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Ansems SM, Ganzevoort IN, van Tol DG, Fokkema T, Olthof M, Berger MY, Holtman GA. Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner. BMJ Open 2023; 13:e069429. [PMID: 37192810 DOI: 10.1136/bmjopen-2022-069429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES Chronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician's management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms. DESIGN We conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a conceptual framework reflecting respondent expectations and experiences. We performed a member check of the interview synopsis and the conceptual framework. SETTING Dutch primary care. PARTICIPANTS We purposively sampled participants from a randomised controlled trial evaluating the effectiveness of faecal calprotectin testing in children with chronic gastrointestinal complaints in primary care. Thirteen parents and two children participated. RESULTS Three key themes emerged: disease burden, GP-patient relationship and reassurance. Often, the experienced disease burden and the pre-existing GP-patient relationship influenced expectations (eg, for further investigations or a sympathetic ear), and when a GP fulfilled these expectations, a trusting GP-patient relationship ensued that facilitated reassurance. We found that individual needs influenced these themes and their interrelationships. CONCLUSION Insights provided by this framework could help GPs managing children with chronic gastrointestinal symptoms in daily practice and may therewith improve the consultation experience for parents. Further research should evaluate whether this framework also holds true for children. TRIAL REGISTRATION NUMBER NL7690.
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Affiliation(s)
- Sophie M Ansems
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilse N Ganzevoort
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Donald G van Tol
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
- Department of Sociology, Faculty of Behavioral and Social Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Tryntsje Fokkema
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke Olthof
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A Holtman
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, The Netherlands
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Simonsen GD, Jensen TS, Kongsted A. Reassuring Patients With Low Back Pain in Primary Care Consultations: Does it Happen, and Does it Matter? A ChiCo Cohort Study. Clin J Pain 2021; 37:598-606. [PMID: 34010222 PMCID: PMC8270505 DOI: 10.1097/ajp.0000000000000946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Reassurance is an important part of treatment for low back pain (LBP). The Consultation-based Reassurance Questionnaire measures patients' perceived reassurance after health care consultations on 4 subdomains (ie, Data-gathering, Relationship-building, Generic reassurance, Cognitive reassurance). The objectives of this study were to investigate associations between the level of reassurance and outcomes and to investigate if the associations were moderated by patients' risk profile. MATERIALS AND METHODS Adult patients consulting chiropractors for LBP were emailed the Consultation-based Reassurance Questionnaire directly after the consultation. Outcomes were Global Perceived Effect (GPE) after 2 weeks, and pain (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) 2 weeks and 3 months following treatment. Associations with GPE were tested in logistic mixed models. Associations between each reassurance domain and pain and disability were tested in longitudinal analyses using linear mixed models. Moderations by risk profile were tested by introducing an interaction between risk groups and reassurance level. All models were controlled for several potential confounders. RESULTS A total of 2056 patients were included in the study, with 46% reporting LBP for less than a week. Associations between reassurance level and improvement in LBP intensity and disability were weak but positive, whereas associations with GPE were potentially clinically relevant. None of the associations were moderated by psychological risk profile. DISCUSSION Identified associations between reassurance and outcomes were weak, however, for GPE the association might be of a clinically relevant magnitude. The causal relationship is unclear, but with communication always present in a consultation these results suggest that efforts to optimize clinician-patient communication might be worthwhile, also for people with very recent onset of LBP.
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Affiliation(s)
| | - Tue S. Jensen
- Chiropractic Knowledge Hub
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M
- Diagnostic Center—Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Alice Kongsted
- Chiropractic Knowledge Hub
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M
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Zipursky JS, Thiruchelvam D, Redelmeier DA. Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study. Obstet Med 2021; 15:31-39. [PMID: 35444726 PMCID: PMC9014547 DOI: 10.1177/1753495x211012502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress.
We examined whether electrocardiogram testing in pregnant women is
associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered
in Ontario, Canada comparing women who received a prenatal ECG to women who
did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom
157,352 (5%) received an electrocardiogram during prenatal care. Receiving
an electrocardiogram test was associated with a one-third relative increase
in the odds of postpartum depression (odds ratio 1.34; 95% confidence
interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum
depression suggests a possible link of organic disease with mental illness,
and emphasizes that cardiovascular symptoms may be a clinical clue to the
presence of an underlying mood disorder.
