Patient Self-worth and Communication Barriers to Trust of Israeli Patients in Acute-Care Physicians at Public General Hospitals

Patient and Care Partner Perspective on Potential Undertreatment of Patients With Mild Cognitive Impairment for Cardiovascular Disease

BACKGROUND AND OBJECTIVES

Mild cognitive impairment (MCI) affects up to 22% of US older adults aged 65 and older. Research suggests that physicians may recommend less cardiovascular disease (CVD) treatment for older adults with MCI due to assumptions about their preferences. To delve into the disparity between patient preferences and physician assumptions in CVD treatment recommendations, we conducted a multi-site qualitative study to explore the underlying reasons for this discrepancy, providing insights into potential communication barriers and strategies to enhance patient-physician relationships.

RESEARCH DESIGN AND METHODS

Employing a descriptive qualitative approach, we conducted interviews with 20 dyads, comprising older adults with MCI (n = 11) and normal cognition NC (n = 9), and their respective care partners. During these interviews, participants were prompted to reflect on physicians recommending fewer guideline-concordant CVD treatments to older adults with MCI than those with NC and physicians presuming that older adults with MCI desired less care or treatment in general than those with NC.

RESULTS

We identified three primary themes: (1) Most participants had negative reactions to the data that physicians might undertreat patients with MCI for CVD; (2) Participants suggested that physicians may undertreat patients with MCI due to physician assumptions about treatment effectiveness, patient prognosis, value, and treatment adherence, and (3) Participants proposed that physicians may elicit less input from patients with MCI about treatments because of negative physician assumptions about patient decision-making capacity and physician time limitations.

DISCUSSION AND IMPLICATIONS

This study underscores the pressing need for person-centered communication and involvement of older adults with MCI and their care partners in the decision-making process to ensure that decisions are well-informed, reflecting patients' genuine preferences and values. Addressing these concerns has the potential to substantially enhance the quality of care and treatment outcomes for this vulnerable population, ultimately promoting their overall well-being.

Revisiting the hospital-issued gown in hospitalizations from a locus of control and patient-centered care perspectives: a call for design thinking

Introduction

Patient-centered care (PCC) is the preferred health policy approach that emphasizes responding to individual patient preferences, wishes, and needs. PCC requires active patient engagement. While there has been extensive research on physicians' robes, there is limited research on hospital-issued patient gowns during hospitalizations. How does the gown affect the cognitive-emotional experience of hospitalized patients? How is the gown associated with PCC?

Methods

The sample of this cross-sectional study consisted of 965 patients who were hospitalized at least once during the past year in a tertiary hospital. Measures were previously published.

Results

The gown was strongly associated with lack of control and increased distress, and was negatively associated with patient proactiveness, engagement, and taking responsibility for self-management of chronic illness. Compared to male patients, female patients wearing the gown had stronger negative emotions and cognitively strong associations with the external locus of control, which inhibited engagement.

Discussion

The hospital gown is an unacknowledged barrier to achieving PCC, inhibits patient engagement, and reflects the paradoxes of inadvertently excluding patients' needs from hospital practice. The hospital gown must be modified to protect the patient's voice and enhance engagement. Policymakers are called to apply design thinking to facilitate patient participation in decision-making to accord hospital clothing to PCC and improve healthcare delivery.

The interrelationship between women's help-seeking experiences for vaginismus and their sense of self: a qualitative study and abductive analysis

Objective

There is a lack of research on women's holistic experiences of vaginismus, also called sexual pain-penetration disorder, from their perspective. To address this gap, an abductive qualitative study aimed to examine women's help-seeking experiences for vaginismus, and its impact on their sense of self.

Methods

This study was informed by a feminist approach to the theory of self focused on participants' negotiation of dis/empowerment when help-seeking for vaginismus. Twenty-one participants aged 19-37 years (mean 27.6 years) and diagnosed with vaginismus in Australia participated in semi-structured interviews, which were thematically analysed.

Results

Three themes were developed: Interconnected constructions of womanhood and help-seeking, Elicit agency to move forward, Resilience to surmount challenges with subthemes. Participant's overall help-seeking experiences, within and outside the healthcare system, shaped their sense of self in ways that drove their approach/es to future help-seeking behaviours.

Conclusions

Positive help-seeking experiences for vaginismus strengthened participants' sense of self to persevere with treatment even when it was difficult. Conversely, negative help-seeking experiences led to participants' weakened sense of self which was often caused by a gap between their ideal and perceived self. This led to negative feelings and responses of demotivation or halting subsequent help-seeking. Recommendations are provided to improve health professional practice to support women help-seeking for vaginismus, and to help close the gap between their ideal and perceived selves. Such insight can help to empower women's sense of self and motivate them to persevere with help-seeking to experience improvement for their vaginismus and quality of life.

