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Mohammadi M, Peyrovi H, Fazeli N, Parsa Yekta Z. Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study. QUALITATIVE HEALTH RESEARCH 2024:10497323241240902. [PMID: 38876482 DOI: 10.1177/10497323241240902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.
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Affiliation(s)
- Marziyeh Mohammadi
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Hamid Peyrovi
- Nursing and Midwifery Care Research Center/School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Parsa Yekta
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
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Cairns P, Isham AE, Zachariae R. The association between empathy and burnout in medical students: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2024; 24:640. [PMID: 38849794 PMCID: PMC11157786 DOI: 10.1186/s12909-024-05625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Burnout levels in medical students are higher than in other student groups. Empathy is an increasingly desired outcome of medical schools. Empathy is negatively associated with burnout in physicians. Our objective was to quantitatively review the available literature on associations between empathy and burnout in medical students, and to explore associations between specific empathy aspects (cognitive and affective) and burnout sub-dimensions (emotional exhaustion, depersonalization and personal accomplishment). METHODS A comprehensive search of the literature published up until January 2024 was undertaken in the PubMed, EMBASE, CINAHL, The Cochrane Library, and PsycINFO databases. Two independent reviewers screened 498 records and quality-rated and extracted data from eligible studies. The effect size correlations (ESr) were pooled using a random-effects model and between-study variation explored with meta-regression. The review was preregistered with PROSPERO (#CRD42023467670) and reported following the PRISMA guidelines. RESULTS Twenty-one studies including a total of 27,129 medical students published between 2010 and 2023 were included. Overall, empathy and burnout were negatively and statistically significantly associated (ESr: -0.15, 95%CI [-0.21; -0.10], p < .001). When analyzing sub-dimensions, cognitive empathy was negatively associated with emotional exhaustion (ESr: -0.10, 95%CI [-0.17; -0.03], p = .006) and depersonalization (ESr: -0.15, 95%CI [-0.24; 0.05], p = .003), and positively associated with personal accomplishment (ESr: 0.21, 95%CI [0.12; 0.30], p < .001). Affective empathy was not statistically significantly associated with emotional exhaustion, depersonalization or personal accomplishment. Supplementary Bayesian analysis indicated the strongest evidence for the positive association between cognitive empathy and personal accomplishment. Response rate and gender moderated the relationship so that higher response rates and more male respondents strengthen the negative association between empathy and burnout. CONCLUSION Greater empathy, in particular cognitive empathy, is associated with lower burnout levels in medical students. This appears to be primarily driven by cognitive empathy's positive association with personal accomplishment. PROTOCOL REGISTRATION #CRD42023467670.
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Affiliation(s)
- P Cairns
- Unit for Psycho-Oncology & Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - A E Isham
- Research and Development Department, Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Nordbyhagen, Norway
| | - R Zachariae
- Unit for Psycho-Oncology & Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Sensky T. The Person-Centred Clinical Interview. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024:1-7. [PMID: 38830341 DOI: 10.1159/000539055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Tom Sensky
- Centre for Mental Health, Department of Brain Sciences, Imperial College London, London, UK
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Hughes L, Bowen J, Davies W, Deslandes R, Ivory M, Kingman S. When pharmacy and theater collide: How diversity can develop inclusive communication skills. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:460-464. [PMID: 38582640 DOI: 10.1016/j.cptl.2024.03.005] [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: 07/11/2023] [Revised: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Effective communication with patients and colleagues is key to a pharmacist's ability to provide effective person-centered care. Neurodivergent patients face many barriers when interacting with health professionals; increased awareness and understanding are therefore paramount to the pharmacist's role. This paper describes an innovative teaching partnership between a school of pharmacy and an inclusive theater company which aims to develop awareness and skills of undergraduate pharmacy students in relation to communicating with patients with autism and/or learning disabilities. EDUCATIONAL ACTIVITY Forum theater and role-plays were used to complement existing communication skills teaching in Years two and four of the undergraduate MPharm (Master of Pharmacy) program. The sessions were designed and delivered in partnership between academic teaching staff and a theater company of neurodivergent actors. An online evaluation form was used to obtain student feedback on these sessions (two Likert-style questions and three open format questions). CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY Of the 241 students who attended a session in 2021, 70 (29%) provided feedback. Feedback was positive, with 99% of respondents finding the session useful. Students spoke about how they found the sessions supportive and enlightening, helping them to reflect on their own communication skills. As a result, the teaching has been developed and now expanded through all years of the undergraduate program. While conscious of challenges such as funding and finding the right partner, the authors recommend this rewarding initiative to fellow academics.
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Affiliation(s)
- Louise Hughes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3NB, Wales, UK.
| | - Jenna Bowen
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3NB, Wales, UK.
| | - Wyn Davies
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3NB, Wales, UK.
| | - Rhian Deslandes
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3NB, Wales, UK.
| | - Matt Ivory
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cathays Park, Cardiff CF10 3NB, Wales, UK.
| | - Susan Kingman
- Hijinx Theatre Company, Millennium Centre, Bute Place, Cardiff Bay, Cardiff CF10 5AL, Wales, UK.
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Howick J, Slavin D, Carr S, Miall F, Ohri C, Ennion S, Gay S. Towards an empathic hidden curriculum in medical school: A roadmap. J Eval Clin Pract 2024; 30:525-532. [PMID: 38332641 DOI: 10.1111/jep.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Sue Carr
- Department of Nephrology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Chandra Ohri
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Steve Ennion
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
| | - Simon Gay
- Leicester Medical School, University of Leicester, George Davies Centre, Leicester, UK
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Howick J, de Zulueta P, Gray M. Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership. J Eval Clin Pract 2024; 30:548-558. [PMID: 38436621 DOI: 10.1111/jep.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024]
Abstract
Empathic care benefits patients and practitioners, and empathy training for practitioners can enhance empathy. However, practitioners do not operate in a vacuum. For empathy to thrive, healthcare consultations must be situated in a nurturing milieu, guided by empathic, compassionate leaders. Empathy will be suppressed, or even reversed if practitioners are burned out and working in an unpleasant, under-resourced environment with increasingly poorly served and dissatisfied patients. Efforts to enhance empathy must therefore go beyond training practitioners to address system-level factors that foster empathy. These include patient education, cultivating empathic leadership, customer service training for reception staff, valuing cleaning and all ancillary staff, creating healing spaces, and using appropriate, efficiency saving technology to reduce the administrative burden on healthcare practitioners. We divide these elements into environmental factors, organisational factors, job factors, and individual characteristics.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Paquita de Zulueta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Muir Gray
- Director of the Oxford Value and Stewardship Programme, Oxford, UK
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
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Zhang X, Li L, Zhang Q, Le LH, Wu Y. Physician Empathy in Doctor-Patient Communication: A Systematic Review. HEALTH COMMUNICATION 2024; 39:1027-1037. [PMID: 37062918 DOI: 10.1080/10410236.2023.2201735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Physician empathy is at the heart of doctor-patient communication and significantly influences patient outcomes. However, the research on how physicians express their empathy and how physician empathy affects patient outcomes and doctor-patient communication has not been well summarized in the latest literature. Thus, we conducted a systematic review to synthesize existing studies on physician empathy and its value to patient outcomes and doctor-patient communication. The systematic review consisted of studies published in English peer-reviewed journals between January 2017 and October 2021. Following the PRISMA procedure, a total of 3055 articles were retrieved, and 11 articles were retained. The thematic analysis revealed three emergent themes: physicians' empathic expressions; patient outcomes (patient functional status, patient safety, and patient satisfaction); and empathy enhancing doctor-patient communication. This study highlighted the different ways empathy may be expressed by physicians and its positive effects on patient outcomes and doctor- patient communication. This study also suggested the under-researched areas that can be expanded in the future.
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Affiliation(s)
- Xin Zhang
- Center for Medical Humanities in the Developing World, Qufu Normal University
| | - Linzi Li
- Department of Gynaecology, Rizhao Maternal and Child Health
| | - Quan Zhang
- School of International Affairs and Public Administration, Ocean University of China
| | | | - Yijin Wu
- Center for Medical Humanities in the Developing World, Qufu Normal University
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Chen H, Xuan H, Cai J, Liu M, Shi L. The impact of empathy on medical students: an integrative review. BMC MEDICAL EDUCATION 2024; 24:455. [PMID: 38664799 PMCID: PMC11047033 DOI: 10.1186/s12909-024-05448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Empathy is considered the ability to understand or feel others emotions or experiences. As an important part of medical education, empathy can affect medical students in many ways. It is still lacking a comprehensive evaluation of the existing articles on empathy's impact on medical students, despite the existence of many articles on the topic. OBJECTIVES To summarize the impact of empathy on medical students during medical education from four perspectives: mental health, academic performance, clinical competence, and specialty preference. METHODS The search terms used for retrieval were "empathy", "medical student", "mental health", "depression", "anxiety", "burnout", "examinations", "academic performance", "clinical competence", "specialty preference" on PubMed, EBSCO, and Web of Science before January 2024. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed based on inclusion/exclusion criteria. A consensus was drawn on which articles were included. RESULTS Our results indicated that high empathy was a positive factor for mental health, However, students with high affective empathy were more likely to suffer from depression, anxiety, and burnout. Empathy was found to be unrelated to academic performance, but positively correlated with clinical competence, particularly in terms of communication skills. Medical students with high levels of empathy tended to prefer people-oriented majors. CONCLUSIONS Medical students who score higher on the self-reported empathy scales often have better mental health, better communication skills, and tend to choose people-oriented specialties. But empathy is not related to academic performance. Additionally, the different dimensions of empathy have different impacts on medical students. It is necessary to design targeted courses and training for medical students to enhance their empathy.
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Affiliation(s)
- Hao Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Hanwen Xuan
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jinquan Cai
- Department of Neurosurgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China.
| | - Meichen Liu
- Modern Educational Technology Center, Harbin Medical University, Harbin, 150086, China.
| | - Lei Shi
- School of Health Management, Guangzhou Medical University, Guangzhou, 511436, China.
- School of Health Management, Southern Medical University, Guangzhou, 510515, China.