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Affiliation(s)
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Canada
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Center for Leading Injury Prevention Practice Education & Research, Toronto, Canada
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Silva Guerrero AV, Setchell J, Maujean A, Sterling M. A Comparison of Perceptions of Reassurance in Patients with Nontraumatic Neck Pain and Whiplash-Associated Disorders in Consultations with Primary Care Practitioners-An Online Survey. PAIN MEDICINE 2020; 21:3377-3386. [PMID: 33036025 DOI: 10.1093/pm/pnaa277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Neck pain remains highly prevalent and costly worldwide. Although reassurance has been recommended as a first line of treatment, specific advice on the best ways to provide reassurance has not been provided due to lack of evidence. Pain symptoms and experiences differ between patients with whiplash-associated disorder (WAD) and those with nontraumatic neck pain (NTNP). The aims of this study were to 1) identify and compare the concerns, fears, and worries of patients with WAD and NTNP; and 2) determine if patients believe their concerns are addressed by primary care providers. METHODS These questions were investigated through an online survey, with a convenience sample of 30 participants with NTNP and 20 with WAD. RESULTS A thematic analysis of survey responses resulted in the following seven themes related to common concerns, and two regarding how well concerns were addressed. Common concerns expressed by both groups shared four themes: 1) further structural damage, 2) psychological distress, 3) concerns about the future, and 4) hardships that eventuate. Theme 5), pain/disability is long term, was specific to WAD. Themes 6), pain is current or reoccurring, and 7), interference with daily life, were specific to NTNP. Regarding how well patient concerns were addressed, two overarching themes were common to both conditions: 1) concerns were addressed, with both groups sharing the subthemes "successful treatment," "reassurance," and "trust"; and 2) concerns were not addressed, where all subthemes were shared with the exception of two unique to NTNP. CONCLUSIONS This detailed comparison provides information about neck pain patients' concerns and fears, while providing health practitioners support for selecting strategies to promote reassurance appropriately for individual patient needs. Our findings from patients' perspectives enhance the understanding for providing reassurance for neck pain as proposed by our analysis.
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Affiliation(s)
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annick Maujean
- Centre for Applied Health Economics, Menzies Health Institute, School of Medicine, Griffith University, Brisbane/Gold Coast, Australia
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia.,NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Australia
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Gol JM, Rosmalen JGM, Gans ROB, Voshaar RCO. The importance of contextual aspects in the care for patients with functional somatic symptoms. Med Hypotheses 2020; 142:109731. [PMID: 32335457 DOI: 10.1016/j.mehy.2020.109731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 12/30/2022]
Abstract
Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained. The pattern or clustering of such symptoms may lead to functional syndromes like chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, among many others. Since the underlying pathophysiology remains unknown, several explanatory models have been proposed, nearly all including social and psychological parameters. These models have stimulated effectiveness studies of several psychological and psychopharmacological therapies. While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit. We hypothesize that the context in which interventions for functional somatic symptoms are delivered substantially influences their effectiveness. Although this hypothesis is in line with explanatory models of functional somatic symptoms, to our knowledge, studies primarily focusing on the influence of contextual aspects on treatment outcome are scarce. Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not), however, just begun and already yielded some valuable results. These findings can be organized according to Duranti's and Goodwin's theoretical approach to context in order to substantiate our hypothesis. Based on this approach, we categorized empirical findings in three contextual aspects, i.e. 1) the setting, 2) the behavioural environment, and 3) the language environment. Collectively, some support is found for the fact that early identification of patients with functional somatic symptoms, starting treatment as soon as possible, having a neat appearance and an organized office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician's competence to help. Nonetheless, in vivo studies addressing the most aspects, i.e. nonverbal behaviour and language, are needed for better understanding of these contextual aspect. Moreover, future research should address to what extent optimizing contextual aspects improve care for functional somatic symptoms.
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Affiliation(s)
- J M Gol
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands.
