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Fusama M, Nakahara H, Gregg M, Kuroe Y, Urata Y, Kawahata K, Kawahito Y, Kojima M, Sugihara T, Hashimoto M, Miyamae T, Murashima A, Mori M, Yajima N, Matsui T. Challenges faced by nurses engaged in rheumatology care in Japan. Mod Rheumatol 2024; 34:711-719. [PMID: 37540545 DOI: 10.1093/mr/road079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES This study aimed to identify the challenges faced by nurses engaged in rheumatology care in Japan. METHODS We conducted a questionnaire survey of nurses in Japan in 2020 on challenges experienced in rheumatology care. The participants were nurses certified by the Japan Rheumatism Foundation. Participants' answers were coded and categorized based on relevant phrases and words. Content analysis was performed on the findings. RESULTS Responses were collected from 162 participants, and a total of 228 issues were identified. Eighteen categories with 56 subcategories emerged from the data analysis, which were grouped into five types of challenges: (1) communication, (2) understanding, (3) expertise, (4) system, and (5) collaboration. In particular, the results highlighted deficiencies in needs-based multidisciplinary team care. CONCLUSION This study elucidated issues experienced by rheumatology nurses in clinical settings in Japan. Furthermore, this investigation revealed the necessity of patient-centred multidisciplinary team care, including health professionals, patients, and other relevant individuals. This study provided practical directions to facilitate the implementation of effective care focused on improving patients' quality of life.
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Affiliation(s)
- Mie Fusama
- School of Nursing, Takarazuka University, Osaka, Japan
| | - Hideko Nakahara
- Faculty of Health Science, Osaka Yukioka College of Health Science, Osaka, Japan
| | - Misuzu Gregg
- Graduate School of Nursing, Meio University, Nago, Japan
| | - Yuriko Kuroe
- Kansai University of Nursing and Health Sciences, Hyogo, Japan
| | - Yukitomo Urata
- Department of Rheumatology, Tsugaru General Hospital, Aomori, Japan
| | - Kimito Kawahata
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayo Kojima
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiko Sugihara
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takako Miyamae
- Department of Pediatric Rheumatology, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuko Murashima
- Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
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2
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Aggarwal NK. Pharmaceuticalization and Care Coordination in New York City Outpatient Mental Health. Med Anthropol 2024; 43:383-396. [PMID: 39037498 PMCID: PMC11306980 DOI: 10.1080/01459740.2024.2378092] [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] [Indexed: 07/23/2024]
Abstract
US government quality measures prioritize pharmaceuticalization and care coordination to promote patient treatment adherence. How these measures affect outpatient mental health service delivery and patient-provider communication where psychiatrists and nonphysicians collaborate is understudied. Analyzing 500 hours of participant-observation, 117 appointments, and 98 interviews with 45 new patients and providers, I show that psychiatrists and social workers coordinated care by encouraging medications and seeing two mental health providers as the default treatment, irrespective of patient preferences. Ethnographic perspectives crucially account for models of service delivery and provider behaviors in researching treatment adherence.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University and the New York State Psychiatric Institute, New York, New York, USA
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3
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Yan T, Yang M. Adult Children as Companions in Geriatric Consultations: An Interpersonal Perspective from China. HEALTH COMMUNICATION 2024:1-14. [PMID: 38862401 DOI: 10.1080/10410236.2024.2364442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Despite the prevalence of accompanied medical visits all over the world, most literature on triadic medical communication shares an Anglo-American background; little is known about non-dyadic medical interactions in Asian societies such as China. This article explores triadic interactions in Chinese geriatric outpatient consultations, focusing on the interpersonal dynamics between doctors, older patients, and the adult children who accompany them throughout the consultation. From an interpersonal pragmatic approach, we conduct a conversation analysis of the transcription of 36 audio-recorded encounters. Our findings demonstrate three patterns of companions' communicative actions during geriatric visits: enhancing rapport, mitigating face threats, and adding tension. These patterns reveal the multi-faceted nature of adult children's participation in geriatric care, highlighting their capacity to simultaneously facilitate a positive interpersonal atmosphere and pose challenges to their older parents' face. Delving into the nuanced mechanisms through which these patterns of engagement are triggered, warranted, and negotiated by all participants in the local contingencies, we further illuminate the institutional and cultural context that informs companions' intervention. Our analysis demonstrates that the influence of Chinese familial values and institutional constraints in Chinese tertiary hospitals, including restricted time and limited privacy within the clinic room, have shaped the interpersonal dynamic in triadic geriatric care. Our research calls for the development of nuanced and targeted interventions and training for healthcare professionals and companions of older patients alike.
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Affiliation(s)
- Tianxin Yan
- School of Foreign Languages, Renmin University of China
| | - Min Yang
- School of Foreign Languages, Renmin University of China
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4
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Hoey EM, Pino M. Procedural Detailing: A Patient's Practice for Normalizing Routine Behaviors. HEALTH COMMUNICATION 2024; 39:1285-1297. [PMID: 37198912 DOI: 10.1080/10410236.2023.2211364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
In palliative care in the UK, occupational and/or physiotherapists consult with patients to assess how they are managing their activities for daily living in light of their life-limiting condition(s), and to identify any activities that might benefit from therapeutic intervention. In this paper we use conversation analysis to describe a patient's practice in these consultations, which we call "procedural detailing," whereby they produce a step-by-step description of how they do some everyday activity, such that it is depicted as adequate, stable, and unproblematic. Based on a collection of 15 cases identified in video recordings of consultations in a large English hospice, we demonstrate how patients use this practice to normalize their routine conduct and thereby reject or rule out an actual or anticipated therapeutic recommendation. Our analysis suggests that such descriptions let patients participate in shared decision-making by revealing their preference for routines that preserve their level of independence and dignity.
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Affiliation(s)
- Elliott M Hoey
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam
| | - Marco Pino
- School of Social Sciences and Humanities, Loughborough University
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5
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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Older patients and dialysis shared decision-making. Insights from an ethnographic discourse analysis of interviews and clinical interactions. PATIENT EDUCATION AND COUNSELING 2024; 122:108124. [PMID: 38232671 DOI: 10.1016/j.pec.2023.108124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To describe and analyse the perspectives and communication practices of kidney clinicians and older patients (aged 60 +) during collaborative education and decision-making about dialysis. METHODS This qualitative study drew on pluralistic data sources and analytical approaches investigating elicited semi-structured interviews (n = 31) with doctors (n = 8), nurses (n = 8) and patients (n = 15), combined with ethnographic observations, written artefacts and audio-recorded naturally-occurring interactions (n = 23, education sessions n = 4; consultations n = 19) in a tertiary Australian kidney outpatient clinic. Data were analysed for themes and linguistic discourse features. RESULTS Five themes were identified across all data sources: 1) lost opportunity in education; 2) persistent disease knowledge gaps; 3) putting up with dialysis; 4) perceived and real involvement in decision-making and 5) complex role of family as decision-making brokers. CONCLUSION As the first study to complement interviews with evidence from naturally-occurring kidney interactions, this study balances the perspectives of how older patients and their clinicians view chronic kidney disease education, with how decision-making about dialysis is reflected in practice. PRACTICE IMPLICATIONS The study provides suggestions for contextualized, multi-perspectives formal and informal training for improving decision-making about dialysis, spanning from indications to boost communication efficiency, to reducing unexplained jargon, incorporating patient navigators and exploring different dialysis modalities.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
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Sommer I, Assa S, Bachmann C, Chen 陈未 W, Elcin M, Funk E, Kamisli C, Liu 刘涛 T, Maass AH, Merse S, Morbach C, Neumann A, Neumann T, Quasinowski B, Störk S, Weingartz S, Wietasch G, Weiss Weiß A. Medical Care as Flea Market Bargaining? An International Interdisciplinary Study of Varieties of Shared Decision Making in Physician-Patient Interactions. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38577850 DOI: 10.1080/10401334.2024.2322456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024]
Abstract
Phenomenon: Shared decision making (SDM) is a core ideal in the interaction between healthcare providers and patients, but the implementation of the SDM ideal in clinical routines has been a relatively slow process. Approach: In a sociological study, 71 interactions between physicians and simulated patients enacting chronic heart failure were video-recorded in China, Germany, the Netherlands, and Turkey as part of a quasi-experimental research design. Participating physicians varied in specialty and level of experience. The secondary analysis presented in this article used content analysis to study core components of SDM in all of the 71 interactions and a grounded theory approach to observe how physicians responded actively to patients even though they did not actively employ the SDM ideal. Findings: Full realization of the SDM ideal remains an exception, but various aspects of SDM in physician-patient interaction were observed in all four locations. Analyses of longer interactions show dynamic processes of interaction that sometimes surprised both patient and physician. We observed varieties of SDM that differ from the SDM ideal but arguably achieve what the SDM ideal is intended to achieve. Our analysis suggests a need to revisit the SDM ideal-to consider whether varieties of SDM may be acceptable, even valuable, in their own right. Insights: The gap between the SDM ideal and SDM as implemented in clinical practice may in part be explained by the tendency of medicine to define and teach SDM through a narrow lens of checklist evaluations. The authors support the argument that SDM defies a checklist approach. SDM is not uniform, but nuanced, dependent on circumstances and setting. As SDM is co-produced by patients and physicians in a dynamic process of interaction, medical researchers should consider and medical learners should be exposed to varieties of SDM-related practice rather than a single idealized model. Observing and discussing worked examples contributes to the physician's development of realistic expectations and personal professional growth.
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Affiliation(s)
- Ilka Sommer
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cadja Bachmann
- Office of the Dean of Educational Affairs, Rostock University Medical Center, Rostock, Germany
| | - Wei Chen 陈未
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, PR China
| | - Melih Elcin
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elisabeth Funk
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Caner Kamisli
- Institute of German Studies, University of Hamburg, Hamburg, Germany
| | - Tao Liu 刘涛
- School of Public Affairs, Zhejiang University, Hangzhou, PR China
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Stefanie Merse
- Empathische Interkulturelle Medizinische Kommunikation, University of Duisburg-Essen, Duisburg, Germany
| | - Caroline Morbach
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Anja Neumann
- Institute of Healthcare Management and Research, University of Duisburg-Essen, Duisburg, Germany
| | - Till Neumann
- Outpatient Department of Cardiology Cardio-Praxis, Bochum, Germany
| | | | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Sarah Weingartz
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Götz Wietasch
- Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands
| | - Anja Weiss Weiß
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
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7
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Junger N, Hirsch O. Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review. Cureus 2024; 16:e57960. [PMID: 38601812 PMCID: PMC11005480 DOI: 10.7759/cureus.57960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/12/2024] Open
Abstract
Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.
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Affiliation(s)
- Nancy Junger
- Psychology, Independent Researcher, Tübingen, DEU
| | - Oliver Hirsch
- Psychology, FOM University of Applied Sciences, Siegen, DEU
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8
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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Shared decision making in chronic kidney disease: a qualitative study of the impact of communication practices on treatment decisions for older patients. BMC Nephrol 2023; 24:383. [PMID: 38129771 PMCID: PMC10734071 DOI: 10.1186/s12882-023-03406-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Effective interpersonal communication is critical for shared decision-making (SDM). Previous SDM communication training in nephrology has lacked context-specific evidence from ethnographic analysis of SDM interactions with older patients considering treatment options of end stage kidney disease (ESKD). This study explores communication strategies in SDM discussions in nephrology, specifically focusing on older patients considering dialysis as kidney replacement therapy (KRT). METHODS We conducted a qualitative study analysing naturally-occurring audio-recorded clinical interactions (n = 12) between Australian kidney doctors, patients aged 60+, and carers. Linguistic ethnography and qualitative socially-oriented functional approaches were used for analysis. RESULTS Two types of communication strategies emerged: (1) Managing and advancing treatment decisions: involving active checking of knowledge, clear explanations of options, and local issue resolution. (2) Pulling back: Deferring or delaying decisions through mixed messaging. Specifically for non-English speaking patients, pulling back was further characterised by communication challenges deferring decision-making including ineffective issue management, and reliance on family as interpreters. Age was not an explicit topic of discussion among participants when it came to making decisions about KRT but was highly relevant to treatment decision-making. Doctors appeared reluctant to broach non-dialysis conservative management, even when it appears clinically appropriate. Conservative care, an alternative to KRT suitable for older patients with co-morbidities, was only explicitly discussed when prompted by patients or carers. CONCLUSIONS The findings highlight the impact of different communication strategies on SDM discussions in nephrology. This study calls for linguistic-informed contextualised communication training and provides foundational evidence for nephrology-specific communication skills training in SDM for KRT among older patients. There is urgent need for doctors to become confident and competent in discussing non-dialysis conservative management. Further international research should explore naturally-occurring SDM interactions in nephrology with other vulnerable groups to enhance evidence and training integration.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
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9
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Koopman WJ, LaDonna KA, Kinsella EA, Venance SL, Watling CJ. Archetypes of incomplete stories in chronic illness medical encounters. PATIENT EDUCATION AND COUNSELING 2023; 117:107973. [PMID: 37734249 DOI: 10.1016/j.pec.2023.107973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE During encounters, patients and practitioners engage in conversations to address health concerns. Because these interactions are time-pressured events, it may be inevitable that any story exchanged during these encounters will be incomplete in some way, potentially jeopardizing how quality and safety of care is delivered. In this study, we explored how and why incomplete stories might arise in health interactions. METHODS Constructivist grounded theory methodology was used to explore how patients and practitioners approach their interactions during encounters. In this two-phase study, we interviewed patients (n = 21) then practitioners (n = 12). RESULTS We identified three distinct archetypes of incomplete storytelling - the hidden story, the interpreted story, and the tailored story. Measured information sharing, triadic encounters and pre-planned agendas influenced these storylines, respectively. CONCLUSION Both patient and practitioner participants focused on what each considered important, appropriate, and useful for productive encounters. While incomplete stories may be a reality, educating practitioners about how incomplete stories come about from both sides of the conversation creates new opportunities to optimize interactions at medical encounters for in-depth patient practitioner storytelling.
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Affiliation(s)
- Wilma J Koopman
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada.
| | - K A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
| | - E A Kinsella
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A 1A3, Canada
| | - S L Venance
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
| | - C J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
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Spagnolli A, Cenzato G, Gamberini L. Modeling the Conversation with Digital Health Assistants in Adherence Apps: Some Considerations on the Similarities and Differences with Familiar Medical Encounters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6182. [PMID: 37372768 DOI: 10.3390/ijerph20126182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Digital health assistants (DHAs) are conversational agents incorporated into health systems' interfaces, exploiting an intuitive interaction format appreciated by the users. At the same time, however, their conversational format can evoke interactional practices typical of health encounters with human doctors that might misguide the users. Awareness of the similarities and differences between novel mediated encounters and more familiar ones helps designers avoid unintended expectations and leverage suitable ones. Focusing on adherence apps, we analytically discuss the structure of DHA-patient encounters against the literature on physician-patient encounters and the specific affordances of DHAs. We synthesize our discussion into a design checklist and add some considerations about DHA with unconstrained natural language interfaces.
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Affiliation(s)
- Anna Spagnolli
- Department of General Psychology, University of Padua, 35131 Padua, Italy
- Human Inspired Technologies Research Centre, University of Padua, 35131 Padua, Italy
| | - Giulia Cenzato
- Department of General Psychology, University of Padua, 35131 Padua, Italy
- Human Inspired Technologies Research Centre, University of Padua, 35131 Padua, Italy
| | - Luciano Gamberini
- Department of General Psychology, University of Padua, 35131 Padua, Italy
- Human Inspired Technologies Research Centre, University of Padua, 35131 Padua, Italy
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11
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Claflin SB, Campbell J, Taylor BV. Confidence communicating about multiple sclerosis among enrolees in an online course. Mult Scler Relat Disord 2023; 75:104751. [PMID: 37186989 DOI: 10.1016/j.msard.2023.104751] [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: 11/23/2022] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Effective communication is essential for multiple sclerosis (MS) disease management. Improving communication about MS may improve healthcare and service quality. OBJECTIVE To evaluate confidence in communicating about MS in a cohort of MS community members and to assess the impact of participation in the Understanding MS massive open online course (MOOC) on communication confidence. The Understanding MS MOOC is a freely available six-week online course that covers a range of topics related to MS, including its underlying pathology, symptoms, risk factors, and management. METHODS We assessed communication confidence among Understanding MS MOOC enrolees (N = 905) at three timepoints: prior to their participation in the course, immediately following course completion, and six months following course completion. Communication confidence was quantified using 5-point Likert scale questions. We identified factors that were associated with communication confidence using chi square and t-tests. Among course completers who also completed all three study surveys (N = 88), we assessed the impact of course participation using paired t-tests and we assessed effect size using Cohen's D. We assessed the relationship between changes in primary and secondary outcomes (i.e., MS-related knowledge, health literacy, quality of life, perceived healthcare quality, and self-efficacy) using Pearson correlation. RESULTS We found that at baseline, communication confidence was positively associated with MS knowledge, health literacy and quality of life. We also found that men and people with MS were more likely to report being confident. Among study participants who completed the course and all three study surveys, we found that course participation improved communication confidence and that this improvement was maintained at the six-month follow-up. The improvement in communication confidence was positively correlated with changes in MS knowledge and health literacy. CONCLUSION Confidence in communicating about MS is associated with MS knowledge and health literacy. By improving MS knowledge and health literacy, online educational interventions such as the Understanding MS MOOC can improve communication confidence in the MS community.
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Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | - Julie Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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12
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Pecanac KE, LeSage E, Stephens E. How Hospitalized Older Adults and Physicians Negotiate Plan-of-Care Decisions during Daily Rounds. HEALTH COMMUNICATION 2023; 38:681-694. [PMID: 34433342 DOI: 10.1080/10410236.2021.1967549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to explore how older adults and physicians negotiate the plan of care during daily rounds in the hospital setting. We audio-recorded 40 physician-patient interactions during daily rounds in a small teaching hospital. We analyzed the data using conversation analysis, a qualitative method that examines the turns-of-talk during interactions. We focused the analysis on how physicians introduced the plan of care and how the plan of care was subsequently negotiated with the patient. Physicians often introduced the plan in two different ways that have a persuasive design: leading with evidence and medical expertise or, for sensitive topics in which the plan could be disagreeable, using preplan sequences to delicately introduce the plan of care and assess patient response. Patients negotiated the plan of care by displaying resistance, both passively and actively. Despite patients sharing their evidence for their preferred plan of care in resisting the physician's plan, physicians often closed the negotiation by reorienting to a different aspect of the plan of care.
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Affiliation(s)
| | - Emily LeSage
- School of Nursing, University of Wisconsin-Madison
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Flannery C, Hennessy M, Dennehy R, Matvienko-Sikar K, Lucey C, Dhubhgain JU, O'Donoghue K. Factors that shape recurrent miscarriage care experiences: findings from a national survey. BMC Health Serv Res 2023; 23:317. [PMID: 36997901 PMCID: PMC10064661 DOI: 10.1186/s12913-023-09347-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Learning what matters to women/couples with recurrent miscarriage (RM) is essential to inform service improvement efforts and future RM care practices. Previous national and international surveys have examined inpatient stays, maternity care, and care experiences around pregnancy loss, but there is little focus on RM care. We aimed to explore the experiences of women and men who have received RM care and identify patient-centred care items linked to overall RM care experience. METHODS Between September and November 2021, we invited people who had experienced two or more consecutive first trimester miscarriages and received care for RM in Ireland in the ten-year period prior to participate in a cross-sectional web-based national survey. The survey was purposefully designed and administered via Qualtrics. It included questions on sociodemographics, pregnancy and pregnancy loss history, investigation and treatment for RM, overall RM care experience, and patient-centred care items at various stages of the RM care pathway such as respect for patients' preferences, information and support, the environment, and involvement of partners/family. We analysed data using Stata. RESULTS We included 139 participants (97% women, n = 135) in our analysis. Of the 135 women, 79% were aged 35-44 years (n = 106), 24% rated their overall RM care experience as poor (n = 32), 36% said the care they received was much worse than expected (n = 48), and 60% stated health care professionals in different places did not work well together (n = 81). Women were more likely to rate a good care experience if they had a healthcare professional to talk to about their worries/fears for RM investigations (RRR 6.11 [95% CI: 1.41-26.41]), received a treatment plan (n = 70) (RRR 3.71 [95% CI: 1.28-10.71]), and received answers they could understand in a subsequent pregnancy (n = 97) (RRR 8 [95% CI: 0.95-67.13]). CONCLUSIONS While overall experience of RM care was poor, we identified areas that could potentially improve people's RM care experiences - which have international relevance - such as information provision, supportive care, communication between healthcare professionals and people with RM, and care coordination between healthcare professionals across care settings.
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Affiliation(s)
- Caragh Flannery
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland.
- INFANT Research Centre, University College Cork, Cork, Ireland.
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | | | - Con Lucey
- RE:CURRENT Research Advisory Group, Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Jennifer Ui Dhubhgain
- RE:CURRENT Research Advisory Group, Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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14
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Stortenbeker I, Salm L, Olde Hartman T, Stommel W, Das E, van Dulmen S. Coding linguistic elements in clinical interactions: a step-by-step guide for analyzing communication form. BMC Med Res Methodol 2022; 22:191. [PMID: 35820827 PMCID: PMC9277943 DOI: 10.1186/s12874-022-01647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/31/2022] [Indexed: 05/31/2023] Open
Abstract
Background The quality of communication between healthcare professionals (HCPs) and patients affects health outcomes. Different coding systems have been developed to unravel the interaction. Most schemes consist of predefined categories that quantify the content of communication (the what). Though the form (the how) of the interaction is equally important, protocols that systematically code variations in form are lacking. Patterns of form and how they may differ between groups therefore remain unnoticed. To fill this gap, we present CLECI, Coding Linguistic Elements in Clinical Interactions, a protocol for the development of a quantitative codebook analyzing communication form in medical interactions. Methods Analyzing with a CLECI codebook is a four-step process, i.e. preparation, codebook development, (double-)coding, and analysis and report. Core activities within these phases are research question formulation, data collection, selection of utterances, iterative deductive and inductive category refinement, reliability testing, coding, analysis, and reporting. Results and conclusion We present step-by-step instructions for a CLECI analysis and illustrate this process in a case study. We highlight theoretical and practical issues as well as the iterative codebook development which combines theory-based and data-driven coding. Theory-based codes assess how relevant linguistic elements occur in natural interactions, whereas codes derived from the data accommodate linguistic elements to real-life interactions and contribute to theory-building. This combined approach increases research validity, enhances theory, and adjusts to fit naturally occurring data. CLECI will facilitate the study of communication form in clinical interactions and other institutional settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01647-0.
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Affiliation(s)
- Inge Stortenbeker
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - Lisa Salm
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Tim Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Enny Das
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.,NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands.,Faculty of Caring Science, University of Borås, Borås, Sweden
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15
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Pieterse AH, Bomhof-Roordink H, Stiggelbout AM, Wieringa TH. Patient role in SDM models: Re: Berger Z, Galasinski D, Scalia P, Dong K, Blunt HB, Elwyn G, "The Submissive Silence of Others: Examining Definitions of Shared Decision Making" [Patient Educ Couns (2021) doi: https://doi.org/10.1016/j.pec.2021.10.026]. PATIENT EDUCATION AND COUNSELING 2022; 105:2625-2626. [PMID: 35168854 DOI: 10.1016/j.pec.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
| | - Hanna Bomhof-Roordink
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas H Wieringa
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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16
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Sterie AC, Weber O, Jox RJ, Rubli Truchard E. "Do you want us to try to resuscitate?": Conversational practices generating patient decisions regarding cardiopulmonary resuscitation. PATIENT EDUCATION AND COUNSELING 2022; 105:887-894. [PMID: 34462247 DOI: 10.1016/j.pec.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/18/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore how physicians elicit patients' preferences about cardio-pulmonary resuscitation (CPR) during hospital admission interviews. METHODS Conversation analysis of 37 audio-recorded CPR patient-physician discussions at admission to a geriatric hospital. RESULTS The most encountered practice is when physicians submit an option to the patient's validation ("do you want us to resuscitate"). Through it, physicians display presuppositions about the patient's preference, which is not elicited as an autonomous contribution. Through open elicitors ("what would you wish"), physicians treat patients as knowledgeable about options and autonomous in determining their preference. A third practice is related to patients delivering their preference in anticipation of the request and is encountered only for choices against CPR. These decisions are revealed as informed and autonomous, and the patient as collaborative. CONCLUSION The way that physicians elicit patients' preferences about CPR influences the delivery of autonomous and informed decisions. Our findings point to an asymmetry in ways of initiating talk about the possibility of not attempting CPR, potentially exacerbated by the context of admission interviews. PRACTICE IMPLICATIONS Decisions about the relevancy life-sustaining interventions need an adequate setting in order to allow for patient participation. Our findings have implications for communication training in regard to involving patients in conversations about goals of care.
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Affiliation(s)
- Anca-Cristina Sterie
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland; Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Orest Weber
- Liaison Psychiatry Service, Lausanne University Hospital and University of Lausanne, Switzerland; Department of Language and Information Sciences, Faculty of Arts, University of Lausanne, Switzerland.
| | - Ralf J Jox
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland; Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Switzerland; Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Eve Rubli Truchard
- Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Chair of Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Switzerland; Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Switzerland.
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17
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Kelder I, Sneijder P, Klarenbeek A, Laan E. Communication practices in conversations about sexual health in medical healthcare settings: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:858-868. [PMID: 34366226 DOI: 10.1016/j.pec.2021.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/29/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Many healthcare professionals experience difficulties in discussing sexual health with their patients. The aim of this review was to synthesize results of studies on communication practices in interactions about sexual health in medical settings, to offer healthcare professionals suggestions on how to communicate about this topic. METHODS We searched for studies using five databases. Reference lists and specialist bibliographies were searched to identify additional studies. We included discourse analytic studies that used recordings of medical consultations. RESULTS We identified five studies that met the inclusion criteria. Findings were synthesized into seven categories of practices deployed by patients and healthcare professionals when talking about sexual health: avoiding delicate terms (1), delaying potentially delicate words and issues (2), using assumptive talk (3), generalized advice-giving (4), deploying patients' talk (5), depersonalization (6), and patient-initiated advice (7). CONCLUSION Practices indicate the delicacy associated with discussing sexual health issues, but results also shed light on practices that can help professionals to deal with this delicacy, and to be responsive to patients' needs and concerns. PRACTICE IMPLICATIONS Findings will assist healthcare professionals in broaching topics related to sexual health so they can help patients deal with challenges that affect their sexual health and overall well-being.
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Affiliation(s)
- Irene Kelder
- Research Group Digital Business & Media, HU University of Applied Sciences Utrecht, Heidelberglaan 15, Utrecht, CS 3584, the Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, AZ 1105, the Netherlands.
| | - Petra Sneijder
- Research Group Digital Business & Media, HU University of Applied Sciences Utrecht, Heidelberglaan 15, Utrecht, CS 3584, the Netherlands.
| | - Annette Klarenbeek
- Research Group Digital Business & Media, HU University of Applied Sciences Utrecht, Heidelberglaan 15, Utrecht, CS 3584, the Netherlands.
| | - Ellen Laan
- Department of Sexology and Psychosomatic OB-GYN, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, AZ 1105, the Netherlands.
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18
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Hayer N, Wassif HS. General dental practitioners' perceptions of shared decision making: a qualitative study. Br Dent J 2022; 232:227-231. [PMID: 35217743 PMCID: PMC8881214 DOI: 10.1038/s41415-022-3980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/07/2021] [Indexed: 11/21/2022]
Abstract
Introduction As patient-centred care becomes more of the focus in healthcare, informed consent is receiving more attention in dental practice as the pinnacle principle in patient care. Shared decision making or person-centred care appears to be taking a back foot in dentistry.Aim This study aims to gain insight into the current views and perceptions of shared decision making by general dental practitioners and how it can be utilised in daily practice.Method Empirical qualitative data were collected using semi-structured interviews of nine dentists working in general practice, with an average of 30 minutes for each interview. The data were analysed using thematic analysis.Results Overall, there was a misunderstanding of what constitutes shared decision making among dental practitioners, with communication focused more on information provision rather than collaborative discussion. There were barriers which prevented full discussions with patients from occurring, some of which directly conflicted with the focus of shared decision making.Conclusion There is a need to provide more clarity of what shared decision making is and how it can facilitate person-centred care in dental practice. Dental practitioners felt that standards and guidelines were not clear; therefore, they were confused as to what was expected of them with regards to communication. More support, in the form of standardised decision-making aids, is needed to assist dental practitioners to streamline the delivery of shared decision making in primary care.
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Affiliation(s)
- Natasha Hayer
- Dental Surgery, 180 Northridge Way, Hemel Hempstead, HP1 2AL, UK
| | - Hoda S Wassif
- University of Bedfordshire, Healthcare Practice, Putteridge Bury Campus, Hitchin Road, Luton, LU2 8LE, UK.
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19
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Colliers A, Bombeke K, Philips H, Remmen R, Coenen S, Anthierens S. Antibiotic Prescribing and Doctor-Patient Communication During Consultations for Respiratory Tract Infections: A Video Observation Study in Out-of-Hours Primary Care. Front Med (Lausanne) 2021; 8:735276. [PMID: 34926492 PMCID: PMC8671733 DOI: 10.3389/fmed.2021.735276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Communication skills can reduce inappropriate antibiotic prescribing, which could help to tackle antibiotic resistance. General practitioners often overestimate patient expectations for an antibiotic. In this study, we describe how general practitioners and patients with respiratory tract infections (RTI) communicate about their problem, including the reason for encounter and ideas, concerns, and expectations (ICE), and how this relates to (non-)antibiotic prescribing in out-of-hours (OOH) primary care. Methods: A qualitative descriptive framework analysis of video-recorded consultations during OOH primary care focusing on doctor-patient communication. Results: We analyzed 77 videos from 19 general practitioners. General practitioners using patient-centered communication skills received more information on the perspective of the patients on the illness period. For some patients, the reason for the encounter was motivated by their belief that a general practitioner (GP) visit will alter the course of their illness. The ideas, concerns, and expectations often remained implicit, but the concerns were expressed by the choice of words, tone of voice, repetition of words, etc. Delayed prescribing was sometimes used to respond to implicit patient expectations for an antibiotic. Patients accepted a non-antibiotic management plan well. Conclusion: Not addressing the ICE of patients, or their reason to consult the GP OOH, could drive assumptions about patient expectations for antibiotics early on and antibiotic prescribing later in the consultation.
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Affiliation(s)
- Annelies Colliers
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | | | - Hilde Philips
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.,Vaccine and Infectious Disease Institute (VAXINFECTIO)-Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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20
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Pino M, Doehring A, Parry R. Practitioners' Dilemmas and Strategies in Decision-Making Conversations Where Patients and Companions Take Divergent Positions on a Healthcare Measure: An Observational Study Using Conversation Analysis. HEALTH COMMUNICATION 2021; 36:2010-2021. [PMID: 32959710 DOI: 10.1080/10410236.2020.1813952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The presence of companions adds complexity to healthcare interactions. Few studies have characterized challenges arising when interactions involve healthcare professionals (HCPs), patients, and companions, or how those challenges are managed. Using conversation analysis, we examined recorded episodes where patients and companions adopt divergent positions on healthcare measures (e.g., walking aids, homecare, medications). We found nine such episodes within a dataset of 37 palliative care consultations with 37 patients, their companions, and ten healthcare practitioners (HCPs) - doctors, physiotherapists and occupational therapists. Palliative care is one of several healthcare domains where companions substantially contribute to care, consultations, and decision making. We propose that, when patients and companions adopt divergent positions, HCPs face a 'dilemma of affiliation' wherein taking a position on the healthcare measure (e.g., recommending it) entails siding with one party, against the other. By examining what happens in the face of patient-companion divergence, we characterize HCPs' strategies and substantiate our proposal that these reflect an underlying dilemma. We show that: HCPs do not immediately take a position on the healthcare measure after patient-companion divergence emerges; and when HCPs take a position later in the consultation, they do so without ostensibly siding with the party who previously supported the healthcare measure. Further, once an HCP takes a position, the party who supports the measure can treat the HCP as an ally. We offer insights and propose implications for: palliative care; the interactional complexities of healthcare decision-making; and consultations in which companions participate.
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Affiliation(s)
- Marco Pino
- School of Social Sciences and Humanities, Loughborough University
| | - Ann Doehring
- School of Social Sciences and Humanities, Loughborough University
| | - Ruth Parry
- School of Social Sciences and Humanities, Loughborough University
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21
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Lawless MT, Drioli-Phillips P, Archibald MM, Ambagtsheer RC, Kitson AL. Communicating with older adults with long-term conditions about self-management goals: A systematic review and thematic synthesis. PATIENT EDUCATION AND COUNSELING 2021; 104:2439-2452. [PMID: 33658141 DOI: 10.1016/j.pec.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/17/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To synthesise a body of fine-grained observational research on communication between healthcare professionals (HCPs), older adults, and carers regarding self-management goals and actions. METHODS We conducted a systematic review, searching nine electronic databases and the grey literature. Two reviewers independently selected for inclusion following a two-stage process and studies and discrepancies were resolved through consultation with the review team. RESULTS 898 records were retrieved, and eight studies were included in the review. Aggregative thematic analysis resulted in 13 categories of communication practices across three decision-making domains: (1) initiating: actions occurring prior to the commitment point; (2) proposing: putting forward a course of action; and (3) committing and closing: committing (or not) to the course of action. CONCLUSIONS Despite an increasing emphasis on the importance of personalised care planning and shared decision-making (SDM) to support older people's health and wellbeing, HCPs did not consistently practice this approach and, in some cases, worked in opposition to it. PRACTICE IMPLICATIONS We encourage HCPs to prepare older adults to engage actively with SDM and the goal setting process by employing patient-centred communication resources. These could assist with identifying different types of goals that are realistic and relevant to patients in daily life.
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Affiliation(s)
- Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia.
| | | | - Mandy M Archibald
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia; College of Nursing Helen Glass Centre for Nursing, 99 Curry Place University of Manitoba, Winnipeg, Canada.
| | - Rachel C Ambagtsheer
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia; Torrens University Australia, 88 Wakefield Street, Adelaide, SA, 5000, Australia.
| | - Alison L Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia.
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22
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McCabe R. When patients and clinician (dis)agree about the nature of the problem: The role of displays of shared understanding in acceptance of treatment. Soc Sci Med 2021; 290:114208. [PMID: 34301437 DOI: 10.1016/j.socscimed.2021.114208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/17/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Abstract
Globally, 4.4% of the world's population suffer from depressive disorder, and 3.6% from anxiety disorder. Previous work found considerable negotiation between providers and patients about the nature of mental health problems and frequent patient resistance to treatment. However, how doctor-patient shared understanding of the problem is reflected in treatment recommendations and whether this is consequential for patient acceptance of treatment is poorly understood. This study explored shared understanding of the problem and patient acceptance of treatment using conversation analysis. In 52 U.K. video recorded primary care consultations (collected July 2014-April 2015), 33 treatment recommendations for medication or talking therapy were identified. Shared understanding was explored focusing on: whether the patient presented the mental health problem as their primary initial concern and how they characterised the concern; whether the mental health concern was raised by the patient; and how the doctor aligned with the patient's earlier characterisation of the problem in the treatment recommendation itself. These phenomena were coded for each treatment recommendation and the impact on treatment acceptance was explored. Patients accepted the recommendation immediately in 38% cases and actively resisted in 62% cases. However, two communication behaviors were associated with patient acceptance: recommending treatment for the patient's initial focal concern and doctors' turn design in the recommendation itself, i.e., using the patient's earlier words from the initial problem presentation to describe and characterise the problem. Given the global burden of mental health problems and frequent patient resistance to treatment, understanding how professionals can engage more closely with the patient's perspective is important. When doctors use the patient's precise words from the initial problem presentation in the treatment recommendation, this displays an understanding of the patient's perspective and personalisation of treatment based on the underlying biomedical or social causes, which then impacts on patient acceptance of treatment.
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Affiliation(s)
- Rose McCabe
- School of Health Sciences, City, University of London, United Kingdom.
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23
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Anderson MP, Hyrkas EK. Patient and family perceptions of an inpatient journal. Nursing 2021; 51:62-68. [PMID: 34157005 DOI: 10.1097/01.nurse.0000754044.26660.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marguerite Peggy Anderson
- At Maine Medical Center in Portland, Me., Marguerite "Peggy" Anderson is the nursing director and Eira Kristiina Hyrkas is the director of the Center for Nursing Research and Quality Outcomes. Paul Bellfy and Paulette Gallant volunteered and contributed their time and effort to this study
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24
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Kaimal A, Norton ME. Society for Maternal-Fetal Medicine Consult Series #55: Counseling women at increased risk of maternal morbidity and mortality. Am J Obstet Gynecol 2021; 224:B16-B23. [PMID: 33309561 DOI: 10.1016/j.ajog.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Women should be provided with evidence-based information when considering options for contraception and pregnancy management. When counseling about health conditions and available treatments, healthcare practitioners should employ strategies that encourage the incorporation of informed patient preferences into a shared decision-making process with the patient. To optimize the health of women at risk of experiencing adverse health outcomes during or after pregnancy, counseling should be a continuous process throughout the reproductive life course. The purpose of this Consult is to provide guidance for all healthcare practitioners about counseling reproductive-aged women who may be at high risk of experiencing maternal morbidity or mortality.
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Affiliation(s)
- Anjali Kaimal
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Mary E Norton
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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25
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Monson A, Hendricks J, Sundin D. What are the shared decision-making experiences of adult children in regard to their parent/s' health care in residential aged care facilities? Int J Older People Nurs 2021; 16:e12375. [PMID: 33760400 DOI: 10.1111/opn.12375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 02/06/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
AIM This scoping literature review aimed to answer the question: What are the shared decision-making experiences of adult children in regard to their parent/s' health care in residential aged care facilities? BACKGROUND Shared decision-making has been an important patient-centred approach to nursing care since the 1990s, yet it is becoming increasingly evident that it is still not the reality in aged care facilities fifty years on. Currently, it is not well understood how adult children participate in shared decision-making and the types of decisions they are required to make. DESIGN A review of original research papers using Kable, Pich and Maslin-Prothero 12-step systematic approach to documenting a search strategy. METHOD The researcher screened 597 articles from four databases, published in the English language, during the period 1985-2019. The researcher used the Mixed Methods Appraisal Tool version 2011 to determine the methodological quality of the included studies. The Joanna Briggs Institute QARI data tool was used to appraise the seven selected articles and thematically analyse findings, respectively. RESULTS Four themes were highlighted: communication; staffing; being involved; and staff-family relationships. Despite these themes being apparent, families have limited opportunities to participate in shared health decision-making in regard to their parents' care. CONCLUSION The findings from this literature show how shared decision-making is affected by the RACF environment. There is a need to find out and understand what is important from a family member's point of view to optimise shared decision-making and nursing care of the family member in residential aged care settings. RELEVANCE TO CLINICAL PRACTICE The limited findings specific to the SDM experiences of adult children of parents in RACFs in this review could help staff and RACFs to develop strategies and staff training to encourage and facilitate the implementation of shared health decision-making with staff and families on older people's care.
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Affiliation(s)
- Ainslie Monson
- School of Nursing, Midwifery and Social Sciences, Higher Education Division, CQUniversity, Brisbane, Qld, Australia
| | - Joyce Hendricks
- School of Nursing, Midwifery and Social Sciences, Higher Education Division, CQUniversity, Bundaberg, Qld, Australia
| | - Deborah Sundin
- School of Nursing, Midwifery, Edith Cowan University, Perth, WA, Australia
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Medina-Perucha L, Gálvez-Hernández P, García-Sangenís A, Moragas A, Cots JM, Lanau-Roig A, Borrás A, Amo I, Barragán N, Monfá R, Llor C, Berenguera A. A Co-Design Process to Elaborate Educational Materials to Promote Appropriate Use of Antibiotics for Acute Lower Respiratory Tract Infections in Primary Healthcare in Catalonia (Spain). Patient Prefer Adherence 2021; 15:543-548. [PMID: 33727799 PMCID: PMC7954036 DOI: 10.2147/ppa.s297581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Co-design processes with patients allow developing health education materials, that are adapted to the population's knowledge and use of language, to reduce inappropriate antibiotic use. PATIENTS AND METHODS This study presents a co-design process of educational material with patients (over 18 years old) with a previous diagnosis of acute lower respiratory tract infection. The co-design was framed within a qualitative study (Phase I, interviews; Phase II, focus group) conducted in Barcelona between April and September 2019. RESULTS Twenty-nine semi-structured interviews were conducted. Six people participated in the focus group. Based on participants' narratives, educational materials can be useful to support healthcare consultations. Materials should be designed to be accessible in terms of the content and language used. CONCLUSION The co-design of educational materials is essential for health promotion. This study presents an example of how materials can be co-developed with patients. The material elaborated in this study is being used for the ISAAC-CAT project and may be useful for future research, practice in health services and health policy.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Pablo Gálvez-Hernández
- Institut Universitari de Pacients (Patients' University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
- University of Toronto, IHPME-BFON Collaborative PhD Specialization Program in Health Services and Policy Research, Ontario, Canada
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana Moragas
- Universitat Rovira i Virgili, Jaume I Health Centre, Institut Català de la Salut, Tarragona, Spain
| | - Josep María Cots
- La Marina Health Centre, Institut Català de la Salut, Associació d'Infermeria Familiar i Comunitària de Catalunya, Barcelona, Spain
| | - Anna Lanau-Roig
- La Marina Health Centre, Institut Català de la Salut, Associació d'Infermeria Familiar i Comunitària de Catalunya, Barcelona, Spain
| | - Alícia Borrás
- Institut Universitari de Pacients (Patients' University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
- Escola Universitària d'Infermeria, Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Spain
| | - Isabel Amo
- Institut Universitari de Pacients (Patients' University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Nieves Barragán
- Societat Catalana de Medicina Familiar i Comunitària (Camfic), Grupo Programa Comunicación y Salud semFYC. CAP Vallcarca Health Centre, Barcelona, Spain
| | - Ramon Monfá
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Carl Llor
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Via Roma Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Lappalainen L, Liira J, Lamminpää A. Work disability negotiations between supervisors and occupational health services: factors that support supervisors in work disability management. Int Arch Occup Environ Health 2021; 94:689-697. [PMID: 33389081 DOI: 10.1007/s00420-020-01623-5] [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: 02/18/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE A work disability negotiation takes place between a supervisor, the disabled employee and the occupational health service (OHS) to support the disabled employee in returning to their work, often with temporary work accommodation. The objective of this study was to define the factors of a work disability negotiation with OHS that supported or hindered supervisors in their task/role in work disability management. METHODS The study setting comprised two parts: the creation of survey questions and the actual survey of supervisors (N = 254) from six public and private organizations in Finland. Of these, 133 (52%) had participated in one or more work disability negotiations. The responses covered about 240 work disability cases and considerably more negotiations. RESULTS The study identified four key elements that the supervisors expressed as major success factors in the negotiations. First, it was crucial that the supervisors learned about the employee's health restrictions and understood the issues relating to their work disability. Second, the parties should aim for common solutions and conclusions through collaboration. Third, active participation of all the negotiation parties is important. The supervisors gave a high rating to OHS taking their views seriously. Last, the supervisors appreciated collaboration in a constructive atmosphere. CONCLUSION In order for a negotiation to help supervisors in their challenges, it should reach solutions, conclusions and a restructured comprehension of the work disability problem in a constructive atmosphere and with active communication between stakeholders.
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Affiliation(s)
- Liisa Lappalainen
- Department of Public Health, Occupational Health, University of Helsinki, Helsinki, Finland
| | - Juha Liira
- Department of Occupational Health, University of Turku, Turku, Finland
| | - Anne Lamminpää
- Department of Public Health, Occupational Health, University of Helsinki, Helsinki, Finland.
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Maxwell CA, Rothman R, Wolever R, Simmons S, Dietrich MS, Miller R, Patel M, Karlekar MB, Ridner S. Development and testing of a frailty-focused communication (FCOM) aid for older adults. Geriatr Nurs 2020; 41:936-941. [PMID: 32709372 PMCID: PMC7738367 DOI: 10.1016/j.gerinurse.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023]
Abstract
The concept of frailty as it pertains to aging, health and well-being is poorly understood by older adults and the public-at-large. We developed an aging and frailty education tool designed to improve layperson understanding of frailty and promote behavior change to prevent and/or delay frailty. We subsequently tested the education tool among adults who attended education sessions at 16 community sites. Specific aims were to: 1) determine acceptability (likeability, understandability) of content, and 2) assess the likelihood of behavior change after exposure to education tool content. Results: Over 90% of participants "liked" or "loved" the content and found it understandable. Eighty-five percent of participants indicated that the content triggered a desire to "probably" or "definitely" change behavior. The desire to change was particularly motivated by information about aging, frailty and energy production. Eight focus areas for proactive planning were rated as important or extremely important by over 90% of participants.
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Affiliation(s)
- Cathy A Maxwell
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
| | - Russell Rothman
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Ruth Wolever
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Sandra Simmons
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
| | - Richard Miller
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mayur Patel
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mohana B Karlekar
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Sheila Ridner
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
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Javaid M, Haleem A. Impact of industry 4.0 to create advancements in orthopaedics. J Clin Orthop Trauma 2020; 11:S491-S499. [PMID: 32774017 PMCID: PMC7394797 DOI: 10.1016/j.jcot.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022] Open
Abstract
Scientists and health professional are focusing on improving the medical sciences for the betterment of patients. The fourth industrial revolution, which is commonly known as Industry 4.0, is a significant advancement in the field of engineering. Industry 4.0 is opening a new opportunity for digital manufacturing with greater flexibility and operational performance. This development is also going to have a positive impact in the field of orthopaedics. The purpose of this paper is to present various advancements in orthopaedics by the implementation of Industry 4.0. To undertake this study, we have studied the available literature extensively on Industry 4.0, technologies of Industry 4.0 and their role in orthopaedics. Paper briefly explains about Industry 4.0, identifies and discusses the major technologies of Industry 4.0, which will support development in orthopaedics. Finally, from the available literature, the paper identifies twelve significant advancements of Industry 4.0 in orthopaedics. Industry 4.0 uses various types of digital manufacturing and information technologies to create orthopaedics implants, patient-specific tools, devices and innovative way of treatment. This revolution is to be useful to perform better spinal surgery, knee and hip replacement, and invasive surgeries.
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Affiliation(s)
- Mohd Javaid
- Corresponding author., https://scholar.google.co.in/citations?user=rfyiwvsAAAAJ&hl=en
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Maxwell CA, Mixon AS, Conner E, Phillippi JC. Receptivity of Hospitalized Older Adults and Family Caregivers to Prognostic Information about Aging, Injury, and Frailty: A Qualitative Study. Int J Nurs Stud 2020; 109:103602. [PMID: 32534291 DOI: 10.1016/j.ijnurstu.2020.103602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/20/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Frailty is the leading prognosticator for poor outcomes and palliative care among older adults. Delivery of negative prognostic information entails potentially difficult conversations about decline and death. OBJECTIVE The study aims were to: 1) examine hospitalized older adults' and family caregivers' receptivity to general (vs. individualized) prognostic information about frailty, injury, and one-year outcomes; and 2) determine information needs based on prognostic information. DESIGN Provision of general prognostic information followed by semi-structured interview questions. We deductively analyzed qualitative data within the context of problematic integration theory. SETTING An academic medical center in the Southeast region of the U.S. PARTICIPANTS Purposive sampling was utilized to obtain a distribution of patients across the frailty continuum (non-frail [N=10], pre-frail [N=9], frail [9=6]). Twenty-five older adults (≥ age 65) hospitalized for a primary injury (e.g. fall) and 15 family caregivers of hospitalized patients were enrolled. METHODS Hospitalized older patients and family caregivers were shown prognostic information about one-year outcomes of injured older adults in the form of simple pictographs. Semi-structured interview questions were administered immediately afterwards. The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis. Demographic and medical information data were used to contextualize the responses during analysis. RESULTS Overall, participants (patients [56%], caregivers [73%]) were open to receiving prognostic information. A small number of family caregivers (N=3) expressed reservations about the frankness of the information and suggested delivery through a softer approach or not at all. Qualitative data was coded using categories and constructs of problematic integration theory. Four codes (personalizing the evidence, vivid understanding, downhill spiral, realities of aging) reflected probabilistic and evaluative orientation categories of problematic integration theory. One code (fatalism vs. hope) represented manifestations of ambivalence and ambiguity in the theory; and another code (exceptionalism) represented divergence and impossibility. Two codes (role of thought processes, importance of faith) reflected forms of resolutions as described in problematic integration theory. Information needs based on prognostic information revealed four additional codes: give it to me straight, what can I do? what can I expect? and how can I prevent decline? A consistently reported desire of both patients and caregivers was for honesty and hope from providers. CONCLUSION This study supports the use of general prognostic information in conversations about aging, injury, frailty and patient outcomes. Incorporating prognostic information into communication aids can facilitate shared decision making before end-of-life is imminent.
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Affiliation(s)
- Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Ave. South, Nashville, TN 37240.
| | - Amanda S Mixon
- Section of Hospital Medicine, Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System.
| | - Elizabeth Conner
- University of Tennessee Health Science Center, College of Medicine, 910 Madison Ave. Suite 1031, Memphis, TN 38163.
| | - Julia C Phillippi
- Vanderbilt University School of Nursing, 461 21st Ave. South, Nashville, TN 37240.
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Stortenbeker I, Stommel W, van Dulmen S, Lucassen P, Das E, Olde Hartman T. Linguistic and interactional aspects that characterize consultations about medically unexplained symptoms: A systematic review. J Psychosom Res 2020; 132:109994. [PMID: 32179304 DOI: 10.1016/j.jpsychores.2020.109994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The apparent absence of any specific underlying diseases challenges patient-provider communication about medically unexplained symptoms (MUS). Previous research focused on general communication patterns in these interactions; however, an overview of more detailed interactional and linguistic aspects is lacking. This review aims to gain a detailed understanding of communicative challenges in MUS consultations by synthesizing evidence from conversation and discourse analytic research. METHODS A systematic review of publications using eight databases (PubMed, Embase, CINAHL, PsychINFO, Web of Science, MLA International Bibliography, LLBA and Communication Abstracts). Search terms included 'MUS', 'linguistics' and 'communication'. Additional studies were identified by contacting experts and searching bibliographies. We included linguistic and/or interactional analyses of natural patient-provider interactions about MUS. Two authors independently extracted the data, and quality appraisal was based on internal and external validity. RESULTS We identified 18 publications that met the inclusion criteria. The linguistic and interactional features of MUS consultations pertained to three dimensions: 1) symptom recognition, 2) double trouble potential (i.e. patients and providers may have differing views on symptoms and differing knowledge domains), and 3) negotiation and persuasion (in terms of acceptable explanations and subsequent psychological treatment). We describe the recurrent linguistic and interactional features of these interactions. CONCLUSIONS Despite the presence of a double trouble potential in MUS consultations, validation of symptoms and subtle persuasive conduct may facilitate agreement on illness models and subsequent (psychological) treatment.
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Affiliation(s)
- Inge Stortenbeker
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands.
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands.
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.
| | - Enny Das
- Centre for Language Studies, Radboud University, Nijmegen, The Netherlands.
| | - Tim Olde Hartman
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.
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“You don’t like to tell them their job but it’s your foot at the end of the day”: theorising and negotiating ‘resistance’ in clinical encounters. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lawless MT, Drioli-Phillips P, Archibald MM, Kitson AL. Engaging older adults in self-management talk in healthcare encounters: a systematic review protocol. Syst Rev 2020; 9:15. [PMID: 31948463 PMCID: PMC6964206 DOI: 10.1186/s13643-020-1276-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions. Yet, healthcare decision-making and communication for this population can pose significant challenges. As a result, healthcare professionals may struggle to help patients define and prioritise their values, goals, and preferences in ways that are clinically and personally meaningful, incorporating physical functioning and quality of life, when faced with numerous diagnostic and treatment alternatives. The aim of this systematic review is to locate and synthesise a body of fine-grained observational research on communication between professionals, older adults, and carers regarding self-management in audio/audio-visually recorded naturalistic interactions. METHODS/DESIGN The paper describes a systematic review of the published conversation analytic and discourse analytic research, using an aggregative thematic approach and following the PRISMA-P guidelines. This review will include studies reporting on adult patients (female or male) aged ≥ 60 years whose consultations are conducted in English in any healthcare setting and stakeholders involved in their care, e.g. general practitioners, nurses, allied health professionals, and family carers. We will search nine electronic databases and the grey literature and two independent reviewers will screen titles and abstracts to identify potential studies. Discrepancies will be resolved via consultation with the review team. The methodological quality of the final set of included studies will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and a detailed description of the characteristics of the included studies using a customised template. DISCUSSION This is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139376.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
| | | | - Mandy M. Archibald
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
- Helen Glass Centre for Nursing, University of Manitoba, 99 Curry Place, Winnipeg, Canada
| | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
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Kerr D, Milnes S, Ammentorp J, McKie C, Dunning T, Ostaszkiewicz J, Wolderslund M, Martin P. Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group study. J Clin Nurs 2019; 29:416-428. [PMID: 31715040 DOI: 10.1111/jocn.15099] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/25/2019] [Accepted: 10/17/2019] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness? BACKGROUND Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession. DESIGN A qualitative descriptive design was used. METHODS Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. RESULTS In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness; (b) interacting with family members adds complexity to care of patients who have life-limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families. CONCLUSIONS Caring for individuals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions. RELEVANCE TO CLINICAL PRACTICE Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.
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Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Waterfront Campus, Geelong, Vic., Australia
| | - Sharyn Milnes
- Barwon Health, University Hospital Geelong, Geelong, Vic., Australia
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Claire McKie
- Barwon Health, University Hospital Geelong, Geelong, Vic., Australia.,School of Medicine, Deakin University, Waurn Ponds Campus, Geelong, Vic., Australia
| | - Trisha Dunning
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Waterfront Campus, Geelong, Vic., Australia.,Barwon Health, University Hospital Geelong, Geelong, Vic., Australia
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Waterfront Campus, Geelong, Vic., Australia.,Barwon Health, University Hospital Geelong, Geelong, Vic., Australia
| | - Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Peter Martin
- Barwon Health, University Hospital Geelong, Geelong, Vic., Australia.,School of Medicine, Institute for Health Transformation, Deakin University, Waurn Ponds Campus, Geelong, Vic., Australia
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Kilpatrick J, Elliott R, Fry M. Health professionals' understanding of person-centred communication for risk prevention conversations: an exploratory study. Contemp Nurse 2019; 55:495-506. [PMID: 31514630 DOI: 10.1080/10376178.2019.1664925] [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] [Indexed: 10/26/2022]
Abstract
Background: Health Professionals are required to balance care practices against patient risk to optimise safety. Communicating clinical risk with the patient requires confidence.Objective: The objective was to explore health professionals understanding and confidence of patient-centred communication during conversations of risk prevention.Design: An exploratory study was conducted.Methods: Nurses, physiotherapists and social workers in a metropolitan hospital in Sydney (New South Wales, Australia) completed face to face interviews (n = 16) regarding person-centred communication and clinical risk.Results: The sample was predominately female and had been a health profession for 11.5 years (mean). Six key themes were generated including: Perceptions of person-centred communication; Preparing for person-centred communication and Understanding and prioritising conversations about preventable clinical risk.Conclusions: Person-centred communication was embedded in clinical practice; the 'patient voice' was considered central. Clinical risk was a priority. Education to improve communication was highlighted as a way to enhance person-centred communication.
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Affiliation(s)
- Jacinta Kilpatrick
- Manly Hospital, Northern Sydney Local Health, Manly, NSW 2065, Australia
| | - Rosalind Elliott
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Margaret Fry
- Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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Aarthun A, Øymar KA, Akerjordet K. Health professionals’ involvement of parents in decision-making in interprofessional practice at the hospital. J Interprof Care 2019; 34:297-306. [DOI: 10.1080/13561820.2019.1632816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antje Aarthun
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Knut A. Øymar
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
- University of Bergen, Bergen, Norway
| | - Kristin Akerjordet
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- School of Psychology, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
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Parents' and Health Professionals' Views of Collaboration in the Management of Childhood Long-term Conditions. J Pediatr Nurs 2018; 43:36-44. [PMID: 30473155 DOI: 10.1016/j.pedn.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore how parents and health professionals view the concept and practice of collaboration in the management of childhood long-term conditions. DESIGNS AND METHODS A qualitative research approach was adopted; sixteen parents and six health professionals participated in either individual or group interviews. Data analysis was underpinned by the Framework approach and involved an iterative process of reading the transcribed data, identifying and refining key themes until a coherent picture emerged. RESULTS Two main concepts were identified: expectations of collaboration and mechanisms for collaboration. Health professionals' expectations of collaborative practice were influenced by their knowledge, experience and relative objectivity. They used relationship building with families as a key strategy for collaboration. Parents' expectations of collaboration varied and appeared to be influenced by their experience of living with their child's condition. Parents' needs were often unmet, particularly in relation to support with coordinating or accessing care on behalf of their child. Parents' strategies included resilience, assertiveness, determination and battling for what they needed. CONCLUSION Parents and professionals valued collaboration as a concept but differed in their expectations of collaborative practice and adopted different mechanisms to foster meaningful collaboration. A better understanding of the unique needs and experiences of parents of a child with a long-term condition is key to developing positive collaborative practice. PRACTICE IMPLICATIONS Collaborative practice could be enhanced by health professionals' being more responsive to the full range of parent support needs, and being more pro-active about helping them work with the complexities of care systems.
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Schön UK, Grim K, Wallin L, Rosenberg D, Svedberg P. Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study. Int J Qual Stud Health Well-being 2018; 13:1421352. [PMID: 29405889 PMCID: PMC5804774 DOI: 10.1080/17482631.2017.1421352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. METHOD The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. RESULTS The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. CONCLUSION The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.
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Affiliation(s)
- Ulla-Karin Schön
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Katarina Grim
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden.,b Institution for Social Work , Karlstad University , Karlstad , Sweden
| | - Lars Wallin
- a School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - David Rosenberg
- c Department of Social Work , Umeå University , Umeå , Sweden
| | - Petra Svedberg
- d School of Social and Health Sciences , Halmstad University , Halmstad , Sweden
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Norton W, Furber L. An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: an interpretive phenomenological analysis. BMJ Open 2018; 8:e023579. [PMID: 30121616 PMCID: PMC6104788 DOI: 10.1136/bmjopen-2018-023579] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/13/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of the study was to explore how women experience care within an early pregnancy assessment unit (EPAU) and how they are helped to understand, reconcile and make sense of their loss and make informed decisions about how their care will be managed following a first trimester miscarriage. DESIGN This was a single centre, prospective qualitative study. An interpretive phenomenological analysis approach was used to interpret the participants' meanings of their experiences. It is an ideographic approach that focuses in depth on a small set of cases to explore how individuals make sense of a similar experience. SETTING An EPAU in a large teaching hospital in the Midlands that provides care to women in their early pregnancy, including those experiencing pregnancy loss. PARTICIPANTS A purposive sample of 10 women were recruited to this study. All of the women were either miscarrying at the time of this study or had miscarried within the previous few weeks. RESULTS Six superordinate themes in relation to women's experiences of miscarriage were identified: (1) the waiting game, (2) searching for information, (3) management of miscarriage: no real choice, (4) the EPAU environment, (5) communication: some room for improvement and (6) moving on. CONCLUSIONS This study found that improvements are required to ensure women and their partners receive a streamlined, informative, supportive and continuous package of care from the point they first see their general practitioner or midwife for support to being discharged from the EPAU. The provision of individualised care, respect for women's opinions and appropriate clinical information is imperative to those experiencing miscarriage to help them gain a degree of agency within an unfamiliar situation and one in which they feel is out of their control.
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Affiliation(s)
- Wendy Norton
- Leicester School Nursing & Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Lynn Furber
- Leicester School Nursing & Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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Bunn F, Goodman C, Russell B, Wilson P, Manthorpe J, Rait G, Hodkinson I, Durand MA. Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BackgroundHealth-care systems are increasingly moving towards more integrated approaches. Shared decision-making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; this is particularly the case for older people with complex needs.ObjectivesTo provide a context-relevant understanding of how models to facilitate SDM might work for older people with multiple health and care needs and how they might be applied to integrated care models.DesignRealist synthesis following Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.ParticipantsTwenty-four stakeholders took part in interviews.Data sourcesElectronic databases including MEDLINE (via PubMed), The Cochrane Library, Scopus, Google and Google Scholar (Google Inc., Mountain View, CA, USA). Lateral searches were also carried out. All types of evidence were included.Review methodsIterative stakeholder-driven, three-stage approach, involving (1) scoping of the literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, (2) systematic searches for evidence to test and develop the theories and (3) validation of programme theory/ies with stakeholders (n = 11).ResultsWe included 88 papers, of which 29 focused on older people or people with complex needs. We identified four theories (context–mechanism–outcome configurations) that together provide an account of what needs to be in place for SDM to work for older people with complex needs: understanding and assessing patient and carer values and capacity to access and use care; organising systems to support and prioritise SDM; supporting and preparing patients and family carers to engage in SDM; and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that create trust between those involved, allow service users to feel that they are respected and understood, and engender confidence to engage in SDM.LimitationsThere is a lack of evidence on interventions to promote SDM in older people with complex needs or on interprofessional approaches to SDM.ConclusionsModels of SDM for older people with complex health and care needs should be conceptualised as a series of conversations that patients, and their family carers, may have with a variety of different health and care professionals. To embed SDM in practice requires a shift from a biomedical focus to a more person-centred ethos. Service providers are likely to need support, both in terms of the way services are organised and delivered and in terms of their own continuing professional development. Older people with complex needs may need support to engage in SDM. How this support is best provided needs further exploration, although face-to-face interactions and ongoing patient–professional relationships are key.Future workThere is a need for further work to establish how organisational structures can be better aligned to meet the requirements of older people with complex needs. This includes a need to define and evaluate the contribution that different members of health and care teams can make to SDM for older people with complex health and care needs.Study registrationThis study is registered as PROSPERO CRD42016039013.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, UK
| | - Isabel Hodkinson
- Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK
| | - Marie-Anne Durand
- The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Bunn F, Goodman C, Russell B, Wilson P, Manthorpe J, Rait G, Hodkinson I, Durand MA. Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis. BMC Geriatr 2018; 18:165. [PMID: 30021527 PMCID: PMC6052575 DOI: 10.1186/s12877-018-0853-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models. METHODS Iterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n = 11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included. RESULTS We included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM. CONCLUSIONS To embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB UK
| | - Bridget Russell
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB UK
| | - Patricia Wilson
- Centre for Health Service Studies, University of Kent, George Allen Wing, Canterbury, Kent CT2 7NF UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, Strand, London, WC2B 4LL UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Isabel Hodkinson
- Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, E3 5JD UK
| | - Marie-Anne Durand
- The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Level 5, Williamson Translational Research Building, Lebanon, New Hampshire USA
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Pecanac KE. Combining conversation analysis and event sequencing to study health communication. Res Nurs Health 2018; 41:312-319. [DOI: 10.1002/nur.21863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/28/2017] [Indexed: 11/08/2022]
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Land V, Parry R, Seymour J. Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research. Health Expect 2017; 20:1228-1247. [PMID: 28520201 PMCID: PMC5690232 DOI: 10.1111/hex.12557] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 11/29/2022] Open
Abstract
Background Shared decision making (SDM) is generally treated as good practice in health‐care interactions. Conversation analytic research has yielded detailed findings about decision making in health‐care encounters. Objective To map decision making communication practices relevant to health‐care outcomes in face‐to‐face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. Search strategy We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Inclusion criteria Published conversation analyses (no restriction on publication dates) using recordings of health‐care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness‐related decision making. Data extraction and synthesis We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Results Twenty‐eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision‐making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Conclusions Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non‐negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale).
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Affiliation(s)
| | - Ruth Parry
- University of Nottingham, Nottingham, UK
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