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Licciardone JC, Tran Y, Ngo K, Toledo D, Peddireddy N, Aryal S. Physician Empathy and Chronic Pain Outcomes. JAMA Netw Open 2024; 7:e246026. [PMID: 38602675 PMCID: PMC11009829 DOI: 10.1001/jamanetworkopen.2024.6026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 04/12/2024] Open
Abstract
Importance Empathy is an aspect of the patient-physician relationship that may be particularly important in patients with chronic pain. Objective To measure the association of physician empathy with pain, function, and health-related quality of life (HRQOL) among patients with chronic low back pain. Design, Setting, and Participants This cohort study included adult enrollees from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation national pain research registry. Study dates were from April 1, 2016, to July 25, 2023, with up to 12 months of follow-up. Exposure Physician empathy was assessed with the Consultation and Relational Empathy measure and dichotomized to yield very empathic physician and slightly empathic physician groups. Main Outcomes and Measures Main outcomes were patient-reported pain, function, and HRQOL measured with a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System for HRQOL deficits pertaining to anxiety, depression, fatigue, sleep disturbance, and pain interference. Data were collected at 5 quarterly encounters from registry enrollment through 12 months and analyzed with generalized estimating equations, including multivariable models to measure temporal trends and to adjust for baseline and longitudinal covariates. Results Among the 1470 patients, the mean (SD) age was 53.1 (13.2) years, and 1093 (74.4%) were female. Patients completed 5943 encounters in which multivariable analyses demonstrated that greater physician empathy was inversely associated with pain intensity (β = -0.014; 95% CI, -0.022 to -0.006; P < .001), back-related disability (β = -0.062; 95% CI, -0.085 to -0.040; P < .001), and HRQOL deficits on each measure (eg, pain interference: β = -0.080; 95% CI, -0.111 to -0.049; P < .001). Correspondingly, compared with the slightly empathic physician group, the very empathic physician group reported lower mean pain intensity (6.3; 95% CI, 6.1-6.5 vs 6.7; 95% CI, 6.5-6.9; P < .001), less mean back-related disability (14.9; 95% CI, 14.2-15.6 vs 16.8; 95% CI, 16.0-17.6; P < .001), and fewer HRQOL deficits on each measure (eg, fatigue: 57.3; 95% CI, 56.1-58.5 vs 60.4; 95% CI, 59.0-61.7; P < .001). All physician empathy group differences were clinically relevant, with Cohen d statistics ranging from 0.21 for pain intensity to 0.30 for back-related disability, fatigue, and pain interference. Physician empathy was associated with more favorable outcomes than non-pharmacological treatments, opioid therapy, and lumbar spine surgery. Conclusions and Relevance In this cohort study of adult patients with chronic pain, physician empathy was associated with better outcomes over 12 months. Greater efforts to cultivate and improve physician empathy appear warranted.
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Affiliation(s)
- John C. Licciardone
- Department of Family Medicine, University of North Texas Health Science Center at Fort Worth, Fort Worth
| | - Yen Tran
- University of North Texas Health Science Center at Fort Worth, Fort Worth
| | - Khang Ngo
- University of North Texas Health Science Center at Fort Worth, Fort Worth
| | - David Toledo
- University of North Texas Health Science Center at Fort Worth, Fort Worth
| | - Navya Peddireddy
- University of North Texas Health Science Center at Fort Worth, Fort Worth
| | - Subhash Aryal
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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Shah HA, O'Donnell DB, Galvez R, Reed ME, Ghosh D, Katz RR, Bedi AD, D'Amico RS. Digital health technology utilization is associated with enhanced patient perspectives of care. Clin Neurol Neurosurg 2024; 239:108218. [PMID: 38447481 DOI: 10.1016/j.clineuro.2024.108218] [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: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores measure patient experience and perspectives on care. Novel health information technologies facilitate communication between patients and healthcare teams. Playback Health is a health information technology that incorporates multimedia for providers to communicate health information to patients, their support network, and their healthcare teams. We hypothesized implementing Playback Health may enhance patient perspectives on care. METHODS HCAHPS scores were obtained retrospectively from a neurosurgical practice located in a metropolitan area between 2020 and 2022 for seven providers. Of these, four providers utilized Playback Health, and three did not. Individual providers' scores were compared between domains using two tailed t-tests at a significance level of p < 0.05. RESULTS Playback Health use was associated with higher HCAHPS scores across varying domains from 2020 through 2022 as well as overall scores. In 2020, the mean overall score of HCAHPS users was higher than non-users (89.65 vs. 87.28, p = 0.0095). In 2021, again higher mean overall scores were observed in users as compared to non-users (89.11 vs. 87.79, p 0.0266). In 2022, Playback Health users maintained higher scores across communication domains and overall scores (p < 0.00001). Comparisons within domains between Playback Health users and non-users revealed no domains in which non-users had a significantly higher score than users. CONCLUSION The addition of Playback Health multimedia health information technology was associated with improved patient satisfaction scores. When used as an adjunct to existing patient care, multimedia health information technologies may improve patient perceived care.
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Affiliation(s)
- Harshal A Shah
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Devon B O'Donnell
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Rosivel Galvez
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Max E Reed
- Weill Cornell Medical College, New York, NY, USA
| | | | - Rebecca R Katz
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Anupama D Bedi
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Chen YH, Hsiao CY, Chien HW. Attitudes Toward People With Schizophrenia Among Undergraduate Nursing Students. J Am Psychiatr Nurses Assoc 2024; 30:313-321. [PMID: 35620801 DOI: 10.1177/10783903221096360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Negative attitudes toward mental disorders are not only an interpersonal issue but also a concern of mental health care. Given that nursing students are future health care providers, it is pivotal to improve their attitudes toward individuals with mental disorders prior to their transition into clinical practice. However, research on nursing students' attitudes in relation to schizophrenia in Taiwan remains unexplored. AIM The aim of this article is to examine the correlates of attitudes toward individuals with schizophrenia among Taiwanese undergraduate nursing students. METHOD A descriptive, correlational, and cross-sectional study was adopted. Self-reported questionnaires were conducted with a convenience sample of 306 Taiwanese undergraduate nursing students. Descriptive statistics, independent t tests, one-way analysis of variance, Pearson's correlations, and a stepwise regression analysis were performed. RESULTS Nursing students expressed negative attitudes toward individuals with schizophrenia. Nursing students, who were female, had contact with individuals with mental disorders, and expressed greater empathy and personality traits held more favorable attitudes toward individuals with schizophrenia. The study found that empathy, personality traits, and academic year were the most crucial attributes contributing to attitudes of nursing students toward individuals with schizophrenia. CONCLUSION Findings suggest that nursing education programs with empathy- and personality-tailored modules in mental health are pivotal to provide humanistic approaches with supportive attitudes regarding schizophrenia.
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Affiliation(s)
- Yi-Han Chen
- Yi-Han Chen, BSN, RN, China Medical University Hospital, Taichung City, Taiwan, Republic of China
| | - Chiu-Yueh Hsiao
- Chiu-Yueh Hsiao, PhD, RN, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Hui-Wen Chien
- Hui-Wen Chien, PhD, RN, Asia University, Taichung City, Taiwan, Republic of China
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Ortiz-Paredes D, Adam Henet P, Desseilles M, Rodríguez C. Empathy in family medicine postgraduate education: A mixed studies systematic review. MEDICAL TEACHER 2024:1-17. [PMID: 38555732 DOI: 10.1080/0142159x.2024.2328324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Empathy is an important construct in patient-physician relationships, particularly critical in family physicians' daily practice. We aimed to understand how empathy has been conceived and integrated into family medicine postgraduate training. MATERIALS AND METHODS Medline, PsyINFO, and Embase were searched in this systematic mixed studies systematic review. Two independent reviewers screened abstracts and full texts. Disagreements were solved through research team consensus-based discussion. Included studies were synthesized thematically. RESULTS A total of 18 studies were included. Four themes were identified. (1) Empathy definition. Included studies stressed the cognitive component of empathy, paired either with a behavioural or an affective response. (2) Empathy modifiers. Starting residency right after medical school, having a role model, having high empathy levels before residency, having children, being married, and being exposed to patient involvement in education were found to have a positive impact on empathy. (3) Empathy-burnout relationship. Whereas greater burnout was related to lower empathy levels, excess empathy seems to favour burnout through 'compassion fatigue.' (4) Educational programs for empathy development. Five programs were identified: a communication workshop, a patient-led program, a mindfulness program, a family-oriented intervention, and an arts-based program. CONCLUSIONS Studies mostly measured the cognitive component of empathy. The moral component of empathy was underrepresented in the conceptualization of empathy and the development of educational interventions. Conflicting evidence exists regarding the decline of empathy levels during the family medicine residency. Longitudinal designs should be privileged when exploring the evolution of empathy levels across the continuum of medical education.
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Affiliation(s)
- David Ortiz-Paredes
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Peterson Adam Henet
- Institute of Neuroscience (IoNS), Faculty of Medicine, Université Catholique de Louvain, Brussels, Belgium
- Pôle Enseignement et recherche, Le Beau Vallon-Soins spécialisés en santé mentale, Namur, Belgium
| | - Martin Desseilles
- Department of Psychology, Faculty of Medicine and Transition Institute, Université de Namur, Namur, Belgium
| | - Charo Rodríguez
- Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Bishop FL, Cross N, Dewar-Haggart R, Teasdale E, Herbert A, Robinson ME, Ridd MJ, Mallen C, Clarson L, Bostock J, Becque T, Stuart B, Garfield K, Morrison L, Pollet S, Vennik J, Atherton H, Howick J, Leydon GM, Nuttall J, Islam N, Lee PH, Little P, Everitt HA. Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement. BMJ Open 2024; 14:e081932. [PMID: 38508652 PMCID: PMC10953007 DOI: 10.1136/bmjopen-2023-081932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. METHODS AND ANALYSIS A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. ETHICS APPROVAL AND DISSEMINATION Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. TRIAL REGISTRATION NUMBER ISRCTN18010240.