Professional burnout among expert physicians, patient-focused care, and trust in top management: Moving forward

INTRODUCTION

Professional burnout in physicians is perceived as an inevitable occupational hazard inhibiting patient-focused care, the preferred approach of care, which enhances satisfaction of physicians with their work and improves clinical outcomes. Burnout jeopardizes the physical, mental, and emotional health of physicians, inhibiting high-quality care. Most individual-driven interventions and job-level interventions to reduce burnout proved inefficient or reduced burnout for only a short term. The potential of organizational processes to reduce burnout was acknowledged but is yet to be empirically tested. Drawing on social exchange theory, this study investigates the role of an organizational phenomenon, organizational trust among physicians in top management, on burnout.

METHODS

Data were collected across specialties in 10 out of 20 Israeli public general hospitals. The sample comprised 798 senior expert physicians. Measures were all previously published. Structural equation modeling was performed.

RESULTS

Response rates ranged from 17% to 77% across the 10 hospitals. Mean burnout was 4.7 (SD = 0.68), mean patient-focused care was 3.9 (SD = 0.79), and mean organizational trust was 3.7 (SD = 0.84). Mean burnout for women was 5.6 and for physicians from internal medicine was 5.5. The structural equation modeling supported the proposed study model, which explained 45% of burnout. Organizational trust reduced burnout by 14%.

DISCUSSION

Efforts to reduce burnout should integrate effective individual-level and job-level interventions with building trust among physicians in top management through implementing the paramount professional value of patient-focused care.

CONCLUSIONS

Perceiving management, among physicians, as facilitating the value of patient-focused care led to organizational trust in top management, which was negatively associated with burnout.

Bridge the gap caused by public health crises: medical humanization and communication skills build a psychological bond that satisfies patients

BACKGROUND

Patient satisfaction is an important outcome domain of patient-centered care. Medical humanization follows the patient-centered principle and provides a more holistic view to treat patients. The COVID-19 pandemic posed significant barriers to maintaining medical humanization. However, empirical study on the relationship between medical humanization and patient satisfaction is clearly absent.

OBJECTIVES

We examined the mediation effects of communication on the relationship between medical humanization and patient satisfaction when faced with a huge public health crisis like the COVID-19 pandemic, and the moderation effect of medical institutional trust on the mediation models.

METHODS

A cross-sectional survey study was performed. A final sample size of 1445 patients was surveyed on medical humanization, communication, patient satisfaction and medical institutional trust.

RESULTS

All correlations were significantly positive across the main variables (r = 0.35-0.67, p < 0.001 for all) except for medical institutional trust, which was negatively correlated with the medical humanization (r=-0.14, p < 0.001). Moderated mediation analysis showed that the indirect effect of medical humanization on patient satisfaction through communication was significant (b = 0.22, 95% CI: 0.18 ~ 0.25). Medical institutional trust significantly moderated the effect of medical humanization on patient satisfaction (b=-0.09, p < 0.001) and the effect of medical humanization on communication (b= -0.14, p < 0.001).

CONCLUSION

Medical humanization positively influence patient satisfaction, communication mediated the association between medical humanization and patient satisfaction, and medical institutional trust negatively moderated the effects of medical humanization on patient satisfaction and communication. These findings suggest that humanistic communication contributes to patient satisfaction in the face of a huge public health crisis, and patients' evaluation of satisfaction is also regulated by rational cognition.

Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View

BACKGROUND

Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care.

AIMS

This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine.

METHODS

The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages.

RESULTS

Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication.

CONCLUSIONS

The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.

Patient satisfaction impact indicators from a psychosocial perspective

Background

Patient satisfaction plays an important role in improving patient behavior from care, reducing healthcare costs, and improving outcomes. However, since patient satisfaction is a multidimensional concept, it remains unclear which factors are the key indicators of patient satisfaction. The purpose of this study was to verify whether and how patients' psychosocial perceptions of physicians influenced patient satisfaction.

Method

In China, 2,256 patients were surveyed on stereotypes of physicians, institutional trust, humanized perception, and communication skills, as well as patient expectations and patient satisfaction. The data were analyzed using structural equation modeling.

Results

Stereotypes, institutional trust, and humanized perception have an indirect effect on patient satisfaction through communication, and patient expectations have a direct effect on patient satisfaction.

