What is in the toolkit (and what are the tools)? How to approach the study of doctor-patient communication

Systematic review of observational coding systems to assess patient-healthcare professional interactions

OBJECTIVES

Systematic coding is used to study interactions between patients and healthcare professionals from an independent observer perspective. Many coding systems are available, but an up-to-date overview is lacking. We aimed to: (1) provide a comprehensive overview of systems for systematic coding of patient-healthcare professional interactions; and describe their 2) general characteristics and development, and 3) validation and adaptation.

METHODS

We systematically searched peer-reviewed empirical articles in five databases (Cochrane, Embase, PubMed/Medline, CINAHL, PsychINFO) using variations of the following keywords: (i) patient and/or other stakeholder, (ii) healthcare professional (iii), interactions in healthcare, (iv) coding tool, and (v) development and/or validation. All titles/abstracts and full-texts were screened independently and in duplicate. Additionally, coding systems were identified through an earlier review, an open-access research database, and a forward-reference search of all included coding systems up to that point. For all eligible systems, we extracted characteristics and psychometric properties.

RESULTS

From a total of 6950 identified articles from literature databases, 188 full-text articles were screened. Thirty-five articles were included from additional sources. In total, we included 124 articles describing 98 coding systems. Systems were highly variable in terms of topic (e.g., patient-centered communication, shared decision making, behavior change counseling), clinical context (e.g., oncology, pediatrics, generic), rigor of development and reporting, coding complexity, and extent of psychometric testing. Inter-rater reliability was reported for most coding systems; only few were tested for other types of reliability or for validity.

CONCLUSIONS

A plethora of coding systems are available, but more systematic reporting and psychometric testing are urgently needed to enhance evidence of validity. Testing may initially focus on the most relevant and broadly applicable coding systems.

PRACTICE IMPLICATIONS

These results can aid researchers in selecting the most suitable coding system for their purposes. Researchers may consider using or adapting existing systems, before developing new coding systems.

Creating and administering video vignettes for a study examining the communication of diagnostic uncertainty: methodological insights to improve accessibility for researchers and participants

BACKGROUND

Studying clinician-patient communication can be challenging, particularly when research seeks to explore cause-and-effect relationships. Video vignettes - hypothetical yet realistic scenarios - offer advantages to traditional observational approaches by enabling standardisation and manipulation of a clinician-patient encounter for assessment by participants. While published guidelines outline stages to create valid video vignette studies, constructing high quality vignettes which are accessible to a wide range of participants and feasible to produce within time and budget restraints remains challenging. Here, we outline our methods in creating valid video vignettes to study the communication of diagnostic uncertainty. We aim to provide practically useful recommendations for future researchers, and to prompt further reflection on accessibility issues in video vignette methodology.

METHODS

We produced four video vignettes for use in an online study examining the communication of diagnostic uncertainty. We followed established guidelines for vignette production, with specific consideration of how these might be applied pragmatically to save time and resources. Scripts were pilot-tested with 15 laypeople, and videos with 14 laypeople; pilot-testing involved both quantitative and qualitative analysis.

RESULTS AND DISCUSSION

We demonstrate the usefulness of existing guidelines, while also determining that vignette production need not necessarily be expensive or time-consuming to be valid. Our vignettes were filmed using an iPhone camera, and featured a physician rather than a professional actor; nonetheless, pilot-testing found them to be internally and externally valid for experimental use. We thus propose that if care is taken in initial script development and if pragmatic choices are made regarding filming techniques and pilot-testing, researchers can produce valid vignettes within reasonable time and budget restraints. We also suggest that existing research fails to critically examine the potential benefits and harms of online video vignette methodology, and propose that further research should consider how it can be adapted to be inclusive of those from underserved backgrounds.

CONCLUSIONS

Researchers creating video vignette studies can adapt the video vignette development process to suit time and budget constraints, and to make best use of available technology. Online methods may be harnessed to increase participant accessibility, but future research should explore more inclusive vignette design.

Digital Health Care, Telemedicine, and Medicolegal Issues in Orthopedics: A Review

The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.

Informed consent and biological agents in rheumatology and internal medicine

BACKGROUND

The need for highly effective therapies in rheumatologic diseases has led to the widespread and growing use of a heterogeneous class of molecules called biological agents. The increasing experience with biological agents has raised concerns about safety and efficacy issues that need to be discussed in the informed consent acquisition process.

METHODS

The authors performed a review of the literature on biological agents focusing on their most important characteristics concerning the informed consent procedures.

RESULTS

No studies specifically addressed the issue of informed consent in patients receiving biological agents. Several studies reported data about off-label use of biological agents usually with no obvious attention to informed consent shortcomings.

CONCLUSION

The reported association between biological agents and serious infections or malignancies, including reactivation of latent tuberculosis, needs specific disclosure in informed consent acquisition, together with information about the possible efficacy in clinical contexts often characterized by resistance to previous treatments. Ethical and clinical issues bound to the need for experimenting with new agents with potentially serious adverse effects deserve specific attention. Studies aimed at evaluating mental capacity to consent in subjects receiving biological agents are required.