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Affiliation(s)
| | - Nadia Cross
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Rachel Dewar-Haggart
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Amy Herbert
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Christian Mallen
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lorna Clarson
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Jennifer Bostock
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
| | - Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Sebastien Pollet
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Jeremy Howick
- Leicester Medical School, University of Leicester, Leicester, UK
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Geraldine M Leydon
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Hazel A Everitt
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
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14
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Doidge C, Ånestad LM, Burrell A, Frössling J, Palczynski L, Pardon B, Veldhuis A, Bokma J, Carmo LP, Hopp P, Guelbenzu-Gonzalo M, Meunier NV, Ordell A, Santman-Berends I, van Schaik G, Kaler J. A living lab approach to understanding dairy farmers' needs of technologies and data to improve herd health: Focus groups from 6 European countries. J Dairy Sci 2024:S0022-0302(24)00550-2. [PMID: 38490555 DOI: 10.3168/jds.2024-24155] [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: 09/04/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
For successful development and adoption of technology on dairy farms, farmers need to be included in the innovation process. However, the design of agricultural technologies usually takes a top-down approach with little involvement of end-users at the early stages. Living Labs offer a methodology that involve end-users throughout the development process and emphasize the importance of understanding users' needs. Currently, exploration of dairy farmers' needs of technologies has been limited to specific types of technology (e.g., smartphone apps) and adult cattle. The aim of this study was to use a Living Lab approach to identify dairy farmers' needs of data and technologies to improve herd health and inform innovation development. Eighteen focus groups were conducted with, in total, 80 dairy farmers from Belgium, Ireland, the Netherlands, Norway, Sweden, and the UK. Data were analyzed using Template Analysis and 6 themes were generated which represented the fundamental needs of autonomy, comfort, competence, community and relatedness, purpose, and security. Farmers favored technologies that provided them with convenience, facilitated their knowledge and understanding of problems on farm, and allowed them to be self-reliant. Issues with data sharing and accessibility, and usability of software were barriers to technology use. Furthermore, farmers were facing problems around recruitment and management of labor and needed ways to reduce stress. Controlling aspects of the barn environment, such as air quality, hygiene, and stocking density, was a particular concern in relation to youngstock management. In conclusion, the findings suggest that developers of farm technologies may want to include farmers in the design process to ensure a positive user experience and improve accessibility. The needs identified in this study can be used as a framework when designing farm technologies to strengthen need satisfaction and reduce any potential harm toward needs.
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Affiliation(s)
- C Doidge
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, LE12 5RD, UK.
| | - L M Ånestad
- Norwegian Veterinary Institute, P.O. Box 64, 1431 Ås, Norway
| | - A Burrell
- Animal Health Ireland, 2 - 5 The Archways, Carrick-on-Shannon, Co. Leitrim, Ireland, N41 WN27
| | - J Frössling
- Department of Epidemiology, Surveillance and Risk Assessment, Swedish Veterinary Agency (SVA), 751 89 Uppsala, Sweden; Department of Applied Animal Science and Welfare, Swedish University of Agricultural Sciences (SLU), Box 234, 532 23 Skara, Sweden
| | - L Palczynski
- Innovation for Agriculture, Stoneleigh Park, Warwickshire, CV8 2LZ, UK
| | - B Pardon
- Department of Internal Medicine, Reproduction, and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - A Veldhuis
- Royal GD, P.O. 9, 7400 AA, Deventer, the Netherlands
| | - J Bokma
- Department of Internal Medicine, Reproduction, and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - L P Carmo
- Norwegian Veterinary Institute, P.O. Box 64, 1431 Ås, Norway
| | - P Hopp
- Norwegian Veterinary Institute, P.O. Box 64, 1431 Ås, Norway
| | - M Guelbenzu-Gonzalo
- Animal Health Ireland, 2 - 5 The Archways, Carrick-on-Shannon, Co. Leitrim, Ireland, N41 WN27
| | - N V Meunier
- Animal Health Ireland, 2 - 5 The Archways, Carrick-on-Shannon, Co. Leitrim, Ireland, N41 WN27
| | - A Ordell
- Department of Epidemiology, Surveillance and Risk Assessment, Swedish Veterinary Agency (SVA), 751 89 Uppsala, Sweden
| | | | - G van Schaik
- Royal GD, P.O. 9, 7400 AA, Deventer, the Netherlands; Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - J Kaler
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, LE12 5RD, UK
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15
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Christoforou R, Pallubinsky H, Burgholz TM, El-Mokadem M, Bardey J, Rewitz K, Müller D, Schweiker M. Influences of Indoor Air Temperatures on Empathy and Positive Affect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:323. [PMID: 38541322 PMCID: PMC10969910 DOI: 10.3390/ijerph21030323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
The consequences of climate change are already visible, and yet, its effect on psychosocial factors, including the expression of empathy, affect, and social disconnection, is widely unknown. Outdoor conditions are expected to influence indoor conditions. Therefore, the aim of this study was to investigate the effect of indoor air temperature during work hours on empathy, positive and negative affect, and social disconnection. Participants (N = 31) were exposed, in a cross-over design, to two thermal conditions in a simulated office environment. Questions on empathy and social disconnection were administered before and after the exposure to each condition, while affect was measured throughout the day. Subjective thermal sensation and objective measures of mean skin temperature were considered. The results indicated a significant difference in empathy (F(1, 24) = 5.37, p = 0.03, with an η2 = 0.126) between conditions. Participants reported increases in empathy after exposure to the warm condition compared to the cool condition, in which reductions in empathy were reported. Although the same pattern was observed for positive affect, the difference was smaller and the results were not significant. Thermal sensation had a significant effect on changes in empathy too (F(1, 54) = 7.015, p = 0.01, with an R2 = 0.115), while mean skin temperature had no effect on empathy (F(1, 6) = 0.53, p = 0.89, with an R2 = 0.81). No effects were observed for positive and negative affect and social disconnection. Longitudinal studies are needed to support these findings.
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Affiliation(s)
- Rania Christoforou
- Healthy Living Spaces Lab, Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Hannah Pallubinsky
- Healthy Living Spaces Lab, Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 KL Maastricht, The Netherlands
| | - Tobias Maria Burgholz
- Institute for Energy Efficient Buildings and Indoor Climate, E.ON Energy Research Center, RWTH Aachen University, 52074 Aachen, Germany
- Heinz Trox Wissenschafts gGmbH, 52074 Aachen, Germany
| | - Mahmoud El-Mokadem
- Institute for Energy Efficient Buildings and Indoor Climate, E.ON Energy Research Center, RWTH Aachen University, 52074 Aachen, Germany
| | - Janine Bardey
- Healthy Living Spaces Lab, Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
- Heinz Trox Wissenschafts gGmbH, 52074 Aachen, Germany
| | - Kai Rewitz
- Institute for Energy Efficient Buildings and Indoor Climate, E.ON Energy Research Center, RWTH Aachen University, 52074 Aachen, Germany
| | - Dirk Müller
- Institute for Energy Efficient Buildings and Indoor Climate, E.ON Energy Research Center, RWTH Aachen University, 52074 Aachen, Germany
- Heinz Trox Wissenschafts gGmbH, 52074 Aachen, Germany
| | - Marcel Schweiker
- Healthy Living Spaces Lab, Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
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Sweeney KD, Donaghy E, Henderson D, Huang H, Wang HH, Thompson A, Guthrie B, Mercer SW. Patients' experiences of GP consultations following the introduction of the new GP contract in Scotland: a cross-sectional survey. Br J Gen Pract 2024; 74:e63-e70. [PMID: 38253549 PMCID: PMC10824335 DOI: 10.3399/bjgp.2023.0239] [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: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The new Scottish GP contract commenced in April 2018 with a stated aim of mitigating health inequalities. AIM To determine the health characteristics and experiences of patients consulting GPs in deprived urban (DU), affluent urban (AU), and remote and rural (RR) areas of Scotland. DESIGN AND SETTING In 2022, a postal survey of a random sample of adult patients from 12 practices who had consulted a GP within the previous 30 days was undertaken. METHOD Patient characteristics and consultation experiences in the three areas (DU, AU, RR) were evaluated using validated measures including the Consultation and Relational Empathy (CARE) Measure and Patient Enablement Instrument (PEI). RESULTS In total, 1053 responses were received. In DU areas, multimorbidity was more common (78% versus 58% AU versus 68% RR, P<0.01), complex presentations (where the consultation addressed both psychosocial and physical problems) were more likely (16% versus 10% AU versus 11% RR, P<0.05), and more consultations were conducted by telephone (42% versus 31% AU versus 31% RR, P<0.01). Patients in DU areas reported lower satisfaction (82% DU completely, very, or fairly satisfied versus 90% AU versus 86% RR, P<0.01), lower perceived GP empathy (mean CARE score 38.9 versus 42.1 AU versus 40.1 RR, P<0.05), lower enablement (mean PEI score 2.6 versus 3.2 AU versus 2.8 RR, P<0.01), and less symptom improvement (P<0.01) than those in AU or RR areas. Face-to-face consultations were associated with significantly higher satisfaction, enablement, and perceived GP empathy than telephone consultations in RR areas (all P<0.05). CONCLUSION Four years after the start of the new GP contract in Scotland, patients' experiences of GP consultations suggest that the inverse care law persists.
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Affiliation(s)
- Kieran D Sweeney
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Huayi Huang
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Harry Hx Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Andrew Thompson
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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17
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Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. PATIENT EDUCATION AND COUNSELING 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [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: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
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Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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18
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He S, Sultana R, Anantham D, Loh HP, Zhou JX, Tang JY, Sim M, Ayre TC, Fong KY, Tan KH. Empathy Levels Among Healthcare Professionals: An Asian Multi-professional Cross-Sectional Study. Cureus 2024; 16:e53750. [PMID: 38465054 PMCID: PMC10921128 DOI: 10.7759/cureus.53750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The aim of the study was to measure empathy in healthcare professionals in Singapore and to compare the scores between the different professions: doctors, nurses, and allied health professionals. METHODS An online survey questionnaire was conducted using the Jefferson Scale of Empathy (JSE) from July 2019 to January 2020. The total JSE score was calculated and compared among the different groups. Multiple linear regression was performed to assess predictors of total empathy scores for groups with statistically lower scores. RESULTS The survey was completed by 4,188 healthcare professionals (doctors (n=569, 13.6%), nurses (n=3032, 72.4%), and allied health professionals (n=587, 14.0%)) out of the 9,348-strong survey population, with a response rate of 44.8%. The study revealed a mean empathy score (SD) of 103.6 (15.6) for the cohort. The mean empathy score (SD) was 112.3 (14.7), 101.3 (15.2), and 107.0 (15.0), respectively for doctors, nurses, and allied health professionals. These were statistically significantly different among the groups (p< 0.0001), with nurses scoring significantly lower than either doctors (p< 0.0001) or allied health professionals (p< 0.0001). Multiple linear regression showed that age < 30 years old, male gender, Malay ethnicity, and working in a hospital setting were associated with significantly lower empathy scores in the nursing group. CONCLUSION Nurses in Singapore had significantly lower empathy scores compared to doctors and allied health professionals. Further research on the underlying causes should be undertaken and measures to improve empathy among Singapore nursing staff should be explored and implemented.
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Affiliation(s)
- Song He
- Department of Obstetrics and Gynaecology, KK (Kandang Kerbau) Women's and Children's Hospital, Singapore, SGP
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS (National University of Singapore) Medical School, Singapore, SGP
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, SGP
| | - Huey Peng Loh
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | - Jamie X Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, SGP
| | - Joo Ying Tang
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | - Mabel Sim
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
| | | | - Kok Yong Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, SGP
| | - Kok Hian Tan
- Institute for Patient Safety & Quality, SingHealth Duke-NUS (National University of Singapore) Academic Medical Centre, Singapore, SGP
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19
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Keshtkar L, Madigan CD, Ward A, Ahmed S, Tanna V, Rahman I, Bostock J, Nockels K, Wang W, Gillies CL, Howick J. The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials. Ann Intern Med 2024; 177:196-209. [PMID: 38285985 DOI: 10.7326/m23-2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival. PURPOSE To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials. DATA SOURCES Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023. STUDY SELECTION Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale. DATA EXTRACTION Data extraction, risk-of-bias assessments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus. DATA SYNTHESIS Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogeneous in terms of geographic locations (North America, Europe, Asia, and Africa), settings (hospital and primary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials suggested a positive change in patient satisfaction, inadequate reporting hindered the ability to draw definitive conclusions about the overall effect size. LIMITATIONS Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence. CONCLUSION Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction. PRIMARY FUNDING SOURCE Stoneygate Trust. (PROSPERO: CRD42023412981).
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Affiliation(s)
- Leila Keshtkar
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | - Claire D Madigan
- Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom (C.D.M.)
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Vinay Tanna
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom (V.T.)
| | - Ismail Rahman
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Keith Nockels
- Library and Learning Services, University of Leicester, Leicester, United Kingdom (K.N.)
| | - Wen Wang
- School of Business, University of Leicester, Leicester, United Kingdom (W.W.)
| | - Clare L Gillies
- Leicester Real World Evidence Unit, University of Leicester, Leicester, United Kingdom (C.L.G.)
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
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20
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Porsius JT, Ter Stege MHP, Selles RW, Slijper HP. Driving Factors of Recommending a Hand Surgery Clinic After Surgery. J Hand Surg Am 2024; 49:114-123. [PMID: 38099875 DOI: 10.1016/j.jhsa.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Since a patient's recommendation of a clinic to others is an important indicator of patient experience, more insight is needed into the underlying factors that motivate such recommendations. This retrospective cohort study assessed the relative contribution of the following: (1) patient-related characteristics, (2) treatment outcome, (3) satisfaction with treatment outcome, and (4) patients' experience with the process of care to patients' recommendation of a specific clinic after elective surgery. METHODS Patients of specialized outpatient hand surgery clinics (N = 6,895) reported the likelihood of recommending the clinic to friends or family 3-5 months after surgery by filling in the Net Promoter Score. Potential predictors of the Net Promoter Score were preoperative patient characteristics, patient-reported treatment outcomes, satisfaction with treatment outcome, and experience with several health care delivery domains. Linear regression analyses were used to examine the contribution of the predictors. RESULTS Mean age of the patients was 53 (SD, 14) years, 62.5% were women, and 62.5% were employed. Preoperative patient characteristics explained 1% of the variance in clinic recommendations. An additional 6% was explained by the treatment outcome, 21.6% by satisfaction with treatment outcome, and 33.8% by patients' experience with care delivery (total explained variance was 62.3%). The strongest independent predictors of clinic recommendations were positive experiences with the quality of the facilities and the communication skills of the physician. CONCLUSIONS Patient recommendations are more strongly driven by patients' experience with care delivery than by treatment outcome and patient characteristics. CLINICAL RELEVANCE In elective surgery, improving patient experiences is pivotal in boosting patient recommendation of the clinic.
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Affiliation(s)
- Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Marloes H P Ter Stege
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, the Netherlands.
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Byrne M, Campos C, Daly S, Lok B, Miles A. The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review. PATIENT EDUCATION AND COUNSELING 2024; 119:108063. [PMID: 38008647 DOI: 10.1016/j.pec.2023.108063] [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: 04/26/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness. METHODS We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis. RESULTS Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations. CONCLUSIONS For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.
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Affiliation(s)
- Monika Byrne
- School of Psychology, University of Auckland, New Zealand.
| | - Carlos Campos
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, New Zealand
| | - Svetlana Daly
- School of Psychology, University of Auckland, New Zealand
| | - Benjamin Lok
- Virtual Experiences Research Group, University of Florida, USA
| | - Anna Miles
- School of Psychology, University of Auckland, New Zealand
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Patole S, Pawale D, Rath C. Interventions for Compassion Fatigue in Healthcare Providers-A Systematic Review of Randomised Controlled Trials. Healthcare (Basel) 2024; 12:171. [PMID: 38255060 PMCID: PMC10815881 DOI: 10.3390/healthcare12020171] [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: 11/29/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Compassion fatigue is a significant issue considering its consequences including negative feelings, impaired cognition, and increased risk of long-term morbidities. We aimed to assess current evidence on the effects of interventions for compassion fatigue in healthcare providers (HCP). METHODS We used the Cochrane methodology for Systematic Reviews and Meta-Analyses (PRISMA) for conducting and reporting this review. RESULTS Fifteen RCTs (n = 1740) were included. The sample size of individual studies was small ranging from 23 to 605. There was significant heterogeneity in participant, intervention, control, and outcome characteristics. The tools for assessing intervention effects on compassion fatigue included ProQOL, compassion fatigue scale, and nurses compassion fatigue inventory. Thirteen out of the fifteen included RCTs had overall high risk of bias (ROB). Meta-analysis could not be performed given the significant heterogeneity. CONCLUSIONS Current evidence on interventions for reducing compassion fatigue in HCPs is inadequate. Given the benefits reported in some of the included studies, well-designed and adequately powered RCTs are urgently needed.
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Affiliation(s)
- Sanjay Patole
- Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia; (D.P.); (C.R.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Dinesh Pawale
- Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia; (D.P.); (C.R.)
| | - Chandra Rath
- Neonatal Directorate, KEM Hospital for Women, Perth, WA 6008, Australia; (D.P.); (C.R.)
- School of Medicine, University of Western Australia, Perth, WA 6009, Australia
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Rey Velasco E, Demjén Z, Skinner TC. Digital empathy in behaviour change interventions: A survey study on health coach responses to patient cues. Digit Health 2024; 10:20552076231225889. [PMID: 38528968 PMCID: PMC10962034 DOI: 10.1177/20552076231225889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/14/2023] [Indexed: 03/27/2024] Open
Abstract
Introduction Digital health coaching interventions for behaviour change (BC) are effective in addressing various health conditions. Implementing these requires accurate descriptions of components and health coaches (HC) delivery methods, alongside understanding patients' perceptions of these interactions. The HC-patient relationship significantly influences BC outcomes. Here, empathy is an important driver that enables HCs to offer tailored advice that resonates with patients' needs, fostering motivation. Yet, defining and measuring empathy remains a challenge. In this study, we draw on various BC frameworks and Pounds' empathy appraisal approach to categorise HCs responses to patient cues and explore the interplay between empathy and BC. Methods Using a two-round survey, we collected responses from 11 HCs to 10 patient messages from the Bump2Baby and Me trial in a simulated interaction. We analysed 88 messages to identify empathic responses and behaviour change techniques. Results Patients' implicit empathy opportunities showed higher response rates than explicit ones. HCs prioritised positive reinforcement and employed various strategies to achieve similar objectives. The most common empathic response was 'Acceptance' for patients' implicit positive expressions of self-judgement. HCs emphasised relatedness-support and competence-promoting techniques for implicit negative feelings and judgements, such as 'Show unconditional regard' and 'Review behaviour goals', and 'Action planning and Problem-solving' techniques to address explicit negative appreciations and feelings. Conclusion The use of different techniques with the same objective highlights the complexity of BC interactions. Further research is needed to explore the impact of this variability on patient outcomes and programme fidelity.
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Affiliation(s)
- E Rey Velasco
- Liva Healthcare, Københavns Universitet Institut for Psykologi, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Kobenhavn, Denmark
| | - Z Demjén
- UCL Centre for Applied Linguistics, University College London, London, UK
| | - TC Skinner
- Department of Psychology, University of Copenhagen, Kobenhavn, Denmark
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24
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Kagan A, Simmons-Mackie N, Villar-Guerrero E, Chan MT, Turczyn I, Victor JC, Shumway E, Chan L, Cohen-Schneider R, Bayley M. Improving communicative access and patient experience in acute stroke care: An implementation journey. JOURNAL OF COMMUNICATION DISORDERS 2024; 107:106390. [PMID: 38103420 DOI: 10.1016/j.jcomdis.2023.106390] [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: 10/20/2022] [Revised: 10/19/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Patient experience for people with aphasia/families in acute care is frequently reported as negative, with communication barriers contributing to adverse events and significant long-term physical and psychosocial sequelae. Although the effectiveness of providing supported communication training and resources for health care providers in the stroke system is well documented, there is less evidence of implementation strategies for sustainable system change. This paper describes an implementation process targeting two specific areas: 1) improving Stroke Team communication with patients with aphasia, and 2) helping the Stroke Team provide support to families. The project aimed for practical sustainable solutions with potential contribution toward the development of an implementation practice model adaptable for other acute stroke contexts. METHODS The project was designed to create a communicatively accessible acute care hospital unit for people with aphasia. The process involved a collaboration between a Stroke Team covering two units/wards led by nurse managers (19 participants), and a community-based Aphasia Team with expertise in Supported Conversation for Adults with Aphasia (SCA™) - an evidence-based method to reduce language barriers and increase communicative access for people with aphasia. Development was loosely guided by the integrated knowledge translation (iKT) model, and information regarding the implementation process was gathered in developmental fashion over several years. OUTCOMES Examples of outcomes related to the two target areas include provision of accessible information about aphasia to patients as well as development of two new products - a short virtual SCA™ eLearning module relevant to acute care, and a pamphlet for families on how to keep conversation alive. Potential strategies for sustaining a focus on aphasia and communicative access emerged as part of the implementation process. CONCLUSIONS This implementation journey allowed for a deeper understanding of the competing demands of the acute care context and highlighted the need for further work on sustainability of communicative access interventions for stroke patients with aphasia and their families.
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Affiliation(s)
- Aura Kagan
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada; University of Toronto, Faculty of Medicine, Department of Speech-Language Pathology, Rehabilitation Sciences Building, 160-500 University Avenue, Toronto, Ontario M5G 1V7, Canada.
| | - Nina Simmons-Mackie
- Southeastern Louisiana University, Department of Health & Human Sciences, White Hall, Room 206, 310W Dakota Street, SLU Box 10863, Hammond, Louisiana 70402, USA
| | - Elizabeth Villar-Guerrero
- North York General Hospital, General Medicine (7SE) & Neurology / Stroke (8SE), 4001 Leslie Street, Toronto, Ontario M2K 1E1, Canada
| | - Melodie T Chan
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada.
| | - Ilona Turczyn
- North York General Hospital, 5WEST General Medicine, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - J Charles Victor
- ICES - Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada; University of Toronto, Institute of Health Policy, Management and Evaluation, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Elyse Shumway
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada
| | - Lisa Chan
- Aphasia Institute, 73 Scarsdale Road, Toronto, Ontario M3B 2R2, Canada
| | | | - Mark Bayley
- Toronto Rehabilitation Institute, The University Centre, Room 3-131, 550 University Avenue, Toronto, Ontario M5G 2A2, Canada
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Lee S, Yoo Y, Moon H, Lee IS, Chae Y. Enhanced Empathic Pain by Facial Feedback. Brain Sci 2023; 14:5. [PMID: 38275510 PMCID: PMC10813713 DOI: 10.3390/brainsci14010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
The facial feedback hypothesis states that feedback from cutaneous and muscular afferents affects our emotion. Based on the facial feedback hypothesis, the purpose of this study was to determine whether enhancing negative emotion by activating a facial muscle (corrugator supercilii) increases the intensity of cognitive and emotional components of empathic pain. We also assessed whether the muscle contraction changed the pupil size, which would indicate a higher level of arousal. Forty-eight individuals completed 40 muscular contraction and relaxation trials while looking at images of five male and five female patients with neutral and painful facial expressions, respectively. Participants were asked to rate (1) how much pain the patient was in, and (2) how unpleasant their own feelings were. We also examined their facial muscle activities and changes in pupil size. No significant differences in pain or unpleasantness ratings were detected for the neutral face between the two conditions; however, the pain and unpleasantness ratings for the painful face were considerably higher in the contraction than relaxation condition. The pupils were considerably larger in the contraction than relaxation condition for both the painful and neutral faces. Our findings indicate that, by strengthening the corrugator supercilii, facial feedback can affect both the cognitive evaluative and affective sharing aspects of empathic pain.
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Affiliation(s)
- Seoyoung Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 26 Kyungheedaero, Dongdaemun-gu, Seoul 02447, Republic of Korea; (S.L.); (Y.Y.); (H.M.); (I.-S.L.)
- Department of Behavioral Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway
| | - Yeonjoo Yoo
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 26 Kyungheedaero, Dongdaemun-gu, Seoul 02447, Republic of Korea; (S.L.); (Y.Y.); (H.M.); (I.-S.L.)
| | - Heeyoung Moon
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 26 Kyungheedaero, Dongdaemun-gu, Seoul 02447, Republic of Korea; (S.L.); (Y.Y.); (H.M.); (I.-S.L.)
| | - In-Seon Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 26 Kyungheedaero, Dongdaemun-gu, Seoul 02447, Republic of Korea; (S.L.); (Y.Y.); (H.M.); (I.-S.L.)
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, 26 Kyungheedaero, Dongdaemun-gu, Seoul 02447, Republic of Korea; (S.L.); (Y.Y.); (H.M.); (I.-S.L.)
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Phillips B, Mackenzie-Croft N. Festive period episodes of Doctor Who and population mortality. BMJ 2023; 383:2833. [PMID: 38110228 DOI: 10.1136/bmj.p2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Bob Phillips
- Leeds Children's Hospital, Leeds General Infirmary, Leeds, LS1 3EX, UK
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Broberg MA, Boyd BS. Similarities between explaining dizziness and explaining pain? Exploring common patient experiences, theoretical models, treatment approaches and potential therapeutic narratives for persistent dizziness or pain. Physiother Theory Pract 2023; 39:2502-2519. [PMID: 35751384 DOI: 10.1080/09593985.2022.2091497] [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: 06/14/2021] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Pain and dizziness are common experiences throughout the lifespan. However, nearly a quarter of those with acute pain or dizziness experience persistence, which is associated with disability, social isolation, psychological distress, decreased independence, and poorer quality of life. Thus, persistent pain or dizziness impacts peoples' lives in similarly negative ways. Conceptual models of pain and dizziness also have many similarities. Many of these models are more expansive than explaining mere symptoms; rather they describe pain or dizziness as holistic experiences that are influenced by biopsychosocial and contextual factors. These experiences also appear to be associated with multi-modal bodily responses related to evaluation of safety, threat detection and anticipation, as influenced by expectations, and predictions anticipation, not simply a reflection of tissue injury or pathology. Conceptual models also characterize the body as adaptable and therefore capable of recovery. These concepts may provide useful therapeutic narratives to facilitate understanding, dethreaten the experience, and provide hope for patients. In addition, therapeutic alliance, promoting an active movement-based approach, building self-efficacy, and condition-specific approaches can help optimize outcomes. In conclusion, there are significant overlaps in the patient experience, theoretical models and potential therapeutic narratives that guide care for people suffering with persistent pain or dizziness.
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Affiliation(s)
- Marc A Broberg
- Department of Physical Therapy, Two Trees Physical Therapy and Wellness, Ventura, CA, USA
| | - Benjamin S Boyd
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA
- Physical and Sports Medicine, Stanford ValleyCare, Livermore, CA, USA
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Barker ME, Leach KT, Levett-Jones T. Patient's views of empathic and compassionate healthcare interactions: A scoping review. NURSE EDUCATION TODAY 2023; 131:105957. [PMID: 37734368 DOI: 10.1016/j.nedt.2023.105957] [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: 07/05/2023] [Revised: 08/09/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients. OBJECTIVE The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions. METHOD This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion. RESULTS Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare. CONCLUSION Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.
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Martin R, Hardcastle S, Moyle B, Dowlman M, Williams A. How to maximise asynchronous video resources that have been co-produced with patient partners. CLINICAL TEACHER 2023; 20:e13622. [PMID: 37874079 DOI: 10.1111/tct.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 10/25/2023]
Abstract
Ensuring that health professional education is person centred is vital in the pursuit of person-centred clinical care. However, the volume of person-centred care content varies broadly in health professional education. One acknowledged approach to designing curriculum that is person-centred is to embed resources that have been co-produced by patients with lived and living experience. In this article, we aim to provide a guideline for the inclusion of asynchronous interdisciplinary video resources that have been co-produced by patients with lived and living experience.
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Affiliation(s)
- Romany Martin
- School of Health Sciences, University of Tasmania, Newnham, Tasmania, Australia
| | - Sibella Hardcastle
- School of Health Sciences, University of Tasmania, Newnham, Tasmania, Australia
| | - Bruce Moyle
- School of Health Sciences, University of Tasmania, Newnham, Tasmania, Australia
| | - Michele Dowlman
- School of Health Sciences, University of Tasmania, Newnham, Tasmania, Australia
| | - Andrew Williams
- School of Health Sciences, University of Tasmania, Newnham, Tasmania, Australia
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Semerci R, Savaş EH. The effects of child health nursing curriculum-integrated therapeutic activities on therapeutic communication skills of nursing students: Non-randomized study. J Pediatr Nurs 2023; 73:221-227. [PMID: 37922859 DOI: 10.1016/j.pedn.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Effective therapeutic communication with hospitalized children is increasingly recognized as crucial for child-centered care in all healthcare settings. The quantity and quality of training nurses receive to promote and enhance nurse-child communication are vital. This study aims to evaluate the impact of planned therapeutic communication activities for the Child Health Nursing Course on the therapeutic communication skills of nursing students. METHOD A non-randomized study with a pre-test and post-test design was conducted with 28 junior nursing students in Turkey. Data were collected using an 'Information Form' and the 'Therapeutic Communication Skills Scale for Nursing Students'. The Child Health Nursing Course curriculum incorporated lectures with various activity designs to enhance students' therapeutic communication skills. RESULTS The curriculum-integrated therapeutic activities significantly decreased non-therapeutic communication skills in students, with a large effect size [d: 0.827, 95% CI: (0.393)-(1.296)]. Furthermore, the activities led to a significant increase in Therapeutic Communication Skills-1 with a large effect size [d: -0.943, 95% CI: (-1.416) - (-0.513)], and improved Therapeutic Communication Skills-2 with a large effect size [d: -1.285, 95% CI: (-1.827) - (-0.804)]. CONCLUSION The findings indicate that therapeutic activities effectively improved the therapeutic communication skills of nursing students. PRACTICE IMPLICATIONS Integrating therapeutic activities into the Child Health Nursing Course curriculum is recommended to enhance nursing students' therapeutic communication skills.
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Affiliation(s)
- Remziye Semerci
- Koç University, School of Nursing, Department of Pediatric Nursing, İstanbul, Turkey.
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Torres TK, Hamann HA, Shen M, Stone J. Empathic Communication and Implicit Bias in the Context of Cancer Among a Medical Student Sample. HEALTH COMMUNICATION 2023:1-12. [PMID: 37906434 PMCID: PMC11058116 DOI: 10.1080/10410236.2023.2272359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters (M = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student (OR = 3.24, p = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.
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Affiliation(s)
- Tara K. Torres
- Department of Psychology, University of Arizona, Tucson, AZ
| | - Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, AZ
- University of Arizona Cancer Center, Tucson, AZ
| | - Megan Shen
- Fred Hutchinson Cancer Research Institute, Seattle, WA
| | - Jeff Stone
- Department of Psychology, University of Arizona, Tucson, AZ
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Panchuay W, Soontorn T, Songwathana P. Exploring nurses' experiences in applying AIDET framework to improve communication skills in the emergency department: A qualitative study. BELITUNG NURSING JOURNAL 2023; 9:464-470. [PMID: 37901372 PMCID: PMC10600701 DOI: 10.33546/bnj.2789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Recognizing the significance of effective communication in raising emergency department service standards and preventing misinterpretation of patient needs among registered nurses is crucial for improving patient satisfaction. The utilization of the AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) communication framework is acknowledged to enhance communication among registered nurses, patients, family members, and other healthcare professionals. Objective This study aimed to explore Thai nurses' experiences in applying the AIDET framework for communications with patients and their relatives in the emergency department. Methods A qualitative descriptive research design was employed. Semi-structured interviews with 15 emergency nurses were conducted between September and March 2022 in a regional hospital in Thailand. Data were analyzed using content analysis. Results Three themes were generated: 1) Ability to follow the AIDET framework, 2) Recognizing the value of using AIDET steps for positive communication, and 3) Establishing a foundation for successful communication. Conclusion The study's findings highlighted the AIDET framework's potential to enhance communication skills between nurses, healthcare professionals, and patients. The results also emphasized the importance of providing training and mentorship to junior nurses, integrating AIDET into daily routines and institutional policies, and facilitating continuous education for registered nurses. These efforts contribute to improving care quality and aligning with patient and family needs.
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Slavin D, Winter R, Ward A, Howick J. On the need for empathy in the acute hospital setting. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 37906071 DOI: 10.12968/hmed.2023.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
This article reviews the need for empathy, and what happens in its absence in an acute hospital setting, using the example of a homeless man in an emergency department. Three simple but meaningful changes that all healthcare practitioners can make are recommended to promote empathy.
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Affiliation(s)
- Daniel Slavin
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Rachel Winter
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
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Hohenschurz-Schmidt D, Scott W, Park C, Christopoulos G, Vogel S, Draper-Rodi J. [Remote management of musculoskeletal pain : A pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice. German version]. Schmerz 2023; 37:360-371. [PMID: 35834004 PMCID: PMC9281242 DOI: 10.1007/s00482-022-00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations. OBJECTIVES This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain. METHODS Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience. RESULTS The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication. CONCLUSION This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Department, Surgery and Cancer, Pain Research Group, Faculty of Medicine, Chelsea and Westminster Hospital Campus, Imperial College London, 4th Floor, 369 Fulham Road, SW10 9NH, London, Großbritannien.
| | - Whitney Scott
- Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, Großbritannien
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, Großbritannien
| | - Charlie Park
- IPRS Triage and Remote Management Team, IPRS Health Limited, Little Blakenham, Suffolk, Großbritannien
| | - Georgios Christopoulos
- First Contact Practitioner, MSc Neuromusculoskeletal Care, BSc (Hons) Physiotherapy, HCPC CSP, Staffordshire, Großbritannien
| | - Steven Vogel
- Research Centre, University College of Osteopathy, London, Großbritannien
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, Großbritannien
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Scheepers RA, Vollmann M, Cramm JM, Nieboer AP. Empathic nurses with sufficient job resources are work-engaged professionals who deliver more individualized care. J Clin Nurs 2023; 32:7321-7329. [PMID: 37469207 DOI: 10.1111/jocn.16830] [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: 02/14/2023] [Revised: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
AIMS This study examined whether nurse work engagement mediated the associations of job resources (collegial support and autonomy) and a personal resource (empathy) with individualized care delivery, in both hospital and long-term care settings. We also explored potential setting-specific differences in how strongly the resources were associated with work engagement and individualized care delivery among nurses. DESIGN We conducted a cross-sectional study in three hospitals and two long-term care facilities. METHODS In total, 454 nurses completed a web-based survey including validated measures on resources (collegial support, autonomy, empathy), work engagement and individualized care delivery. Data were analysed using mediation and moderated mediation analyses. RESULTS In both settings, all resources were indirectly associated with individualized care delivery via work engagement. Empathy was also directly associated with individualized care delivery, and a stronger association was found in the long-term care setting than in the hospital setting. CONCLUSION The present study showed work engagement to mediate the associations of job resources and empathy with individualized care delivery in both hospital and long-term care settings. Individualized care delivery was furthermore directly facilitated by high levels of empathy, especially among nurses working in long-term care settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Patients may benefit from better individualized care delivery by empathic nurses who are more work-engaged in the face of sufficient job resources in their practice environment. IMPACT Nurses are better able to deliver individualized care when provided with sufficient job resources (collegial support and autonomy) that support their being work-engaged professionals. Furthermore, empathic nurses also reported being able to better support patient individuality. These findings can be translated to policies of hospitals and long-term care facilities, to optimize job resources and enhance empathy and thus facilitate the support of patient individuality by nurses. REPORTING METHOD This study adhered to the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION Nurses were involved in the design and data collection of the study.
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Affiliation(s)
- R A Scheepers
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - M Vollmann
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - J M Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - A P Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
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Haenssgen MJ, Charoenboon N, Early A, Althaus T. Community-level incidence and treatment seeking during febrile illness: Insights from health behaviour surveys in rural Thailand and Laos. Trop Med Int Health 2023; 28:806-816. [PMID: 37605295 DOI: 10.1111/tmi.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Critical gaps remain in understanding community perceptions and treatment-seeking behaviours in case of fever. This is especially relevant considering global antimicrobial resistance, where fever is assumed to provoke non-judicious antibiotic use. Our study objective was therefore to document the community-level incidence of fever, the resulting treatment-seeking processes, and their underlying behavioural drivers. METHODS In a cross-sectional observational design, we used descriptive and inferential statistics and multivariable regression analysis to estimate the population-level incidence of fever and individual and socio-economic factors associated with treatment-seeking process characteristics. We utilised a detailed publicly available survey of community-level treatment-seeking behaviour (collected in 2017/2018), comprising a representative sample of 2130 rural adults in Thailand (Chiang Rai Province) and Lao PDR (Salavan Province). RESULTS Fever was reported by 7.1% of the rural adult population in Chiang Rai (95% CI: 5.1%-9.0%) and 7.5% in Salavan (95% CI: 4.5%-10.5%) during a 2-month recall period. Treatment-seeking patterns varied by socio-economic characteristics like precarious employment. 69.3% (95% CI: 60.8%-77.7%) of fever episodes involved access to formal (public/private) healthcare providers, 11.0% (95% CI: 4.5%-17.5%) involved informal providers, and 24.3% (95% CI: 16.6%-32.1%) took place without either formal or informal healthcare access. Febrile patients had on average 0.39 antibiotic use episodes when accessing formal healthcare settings, compared to 0.05 otherwise (p < 0.01). CONCLUSION Treatment-seeking behaviour during fever varies according to population characteristics. Clinical studies would benefit from contextualising quantitative outcomes. Treatment algorithms for non-malarial febrile illnesses should involve outreach to informal healthcare and community settings to support patients in precarious circumstances, and antibiotic resistance interventions should prioritise formal healthcare facilities.
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Affiliation(s)
- Marco J Haenssgen
- Department of Social Science and Development, Chiang Mai University, Chiang Mai, Thailand
| | - Nutcha Charoenboon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Annabelle Early
- Global Sustainable Development, School of Cross-Faculty Studies, University of Warwick, Coventry, UK
| | - Thomas Althaus
- Centre Scientifique de Monaco, Monaco, Monaco
- Direction de l'Action Sanitaire, Monaco, Monaco
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Haines S, Savic M, Nielsen S, Carter A. Opioid-related policy changes: Experiences and perspectives from people who use opioids to manage non-cancer chronic pain. Drug Alcohol Rev 2023; 42:1482-1492. [PMID: 37254597 PMCID: PMC10946843 DOI: 10.1111/dar.13683] [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: 08/10/2022] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION People who use prescription opioids to manage non-cancer chronic pain are particularly vulnerable to opioid-related policy change. This study aims to better understand what prescription opioids provide this population, what concerns they have in the context of new and changing opioid policies, such as the recently implemented prescription drug monitoring program in Victoria, Australia, their experiences of prescription opioid use, chronic pain and what they would like their healthcare to look like. METHODS Semi-structured interviews were conducted with 30 people who use opioids to manage chronic non-cancer pain. RESULTS Prescription opioids played an important role in supporting quality of life and mental health. However, experiences of stigma and lack of empathy from healthcare providers were common. Participants sought accurate information about their medications and expressed a desire for shared decision-making in healthcare. DISCUSSION AND CONCLUSION Prescription opioids can play an important role in pain management as well as social and psychological functioning for people living with non-cancer chronic pain. Opioid-related policy changes to medication availability need to consider the potential impacts that reducing, limiting or discontinuing opioids may have on this population. Including the voices of people who use prescription opioids to manage non-cancer chronic pain in respectful, compassionate and meaningful ways.
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Affiliation(s)
- Sarah Haines
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
| | - Michael Savic
- Turning Point, Eastern HealthMelbourneAustralia
- Monash Addiction Research CentreMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research CentreMonash UniversityMelbourneAustralia
| | - Adrian Carter
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
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Pronovost-Morgan C, Hartogsohn I, Ramaekers JG. Harnessing placebo: Lessons from psychedelic science. J Psychopharmacol 2023; 37:866-875. [PMID: 37392012 PMCID: PMC10481630 DOI: 10.1177/02698811231182602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
The randomized controlled trial (RCT) research design assumes that a drug's "specific" effect can be isolated, added, and subtracted from the "nonspecific" effect of context and person. While RCTs are helpful in assessing the added benefit of a novel drug, they tend to obscure the curative potential of extra-pharmacological variables, known as "the placebo effect." Ample empirical evidence suggests that person/context-dependent physical, social, and cultural variables not only add to, but also shape drug effects, making them worth harnessing for patient benefits. Nevertheless, utilizing placebo effects in medicine is challenging due to conceptual and normative obstacles. In this article, we propose a new framework inspired by the field of psychedelic science and its employment of the "set and setting" concept. This framework acknowledges that drug and nondrug factors have an interactive and synergistic relationship. From it, we suggest ways to reintegrate nondrug variables into the biomedical toolbox, to ethically harness the placebo effect for improved clinical care.
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Affiliation(s)
- Chloé Pronovost-Morgan
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ido Hartogsohn
- The Program for Science, Technology and Society Studies, Bar-Ilan University, Ramat Gan, Israel
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Ellingsen DM, Isenburg K, Jung C, Lee J, Gerber J, Mawla I, Sclocco R, Grahl A, Anzolin A, Edwards RR, Kelley JM, Kirsch I, Kaptchuk TJ, Napadow V. Brain-to-brain mechanisms underlying pain empathy and social modulation of pain in the patient-clinician interaction. Proc Natl Acad Sci U S A 2023; 120:e2212910120. [PMID: 37339198 PMCID: PMC10293846 DOI: 10.1073/pnas.2212910120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/25/2023] [Indexed: 06/22/2023] Open
Abstract
Social interactions such as the patient-clinician encounter can influence pain, but the underlying dynamic interbrain processes are unclear. Here, we investigated the dynamic brain processes supporting social modulation of pain by assessing simultaneous brain activity (fMRI hyperscanning) from chronic pain patients and clinicians during video-based live interaction. Patients received painful and nonpainful pressure stimuli either with a supportive clinician present (Dyadic) or in isolation (Solo). In half of the dyads, clinicians performed a clinical consultation and intake with the patient prior to hyperscanning (Clinical Interaction), which increased self-reported therapeutic alliance. For the other half, patient-clinician hyperscanning was completed without prior clinical interaction (No Interaction). Patients reported lower pain intensity in the Dyadic, relative to the Solo, condition. In Clinical Interaction dyads relative to No Interaction, patients evaluated their clinicians as better able to understand their pain, and clinicians were more accurate when estimating patients' pain levels. In Clinical Interaction dyads, compared to No Interaction, patients showed stronger activation of the dorsolateral and ventrolateral prefrontal cortex (dlPFC and vlPFC) and primary (S1) and secondary (S2) somatosensory areas (Dyadic-Solo contrast), and clinicians showed increased dynamic dlPFC concordance with patients' S2 activity during pain. Furthermore, the strength of S2-dlPFC concordance was positively correlated with self-reported therapeutic alliance. These findings support that empathy and supportive care can reduce pain intensity and shed light on the brain processes underpinning social modulation of pain in patient-clinician interactions. Our findings further suggest that clinicians' dlPFC concordance with patients' somatosensory processing during pain can be boosted by increasing therapeutic alliance.
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Affiliation(s)
- Dan-Mikael Ellingsen
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo0372, Norway
- Department of Psychology, Pedagogy and Law, School of Health Sciences, Kristiania University College, Oslo0107, Norway
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Kylie Isenburg
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Changjin Jung
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- KM Research Science Division, Korea Institute of Oriental Medicine, Daejeon461-24, Republic of Korea
| | - Jeungchan Lee
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
| | - Jessica Gerber
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Ishtiaq Mawla
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Roberta Sclocco
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Radiology, Logan University, Chesterfield, MO63017
| | - Arvina Grahl
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
| | - Alessandra Anzolin
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
| | - Robert R. Edwards
- Department of Anesthesiology, Brigham and Women’s Hospital, Boston, MA02115
| | - John M. Kelley
- School of Social Sciences, Communication, and Humanities, Endicott College, Beverley, MA02115
- Program in Placebo Studies & Therapeutic Encounter, Harvard Medical School, Boston, MA02215
| | - Irving Kirsch
- Program in Placebo Studies & Therapeutic Encounter, Harvard Medical School, Boston, MA02215
| | - Ted J. Kaptchuk
- Program in Placebo Studies & Therapeutic Encounter, Harvard Medical School, Boston, MA02215
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Radiology, Logan University, Chesterfield, MO63017
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Eichbaum Q, Barbeau-Meunier CA, White M, Ravi R, Grant E, Riess H, Bleakley A. Empathy across cultures - one size does not fit all: from the ego-logical to the eco-logical of relational empathy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:643-657. [PMID: 36129550 PMCID: PMC9491267 DOI: 10.1007/s10459-022-10158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/16/2022] [Indexed: 05/11/2023]
Abstract
Empathy is extolled in Western healthcare and medical education as an exemplary quality to cultivate in trainees and providers. Yet it remains an elusive and inadequately understood attribute. It posits a "one size fits all" unidimensional attribute applicable across contexts with scant attention given to its multifaceted dimensions in intercultural contexts. In this article, we uncloak the shortcomings of this conventional empathy in intercultural settings, and instead propound an expanded "relational empathy".
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Affiliation(s)
- Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Division of Medical Education and Administration, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, TVC 4511C, 1301 Medical Center Drive, TN37232, Nashville, TN, USA.
| | | | - Mary White
- Boonshoft School of Medicine, Wright State University, Fairborn, OH, USA
| | - Revathi Ravi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Helen Riess
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan Bleakley
- Plymouth University Peninsula School of Medicine, Plymouth, UK
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Howick J, Dudko M, Feng SN, Ahmed AA, Alluri N, Nockels K, Winter R, Holland R. Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. BMC MEDICAL EDUCATION 2023; 23:270. [PMID: 37088814 PMCID: PMC10124056 DOI: 10.1186/s12909-023-04165-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Several studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines. OBJECTIVE To conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school. METHODS We included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings. RESULTS Our searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies (n = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the 'hidden curriculum' (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students' prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies. DISCUSSION Many of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an 'empathic hidden curriculum' that mitigates the decline in medical student empathy. TRIAL REGISTRATION A protocol for this systematic review was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 28 July 2022 (registration number CRD42022347856).
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Affiliation(s)
- Jeremy Howick
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK.
| | - Maya Dudko
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
| | - Shi Nan Feng
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ahmed Abdirashid Ahmed
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
| | | | - Keith Nockels
- University Library, University of Leicester, Leicester, LE1 7HA, UK
| | - Rachel Winter
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
| | - Richard Holland
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, LE1 7HA, UK
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Watts E, Patel H, Kostov A, Kim J, Elkbuli A. The Role of Compassionate Care in Medicine: Toward Improving Patients' Quality of Care and Satisfaction. J Surg Res 2023; 289:1-7. [PMID: 37068438 DOI: 10.1016/j.jss.2023.03.024] [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: 01/09/2023] [Revised: 03/12/2023] [Accepted: 03/19/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Despite its description as a cornerstone of a healthcare provider's professional identity, the impact of compassionate care on various aspects of medicine has been poorly defined. In this review, we aimed to elucidate the role of compassionate care in various aspects of medicine and healthcare delivery. METHODS Four databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol for a literature review regarding compassionate care and its intersection with medical education, patient-provider communication, patient care, and clinical outcomes, patient and provider characteristics, telemedicine and artificial intelligence, caregiver compassion fatigue, and cost of care. RESULTS Twenty-two articles met the inclusion criteria. Analysis revealed that clinical outcomes are correlated with the degree of patients' perception of empathy and compassion from their providers. Along with enhanced patient outcomes, compassionate care was shown to reduce the costs of care, compassion fatigue and burnout, and the number of malpractice claims. However, compassion can be perceived differently among patients of various cultural and ethnic backgrounds. Compassion training sessions can be implemented among residents in surgical and nonsurgical medical specialties to improve perceived compassion. Furthermore, the use of telehealth modalities may positively or negatively impact compassionate care, requiring further exploration. CONCLUSIONS Compassionate care plays a crucial role in improving patient care and clinical outcomes while reducing caregiver burnout and the risk of malpractice litigation. However, a lack of compassion training and caregiver compassion fatigue may detract from the delivery of effective compassionate care.
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Affiliation(s)
- Emelia Watts
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Heli Patel
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Anthony Kostov
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Jason Kim
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Vennik J, Hughes S, Lyness E, McDermott C, Smith KA, Steele M, Bostock J, Howick J, Little P, Leydon G, Mallen C, Morrison L, Stuart B, Everitt H, Bishop FL. Patient perceptions of empathy in primary care telephone consultations: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2023; 113:107748. [PMID: 37141693 DOI: 10.1016/j.pec.2023.107748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Clinical empathy can enhance patient outcomes. This study examined patients' perceptions of empathy in primary care consultations delivered by telephone. METHODS A mixed methods study was nested in a larger feasibility study conducted May-October 2020. Adults reporting a UK primary care consultation in the previous 2 weeks completed an online survey. A sample of survey respondents participated in a semi-structured qualitative interview. Interviews were analysed thematically. RESULTS Survey respondents (n = 359) rated practitioners as between 'good' and 'very good' at established patient-reported indicators of clinical empathy. Telephone consultations were rated slightly lower than face-to-face or other consultations. 30 survey respondents were interviewed. Three qualitative themes identified how telephone consultations can shape clinical empathy: setting for an empathic encounter; feeling connected; being acknowledged. CONCLUSION Primary care patients typically perceive good levels of clinical empathy in telephone consultations; specific features of telephone consultations may facilitate and/or hinder clinical empathy. PRACTICE IMPLICATIONS To ensure patients feel listened to, acknowledged and understood, practitioners may need to increase their empathic verbalisations in telephone consultations. By using verbal responses to demonstrate active listening and by clearly describing and/or implementing next steps in management, practitioners may be able to enhance clinical empathy in telephone consultations.
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Affiliation(s)
- Jane Vennik
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Clare McDermott
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care Research Centre, University of Southampton, Southampton, UK; School of Computing, University of Portsmouth, Portsmouth, UK
| | - Mary Steele
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Evaluation and Methods Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hazel Everitt
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
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Nembhard IM, David G, Ezzeddine I, Betts D, Radin J. A systematic review of research on empathy in health care. Health Serv Res 2023; 58:250-263. [PMID: 35765156 PMCID: PMC10012244 DOI: 10.1111/1475-6773.14016] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes. DATA SOURCE We searched MEDLINE, MEDLINE In-Process, PsycInfo, and Business Source Complete to identify empirical studies of empathy involving health care personnel in English-language publications up until April 20, 2021, covering the first five decades of research on empathy in health care (1971-2021). STUDY DESIGN We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA COLLECTION/EXTRACTION METHODS Title and abstract screening for study eligibility was followed by full-text screening of relevant citations to extract study information (e.g., study design, sample size, empathy measure used, empathy assessor, intervention type if applicable, other variables evaluated, results, and significance). We classified study predictors and outcomes into categories, calculated descriptive statistics, and produced tables to summarize findings. PRINCIPAL FINDINGS Of the 2270 articles screened, 455 reporting on 470 analyses satisfied the inclusion criteria. We found that most studies have been survey-based, cross-sectional examinations; greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). Of the 128 intervention studies, 103 (80%) found a positive and significant effect. With four exceptions, interventions were educational programs focused on individual clinicians or trainees. No organizational-level interventions (e.g., empathy-specific processes or roles) were identified. CONCLUSIONS Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational-level interventions for systematic improvement are lacking.
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Affiliation(s)
- Ingrid M. Nembhard
- Health Care Management DepartmentThe Wharton School, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Guy David
- Health Care Management DepartmentThe Wharton School, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Iman Ezzeddine
- Health Care Management DepartmentThe Wharton School, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - David Betts
- Life Sciences and Health Care PracticeDeloitte Consulting, LLPNew YorkNew YorkUSA
| | - Jennifer Radin
- Life Sciences and Health Care PracticeDeloitte Consulting, LLPNew YorkNew YorkUSA
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Hookway L, Brown A, Grant A. Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards. MATERNAL & CHILD NUTRITION 2023; 19:e13489. [PMID: 36808886 PMCID: PMC10019061 DOI: 10.1111/mcn.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2-36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.
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Affiliation(s)
- Lyndsey Hookway
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Aimee Grant
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
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Devarakonda SK, Timman R, Bouvy PF, Oemrawsingh A, Apon I, Mureau MAM, Koppert LB, Kranenburg LW. Trends in emotional functioning and psychosocial wellbeing in breast cancer survivors: a prospective cohort study using patient-reported outcome measures. BMC Womens Health 2023; 23:153. [PMID: 36997924 PMCID: PMC10064532 DOI: 10.1186/s12905-023-02243-0] [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: 07/12/2021] [Accepted: 02/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND A breast cancer diagnosis can threaten every aspect of a woman's wellbeing, including her mental health. With the growing number of breast cancer survivors, studies addressing mental health in this population are of increasing importance now more than ever. Therefore, the current study investigated trends in emotional functioning and psychosocial wellbeing of breast cancer survivors, and the demographic and treatment characteristics that may influence these trends. METHODS Prospectively collected data of women treated for breast cancer at the Erasmus MC were analyzed in this study using a cohort study design. Emotional functioning was measured using the EORTC-QLQ-C30, while psychosocial wellbeing was measured using the BREAST-Q. Type of surgery, age, family status and employment status of study participants were retrieved, and multilevel analyses were performed to identify trends in emotional functioning and psychosocial wellbeing and to determine the relationship between aforementioned characteristics and these outcomes. RESULTS Three hundred thirty-four cancer survivors were analyzed. Psychosocial wellbeing declined, but emotional functioning showed a steady improvement over time. Women who underwent breast reconstruction showed a steeper increase in their emotional functioning, and women with no partner or children showed a marginal decline in psychosocial wellbeing between baseline and 12 months after surgery. CONCLUSIONS These findings can be utilized by healthcare teams to identify breast cancer patients at risk for emotional problems and to provide adequate psychological support to those women who need help dealing with their emotions and self-concept in order to optimize clinical treatment.
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Affiliation(s)
- Sri K Devarakonda
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Paul F Bouvy
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Arvind Oemrawsingh
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Inge Apon
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
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Dean S, Ivynian S, Howick J, Levett-Jones T. Patient perspectives of positive messages from clinicians: a qualitative secondary analysis and conceptual model. Contemp Nurse 2023:1-13. [PMID: 36725303 DOI: 10.1080/10376178.2023.2175701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: A review and meta- analysis of empathic communication and patients' expectations of interventions has shown that if positive messages are delivered there is a small but measurable reduction of pain and anxiety and some improvements in physical outcomes. Aim: To identify elements of health messages that may have a positive impact on patient health outcomes to guide effective nurse-patient- communication. Methods: Data were extracted from each study in a qualitative analysis of a systematic review investigating the health effects of positive messages, and analysed following the principles of thematic analysis. Findings: Central to effective positive messages were good communication skills. Five key features were identified. Discussion: The non-treatment care categories such as cognitive care and emotional care can significantly influence health outcomes across a range of interactions. Conclusion: Strategies to facilitate positivity can be incorporated into nursing education programs designed to improve patient outcomes.
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Affiliation(s)
- Sue Dean
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Serra Ivynian
- IMPACCT, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
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Kleiner MJ, Walton DM. A Pan-Canadian Perspective on Education and Training Priorities for Physiotherapists. Part 2: Professional Interactions and Context of Practice. Physiother Can 2023; 75:55-64. [PMID: 37250727 PMCID: PMC10211380 DOI: 10.3138/ptc-2020-0122] [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: 11/02/2020] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 02/11/2024]
Abstract
Purpose: Canadian physiotherapists who participated in the Physio Moves Canada (PMC) project of 2017 identified the state of training programmes as a threat facing professional growth of the discipline. One purpose of the project was to identify priority areas for physiotherapist training programmes as identified by academics and clinicians across Canada. Method: The PMC project included a series of interviews and focus groups conducted across clinical sites in every Canadian province and in Yukon Territory. Data were interpreted using descriptive thematic analysis; identified sub-themes were returned to participants for reflection. Results: Overall, 116 physiotherapists and 1 physiotherapy assistant participated in 10 focus groups and 26 semi-structured interviews. Results are presented using the curriculum guidelines of the time for organization. Here we describe two themes: Physiotherapy Professional Interactions, further defined by interpersonal and interprofessional competencies, and Context of Practice further defined by advocacy, leadership, community awareness, and business competencies. Conclusions: Participants appear to express a desire for programmes to train reflexive and adaptable primary health care practitioners with strong foundational knowledge and clinical expertise, complemented by interpersonal and interprofessional skills to empower physiotherapists to effectively care and advocate for patients, to lead health care teams, and to share ideas to inspire change towards a future of physiotherapy practice.
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Affiliation(s)
- Michelle J. Kleiner
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - David M. Walton
- Health and Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Little C, Lavender AP, Starcevich C, Mesagno C, Mitchell T, Whiteley R, Bakhshayesh H, Beales D. Understanding Fear after an Anterior Cruciate Ligament Injury: A Qualitative Thematic Analysis Using the Common-Sense Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2920. [PMID: 36833617 PMCID: PMC9957354 DOI: 10.3390/ijerph20042920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Fear is a significant factor affecting successful return to sport following an anterior cruciate ligament (ACL) injury. However, there is a lack of understanding of the emotional drivers of fear and how fear beliefs are formed. This study qualitatively explored the contextual and emotional underpinnings of fear and how these beliefs were formed, with reference to the Common-Sense Model of Self-Regulation. Face-to-face online interviews were conducted with ACL-injured participants (n = 18, 72% female) with a mean age of 28 years (range 18-50 years). Participants were either 1 year post ACL reconstruction surgery (n = 16) or at least 1 year post injury without surgery (n = 2) and scored above average on a modified Tampa Scale of Kinesiophobia. Four participants were playing state-level sport or higher. Five themes emerged describing factors contributing to fear: 'External messages', 'Difficulty of the ACL rehabilitation journey', 'Threat to identity and independence', 'Socioeconomic factors', and 'Ongoing psychological barriers'. A sixth theme, 'Positive coping strategies', provided insight into influences that could reduce fear and resolve negative behaviors. This study identified a broad range of contextual biopsychosocial factors which contribute to fear, supporting the notion that ACL injuries should not be treated through a purely physical lens. Furthermore, aligning the themes to the common-sense model provided a conceptual framework conveying the inter-related, emergent nature of the identified themes. The framework provides clinicians with a means to understanding fear after an ACL injury. This could guide assessment and patient education.
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Affiliation(s)
- Cameron Little
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Cobie Starcevich
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
| | - Christopher Mesagno
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3011, Australia
| | | | | | - Hanieh Bakhshayesh
- Curtin School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, WA 6102, Australia
| | - Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
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Silverstein MC, Lee CN, Scherer LD, Phommasathit C, Merrill AL, Peters E. Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy. Med Decis Making 2023; 43:152-163. [PMID: 36059240 PMCID: PMC9898882 DOI: 10.1177/0272989x221121134] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rates of contralateral prophylactic mastectomy (CPM)-removal of the healthy breast following breast cancer diagnosis-have increased, particularly among women for whom CPM provides no survival benefit. Affective (i.e., emotional) decision making is often blamed for this increase. We studied whether greater negative breast cancer affect could motivate uptake of CPM through increased cancer risk perceptions and biased treatment evaluations. METHODS We randomly assigned healthy women with average breast-cancer risk (N = 1030; Mage = 44.14, SD = 9.23 y) to 1 of 3 affect conditions (negative v. neutral v. positive narrative manipulation) in a hypothetical online experiment in which they were asked to imagine being diagnosed with cancer in one breast. We assessed 1) treatment choice, 2) affect toward CPM, and 3) perceived risk of future breast cancer in each breast (cancer affected and healthy) following lumpectomy, single mastectomy, and CPM. RESULTS The manipulation caused women in the negative and neutral narrative conditions (26.9% and 26.4%, respectively) to choose CPM more compared with the positive narrative condition (19.1%). Across conditions, women's CPM affect did not differ. However, exploratory analyses addressing a possible association of affect toward cancer-related targets suggested that women in the negative narrative condition may have felt more positively toward CPM than women in the positive narrative condition. The manipulation did not have significant effects on breast cancer risk perceptions. LIMITATIONS The manipulation of affect had a small effect size, possibly due to the hypothetical nature of this study and/or strong a priori knowledge and attitudes about breast cancer and its treatment options. CONCLUSION Increased negative affect toward breast cancer increased choice of CPM over other surgical options and might have motivated more positive affective evaluations of CPM. HIGHLIGHTS This study used narratives to elicit different levels of negative integral affect toward breast cancer to investigate the effects of affect on breast cancer treatment choices.Increased negative affect toward breast cancer increased the choice of double mastectomy over lumpectomy and single mastectomy to treat a hypothetical, early-stage cancer.The narrative manipulation of negative affect toward breast cancer did not change the perceived risks of future cancer following any of the surgical interventions.Negative affect toward breast cancer may have biased affective evaluations of double mastectomy.
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Affiliation(s)
- Michael C. Silverstein
- Department of Psychology, Center for Science Communication Research, University of Oregon, Eugene, OR, USA
| | - Clara N. Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Laura D. Scherer
- School of Medicine on the Anschutz Medical Campus, University of Colorado, VA Denver Center for Innovation, Aurora, CO, USA
| | | | | | - Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA
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