve relationships between clinicians and patients.
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Affiliation(s)
- Jack K H Pun
- Department of English, The City University of Hong Kong, 83, Tat Chee Avenue, Kowloon, Hong Kong, China; Department of Education, St Antony's College, University of Oxford, 15 Norham Gardens, Oxford, United Kingdom; The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia.
| | - E Angela Chan
- The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia; School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Sophie Wang
- Faculty of Arts and Social Science, The University of Technology Sydney, Sydney, Australia
| | - Diana Slade
- The Institute for Communication in Health Care, School of Languages, Literature and Linguistics, The Australian National University, Canberra, Australia; School of Literature, Language and Linguistics, ANU College of Arts & Social Sciences, The Australian National University, Canberra, Australia
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Une procédure standardisée pour informer les patients d’unité d’hospitalisation de courte durée n’améliore pas leur compréhension. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roh H, Park KH, Park SY. Verbal communication of students with high patient-physician interaction scores in a clinical performance examination assessed by standardized patients. KOREAN JOURNAL OF MEDICAL EDUCATION 2017; 29:241-251. [PMID: 29207455 PMCID: PMC5717412 DOI: 10.3946/kjme.2017.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/04/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Standardized patients (SPs) tend to rate medical students' communication skills subjectively and comprehensively, in contrast to such objective skill set defined in the clinical performance examination (CPX). Meanwhile, medical school instructors have a different approach in their evaluation of students' communication skills. We aim to analyze medical students' verbal communication skills using objective methods, and to determine the contributing factors of a patient-physician interaction (PPI) score. METHODS Students with high- and low-ranking scores for PPI in CPX were selected. The Roter interaction analysis system was used to compare verbal communication behaviors of the students and SPs. Patient-centeredness scores (PCSs), physician's verbal dominance, and number of utterances were compared between the two groups. RESULTS PCSs and physician's verbal dominance had no difference between the groups. The number of utterances during the limited time of 5 minutes of CPX was higher for the high-ranking students. They tended to employ more paraphrase/check for understanding, and closed questions for psychosocial state and open questions for medical condition. The SPs interviewed by high-ranking students gave more medical information and requested for more services. CONCLUSION In the case of the routine checkup, smooth conversations with more frequent utterances were detected in the high-ranking students. More medical information exchange and requests for services by SPs were higher for the high-ranking students. Medical communication instructors should keep in mind that our results could be indicators of a high PPI score.
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Affiliation(s)
- HyeRin Roh
- Department of Medical Education and Institute for Medical Humanities, Inje University College of Medicine, Busan, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Dong-A University Hospital, Busan, Korea
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17
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Harvey ME, Redshaw ME. Qualitative study of the clinician-parent interface in discussing prognosis following MRI and US imaging of preterm infants in the UK. BMJ Open 2016; 6:e011472. [PMID: 27678531 PMCID: PMC5051465 DOI: 10.1136/bmjopen-2016-011472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore communication and interaction between parents and clinicians following neonatal ultrasound (US) and MRI of the brain of babies born preterm. SETTING This qualitative study was undertaken as part of a larger UK study of neonatal brain imaging. 511 infants were cared for in 14 London neonatal units with MR and cerebral US imaging in a specialist centre. PARTICIPANTS Parents with infants born at <33 weeks gestation were randomised to receive prognostic information based on either MRI or US findings on their infants at term-corrected age. METHODS Discussions between parents and clinicians about the MRI or US result were audio recorded. Parents were told about the findings and their baby's predicted outcome. A topic guide ensured essential aspects were covered. Recordings were fully transcribed. Discussion of the scan results, the content and style of the interaction and parental response were analysed qualitatively in 36 recordings using NVivo V.10. OUTCOMES Key themes and subthemes were identified in the clinician-parent discussions. RESULTS The overarching theme of 'the communication interface' was identified with three key themes: 'giving information', 'managing the conversation' and 'getting it right' and further subthemes. A range of approaches were used to facilitate parental understanding and engagement. There were differences in the exchanges when information about an abnormal scan was given. The overall structure of the discussions was largely similar, though the language used varied. In all of the discussions, the clinicians talked more than the parents. CONCLUSIONS The discussions represent a difficult situation in which the challenge is to give and receive complex prognostic information in the context of considerable uncertainty. The study highlights the importance of being able to re-visit specific issues and any potential areas of misunderstanding, of making time to talk to parents appreciating their perspective and level of knowledge. TRIAL REGISTRATION NUMBER EudraCT 2009-013888-19; Pre-results.
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Affiliation(s)
- M E Harvey
- Department of Perinatal Imaging and Health, Division of Imaging and Biomedical Engineering, King's College, London, UK
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - M E Redshaw
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Abstract
Over the past 5 years, early hospital readmissions have become a national focus. With several recent publications highlighting the high rates of early hospital readmissions among transplant recipients, more work is needed to identify risk factors and strategies for reducing unnecessary readmissions among this patient population. Although the American Society of Transplant Surgeons is advocating the exclusion of transplant recipients from the calculation of hospital readmission rates, the outcome of their advocacy efforts remains uncertain. One potential strategy for reducing early hospital readmissions is to critically examine care received by transplant recipients in the emergency department (ED), a critical pathway to readmission. As a starting point, research is needed to assess rates of ED presentation among transplant recipients, diagnostic algorithms, and communication among clinical teams. Mixed-methods studies that enhance understanding of system-level barriers to optimized evaluation and treatment of transplant recipients in the ED may lead to quality improvement interventions that reduce unnecessary readmissions, even if the rates of transplant recipients presenting to the ED remains high.
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Redshaw ME, Harvey ME. Explanations and information-giving: clinician strategies used in talking to parents of preterm infants. BMC Pediatr 2016; 16:25. [PMID: 26863870 PMCID: PMC4750359 DOI: 10.1186/s12887-016-0561-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background The study is part of a larger research programme on neonatal brain imaging in the trial element of which parents were randomised to receive prognostic information based upon either magnetic resonance imaging (MRI) or ultrasound findings (ePrime study). The aim of this study was to investigate the strategies used by clinicians in communicating with parents following imaging at term age of the brain of preterm infants born before 33 weeks gestation, focusing on explanations and information-giving about prognosis Method Audio recordings of discussions between parents and clinicians were made following MRI and ultrasound assessment. Parents were given the scan result and the baby’s predicted prognosis. A framework was developed based on preliminary analysis of the recordings and findings of other studies of information-giving in healthcare. Communication of scan results by the clinicians was further explored in qualitative analysis with 36 recordings using NVivo 10 and the specifically developed framework. Emerging themes and associated sub-themes were identified. Results The ways in which clinicians gave information and helped parents to understand were identified. Within the over-arching theme of clinician strategies a wide range of approaches were used to facilitate parental understanding. These included orienting, checking on previously acquired information, using analogies, explaining terminology, pacing the information, confirming understanding, inviting clarification, answering parents’ questions and recapping at intervals. Ultimately four key themes were identified: ‘Framing the information-giving’, ‘What we are looking at’, ‘Presenting the numbers and explaining the risk’ and ‘Appreciating the position of parents’. Conclusions The interviews represent a multifaceted situation in which there is a tension between the need to explain and inform and the inherent complexity of neurological development, potential problems following preterm birth and the technology used to investigate and monitor these. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0561-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M E Redshaw
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
| | - M E Harvey
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK. .,Department of Perinatal Imaging and Health, Division of Imaging and Biomedical Engineering, King's College, 4th Floor North Wing, St Thomas' Hospital, SE1 7EH, London, UK. .,Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK.
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Roh H, Park KH. A Scoping Review: Communication Between Emergency Physicians and Patients in the Emergency Department. J Emerg Med 2016; 50:734-43. [PMID: 26818383 DOI: 10.1016/j.jemermed.2015.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/19/2015] [Accepted: 11/10/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Understanding the basic qualities of communication between emergency physicians and patients could improve communication in the emergency department. OBJECTIVE The objectives of this scoping review are to map the literature about the gaps in communication between emergency physicians and patients in the emergency department and make recommendations for further research. METHODS A scoping review of literature published since 1980 and written in English was undertaken using the following databases: Pubmed, Scopus, and SocINDEX. The articles were searched for using two-keyword combinations of the following keywords joined by "AND": "communication," "patient," "emergency physician," "emergency department/emergency room/accident," and "emergency room." Seventeen articles were included in the final review. RESULTS Five research issues were covered by the 17 papers: patient-centered communication, information sharing, bad news delivery, shared decision making, and physicians' perspectives on communication. Emergency physicians have several communication characteristics: doctor-driven decision making, focusing on efficient information gathering, immature communication techniques, and obstacles to overcoming miscommunication. Patients also have several communication characteristics: active participation in medical encounters, expectation of physician as a reliable guide, understanding physicians' difficulties, and factors that contribute to understanding. CONCLUSIONS Several conclusions about emergency department communication between patients and emergency physicians were drawn. Additional research is required to consider diverse patient needs in the emergency department. Furthermore, training programs for emergency physicians to improve the quality of communication should be developed and implemented in line with our research findings.
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Affiliation(s)
- HyeRin Roh
- Department of Medical Education, Inje University College of Medicine, Busan, South Korea
| | - Kyung Hye Park
- Department of Emergency Medicine, Inje University College of Medicine, Busan, South Korea
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21
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Eggins S, Slade D. Communication in Clinical Handover: Improving the Safety and Quality of the Patient Experience. J Public Health Res 2015; 4:666. [PMID: 26753165 PMCID: PMC4693345 DOI: 10.4081/jphr.2015.666] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Suzanne Eggins
- Faculty of Arts and Social Sciences, University of Technology, Sydney; International Research Centre for Communication in Health Care, Sydney, Australia
| | - Diana Slade
- Faculty of Arts and Social Sciences, University of Technology, Sydney; International Research Centre for Communication in Health Care, Sydney, Australia
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Abstract
BACKGROUND Research on posttransplant care has predominantly focused on predictors of readmission with little attention to emergency department (ED) visits. The goal of this study was to describe early postoperative ED care of transplant recipients. METHODS A secondary database analysis of adult patients who underwent abdominal organ transplantation between January 1, 2008, and December 31, 2013, and sought ED care within 1 year after transplantation was conducted. Survival was compared using the Kaplan-Meier method with log-rank test. Cox proportional hazards regression analysis was performed to adjust for pertinent covariates RESULTS A total of 1900 abdominal organ transplants were performed during the study period. Of these, 37% (N = 711) transplant recipients sought care in the ED (1343 total visits) with 1.89 mean ED visits per recipient. Of recipients seen in the ED, 58% received a kidney transplant and 28% received a liver transplant, with 45% of recipients presenting within the first 60 postoperative days. The most common chief complaints were gastroenterological (17%) and abnormal laboratory values or vital signs (17%). In total, 74% of recipients were readmitted and 50% of admitted patients were discharged in less than 24 hours. Transplant recipients with ED visits had lower 3-year graft (81% vs 87%; P < 0.001) and patient (89% vs 93%; P = 0.002) survival. CONCLUSIONS Transplant recipients have a high frequency of ED visits in the first posttransplantation year and high rates of subsequent hospital admission. Further investigation is needed to understand what drives recipient presentation to the ED and create care models that achieve the best outcomes.
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Stafa A, Simonetti L, Di Paola F, Leonardi M. Considerations when communicating with awake patients undergoing image-guided neuro-interventions. Interv Neuroradiol 2015; 21:635-8. [PMID: 26261155 DOI: 10.1177/1591019915597416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors empirically evaluated the context of intra-procedural physician-patient communication during imaging-guided procedures in a radiology/neuroradiology interventional clinical framework. Different intra-procedural communicative scenarios are reported.They conclude that the quality of intra-procedural physician-patient communication should be considered an important element of individual and team ethical and professional behaviour, able to strongly influence the therapeutic alliance. As for the whole medical communication strategy, an approach which takes into account the psychological and cultural background of the individual patient is preferred.
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Affiliation(s)
- Altin Stafa
- Neuroradiology Department, "Ca'Foncello" Hospital, Treviso, Italy
| | - Luigi Simonetti
- Interventional and Urgency Radiology and Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
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McCarthy DM, Engel KG, Buckley BA, Huang A, Acosta F, Stancati J, Schmidt MJ, Adams JG, Cameron KA. Talk-time in the emergency department: duration of patient-provider conversations during an emergency department visit. J Emerg Med 2014; 47:513-9. [PMID: 25214177 DOI: 10.1016/j.jemermed.2014.06.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/24/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Analyses of patient flow through the emergency department (ED) typically focus on metrics such as wait time, total length of stay (LOS), or boarding time. Less is known about how much interaction a patient has with clinicians after being placed in a room, or what proportion of their in-room visit is also spent waiting. OBJECTIVE Our aim was to assess the proportion of time that a patient spent in conversation with providers during an ED visit. METHODS Seventy-four audio-taped encounters of patients with low-acuity diagnoses were analyzed. Recorded ED visits were edited to remove downtime. The proportion of time the patient spent in conversation with providers (talk-time) was calculated as follows: (talk-time = [edited audio time/{LOS - door-to-doctor time}]). RESULTS Participants were 46% male; mean age was 41 years (standard deviation 15.7 years). Median LOS was 126 min (interquartile range [IQR] 96 to 163 min), median time in a patient care area was 76 min (IQR 55 to 122 min). Median time in conversation with providers was 19 min (IQR 14 to 27 min), corresponding to a talk-time percentage of 24.9% (IQR 17.8%-35%). Multivariable regression analysis revealed that patients with older age, longer visits, and those requiring a procedure had more talk-time: total talk-time = 13 s + 9 s × (total time in room in minutes) + 8 s × (years in age of patient) + 482 s × (procedural diagnosis). CONCLUSIONS Approximately 75% of a patient's time in a care area is spent not interacting with providers. Although some of the time waiting is out of the providers' control (eg, awaiting imaging studies), this significant downtime represents an opportunity for both process improvement efforts and innovative patient-education efforts to make use of remaining downtime.
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Affiliation(s)
- Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Kirsten G Engel
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Barbara A Buckley
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Annsa Huang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Francisco Acosta
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer Stancati
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Michael J Schmidt
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - James G Adams
- Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois
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Butrick MN, Vanhusen L, Leventhal KG, Hooker GW, Nusbaum R, Peshkin BN, Salehizadeh Y, Pavlick J, Schwartz MD, Graves KD. Discussing race-related limitations of genomic testing for colon cancer risk: implications for education and counseling. Soc Sci Med 2014; 114:26-37. [PMID: 24908172 DOI: 10.1016/j.socscimed.2014.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 12/23/2022]
Abstract
This study examines communication about limitations of genomic results interpretation for colon cancer risk during education and counseling of minority participants. As part of a larger study conducted from 2010 to 2012, participants recruited from a large primary care clinic were offered testing for a research panel of 3 genomic markers (single nucleotide polymorphisms or SNPs) for colorectal cancer risk. Genetic counselors conducted pre- and post-test sessions which included discussion of limitations of result interpretation due to the lack of racial/ethnic diversity in research populations from which risk data are derived. Sessions were audio-recorded, transcribed and thematically analyzed. Many participants did not respond directly to this limitation. Among the participants that responded directly to this race-related limitation, many responses were negative. However, a few participants connected the limited minority information about SNPs with the importance of their current research participation. Genetic counselor discussions of this limitation were biomedically focused with limited explanations for the lacking data. The communication process themes identified included: low immediacy (infrequent use of language directly involving a participant), verbal dominance (greater speaking ratio of the counselor to the patient) and wide variation in the degree of interactivity (or the amount of turn-taking during the discussion). Placed within the larger literature on patient-provider communication, these present results provide insight into the dynamics surrounding race-related educational content for genomic testing and other emerging technologies. Clinicians may be better able to engage patients in the use of new genomic technology by increasing their awareness of specific communication processes and patterns during education or counseling sessions.
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Affiliation(s)
- Morgan N Butrick
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Lauren Vanhusen
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Kara-Grace Leventhal
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Gillian W Hooker
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Rachel Nusbaum
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Beth N Peshkin
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Yasmin Salehizadeh
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Jessica Pavlick
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Marc D Schwartz
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA
| | - Kristi D Graves
- Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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Kourkouta L, Papathanasiou IV. Communication in nursing practice. Mater Sociomed 2014; 26:65-7. [PMID: 24757408 PMCID: PMC3990376 DOI: 10.5455/msm.2014.26.65-67] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/15/2014] [Indexed: 11/03/2022] Open
Abstract
Good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient. To achieve this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Also they should devote time to the patient to communicate with the necessary confidentiality, and must not forget that this communication includes persons who surround the sick person, which is why the language of communication should be understood by all those involved in it. Good communication also is not only based on the physical abilities of nurses, but also on education and experience.
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Affiliation(s)
- Lambrini Kourkouta
- Nursing Department, Technological Educational Institute of Thessaloniki, Greece
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