Conclusions

"Patient-centered" communication is the key to improving patient satisfaction, while positive stereotypes at the societal level, standardization of organizational institutions, expression of the doctor's view of humanity in the doctor-patient interaction, and reasonable guidance of patient expectations are important for improving patient satisfaction.

Doctors, Patients, and Interpreters' Views on the Co-Construction of Empathic Communication in Interpreter-Mediated Consultations: A Qualitative Content Analysis of Video Stimulated Recall Interviews

Doctors and patients rely on verbal and nonverbal resources to co-construct clinical empathy. In language-discordant consultations, interpreters' communicative actions might compromise this process. We aim to explore doctors, patients, and professional interpreters' perspectives on their own and others' actions during their empathic interaction in interpreter-mediated consultations (IMCs). We analyzed 20 video stimulated recall interviews with doctors, patients, and interpreters using qualitative content analysis. Doctors and patients found ways to connect with each other on the level of empathic communication (EC) that is not limited by interpreters' alterations or disengaged demeanor. Some aspects of doctors and interpreters' professional practices might jeopardize the co-construction of EC in IMCs. The co-construction of EC in IMCs is not only subject to participants' communicative (inter)actions, but also to organizational and subjective factors. These results provide evidence of the transactional process between the behavioral, cognitive, and affective components of clinical empathy in the context of IMCs.

Personalized Communication with Patients at the Emergency Department—An Experimental Design Study

Communication of clinicians at the emergency department is a barrier to patient satisfaction due to lack of human connection, lack of control over the situation, low health literacy, deficient information, poor support at a time of uncertainty all affecting perceived quality of care. This explorative study tests drivers of patient satisfaction with communication of clinicians at the emergency department. The sample comprises 112 Americans from the New York greater area, who visited an emergency department in the past year. A conjoint-based experimental design was performed testing six messages in six categories. The categories encompass acknowledged aspects of communication with health providers enabling to compare among them when exploring communication at the ED by patient preferences. Respondents rated messages by the extent to which it drives their satisfaction with communication of clinicians at the emergency department. Based on the similarity of patients’ response patterns to each message, three significantly distinct mindsets of patient preferences regarding communication exchanges with clinicians at the emergency department emerged. Different conduct and communication messages drive the satisfaction of members of each mindset with the communication of clinicians at the emergency department. The strong performing messages for one mindset are irrelevant for members of other mindsets. Clinicians may identify the patient-belonging to a mindset and communicate using mindset-tailored messages. This novel strategy may enable clinicians to implement patient-centered communication, by mindset, promoting patient satisfaction and enabling clinicians to better cope with patients in the chaotic emergency department environment.

An Inverted Container in Containing and Not Containing Hospitalized Patients—A Multidisciplinary Narrative Inquiry

Objective

Patient-centered care calls to contain patients in their time of crisis. This study extends the knowledge of provider patient interactions in the hectic environment of acute care applying Bion's container-contained framework from psychoanalysis.

Methods

Following ethical approval, we performed a narrative inquiry of the experiences of ten patients upon discharge from lengthy hospitalizations in acute care. Interviews were conducted upon discharge and about one-month post-discharge.

Findings

Data analysis suggests four modes of containing of patients by providers. In nurturing interactions, typical of an active container-contained mode, patients experienced humanized care, symptom control, hope, and internal locus of control. This mode yielded patient gratitude toward providers, wellbeing, and post-discharge self-management of diseases. In rigid and wall-free modes of containing, patients experienced a sense of powerlessness and discomfort. A new mode of container-contained was identified, the “Inverted Container”, which extends Bion's theory and contradicts patient-centered care. In inverted containers, patients contained the providers yet reported feeling gratitude toward providers. The gratitude constitutes a defense mechanism and reflects a traumatic experience during hospitalization, which led to post-discharge distrust in providers and hospitals and poor self-management of illness.

Conclusions

To effectively provide patient-centered care, provider-patient interaction in lengthy hospitalizations must move along a clinical axis and a relationship axis. This shifting may facilitate containing patients in their time of crisis so essential processes of reflection, projection, and transference are facilitated in-hospital care.