| | - J G M Rosmalen
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
| | - R O B Gans
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
| | - R C Oude Voshaar
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
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Giroldi E, Timmerman A, Veldhuijzen W, Muris J, van der Vleuten C, van der Weijden T. How doctors recognise that their patients are worried: A qualitative study of patient cues. PATIENT EDUCATION AND COUNSELING 2020; 103:220-225. [PMID: 31585821 DOI: 10.1016/j.pec.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/28/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Recognising patient cues indicating worry is essential for successful reassurance. To obtain more insight into the variety and nature of patient cues that may arise in practice, this study explores doctors' reflections on patient cues they recognise during consultations. METHODS We performed a qualitative study during which GPs participated in stimulated recall interviews, using their own video-recorded consultations to enhance reflection. First, we reanalysed an existing dataset of 15 interviews during which GPs elaborated on the doctor-patient interaction. Additionally, 12 GPs were interviewed specifically about recognising patients' cues. RESULTS GPs described four categories of patient cues that indicate worry. GPs recognised worry based on non-verbal cues such as visible bodily reactions, and verbal cues that can be further categorised by type of worry (e.g. about serious disease). Moreover, GPs described behavioural cues, e.g. the patient bringing a list of symptoms. Lastly, GPs recognise worry based on prior knowledge about the patient. CONCLUSIONS GPs reflections have given insight into a wide variety of non-verbal -, verbal -, behavioural- and foreknowledge-based cues. PRACTICE IMPLICATIONS The identified cues can guide other clinicians in recognising worries and inform medical communication training and future research on the effectiveness of recognising cues and patient reassurance.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Jean Muris
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute CAPHRI), Maastricht University, Maastricht, the Netherlands.
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Rudebeck CE. Relationship based care - how general practice developed and why it is undermined within contemporary healthcare systems. Scand J Prim Health Care 2019; 37:335-344. [PMID: 31299870 PMCID: PMC6713111 DOI: 10.1080/02813432.2019.1639909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: Investigating the state of generalism in medicine from the outlook of general practice. Line of argument: General practice developed when its pioneers, in continuing relationships, learnt to know their patients through the variety of medical situations. From the 50s, there is an increasing literature on the virtues and challenges of relationship based general practice, and register-based research indicate its benefits. Generalist perspectives and person-centeredness are implemented in specialised care and medical education but need to be complemented by an input from relationship based general practice. The politically defined aim of primary care is not to balance the draw-backs of specialisation, but to provide medicine at the primary care level. In Sweden, and increasingly even in traditional strongholds of general practice, team-based primary care is thought to respond to increasing demands, filtering out non- and minor disease through triage, practicing task distribution, and moving the GP to a secondary level working with the 'really sick', in all a decline in direct contact between patient and GP. Conclusions: When this happens, clinical medicine as a whole becomes drained of the practice of its human dimension. The lack of absolute proof of medical benefits cannot justify a disregard of the value of mutual knowledge and trust in the relationship, but still, in several countries, relationshipbased general practice will be hard to achieve for GPs planning their career. If the political winds should change, a sustaining profession of GPs preserving their relational ethos inside the team model, may be prepared to reform primary care. KEY POINTS Proclaiming both biomedical breadth and the trustful relationship between doctor and patient, as a specialty, general practice embodies medical generalism. A direct input from the patient's personal GP is necessary to make specialised care become more comprehensive and individualised. In reality, the team, practicing triage and task distribution, is increasingly replacing the doctor-patient relationship as working mode in primary care When the disease rather than the doctor-patient relationship, becomes the organising principle of primary care, medicine as a whole will be drained of the practice of its human dimension.
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Affiliation(s)
- Carl Edvard Rudebeck
- Research Unit, Kalmar County Council, Kalmar, Sweden
- CONTACT Carl Edvard Rudebeck Djurgårdsgatan 7, SE-59341 Västervik, Sweden
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van Braak M, de Groot E, Veen M, Welink L, Giroldi E. Eliciting tacit knowledge: The potential of a reflective approach to video-stimulated interviewing. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:386-393. [PMID: 30446951 PMCID: PMC6283779 DOI: 10.1007/s40037-018-0487-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | | | - Mario Veen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lisanne Welink
- University Medical Center Utrecht, Utrecht, The Netherlands
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Predicting patient reassurance after colonoscopy: The role of illness beliefs. J Psychosom Res 2018; 114:58-61. [PMID: 30314580 DOI: 10.1016/j.jpsychores.2018.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Failure to effectively reassure patients can lead to patients becoming distressed and seeking further medical care. Whilst existing studies have identified that patients' psychological and demographic characteristics can impact patient reassurance, little research has explored specific predictors of patient reassurance following a colonoscopy. This study investigates demographic and psychological predictors of patient reassurance after receiving normal test results following a colonoscopy. METHODS Eighty-five participants receiving colonoscopies due to gastrointestinal symptoms were recruited from two endoscopy clinics. Patients provided demographic information and completed questionnaires assessing illness perceptions, health-related anxiety, hypochondriasis, somatisation and state and trait anxiety prior to the colonoscopy, as well as reassurance the day after the colonoscopy. Seventy-three participants provided complete data and were included in the analyses. Pearson's correlations and hierarchical linear regression were conducted to examine the associations between the baseline variables and patient reassurance after the colonoscopy. RESULTS Health-related anxiety, hypochondriasis and four items from the Brief Illness Perceptions Questionnaire (consequence, identity, concern, and emotional response beliefs) were negatively correlated with reassurance (r's ranged from -0.28 to -0.54, P < .05). The hierarchical linear regression demonstrated that in the fully adjusted model, only consequence beliefs (i.e. negative beliefs regarding the impact of gastrointestinal symptoms) remained a robust predictor of reassurance (β = -0.56, P = .005). CONCLUSION This study extends existing research on patient reassurance and is the first study to demonstrate that illness beliefs predicted reassurance following a colonoscopy. These findings suggest that targeting consequence beliefs may be a useful intervention for improving patient reassurance following clinical investigations.
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Mazzi MA, Rimondini M, van der Zee E, Boerma W, Zimmermann C, Bensing J. Which patient and doctor behaviours make a medical consultation more effective from a patient point of view. Results from a European multicentre study in 31 countries. PATIENT EDUCATION AND COUNSELING 2018; 101:1795-1803. [PMID: 29891103 DOI: 10.1016/j.pec.2018.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess European patients' preferences regarding seven aspects of doctor-patient communication. METHODS 6049 patients from 31 European countries evaluated 21 doctor and 12 patient behaviours, through a patient-generated questionnaire (PCVq). Multilevel models explored the effects of patient characteristics, contextual and cultural dimensions on preferences. RESULTS Patients attributed more responsibility to doctors, by giving greater importance to doctor than to patient factors, in particular to Treating the patient as a partner and as a person and Continuity of care. Gender, age, education, the presence of chronic illness and two of Hofstede's cultural dimensions, Individualism and Indulgence, showed differential evaluations among patients. Women gave greater importance to all seven communication aspects, older patients to being prepared for the consultation, lower educated patients to Treating patient as a person and Thoughtful planning. Patients from countries with an indulgent background rated all seven communication aspects of greater importance. A more individualistic orientation was related to lower importance regarding the four doctor's factors and the patient factor Open and Honest. CONCLUSIONS Treating the patient as a person and providing continuity of care emerged as universal values. PRACTICE IMPLICATIONS The findings should represent a landmark for the adaptation of patient-generated communication guidelines and programs in Europe.
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Affiliation(s)
- Maria Angela Mazzi
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy.
| | - Michela Rimondini
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy
| | | | - Wienke Boerma
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
| | - Christa Zimmermann
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy
| | - Jozien Bensing
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
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Dekkers T, Melles M, Mathijssen NMC, Vehmeijer SBW, Ridder HD. Tailoring the orthopaedic consultation: How perceived patient characteristics influence surgeons' communication. PATIENT EDUCATION AND COUNSELING 2018; 101:428-438. [PMID: 28911881 DOI: 10.1016/j.pec.2017.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether and how orthopaedic surgeons tailor communication during medical consultations based on perceived patient characteristics. METHODS Seven orthopaedic surgeons were repeatedly interviewed following an approach based on ecological momentary assessment. Qualitative content analysis was used to analyse the eighty short interviews. The association between patient characteristics and tailoring approaches was explored in a correspondence analysis of the counted codes. RESULTS Surgeons estimate patients' competence (illness management and communication abilities), autonomy, and interpersonal behaviour. They report tailoring communication in two-thirds of the consultations. The surgeons' perception was associated with the employment of specific approaches to communication: (1) high patient competence with extensive information provision or no changes in communication, (2) less autonomy and less competence with reassurance and direction, (3) high autonomy with discussions about pace and expectations, and (4) high sociability with communication about personal circumstances and wishes. CONCLUSION The surgeon's perception of a patient influences communication during consultations. Future research should address whether these intuitively employed approaches are appropriate, effective, and generalizable to other medical specialists. PRACTICE IMPLICATIONS Tailoring physician-patient communication can improve its quality. The novel approaches identified in this study can be used to formulate and test formal guidelines for tailored communication.
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Affiliation(s)
- Tessa Dekkers
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Huib de Ridder
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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Giroldi E, Veldhuijzen W, Geelen K, Muris J, Bareman F, Bueving H, van der Weijden T, van der Vleuten C. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1263-1278. [PMID: 28220333 PMCID: PMC5663797 DOI: 10.1007/s10459-017-9765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/14/2017] [Indexed: 05/16/2023]
Abstract
To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Kristel Geelen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frits Bareman
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Maurice-Szamburski A, Michel P, Loundou A, Auquier P. Validation of the generic medical interview satisfaction scale: the G-MISS questionnaire. Health Qual Life Outcomes 2017; 15:36. [PMID: 28196503 PMCID: PMC5310066 DOI: 10.1186/s12955-017-0608-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background Patients have about seven medical consultations a year. Despite the importance of medical interviews in the healthcare process, there is no generic instrument to assess patients’ experiences in general practices, medical specialties, and surgical specialties. The main objective was to validate a questionnaire assessing patients’ experiences with medical consultations in various practices. Method The G-MISS study was a prospective multi-center trial that enrolled patients from May to July 2016. A total of 2055 patients were included from general practices, medical specialties, and surgical specialties. Patients filled out a questionnaire assessing various aspects of their experience and satisfaction within 1 week after their medical interview. The validation process relied on item response theory. Internal validity was examined using exploratory factorial analysis. The statistical model used the root mean square error of approximation, confirmatory fit index, and standard root mean square residual as fit indices. Scalability and reliability were assessed with the Rasch model and Cronbach’s alpha coefficients, respectively. Scale properties across the three subgroups were explored with differential item functioning. Results The G-MISS final questionnaire contained 16 items, structured in three dimensions of patients’ experiences: “Relief”, “Communication”, and “Compliance”. A global index of patients’ experiences was computed as the mean of the dimension scores. All fit indices from the statistical model were satisfactory (RMSEA = 0.03, CFI = 0.98, SRMR = 0.06). The overall scalability had a good fit to the Rasch model. Each dimension was reliable, with Cronbach’s alpha ranging from 0.73 to 0.86. Differential item functioning across the three consultation settings was negligible. Patients undergoing medical or surgical specialties reported higher scores in the “Relief” dimension compared with general practice (83.0 ± 11.6 or 82.4 ± 11.6 vs. 73.2 ± 16.7; P < .001). A consultation shorter than 5 min correlated with low patient satisfaction in “Relief” and “Communication” and in the global index, P < .001. Conclusions The G-MISS questionnaire is a valid and reliable questionnaire for assessing patients’ experiences after consultations with general practitioners, medical specialists, and surgical specialists. The multidimensional structure relies on item response theory and assesses different aspects of patients’ experiences that could be useful in clinical practice and research settings.
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Affiliation(s)
- Axel Maurice-Szamburski
- Laboratoire Universitaire EA 3279, Santé Publique et Maladies Chroniques, 27 boulevard Jean Moulin, Marseille, 13005, France.
| | - Pierre Michel
- Laboratoire Universitaire EA 3279, Santé Publique et Maladies Chroniques, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Anderson Loundou
- Unité d'aide méthodologique, Direction de la Recherche Clinique, AP-HM, Marseille, France
| | - Pascal Auquier
- Laboratoire Universitaire EA 3279, Santé Publique et Maladies Chroniques, 27 boulevard Jean Moulin, Marseille, 13005, France
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14
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Rosendal M, Olde Hartman TC, Aamland A, van der Horst H, Lucassen P, Budtz-Lilly A, Burton C. "Medically unexplained" symptoms and symptom disorders in primary care: prognosis-based recognition and classification. BMC FAMILY PRACTICE 2017; 18:18. [PMID: 28173764 PMCID: PMC5297117 DOI: 10.1186/s12875-017-0592-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/25/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many patients consult their GP because they experience bodily symptoms. In a substantial proportion of cases, the clinical picture does not meet the existing diagnostic criteria for diseases or disorders. This may be because symptoms are recent and evolving or because symptoms are persistent but, either by their character or the negative results of clinical investigation cannot be attributed to disease: so-called "medically unexplained symptoms" (MUS). MUS are inconsistently recognised, diagnosed and managed in primary care. The specialist classification systems for MUS pose several problems in a primary care setting. The systems generally require great certainty about presence or absence of physical disease, they tend to be mind-body dualistic, and they view symptoms from a narrow specialty determined perspective. We need a new classification of MUS in primary care; a classification that better supports clinical decision-making, creates clearer communication and provides scientific underpinning of research to ensure effective interventions. DISCUSSION We propose a classification of symptoms that places greater emphasis on prognostic factors. Prognosis-based classification aims to categorise the patient's risk of ongoing symptoms, complications, increased healthcare use or disability because of the symptoms. Current evidence suggests several factors which may be used: symptom characteristics such as: number, multi-system pattern, frequency, severity. Other factors are: concurrent mental disorders, psychological features and demographic data. We discuss how these characteristics may be used to classify symptoms into three groups: self-limiting symptoms, recurrent and persistent symptoms, and symptom disorders. The middle group is especially relevant in primary care; as these patients generally have reduced quality of life but often go unrecognised and are at risk of iatrogenic harm. The presented characteristics do not contain immediately obvious cut-points, and the assessment of prognosis depends on a combination of several factors. CONCLUSION Three criteria (multiple symptoms, multiple systems, multiple times) may support the classification into good, intermediate and poor prognosis when dealing with symptoms in primary care. The proposed new classification specifically targets the patient population in primary care and may provide a rational framework for decision-making in clinical practice and for epidemiologic and clinical research of symptoms.
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Affiliation(s)
- Marianne Rosendal
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, DK-8000 Aarhus C, Denmark
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J.B. Winslows Vej 9 A, DK-5000 Odense, Denmark
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Aase Aamland
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Henriette van der Horst
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Anna Budtz-Lilly
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Alle 2, DK-8000 Aarhus C, Denmark
| | - Christopher Burton
- Academic Unit of Primary Medical Care, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield, S5 7 AU UK
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15
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den Boeft M, Huisman D, Morton L, Lucassen P, van der Wouden JC, Westerman MJ, van der Horst HE, Burton CD. Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis. Fam Pract 2017; 34:107-113. [PMID: 28122926 DOI: 10.1093/fampra/cmw113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations. OBJECTIVE To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes. METHODS Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes. RESULTS We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted. CONCLUSION We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.
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Affiliation(s)
- Madelon den Boeft
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands,
| | - Daniëlle Huisman
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - LaKrista Morton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands and
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Christopher D Burton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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16
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Morton L, Elliott A, Thomas R, Cleland J, Deary V, Burton C. Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms. J Psychosom Res 2016; 84:37-43. [PMID: 27095157 DOI: 10.1016/j.jpsychores.2016.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is a need for primary care interventions for patients with multiple medically unexplained symptoms (MUS). We examined whether GPs could be taught to deliver one such intervention, the Symptoms Clinic Intervention (SCI), to patients. The intervention includes recognition and validation of patients' symptoms, explanation of symptoms and actions to manage symptoms. METHODS We conducted an uncontrolled observational study in Northeast Scotland. GPs were recruited and received two days of structured training. Patients were identified via a two stage process (database searching followed by postal questionnaire) and received the SCI intervention from a GP in their practice. Treatment fidelity was assessed by applying a coding framework to consultation transcripts. Safety was assessed by examining changes in patient symptoms (PHQ-15) and checking for unexpected events. Acceptability was primarily assessed by patient interview. RESULTS Four GPs delivered the SCI to 23 patients. GPs delivered all core components of the SCI, and used the components flexibly across the consultations and between patients. They spent more time on recognition than either explanation or actions components. 10 out of 17 patients interviewed described feeling validated, receiving useful explanation and learning actions. 9 out of 20 patients (45%) reported an improvement in PHQ-15 of between 3 and 8 points. Patients who reported the most improvement also described receiving all three components of the intervention. CONCLUSIONS GPs can be taught to deliver the SCI with reasonable fidelity, safety and acceptability, although some items were inconsistently delivered: further training would be needed before use.
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Affiliation(s)
- LaKrista Morton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Alison Elliott
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Ruth Thomas
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Vincent Deary
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK
| | - Christopher Burton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
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17
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Giroldi E, Veldhuijzen W, Dijkman A, Rozestraten M, Muris J, van der Vleuten C, van der Weijden T. How to gather information from talkative patients in a respectful and efficient manner: a qualitative study of GPs' communication strategies. Fam Pract 2016; 33:100-6. [PMID: 26601673 DOI: 10.1093/fampra/cmv094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gathering information from talkative patients presents a challenge to clinicians. Empirical evidence on how to effectively deal with this challenge is scant. OBJECTIVE This study explores communication strategies and their underlying mechanisms that GPs consider effective when gathering information from talkative patients in order to inform the development of best practices. METHODS We conducted a qualitative study with experienced GPs. We held individual stimulated-recall interviews (SRIs) with six GPs using their videotaped consultations as a stimulus. The transcripts that ensued were triangulated with data from three focus-group discussions (FGs). We performed a thematic network analysis during an iterative process of data collection and analysis. RESULTS To deal with talkative patients during consultations, GPs first try to pinpoint the cause of patients' talkativeness before deciding on the approach to take. Moreover, they resort to the familiar communication strategies, however, in doing so adopt take a more directive attitude. To prevent such attitude from damaging the relationship, GPs take a stepped approach in which they try not to be overly directive, make the patient co-responsible for efficient time management and make use of empathic interrupting. CONCLUSIONS In the absence of evidence, this description of GPs' communication strategies can guide clinicians, residents and students in gathering information from talkative patients in an efficient, yet empathic and respectful manner. When developing best practices, heed should be paid to the causes of patients' talkativeness and the tension between taking a directive approach and building a doctor-patient relationship.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Annika Dijkman
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Maxime Rozestraten
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) and
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18
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Makanjee CR, Bergh AM, Hoffmann WA. Healthcare provider and patient perspectives on diagnostic imaging investigations. Afr J Prim Health Care Fam Med 2015; 7:801. [PMID: 26245604 PMCID: PMC4666288 DOI: 10.4102/phcfm.v7i1.801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/05/2015] [Accepted: 02/13/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Much has been written about the patient-centred approach in doctor-patient consultations. Little is known about interactions and communication processes regarding healthcare providers' and patients' perspectives on expectations and experiences of diagnostic imaging investigations within the medical encounter. Patients journey through the health system from the point of referral to the imaging investigation itself and then to the post-imaging consultation. AIM AND SETTING: To explore healthcare provider and patient perspectives on interaction and communication processes during diagnostic imaging investigations as part of their clinical journey through a healthcare complex. METHODS A qualitative study was conducted, with two phases of data collection. Twenty-four patients were conveniently selected at a public district hospital complex and were followed throughout their journey in the hospital system, from admission to discharge. The second phase entailed focus group interviews conducted with providers in the district hospital and adjacent academic hospital (medical officers and family physicians, nurses, radiographers, radiology consultants and registrars). RESULTS Two main themes guided our analysis: (1) provider perspectives; and (2) patient dispositions and reactions. Golden threads that cut across these themes are interactions and communication processes in the context of expectations, experiences of the imaging investigations and the outcomes thereof. CONCLUSION Insights from this study provide a better understanding of the complexity of the processes and interactions between providers and patients during the imaging investigations conducted as part of their clinical pathway. The interactions and communication processes are provider-patient centred when a referral for a diagnostic imaging investigation is included.
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Affiliation(s)
- Chandra R Makanjee
- Faculty of Health Sciences, Department of Radiography, University of Pretoria.
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19
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Giroldi E, Veldhuijzen W, Leijten C, Welter D, van der Weijden T, Muris J, van der Vleuten C. 'No need to worry': an exploration of general practitioners' reassuring strategies. BMC FAMILY PRACTICE 2014; 15:133. [PMID: 25001991 PMCID: PMC4118274 DOI: 10.1186/1471-2296-15-133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022]
Abstract
Background In view of the paucity of evidence regarding effective ways of reassuring worried patients, this study explored reassuring strategies that are considered useful by general practitioners (GPs). Methods In a study using a qualitative observational design, we re-analysed an existing dataset of fifteen stimulated recall interviews in which GPs elaborated on their communication with patients in two videotaped consultations. Additionally we held stimulated recall interviews with twelve GPs about two consultations selected for a strong focus on reassurance. Results To reassure patients, GPs pursued multiple goals: 1. influencing patients’ emotions by promoting trust, safety and comfort, which is considered to be reassuring in itself and supportive of patients’ acceptance of reassuring information and 2. influencing patients’ cognitions by challenging patients’ belief that their symptoms are indicative of serious disease, often followed by promoting patients’ belief that their symptoms are benign. GPs described several actions to activate mechanisms to achieve these goals. Conclusions GPs described a wealth of reassuring strategies, which make a valuable contribution to the current literature on doctor-patient communication. This detailed description may provide practicing GPs with new tools and can inform future studies exploring the effectiveness of reassurance strategies.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, Maastricht University, School of Public Health and Primary Care (CAPHRI), P,O, Box 616, Maastricht, The Netherlands.
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