Patients' Self-Disclosure Positively Influences the Establishment of Patients' Trust in Physicians: An Empirical Study of Computer-Mediated Communication in an Online Health Community

With the development of telemedicine and e-health, usage of online health communities has grown, with such communities now representing convenient sources of information for patients who have geographical and temporal constraints regarding visiting physical health-care institutions. Many previous studies have examined patient-provider communication and health-care service delivery in online health communities; however, there is a dearth of research exploring the relationship between patients' level of self-disclosure and the establishment of patients' trust in physicians. Consequently, this study aims to explore how patients' self-disclosure affects the establishment of patients' trust in physicians. "Good Doctor," which is a China-based online health community, was used as a data source, and a computer program was developed to download data for patient-physician communication on this community. Then, data for communications between 1,537 physicians and 63,141 patients were obtained. Ultimately, an empirical model was built to test our hypotheses. The results showed that patients' self-disclosure positively influences their establishment of trust in physicians. Further, physicians' provision of social support to patients showed a complete mediating effect on the relationship between patients' self-disclosure and patients' establishment of trust in physicians. Finally, evidence of "hope-for-help" motivation in patients' messages weakened the effect of patients' self-disclosure when physicians' social support was text-based, but strengthened it when physicians' social support was voice-based.

From a View of the Hospital as a System to a View of the Suffering Patient

Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory.

Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness.

Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care.

Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.

Patient-centered care in telemedicine - An experimental-design study

BACKGROUND

Patients using telemedicine expect health providers to meet their expectations and are concerned about losing interpersonal contact. Studies on tailoring telemedicine to patient expectations are scant. This experimental design starts to close the gap in the state-of-the-art testing of patient expectations of communication with healthcare providers in telemedicine based on the patient-centered approach. The study was conducted from June 2021 through September 2021.

METHODS

The convenience sample comprised 677 students, 298 females and 379 males, ages 18 to 64 who are all patients of one of four national health funds in Israel, using telemedicine. We used a conjoint-based experimental design. Each respondent evaluated a unique set of 24 vignettes of messages. The dependent variable was patient expectations of communication with healthcare providers in Telemedicine. The independent variables were four acknowledged categories of patient expectations of provider-patient communication.

RESULTS

Coefficients for the total panel suggest no significant differences. Applying mathematical clustering, three mindsets emerged. A Post-hoc ANOVA test indicated that the mindsets are significantly different. Members of Mindset 1 expect the provider to walk them through the change process. Members of Mindset 2 expect healthcare providers to refer them to a reliable source of information to enhance their healthcare literacy. Members of Mindset 3 expect respect, both in non-verbal conduct and for their time. We developed a prediction tool enabling to identify the mindset-belonging of each patient in the population to a mindset in the sample.

CONCLUSIONS

Findings call healthcare providers to communicate with patients via telemedicine based on mindset-tailored messages rather than based on socio-demographics for optimum patient-centered communication. Using the prediction tool, providers may identify the mindset-belonging of each patient. To enhance patient-centered care via telemedicine, providers are called upon to meet expectations by using mindset-tailored communication that structures the communication with greater specificity enhancing patient-centered care.

From the crisis in acute care to postdischarge resilience - The communication experience of Geriatric patients: A qualitative study

BACKGROUND

Hospital readmissions due to illness among geriatric patients result in human suffering and psychological trauma. Resilience in chronic illness protects geriatric patients from outcomes of trauma leads to psychological and physical well-being and enables bouncing back to life. While communication has been linked to improved health outcomes, little is known about communication pathways in the context of postdischarge resilience.

AIM AND OBJECTIVE

To explore the role of communication pathways that acute-care clinicians used with geriatric patients in postdischarge resilience.

METHODOLOGICAL DESIGN AND JUSTIFICATION

Participants were ten geriatric patients who were readmitted several times in the past year. Twenty narrative interviews were conducted, one upon discharge and the other a month thereafter. Data for each phase of interviews were analysed using methods of selection mechanisms and Bricolage.

ETHICAL ISSUES

The ethics committee approved the study. Participants signed an informed-consent form for participation and publication.

FINDINGS

Communication in acute care that enhanced health literacy, perceived control and reflection, contributed to higher comprehensibility and manageability during the hospitalisation and postdischarge meaningfulness postdischarge, contributing resilience. Participants who experienced other forms of communication demonstrated anxiety and helplessness with lingering psychological trauma postdischarge.

CONCLUSIONS

Acute care may provide clinicians with opportunities to alleviate the suffering of geriatric patients and contribute to their postdischarge resilience. The suggested T.E.R model delineates communication pathways to fuel the trajectory from psychological trauma to postdischarge resilience in practice.

Infringement of the right to surgical informed consent: negligent disclosure and its impact on patient trust in surgeons at public general hospitals - the voice of the patient

BACKGROUND

There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence.

METHODS

Informants were 12 Israelis (6 men and 6 women), aged 29-81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process upon discharge.

RESULTS

Our empirical evidence indicates an infringement of patients' right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants' moral agency and dignity.

DISCUSSION

Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons.

CONCLUSIONS

Patient experiences attest to the infringement of a patient's right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient's needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent.