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López García A, Barber Pérez P. [Systematic review of the primary care quality assessment instruments used in the last 10 years]. Aten Primaria 2024; 56:103046. [PMID: 39018797 DOI: 10.1016/j.aprim.2024.103046] [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: 04/04/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE There are numerous instruments in the scientific literature for the evaluation of the quality of Primary Care (PC) and to know which of them are the most used and in which countries provides more information to make a well-founded decision. The aim is to determine which, between 2013 and 2023, have been the instruments used to assess the international quality of PC, its evolution and geographical distribution. DESIGN Systematic review. DATA SOURCES PubMed and Embase. From March to December 2023. INCLUSION CRITERIA 1) Validation studies of specific assessment instruments to measure the quality of PC and/or the satisfaction of patients, providers or managers. 2) carried out in the field of PC and 3) published between 1/01/2013 and 01/02/2023. 83 full-text articles were included. DATA EXTRACTION From each publication, an instrument used to evaluate the quality of the PC, attributes of the PC it evaluates, recipient of the evaluation, user, provider or manager, year, and country. RESULTS Fifteen PC assessment instruments were found. The most widely used is the Primary Care Assessing Tool (PCAT), with wide geographical distribution, versions in several languages, is more limited in Europe, except in Spain, and is mostly used in the Primary Care Assessing Tool (PCAT). CONCLUSIONS The PCAT, due to its cultural adaptability, availability in several languages, its ability to evaluate the fundamental principles of PC enunciated by the World Health Organization and to contemplate the perspectives of all health agents, is a complete, versatile, and consistent questionnaire for the evaluation of the quality of PC.
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Affiliation(s)
- Alberto López García
- Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Patricia Barber Pérez
- Profesora titular de universidad, Departamento de Métodos Cuantitativos, Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Weidner M, Towsley GL. Meaningful connections: An education program to enhance resident-certified nursing assistant relationships. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:259-275. [PMID: 36752118 DOI: 10.1080/02701960.2023.2174116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Close relationships between nursing home residents and Certified Nursing Assistants (CNAs) result in positive outcomes for both residents and staff, including increased well-being for residents. However, many resident-CNA relationships remain superficial, are focused primarily on physical care, and interpersonal skill training for CNAs is sparse. The purpose of this study was to develop an education program to foster CNAs' interpersonal skills and relationship development. We conducted a literature review on CNA interpersonal skill training and disseminated a survey to CNAs to inform the education program. Literature review findings revealed that CNAs value their relationships with residents and desire more interpersonal training, but this training is often limited. The survey, which was disseminated via social media and facility contact referrals, asked responding CNAs (n = 73) to evaluate their perceptions of empowerment, interpersonal skill competency, and learning preferences. We found that most CNAs feel confident in their interpersonal skills, but they lack training in boundary-setting and bereavement support. About one-third of respondents did not feel that their work was valued or their strengths recognized by their supervisors. Most respondents reported that they valued visual (85%), experiential (91%) learning. The final program, Meaningful Connections, includes nine modules covering topics such as person-centered caregiving, empathy, emotional intelligence, and boundary-setting. One supplementary module provides potential adaptations to the curriculum to customize the needs of each participant group. The results of this project suggest a need for more CNA relationship training and support, especially in the areas of boundary-setting and bereavement.
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Affiliation(s)
- Michelle Weidner
- University of Utah College of Nursing, Salt Lake City, UT, United States
| | - Gail L Towsley
- University of Utah College of Nursing, Salt Lake City, UT, United States
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Sánchez-Torres A, Camps-Font O, Figueiredo R, Valmaseda-Castellón E. Validity and reliability of the Spanish version of the consultation and relational empathy measure in dental students (Sp-Dent-CARE): A cross-sectional study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:267-274. [PMID: 37649221 DOI: 10.1111/eje.12944] [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: 02/15/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION An evaluation was made of the psychometric properties of a Spanish version of the Consultation and Relational Empathy Measure (CARE) to assess relational empathy in undergraduate dental students. In addition, the influence of demographic, socio-economic and consultation-related factors upon the degree of perceived empathy and overall satisfaction was studied. MATERIALS AND METHODS A cross-sectional study was carried out in patients seen in the Oral Surgery Unit by fourth year dental students. Dentists, specialized translators and psychologists developed the translation of the questionnaire. After a pilot test, a convenience sample of patients was included. Construct validity was tested by factor analysis using principal component analysis with varimax rotation and Kaiser standardization, and internal consistency was assessed by Cronbach's α. RESULTS Two pilot tests were carried out with a panel of experts until the final version of the questionnaire was established. In the validation stage, 191 patients participated (92 men and 99 women), with a mean age of 52.5 ± 17 years. The mean score of the CARE measure was 47.2 ± 4.4, and 57.6% of the patients (n = 110) reported the maximum score on the questionnaire. The final version showed a 1-factor solution explaining 68.6% of the total variance, with excellent final internal consistency (α = 93.4%). CONCLUSION The Spanish version of the CARE measure affords high reliability and validity in assessing relational empathy in dental students. Perceived empathy is related to overall satisfaction. Patient demographics and the number of visits do not influence perceived empathy.
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Affiliation(s)
- Alba Sánchez-Torres
- Department of Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- IDIBELL Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Octavi Camps-Font
- Department of Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- IDIBELL Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rui Figueiredo
- Department of Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- IDIBELL Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- Department of Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- IDIBELL Institute, L'Hospitalet de Llobregat, Barcelona, Spain
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Dufayet L, Piot MA, Geoffroy PA, Oulès B, Petitjean-Brichant C, Peiffer-Smadja N, Bouzid D, Tran Dinh A, Mirault T, Faye A, Lemogne C, Ruszniewski P, Peyre H, Vodovar D. CARECOS study: Medical students' empathy as assessed with the CARE measure by examiners versus standardized patients during a formative Objective and Structured Clinical Examination (OSCE) station. MEDICAL TEACHER 2024:1-9. [PMID: 38285021 DOI: 10.1080/0142159x.2024.2306840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE To assess the Consultation And Relational Empathy (CARE) measure as a tool for examiners to assess medical students' empathy during Objective and Structured Clinical Examinations (OSCEs), as the best tool for assessing empathy during OSCEs remains unknown. METHODS We first assessed the psychometric properties of the CARE measure, completed simultaneously by examiners and standardized patients (SP, either teachers - SPteacher - or civil society members - SPcivil society), for each student, at the end of an OSCE station. We then assessed the qualitative/quantitative agreement between examiners and SP. RESULTS We included 129 students, distributed in eight groups, four groups for each SP type. The CARE measure showed satisfactory psychometric properties in the context of the study but moderate, and even poor inter-rater reliability for some items. Considering paired observations, examiners scored lower than SPs (p < 0.001) regardless of the SP type. However, the difference in score was greater when the SP was a SPteacher rather than a SPcivil society (p < 0.01). CONCLUSION Despite acceptable psychometric properties, inter-rater reliability of the CARE measure between examiners and SP was unsatisfactory. The choice of examiner as well as the type of SP seems critical to ensure a fair measure of empathy during OSCEs.
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Affiliation(s)
- Laurene Dufayet
- UFR de médecine, Université Paris Cité, Paris, France
- Unité Médico-judiciaire, Hôtel-Dieu, AP-HP, Paris, France
- Centre Antipoison de Paris, Hôpital Fernand-Widal, AP-HP, Paris, France
- INSERM, UMRS-1144, Faculté de pharmacie, Paris, France
| | - Marie-Aude Piot
- UFR de médecine, Université Paris Cité, Paris, France
- Département de psychiatrie de l'enfant et de l'adolescent, Hôpital Necker, AP-HP, Paris, France
- INSERM, UMR 1018, Université Paris-Saclay, Villejuif cedex, France
| | - Pierre-Alexis Geoffroy
- UFR de médecine, Université Paris Cité, Paris, France
- Département de psychiatrie et d'addictologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
- Psychiatrie & Neurosciences, Hôpital Saint-Anne, GHU Paris, Paris, France
- Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, Paris, France
| | - Bénédicte Oulès
- UFR de médecine, Université Paris Cité, Paris, France
- Service de dermatologie, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Clara Petitjean-Brichant
- Département de psychiatrie et d'addictologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Nathan Peiffer-Smadja
- UFR de médecine, Université Paris Cité, Paris, France
- Service de maladies infectieuses et tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
- Université Paris Cité, INSERM UMR1137, IAME, Paris, France
| | - Donia Bouzid
- UFR de médecine, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM UMR1137, IAME, Paris, France
- Service d'accueil des urgences, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Alexy Tran Dinh
- UFR de médecine, Université Paris Cité, Paris, France
- Département d'anesthésie-réanimation, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Tristan Mirault
- UFR de médecine, Université Paris Cité, Paris, France
- Service de médecine vasculaire, Hôpital Européen Georges Pompidou, Paris, France
| | - Albert Faye
- UFR de médecine, Université Paris Cité, Paris, France
- Service de Pédiatrie générale, Maladies infectieuses et Médecine interne, Hôpital Robert Debré, AP-HP, Paris, France
| | - Cédric Lemogne
- UFR de médecine, Université Paris Cité, Paris, France
- Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
- Center for Research in Epidemiology and StatisticS (CRESS), Université Paris Cité and Université Sorbonne Paris Nord, INSERM, INRAE, Paris, France
| | - Philippe Ruszniewski
- UFR de médecine, Université Paris Cité, Paris, France
- Service de gastro-entérologie et pancréatologie, Hôpital Beaujon AP-HP, Clichy, France
| | - Hugo Peyre
- UFR de médecine, Université Paris Cité, Paris, France
- Service de psychiatrie de l'enfant et de l'adolescent, Hôpital Robert Debré, APHP, Paris, France
- INSERM UMR 1141, Université Paris Cité, Paris, France
| | - Dominique Vodovar
- UFR de médecine, Université Paris Cité, Paris, France
- Centre Antipoison de Paris, Hôpital Fernand-Widal, AP-HP, Paris, France
- INSERM, UMRS-1144, Faculté de pharmacie, Paris, France
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Lygre RB, Gjestad R, Norekvål TM, Mercer SW, Elgen IB. An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study. BMC Health Serv Res 2023; 23:1241. [PMID: 37951903 PMCID: PMC10638682 DOI: 10.1186/s12913-023-10250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Children and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents. METHODS In all, 47 children and adolescents aged 6-16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent's condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences. RESULTS Almost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18-30 (47-77%) rated relational empathy in the intervention as "Very good" or "Excellent". Of the parents, 35-39 (92-100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001). CONCLUSIONS The present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.
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Affiliation(s)
- Ragnhild B Lygre
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Centre on Patient-Reported Outcomes, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Irene Bircow Elgen
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway
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Brown A, Kumar AT, Melamed O, Ahmed I, Wang YH, Deza A, Morcos M, Zhu L, Maslej M, Minian N, Sujaya V, Wolff J, Doggett O, Iantorno M, Ratto M, Selby P, Rose J. A Motivational Interviewing Chatbot With Generative Reflections for Increasing Readiness to Quit Smoking: Iterative Development Study. JMIR Ment Health 2023; 10:e49132. [PMID: 37847539 PMCID: PMC10618902 DOI: 10.2196/49132] [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] [Received: 05/25/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The motivational interviewing (MI) approach has been shown to help move ambivalent smokers toward the decision to quit smoking. There have been several attempts to broaden access to MI through text-based chatbots. These typically use scripted responses to client statements, but such nonspecific responses have been shown to reduce effectiveness. Recent advances in natural language processing provide a new way to create responses that are specific to a client's statements, using a generative language model. OBJECTIVE This study aimed to design, evolve, and measure the effectiveness of a chatbot system that can guide ambivalent people who smoke toward the decision to quit smoking with MI-style generative reflections. METHODS Over time, 4 different MI chatbot versions were evolved, and each version was tested with a separate group of ambivalent smokers. A total of 349 smokers were recruited through a web-based recruitment platform. The first chatbot version only asked questions without reflections on the answers. The second version asked the questions and provided reflections with an initial version of the reflection generator. The third version used an improved reflection generator, and the fourth version added extended interaction on some of the questions. Participants' readiness to quit was measured before the conversation and 1 week later using an 11-point scale that measured 3 attributes related to smoking cessation: readiness, confidence, and importance. The number of quit attempts made in the week before the conversation and the week after was surveyed; in addition, participants rated the perceived empathy of the chatbot. The main body of the conversation consists of 5 scripted questions, responses from participants, and (for 3 of the 4 versions) generated reflections. A pretrained transformer-based neural network was fine-tuned on examples of high-quality reflections to generate MI reflections. RESULTS The increase in average confidence using the nongenerative version was 1.0 (SD 2.0; P=.001), whereas for the 3 generative versions, the increases ranged from 1.2 to 1.3 (SD 2.0-2.3; P<.001). The extended conversation with improved generative reflections was the only version associated with a significant increase in average importance (0.7, SD 2.0; P<.001) and readiness (0.4, SD 1.7; P=.01). The enhanced reflection and extended conversations exhibited significantly better perceived empathy than the nongenerative conversation (P=.02 and P=.004, respectively). The number of quit attempts did not significantly change between the week before the conversation and the week after across all 4 conversations. CONCLUSIONS The results suggest that generative reflections increase the impact of a conversation on readiness to quit smoking 1 week later, although a significant portion of the impact seen so far can be achieved by only asking questions without the reflections. These results support further evolution of the chatbot conversation and can serve as a basis for comparison against more advanced versions.
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Affiliation(s)
- Andrew Brown
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Ash Tanuj Kumar
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Osnat Melamed
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Imtihan Ahmed
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Yu Hao Wang
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Arnaud Deza
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Marc Morcos
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Leon Zhu
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Marta Maslej
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Vidya Sujaya
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Jodi Wolff
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Olivia Doggett
- Faculty of Information, University of Toronto, Toronto, ON, Canada
| | - Mathew Iantorno
- Faculty of Information, University of Toronto, Toronto, ON, Canada
| | - Matt Ratto
- Faculty of Information, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jonathan Rose
- The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Garza KB, Grabowsky A, Moseley LE, Wright BM, Davis BR, Ford CR. Activities to promote empathy for patients among pharmacy learners: A scoping review. CURRENTS IN PHARMACY TEACHING & LEARNING 2023; 15:911-922. [PMID: 37633755 DOI: 10.1016/j.cptl.2023.08.003] [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: 11/21/2022] [Revised: 07/17/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners. METHODS This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included. RESULTS The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities. IMPLICATIONS A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.
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Affiliation(s)
- Kimberly B Garza
- Auburn University Harrison College of Pharmacy, 4306b Walker Building, Auburn, AL 36849, United States.
| | - Adelia Grabowsky
- Ralph Brown Draughon Library, 231 Mell Street, Auburn, AL 36849, United States.
| | - Lindsey E Moseley
- Auburn University Harrison College of Pharmacy, 2229 Walker Building, Auburn University, AL 36849, United States.
| | - Bradley M Wright
- Auburn University Harrison College of Pharmacy, 2229 Walker Building, Auburn University, AL 36849, United States.
| | - Brandy R Davis
- Auburn University Harrison College of Pharmacy, 1330 Walker Building, Auburn University, AL 36849, United States.
| | - Channing R Ford
- Jacksonville State University, Graduate School, 700 Pelham Rd., North Jacksonville, AL 36365, United States.
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Natali F, Corradini L, Sconza C, Taylor P, Furlan R, Mercer SW, Gatti R. Development of the Italian version of the Consultation and Relational Empathy (CARE) measure: translation, internal reliability, and construct validity in patients undergoing rehabilitation after total hip and knee arthroplasty. Disabil Rehabil 2023; 45:703-708. [PMID: 35191359 DOI: 10.1080/09638288.2022.2037742] [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: 01/26/2023]
Abstract
PURPOSE To translate and cross-culturally adapt the Consultation and Relational Empathy (CARE) measure into Italian, examine its internal reliability, and construct validity in a rehabilitation setting. MATERIALS AND METHODS The translation process consisted of two forward translations, a pre-final version, a back-translation, and a final version, in accordance with available guidelines. We administered the Italian version of the CARE measure to 101 patients hospitalised for rehabilitation after total hip or total knee arthroplasty (THA and TKA). We assessed face validity, internal reliability, and construct validity. RESULTS Face validity was high. Patients answered all questions and the "does not apply" option was never selected. Internal reliability (Cronbach's α = 0.962) resulted in line with the original version. The exploratory factor analysis confirmed the unidimensional structure of the CARE measure with 74.82% of variance explained by the first factor. CONCLUSIONS The Italian version of the CARE measure showed high face validity. Internal reliability and construct validity were in line with the original version in patients undergoing rehabilitation after THA and TKA.IMPLICATIONS FOR REHABILITATIONInternal reliability and construct validity of the Italian version of the CARE measure are in line with those of the original version of the CARE measure.The Italian CARE measure can be used to assess patient's perceived therapist's empathy in patients undergoing physical therapy after THA and TKA.Physiotherapists should use the CARE measure with more caution in other rehabilitative contexts.
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Affiliation(s)
- Fabrizio Natali
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Laura Corradini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cristiano Sconza
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Patricia Taylor
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Raffaello Furlan
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Stewart W Mercer
- Usher Institute Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Stepanchak M, Katzman K, Soukup M, Elkin E, Choate K, Kristman-Valente A, McCarty CA. Youth-Reported School Connection and Experiences of a Middle School-Based Screening, Brief Intervention, and Referral to Treatment Initiative: Preliminary Results From a Program Evaluation. J Adolesc Health 2022; 71:S49-S56. [PMID: 36122969 DOI: 10.1016/j.jadohealth.2022.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/26/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed (1) to evaluate the feasibility of a school-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) program that expands on traditional SBIRT to support the mental health and well-being of middle school students and (2) to assess its effects on students' connection with adults at school. METHODS Focus group discussions were conducted with 26 students in grades 6-8 to understand student perspectives about an innovative school-based SBIRT program. A subset of middle school students from the SBIRT program who received a brief intervention (BI) after screening (n = 116) were asked to rate their experience meeting with the interventionist in terms of feeling comfortable, feeling listened to, and talking about their goals. Additionally, these students' ratings of connection to adults at school was compared from the time of screening (baseline) to following BI using two-sided paired t-tests. RESULTS Students who participated in focus groups expressed favorable opinions about universal screening and this school-based SBIRT model and noted that relationship building with adults at school was an important factor for open communication and motivating behavior change for students. Nearly all students who completed the post-BI survey rated their experiences with interventionists during BI as "Excellent," "Very Good," or "Good" in all categories (98%). Students' reported mean school connection scores significantly higher after participation in school-based SBIRT than at baseline (5.9/8 vs. 7.0/8, p < .001). DISCUSSION Middle school students were satisfied with the school-based SBIRT model and participation in the program resulted in increased student connection with adults at school. These findings improve our understanding of the experience of SBIRT intervention with middle school students and on school connection in particular.
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Affiliation(s)
- Maria Stepanchak
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
| | - Kate Katzman
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Margaret Soukup
- King County Department of Community and Human Services, Seattle, Washington
| | - Evan Elkin
- Reclaiming Futures, Portland State University, Portland, Oregon
| | - Kathryn Choate
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Allison Kristman-Valente
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Carolyn A McCarty
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
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10
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Park KY, Shin J, Park HK, Kim YM, Hwang SY, Shin JH, Heo R, Ryu S, Mercer SW. Validity and reliability of a Korean version of the Consultation and Relational Empathy (CARE) measure. BMC MEDICAL EDUCATION 2022; 22:403. [PMID: 35614452 PMCID: PMC9134586 DOI: 10.1186/s12909-022-03478-5] [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: 11/25/2021] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No validated tool is available to assess patients' perception of physician empathy in Korea. The objective of this study was to establish a Korean version of the Consultation and Relational Empathy (CARE) measure-originally developed in English and widely used internationally-and to examine its reliability and validity. METHODS The CARE measure was translated into Korean and tested on 240 patients from one secondary care hospital and one tertiary care hospital in Korea. Internal consistency by Cronbach's alpha, exploratory analysis, and confirmatory factor analysis were conducted to verify the 10 items of the Korean CARE measure. RESULTS The Korean CARE measure demonstrated high acceptability and face validity, excellent internal reliability (Cronbach's alpha = 0.97) and moderate test-retest reliability (Pearson correlation coefficient = 0.53; Spearman correlation coefficient = 0.51). Distribution of scores showed negative skewedness. Corrected item-total correlations ranged from 0.77-0.92, indicating homogeneity. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.949, and Bartlett's test of sphericity was good (χ2 = 3157.11, P < 0.001). Factor analysis yielded a single dimensional structure of physician empathy with all factor loadings exceeding 0.80 and showing excellent goodness of fit. CONCLUSION This study supports the reliability and validity of the Korean CARE measure in a university hospital setting in Korea.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea.
| | - Yu Mi Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | | | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Soorack Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland
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11
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Anderson NC, Zhou Y, Humphris G. How are emotional distress and reassurance expressed in medical consultations for people with long-term conditions who were unable to receive curative treatment? A pilot observational study with huntington's disease and prostate cancer. Pilot Feasibility Stud 2021; 7:119. [PMID: 34082819 PMCID: PMC8176610 DOI: 10.1186/s40814-021-00833-z] [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: 10/06/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Objective It is unclear whether how people with long-term conditions express distress, and how clinicians respond, influences perceptions of consultation outcomes. The pilot study examined emotional distress and reassurance in consultations with people whose long-term conditions (at the time of consultations) were treated using active surveillance or symptom management (as no curative treatment was suitable). Methods An observational pilot study was conducted involving consultations between people with long-term conditions and their respective clinician. Consultations between three clinicians (two Huntington’s Disease; one Prostate Cancer) and 22 people with long-term conditions (11 Huntington’s Disease; 11 Prostate Cancer) were audio-recorded. Participants also completed an expanded Consultation and Relational Empathy (CARE) Measure. Two researchers coded sessions using Verona Coding Definitions of Emotional Sequences (VR-CoDES/VR-CoDES-P). Code frequencies were calculated, t tests performed between conditions, and Pearson’s correlations performed for associations between CARE responses and clinician utterances. Results People with long-term conditions expressed emotional distress on average 4.45 times per session, averaging 1.09 Concern and 3.36 Cue utterances. Clinicians responded with more explicit (2.59) and space-providing (3.36), than non-explicit (1.86) and space-reducing (1.09), responses per session. Clinicians expressed spontaneous reassurance on average 5.18 times per session, averaging 3.77 Cognitive and 1.5 Affective reassurance utterances. Huntington’s Disease consultations featured significantly more 'Cues', 'Concerns' and 'Overall' 'Emotional Distress', and 'Cognitive' and 'Overall' ‘Reassurance'. Conclusion Emotional distress was expressed more using hints than explicit concern utterances. Clinicians predominantly explicitly explored distress rather than providing information/advice and provided advice using spontaneous cognitive reassurance. People with Huntington’s Disease expressed more concerns and received more reassurance, indicating different needs between conditions. Future research is required to explore emotional distress and reassurance in a larger sample of participants and long-term condition types, and how the practical implications of these findings may be used to enhance outcomes of consultations. Trial registration N/A. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00833-z.
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Affiliation(s)
- Niall C Anderson
- School of Medicine, University of St Andrews, St. Andrews, KY16 9TF, UK.
| | - Yuefang Zhou
- School of Medicine, University of St Andrews, St. Andrews, KY16 9TF, UK
| | - Gerry Humphris
- School of Medicine, University of St Andrews, St. Andrews, KY16 9TF, UK
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12
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Feo R, Kumaran S, Conroy T, Heuzenroeder L, Kitson A. An evaluation of instruments measuring behavioural aspects of the nurse-patient relationship. Nurs Inq 2021; 29:e12425. [PMID: 34076309 DOI: 10.1111/nin.12425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Sheela Kumaran
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Louise Heuzenroeder
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
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13
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Too A, Gatien C, Cormier S. Treatment satisfaction mediates the association between perceived physician empathy and psychological distress in a community sample of individuals with chronic pain. PATIENT EDUCATION AND COUNSELING 2021; 104:1213-1221. [PMID: 33059949 DOI: 10.1016/j.pec.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE While the benefits of patient-centered care have been consistently demonstrated in the health literature, there exists a dearth of pathway research within health outcome research, especially within the chronic pain context. This study examined the relationship between perceived physician empathy and patient psychological distress and its underlying mechanism. METHODS A community sample of 259 adults with chronic pain completed online questionnaires measuring patient-perceived physician empathy, treatment satisfaction, depressive and anxiety symptoms. Analyses were conducted using correlational and mediation analyses. RESULTS Results revealed perceived empathy to be positively and strongly correlated with treatment satisfaction (r = .72, p < .001). A significant negative correlation was also demonstrated between perceived empathy and depressive symptoms (r = -.13, p < .05), but not between perceived empathy and anxious symptoms (r = .03, p = .65). Results revealed significant mediation models between perceived empathy and patient depressive symptoms (indirect effect: B = -.19, SE =.06, 95 % CI [-.31, -.09]) and anxious symptoms (indirect effect: B = -.24, SE = .06, 95 % CI [-.35, -.14]), via treatment satisfaction as mediator and including covariates. CONCLUSION Chronic pain patients who perceive greater levels of physician empathy experience fewer depressive and anxious symptoms, as mediated by treatment satisfaction. PRACTICE IMPLICATIONS Clinical training and practice should promote empathetic components of health communication within chronic pain treatment.
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Affiliation(s)
- Andrea Too
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
| | - Catherine Gatien
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
| | - Stéphanie Cormier
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais Gatineau, Québec, Canada.
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14
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Roberts BW, Puri NK, Trzeciak CJ, Mazzarelli AJ, Trzeciak S. Socioeconomic, racial and ethnic differences in patient experience of clinician empathy: Results of a systematic review and meta-analysis. PLoS One 2021; 16:e0247259. [PMID: 33657153 PMCID: PMC7928470 DOI: 10.1371/journal.pone.0247259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy. Methods Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity. Results Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance. Conclusion These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity. Trial registration Registration (PROSPERO): CRD42019142809.
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Affiliation(s)
- Brian W. Roberts
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Nitin K. Puri
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | | | - Anthony J. Mazzarelli
- Cooper University Health Care, Camden, New Jersey, United States of America
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
| | - Stephen Trzeciak
- Cooper University Health Care, Camden, New Jersey, United States of America
- Center for Humanism, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America
- * E-mail:
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15
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Nwadiugwu MC. Multi-Morbidity in the Older Person: An Examination of Polypharmacy and Socioeconomic Status. Front Public Health 2021; 8:582234. [PMID: 33537273 PMCID: PMC7848189 DOI: 10.3389/fpubh.2020.582234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022] Open
Abstract
There has been increased focus on clinically managing multi-morbidity in the older population, but it can be challenging to find appropriate paradigm that addresses the socio-economic burden and risk for polypharmacy. The Commission on Social Determinants of Health (CSDH) has examined the need for institutional change and the parallel need to address the social causes of poor health. This study explored three potential interventions namely, meaningful information from electronic health records (EHR), social prescribing, and redistributive welfare policies from a person-centered perspective using the CARE (connecting, assessing, responding, and empowering) approach. Economic instruments that immediately redistribute state welfare and reduce income disparity such as direct taxation and conditional cash transfers could be adopted to enable older people with long-term conditions have access to healthcare services. Decreased socioeconomic inequality and unorthodox prescriptive interventions that reduce polypharmacy could mitigate barriers to effectively manage the complexities of multi-morbidity.
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Affiliation(s)
- Martin C Nwadiugwu
- Faculty of Health and Sports University of Stirling, Stirling, United Kingdom.,Department of Biomedical Informatics, University of Nebraska, Omaha, NE, United States
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16
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Elgen I, Heggestad T, Tronstad R, Greve G. Bridging the Gap for Children With Compound Health Challenges: An Intervention Protocol. Front Pediatr 2021; 9:721926. [PMID: 35004532 PMCID: PMC8728000 DOI: 10.3389/fped.2021.721926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: During the last decades, there is a major shift in the panorama of diseases in children and adolescents. More children are referred to the specialized health care services due to less specific symptoms and more complex health challenges. These children are particularly difficult to care for in a "single-disease" oriented system. Our objective was to develop an alternative and more holistic approach better tailored to the complex needs of these children. Method: The target patient population is children between 6 and 13 years with three or more referrals including both the pediatric department and the mental health services. Furthermore, to be included in the project, the child's actual complaints needed to be clinically considered as an unclear or compound condition in need of an alternative approach. This paper describes the process of developing an intervention where a complementary professional team meets the patient and his/her family altogether for 2.5 h. The consultation focus on clarifying the complex symptomatology and on problem solving. The bio-psycho-social model is applied, emphasizing the patient's story as told on the whiteboard. In the dynamic processes of development, piloting, evaluating, and adjusting the components, feed-back from the patients, their families, professional team members, and external team coaches is important. The professional teams include pediatricians, psychologists and physiotherapists. Achieving the transformation from a logistic oriented team where members act separately toward a real complementary team, seems to be a success factor. Discussion: Composing multi-disciplinary and complementary teams was an essential part of the re-designed intervention. Team interaction transforming the professionals from working as a logistic team to act as a complementary team, was one of the important requirements in the process. When re-designing the specialist health service, it is mandatory to anchor all changes among employees as well as the hospital leadership. In addition, it is important to include patient experiences in the process of improvement. Evaluation of long-term outcomes is needed to investigate possible benefits from the new intervention. Trial Registration: Transitioning Young Patients' Health Care Trajectories, NCT04652154. Registered December 3rd, 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04652154?term=NCT04652154&draw=2&rank=1.
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Affiliation(s)
- Irene Elgen
- Division of Psychiatry, Department of Child and Adolescent, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torhild Heggestad
- Department of Research & Development, Haukeland University Hospital, Bergen, Norway
| | - Rune Tronstad
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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17
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Improving Interactions with Healthcare Robots: A Review of Communication Behaviours in Social and Healthcare Contexts. Int J Soc Robot 2020. [DOI: 10.1007/s12369-020-00719-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Exploring the psychometric properties of the Working Alliance Inventory in general practice: a cross-sectional study. BJGP Open 2020; 5:bjgpopen20X101131. [PMID: 33172852 PMCID: PMC7960525 DOI: 10.3399/bjgpopen20x101131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background The therapeutic alliance is a framework from psychology that describes three components: goals, tasks, and bond. The Working Alliance Inventory adapted for general practice (WAI-GP) measures the strength of the therapeutic alliance between the patient and the clinician, and it could be useful in both research and clinical settings. Aim To determine if the patient score on WAI-GP can delineate the three components (goals, tasks, and bond), and to test concurrent validity with the Consultation and Relational Empathy (CARE) measure and the Patient Perception of Patient-Centredness (PPPC) measure. Design & setting A cross-sectional study took place in 12 general practice waiting rooms in Australia. Method The research instruments included the 12-item WAI-GP (the patient version), the CARE and PPPC measures, plus a survey of demographics and reason for consultation. To perform a principal components factor analysis of the WAI-GP, this dataset was combined with an existing dataset. The Spearman rank correlation was used to determine concurrent validity between the WAI-GP and the CARE and PPPC measures. Results Participants (97–99%) reported a strong positive alliance after the consultation (average WAI-GP mean 4.27 ± 0.67 out of 5, n = 146). Factor analysis could not separate the three components (one factor, eigenvalue >1; Cronbach’s α = 0.957; n = 281). Concurrent validity was supported by moderate correlations with the other measures (PPPC ρ = –0.51, P<0.005, CARE ρ = 0.56, P<0.005). Conclusion Three components could not be identified, but the WAI-GP has a high internal consistency and concurrent validity with moderate correlations with the CARE and PPPC. A more diverse sample may better distinguish the three components leading to more specific feedback to clinicians on their consultation practices.
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19
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Dobransky J, Gartke K, Pacheco-Brousseau L, Spilg E, Perreault A, Ameen M, Finless A, Beaulé PE, Poitras S. Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution. J Patient Exp 2020; 7:1549-1555. [PMID: 33457613 PMCID: PMC7786763 DOI: 10.1177/2374373520968972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.
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Affiliation(s)
- Johanna Dobransky
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kathleen Gartke
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Spilg
- Division of Geriatrics, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ashley Perreault
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mohammad Ameen
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Finless
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
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20
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Décary S, Toupin-April K, Légaré F, Barton JL. Five Golden Rings to Measure Patient-Centered Care in Rheumatology. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:686-702. [PMID: 33091246 DOI: 10.1002/acr.24244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Simon Décary
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Jennifer L Barton
- Oregon Health & Science University and US Department of Veteran Affairs Portland Health Care System, Portland, Oregon
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21
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Rajput S, Kumar A, Puranik MP, Shanbhag N. Exploring the educational opportunity and implementation of CARE among dental students in India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:249. [PMID: 33209941 PMCID: PMC7652080 DOI: 10.4103/jehp.jehp_22_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Empathy is considered to be backbone of the patient-physician relationship. The consultation and relational empathy (CARE) measure is widely used internationally to measure empathy. However, no validated tool is available to gather patient feedback on dentists' empathy in India. OBJECTIVE The objective of this study was to explore the reliability and validity of a CARE measure and to assess the factors influencing CARE score and to determine if there was an association between their CARE score and satisfaction of the patient. SETTING AND DESIGN A cross-sectional study was done in dental colleges. SUBJECTS AND METHODS A questionnaire study was carried out among 100 patients from 6 dental colleges in Bangalore using validated CARE measure. STATISTICAL ANALYSIS Internal consistency of items was evaluated by the Cronbach's alpha, and construct validity was assessed by confirmatory factor analysis. Satisfaction was assessed by a question response on 5-point Likert scale. Descriptive and inferential statistics were performed with significance set at 5%. RESULTS The mean CARE score was 43.80 ± 5.36. Internal reliability was high (Cronbach's alpha: 0.859) and was reduced by the removal of any of 10 items. High corrected item-total correlations ranged from 0.752 to 0.847. Factor analysis showed a single solution with high item loadings (>0.80). Self-perception of overall health (odds ratio [OR] = 3.78), relationship with family (OR = 4.61) and friends (OR = 3.78), and previous dental experience (OR = 16.00) were more likely, whereas dentist-provided treatment (OR = 0.20), number (OR = 0.07) and dental treatment taken (OR = 0.13), presence of anxiety (OR = 0.03), and fear (OR = 0.05) were less likely to have CARE score. The satisfaction of the patient regressed significantly with the relationship with family members (ß = 0.77) and CARE score (ß = 0.21). CONCLUSION This study confirms the educational opportunity and implementation of CARE in dental students. CARE scores among patients varied depending on personal factors and dental treatment-related factors. The satisfaction of the patient was influenced by the relationship with family members and CARE scores.
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Affiliation(s)
- Soni Rajput
- Department of Community Dentistry, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Amit Kumar
- Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Manjunath P. Puranik
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Namita Shanbhag
- Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
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22
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Gehenne L, Lelorain S, Anota A, Brédart A, Dolbeault S, Sultan S, Piessen G, Grynberg D, Baudry A, Christophe V. Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure. Eur J Cancer Care (Engl) 2020; 29:e13306. [DOI: 10.1111/ecc.13306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/12/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Lucie Gehenne
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Sophie Lelorain
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit (IMSER UMR 1098) University of Besançon Besançon France
| | - Anne Brédart
- Psycho‐oncology and Social Service Institut Curie Paris France
- Psychopathology and Health Process Laboratory (LPPS UR 4057) Psychology Institute University Paris Descartes France
| | - Sylvie Dolbeault
- Psycho‐oncology and Social Service Institut Curie Paris France
- University Paris SudUniversity PSL Paris France
| | - Serge Sultan
- Sainte Justine University Health Center Montréal QC Canada
- Departments of Pediatrics and Psychology University of Montreal Montréal QC Canada
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery Claude Huriez University Hospital University of Lille Lille France
- Jean‐Pierre Aubert Research Center – Neurosciences and Cancer University of Lille (IMR‐S 1172‐JPArc) Lille France
| | - Delphine Grynberg
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Institut Universitaire de France Paris France
| | - Anne‐Sophie Baudry
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
- Oncology and Medical Specialties Department Valenciennes Hospital Valenciennes France
| | - Véronique Christophe
- CNRS, UMR 9193 ‐ SCALab ‐ Sciences Cognitives et Sciences Affectives Univ. Lille Lille France
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23
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Howick J. Why include humanities in medical studies: comment. Intern Emerg Med 2020; 15:527-528. [PMID: 31598827 DOI: 10.1007/s11739-019-02198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
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24
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Kedroff L, Li Ko Lun A, Shimoni D, Bearne LM. Cognitive behavioural therapy-informed physiotherapy for patellofemoral pain: A feasibility study. Musculoskeletal Care 2019; 17:382-389. [PMID: 31691524 DOI: 10.1002/msc.1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Louise Kedroff
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Alain Li Ko Lun
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Doron Shimoni
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Lindsay M Bearne
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
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25
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Johanson DL, Ahn HS, MacDonald BA, Ahn BK, Lim J, Hwang E, Sutherland CJ, Broadbent E. The Effect of Robot Attentional Behaviors on User Perceptions and Behaviors in a Simulated Health Care Interaction: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13667. [PMID: 31588904 PMCID: PMC6914232 DOI: 10.2196/13667] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/06/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background For robots to be effectively used in health applications, they need to display appropriate social behaviors. A fundamental requirement in all social interactions is the ability to engage, maintain, and demonstrate attention. Attentional behaviors include leaning forward, self-disclosure, and changes in voice pitch. Objective This study aimed to examine the effect of robot attentional behaviors on user perceptions and behaviors in a simulated health care interaction. Methods A parallel randomized controlled trial with a 1:1:1:1 allocation ratio was conducted. We randomized participants to 1 of 4 experimental conditions before engaging in a scripted face-to-face interaction with a fully automated medical receptionist robot. Experimental conditions included a self-disclosure condition, voice pitch change condition, forward lean condition, and neutral condition. Participants completed paper-based postinteraction measures relating to engagement, perceived robot attention, and perceived robot empathy. We video recorded interactions and coded for participant attentional behaviors. Results A total of 181 participants were recruited from the University of Auckland. Participants who interacted with the robot in the forward lean and self-disclosure conditions found the robot to be significantly more stimulating than those who interacted with the robot in the voice pitch or neutral conditions (P=.03). Participants in the forward lean, self-disclosure, and neutral conditions found the robot to be significantly more interesting than those in the voice pitch condition (P<.001). Participants in the forward lean and self-disclosure conditions spent significantly more time looking at the robot than participants in the neutral condition (P<.001). Significantly, more participants in the self-disclosure condition laughed during the interaction (P=.01), whereas significantly more participants in the forward lean condition leant toward the robot during the interaction (P<.001). Conclusions The use of self-disclosure and forward lean by a health care robot can increase human engagement and attentional behaviors. Voice pitch changes did not increase attention or engagement. The small effects with regard to participant perceptions are potentially because of the limitations in self-report measures or a lack of comparison for most participants who had never interacted with a robot before. Further research could explore the use of self-disclosure and forward lean using a within-subjects design and in real health care settings.
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Affiliation(s)
- Deborah L Johanson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Ho Seok Ahn
- Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand.,Department of Electrical, Computer, and Software Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Bruce A MacDonald
- Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand.,Department of Electrical, Computer, and Software Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Byeong Kyu Ahn
- Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand.,Department of Electrical, Computer, and Software Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - JongYoon Lim
- Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand.,Department of Electrical, Computer, and Software Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Euijun Hwang
- Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand.,Department of Electrical, Computer, and Software Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Craig J Sutherland
- Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand.,Department of Electrical, Computer, and Software Engineering, Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Centre for Automation and Robotic Engineering Science, The University of Auckland, Auckland, New Zealand
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26
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Keulen MHF, Teunis T, Kortlever JTP, Vagner GA, Ring D, Reichel LM. Measurement of Perceived Physician Empathy in Orthopedic Patients. J Patient Exp 2019; 7:600-606. [PMID: 33062884 PMCID: PMC7534139 DOI: 10.1177/2374373519875842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Empathy is a key component of a therapeutic relationship. Perceived empathy and compassion are associated with patient satisfaction, reduced symptoms, and adherence to treatment. Objective To assess the advantages and disadvantages of the validated Jefferson Scale of Patient's Perception of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy (CARE) tools. Methods Eighty-four patients completed the JSPPPE and the CARE measure. With Pearson's correlation and exploratory factor analysis, we measured the underlying construct. Flooring and ceiling effects were measured. Multivariable models were created to assess factors associated with both measures. Results The high interquestionnaire correlation (rho = 0.70) and factor loading (0.77) confirm that the JSPPPE and CARE measure the same construct. The CARE (55%) had a higher ceiling effect than JSPPPE (18%). Both JSPPPE (partial R 2 = 0.53, 95% confidence interval [CI]: 0.38-0.64) and CARE (partial R 2 = 0.60, 95% CI: 0.46-0.69) accounted for similar amounts of variation in satisfaction with the orthopedic surgeon. Conclusion Perceived empathy accounts for a substantial amount of the variation in satisfaction. The JSPPPE measures the same construct as CARE with a lower ceiling effect. Because both questionnaires have considerable ceiling effects, a new questionnaire might help to study factors associated with a more empathetic experience.
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Affiliation(s)
| | - Teun Teunis
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Gregg Alan Vagner
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Lee Matthew Reichel
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Rodriguez AM, Lown BA. Measuring compassionate healthcare with the 12-item Schwartz Center Compassionate Care Scale. PLoS One 2019; 14:e0220911. [PMID: 31487300 PMCID: PMC6728044 DOI: 10.1371/journal.pone.0220911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/25/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients and clinicians endorse the importance of compassionate healthcare but patients report gaps between its perceived importance and its demonstration. Empathy and compassion have been associated with quality of life and significant health outcomes but these characteristics are not optimally measured or used for performance and organizational improvement. OBJECTIVE To address these gaps, we conducted a study with the objective of evaluating the properties of the 12-item Schwartz Center Compassionate Care Scale® using psychometric analysis and cognitive debriefing. METHODS Non-hospitalized patients with multiple chronic conditions were sampled using an on-line platform. Classical test theory and Rasch measurement theory were used to evaluate psychometric properties of the scale. Structured questions elicited cognitive responses regarding clarity of each item. RESULTS Classical test theory analysis confirmed that the 12-item Schwartz Center Compassionate Care Scale is a unidimensional scale with excellent internal consistency and test-retest reliability. Patients' ratings of compassionate behaviors using the Schwartz Center Compassionate Care Scale correlated significantly with a related instrument designed to measure empathy, demonstrating convergent validity. Rasch measurement theory showed that reducing the number of response options on 3 items in the scale would improve respondents' discrimination between responses on these items. Although person-item threshold distribution analysis showed that patients may wish to rate compassionate care at levels both higher and lower than the scale permits, items could be ordered on an interval scale from low to high levels of compassionate care. CONCLUSIONS The current 12-item Schwartz Center Compassionate Care Scale demonstrates excellent psychometric properties by Classical Test Theory and Rasch measurement theory. The 12-item Schwartz Center Compassionate Care Scale adds questions related to understanding and discussing emotional, contextual issues and the needs of the patient and family. Easily completed on-line, it could be used for work-place based assessment and feedback to clinicians and performance or quality improvement.
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Affiliation(s)
- Ana Maria Rodriguez
- PatientsLikeMe, Boston, Massachusetts, United States of America
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Beth A. Lown
- The Schwartz Center for Compassionate Healthcare, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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28
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Bas-Sarmiento P, Fernández-Gutiérrez M, Díaz-Rodríguez M. Teaching empathy to nursing students: A randomised controlled trial. NURSE EDUCATION TODAY 2019; 80:40-51. [PMID: 31252353 DOI: 10.1016/j.nedt.2019.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/13/2019] [Accepted: 06/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Empathy has been reported to produce a positive effect on improving patient health outcomes, becoming a fundamental skill in any health personnel-patient relationship. OBJECTIVE To evaluate the effectiveness of an intervention designed to improve the nursing students´ empathy, the learning perception, the improvement of the perception in the understanding of the content, and in the degree of difficulty as well as the acquisition of skills. DESIGN Multicentre randomised controlled trial. SETTING This research was conducted at two schools of nursing at a public university in the Southwest of Spain. PARTICIPANTS 116 nursing students were randomly assigned to an experimental or a control group (delayed intervention group once the post-training analysis was completed) during the second semester of the 2015/2016 academic year. METHODS Pre-test, post-test, and follow-up data were obtained for each group using a simulated clinical interview. Empathy was the primary outcome (The Consultation and Relational Empathy Measure, Jefferson Scale of Empathy student version, Reynolds Empathy Scale, and Carkhuff Scale). The students' perceived knowledge, the learning perception, the self-esteem (Rosenberg Self-Esteem Scale) and the understanding of the content and acquisition of skills (ad-hoc questions) were also analysed. RESULTS The results were improved in all the measures conducted in the experimental groups at the different centres after the intervention. The mean post-test simulation scores were higher than the pre-test with statistically significant differences. The results were maintained in the follow-up. The student's perception of learning and the perception of understanding of the content and the acquisition of skills were improved as well. CONCLUSION The study support that training in empathic competence is effective.
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Affiliation(s)
- Pilar Bas-Sarmiento
- Faculty of Nursing. University of Cádiz. Venus Street, 11207 Algeciras, Cádiz, Spain.
| | | | - Mercedes Díaz-Rodríguez
- Faculty of Nursing and Physiotherapy. University of Cadiz. Ana de Viya Avenue 52, 11009 Cádiz, Spain.
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29
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Sturgiss EA, Rieger E, Haesler E, Ridd MJ, Douglas K, Galvin SL. Adaption and validation of the Working Alliance Inventory for General Practice: qualitative review and cross-sectional surveys. Fam Pract 2019; 36:516-522. [PMID: 30476031 PMCID: PMC6669034 DOI: 10.1093/fampra/cmy113] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Relational aspects of primary care are important, but we have no standard measure for assessment. The 'working alliance' incorporates elements of the therapeutic relationship, shared decision-making, goal setting and communication skills. The Working Alliance Inventory (short form) (WAI-SF) has been used in adult psychology, and a high score on the survey is associated with improved outcomes for clients. OBJECTIVE To adapt the WAI-SF for use between GPs and patients and to test its concurrent validity with measures of shared decision-making and the doctor-patient relationship and discriminant validity with measures of social desirability. METHODS Two rounds of online survey feedback from 55 GPs and 47 patients were used to adapt the WAI-SF-the WAI-GP. The tool was then completed by 142 patients in waiting rooms after seeing their GP and by 16 GPs at the end of their session. Concurrent validity with measures of shared decision-making and patient-doctor depth of relationship was determined using Spearman Rho correlations. Patients also completed two social desirability surveys, and discriminant validity with WAI-GP was assessed. RESULTS Following feedback, the survey was re-worded to remove phrases that were perceived as judgmental or irrelevant. The patient measure of the WAI-GP was strongly correlated with Dyadic OPTION (rho = 0.705, P = 0.0001) and Patient-Doctor Depth of Relationship scale (rho = 0.591, P = 0.0001) and not with measures of social desirability. CONCLUSION The psychometric properties of the WAI-GP support its use for measuring GP-patient alliance. Possibilities for use include assessing the influence of therapeutic alliance on the effectiveness of interventions.
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Affiliation(s)
- Elizabeth A Sturgiss
- Academic Unit of General Practice, Australian National University Medical School, The Australian National University, Garran, Australia
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University Research School of Psychology, The Australian National University, Acton, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian National University Medical School, The Australian National University, Garran, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Matthew J Ridd
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kirsty Douglas
- Academic Unit of General Practice, Australian National University Medical School, The Australian National University, Garran, Australia
| | - Shelley L Galvin
- UNC Health Sciences at MAHEC, Mountain Area Health Education Center, Asheville, NC, USA
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30
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Rocha J, Carvalho IP. The Influence of Professionals' Empathy on Parents' Anxiety in Cases of Juvenile Criminology. SOCIAL WORK 2019; 64:242-252. [PMID: 31190053 DOI: 10.1093/sw/swz012] [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: 04/03/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 06/09/2023]
Abstract
In situations of juvenile delinquency, abuse, or neglect, determination of child custody relies on interviews with parents. This study aims to examine the effects of the interviewer's empathy on parents' anxiety, and to explore how parents experience these situations. A measure of anxiety was applied to 41 parents under evaluation for child custody before and after the assessment interview. Professionals' empathy was rated by both parents and professionals after each appointment. Parents participated in semistructured interviews. Data were analyzed through statistical and content analyses. The decrease in anxiety was significantly greater for parents who perceived professionals as "perfect" than for parents who perceived professionals as "less than perfect" in empathy. Parents' and professionals' empathy scores correlated positively, but the association between professionals' self-rated empathy and parents' anxiety was nonsignificant. Reactions to the justice system's intervention emerging in the semistructured interviews were "unjustifiable intrusion," "disconcerting information," and "reality confirmation." Each associated differently with parents' expectations for the assessment interview (respectively, that the process be over quickly, that it be over successfully, and that help start quickly). Our results support the important effects, from parents' perspectives, of empathy in assessment interviews in the context of juvenile criminology.
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Affiliation(s)
- Juliana Rocha
- Department of Neurosciences and Mental Health, School of Medicine, University of Porto, Portugal
| | - Irene Palmares Carvalho
- Department of Neurosciences and Mental Health, School of Medicine, University of Porto, Portugal
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31
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Yang WY, Low YE, Ng WJ, Ong SH, Jamil JA. Investigation of empathy amongst dietetic interns at selected primary and tertiary health-care facilities. Nutr Diet 2019; 77:231-239. [PMID: 31199060 DOI: 10.1111/1747-0080.12562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 05/03/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022]
Abstract
AIM Empathy is an essential aspect in the delivery of quality nutrition care and promoting better outcomes in patients. With an increased emphasis of patient-centred care in dietetic practice, empathy should underpin the construct of the curriculum in dietetic education. The present study investigated the empathy level of dietetic interns through self-reporting measures and patients' perception. METHODS This cross-sectional study was conducted on a total of 57 dietetic interns and 99 patients from primary and tertiary health care settings. The dietetic interns completed the Toronto Empathy Questionnaire (TEQ) while the Consultation and Relational Empathy (CARE) measure was self-administered by patients. Socio-demographic information of participants was collected. RESULTS The dietetic interns' mean (standard deviation [SD]) TEQ scores were 46.90 ± 5.28 and 47.78 ± 5.34 in primary and tertiary care, respectively. CARE measure scores rated by patients in the primary care were 38.61 ± 8.38 and for tertiary setting, the scores were slightly higher (39.47 ± 7.65). The settings, gender, ethnicity and period of internship did not affect dietetic interns' empathy level. In primary care, CARE scores were significantly different between patients' age grouping (P = 0.007). CONCLUSIONS Findings from the present study showed that patients' age significantly affected their perception of dietetic interns' empathy in primary health care. These preliminary findings could facilitate an understanding of the level of empathy amongst interns for consideration in the future design of dietetic training.
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Affiliation(s)
- Wai Y Yang
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Yi E Low
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Wan J Ng
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Shu H Ong
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - Jamilah A Jamil
- Department of Nutrition and Dietetics, School of Health Sciences, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
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32
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Taylor I, Bing-Jonsson PC, Johansen E, Levy-Malmberg R, Fagerström L. The Objective Structured Clinical Examination in evolving nurse practitioner education: A study of students' and examiners’ experiences. Nurse Educ Pract 2019; 37:115-123. [DOI: 10.1016/j.nepr.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/10/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
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33
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Moss J, Roberts MB, Shea L, Jones CW, Kilgannon H, Edmondson DE, Trzeciak S, Roberts BW. Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study. Intensive Care Med 2019; 45:815-822. [PMID: 30911803 DOI: 10.1007/s00134-019-05601-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/13/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE We tested the hypothesis that, during a life-threatening medical emergency, patient perception of healthcare provider (HCP) compassion is associated with the subsequent development of post-traumatic stress disorder (PTSD) symptoms. METHODS Prospective cohort study in the emergency department (ED) of an urban academic medical center. We included adult patients presenting with a life-threatening medical emergency, defined as respiratory or cardiovascular instability requiring a potentially life-sustaining intervention in the ED. We measured patient perception of HCP compassion in the ED using the Consultation and Relational Empathy (CARE) measure, a validated 40-point scale. Blinded to clinical outcomes (including the CARE measure), we assessed PTSD symptoms 1 month post-discharge using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5. RESULTS Of the 99/113 (88%) patients who completed follow-up, 25% (95% CI 17-35%) had PTSD symptoms at 1 month. In a multivariable model adjusting for potential confounders (e.g. severity of illness score in ED, need for intensive care unit admission, ED overcrowding, and family member emotional support in the ED), patient perception of greater HCP compassion in the ED was independently associated with lower PTSD symptoms at 1 month [odds ratio 0.93 (95% CI 0.89-0.98)]. A one-point increase in the CARE measure was associated with a 7% decrease in the odds of developing PTSD symptoms. CONCLUSIONS PTSD symptoms are common among ED patients with life-threatening medical emergencies. Patient perception of greater HCP compassion during the emergency is independently associated with lower risk of developing PTSD symptoms.
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Affiliation(s)
- Jeena Moss
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
| | - Michael B Roberts
- Institutional Research and Outcomes Assessment, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Lisa Shea
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
| | - Hope Kilgannon
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
| | - Donald E Edmondson
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Stephen Trzeciak
- Department of Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brian W Roberts
- Department of Emergency Medicine, Cooper University Health Care, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA. .,Center for Humanism, Cooper Medical School of Rowan University, Camden, NJ, USA.
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Pet Grief: Tools to Assess Owners' Bereavement and Veterinary Communication Skills. Animals (Basel) 2019; 9:ani9020067. [PMID: 30795619 PMCID: PMC6406392 DOI: 10.3390/ani9020067] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
Simple Summary In Italy, there are approximately 60.5 million companion animals, and 92% of Italian owners consider them as family members. Despite the growing interest in pet bereavement and in end-of-life (EOL) issues in veterinary medicine across the world, there are still very few Italian studies on the psychological impact of losing a pet, and there are no instruments in the Italian language to assess grief, following the death of a companion animal and the impact of effective veterinary communication skills on pet bereavement. The aim of this study is the Italian adaptation of instruments (Pet Bereavement Questionnaire (PBQ); Regret of Bereaved Family Members (RBFM); Shared Decision-Making Questionnaire (SDM-Q-9); Consultation and Relational Empathy Measure (CARE)), which can be useful in assessing bereavement in companion animal owners and communication skills in veterinary medicine. All the instruments obtained good internal reliability. The results showed that the use of the Italian versions of all the instruments is useful, and that the CARE, the SDM-Q-9, and the Regret of Bereaved Family Members (RBFM) developed for the human healthcare context, may also be used in veterinary medicine, and in further Italian pet bereavement and EOL veterinary studies. Abstract In Italy, there are still very few studies on the psychological impact of losing a pet. The need to fill this gap springs from the fact that pet loss counseling services are increasingly being activated. The aim of this study is the Italian adaptation of instruments for veterinary counseling services. The survey instruments adapted were: Pet Bereavement Questionnaire (PBQ) to describe the individual experience of pet-grief; Regret of Bereaved Family Members (RBFM) to assess the family regret; Shared Decision-Making Questionnaire (SDM-Q-9) for decision making in end of life; Consultation and Relational Empathy Measure (CARE) to assess the veterinarian relational empathy during clinical encounters. All the instruments obtained good internal reliability, and the results of the confirmative factor analysis of all the Italian versions were in accordance with the original ones. The correlational analysis among the variables evidenced the following aspects: the more the owner feels involved by the veterinarian in the decision making process the more the veterinarian is perceived by the owner as empathetic; when the veterinarian is perceived as empathic and the decision making is shared the owners’ pet bereavement distress and regrets are reduced; negative dimensions of bereavement (grief, guilt, anger, intrusive thoughts and decisional regrets) are strictly linked to each other, therefore if one dimension increases or decreases the others do too. The path analysis suggests that developing a veterinary relationship-centered care practice may be beneficial for pet owners facing end-of-life issues and the death of their companion animals since it showed that shared-decision making strategies and empathic communication may reduce negative dimensions of bereavement that may complicate grief. Interestingly, adopting shared decision-making strategies may contribute to be perceived as more empathic. These aspects may be taken into consideration in end-of -life communication training in veterinary medicine.
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Maurici M, Arigliani M, Dugo V, Leo C, Pettinicchio V, Arigliani R, Franco E. Empathy in vaccination counselling: a survey on the impact of a three-day residential course. Hum Vaccin Immunother 2018; 15:631-636. [PMID: 30325260 PMCID: PMC6605730 DOI: 10.1080/21645515.2018.1536587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure. The survey involved 20 healthcare workers, doctors, and nurses in three immunization services of a Local Health Unit in South Italy. Before and after attending the course, all of them administered the questionnaire to 50 consecutive parents of vaccinated children. Statistical tests were used to assess the homogeneity of pre- and post -course samples, to measure the level of empathy perceived by parents in doctors and nurses in pre- and post-course evaluations, and to compare the average CARE Measure scores among groups. RESULTS Analysis of the questionnaires showed an increase of "excellent" scores and statistically significant differences between the pre- and post -course median values. Statistically significant differences between doctors and nurses were shown in almost all questions pre-course and in only four questions post-course. CONCLUSIONS This study demonstrated that a residential course is effective at improving patient-rated empathy of doctors and nurses working in vaccination centers and could result in an increase of parents' adherence to vaccination programs.
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Affiliation(s)
- Massimo Maurici
- a Department of Biomedicine and Prevention , University of Rome Tor Vergata , Italy
| | - Michele Arigliani
- b Department of Clinical and Experimental Medical Sciences , University Hospital of Udine , Italy
| | - Valentina Dugo
- c Department of Biomedicine and Prevention, Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Carlo Leo
- d Department of Clinical and Experimental Medical Sciences , University Hospital of Udine, Italy TO Department of Medicine , Udine , Italy
| | - Valentina Pettinicchio
- c Department of Biomedicine and Prevention, Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Raffaele Arigliani
- e Department of Biomedicine and Prevention , Specialization School for Hygiene and Preventive Medicine, University of Rome Tor Vergata , Rome , Italy
| | - Elisabetta Franco
- a Department of Biomedicine and Prevention , University of Rome Tor Vergata , Italy
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Goldenberg JZ, Steel A, Day A, Yap C, Bradley R, Cooley K. Naturopathic approaches to irritable bowel syndrome: protocol for a prospective observational study in academic teaching clinics. Integr Med Res 2018; 7:279-286. [PMID: 30271717 PMCID: PMC6160506 DOI: 10.1016/j.imr.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/18/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) is a common functional bowel disorder with a worldwide prevalence estimated between 10% and 20%. It has a significant impact on quality of life and societal expense. While there are pharmaceutical options available, few can be reliably recommended. Many IBS sufferers turn to complementary and alternative medicine including naturopathy. Naturopathic approaches to IBS are poorly studied to date. Methods We aim to describe naturopathic approaches to IBS as well as establish pilot data on before and after changes in validated IBS instruments. The study will employ a multi-centered, international, prospective, observational, naturalistic design. The uncontrolled before-and-after study will examine the outcomes associated with individualized, whole system naturopathic care as determined by each provider. We will recruit adult patients diagnosed with IBS and presenting to a participating naturopathic academic teaching clinic. Participants’ IBS symptoms will be measured using validated instruments (IBS-SSS and IBS-AR). Quality of life will be measured by using the PROMIS-29 profile. Adverse events will be tracked, as followed for treatment descriptions. Our primary outcomes will be before-and-after differences using week twelve as the primary endpoint. A p values will be set at 0.05, and descriptive and summary data will be presented. Discussion This study is designed to plug significant evidence gaps and to gather preliminary evidence to guide the design of a follow-up randomized active controlled trial. Australia and New Zealand Clinical Trial Registration Number: ACTRN12617001413314 Version 1.1
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Affiliation(s)
- Joshua Z. Goldenberg
- Bastyr University, Kenmore, USA
- University of Technology Sydney, Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, Ultimo, Australia
- Corresponding author at: Bastyr University, 14500 Juanita Dr NE,Kenmore, WA 98028,USA.
| | - Amie Steel
- University of Technology Sydney, Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, Ultimo, Australia
- Endeavour College of Natural Health, Office of Research, Brisbane, Australia
| | | | | | - Ryan Bradley
- University of Technology Sydney, Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, Ultimo, Australia
- National University of Natural Medicine, Portland, USA
- University of California, San Diego, La Jolla, USA
| | - Kieran Cooley
- University of Technology Sydney, Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, Ultimo, Australia
- Canadian College of Naturopathic Medicine, North York, Canada
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Matsuhisa T, Takahashi N, Aomatsu M, Takahashi K, Nishino J, Ban N, Mercer SW. How many patients are required to provide a high level of reliability in the Japanese version of the CARE Measure? A secondary analysis. BMC FAMILY PRACTICE 2018; 19:138. [PMID: 30115032 PMCID: PMC6097289 DOI: 10.1186/s12875-018-0826-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/30/2018] [Indexed: 08/23/2023]
Abstract
Background Empathy is widely regarded as being key to effective consultation in general practice. The Consultation and Relational Empathy (CARE) Measure is a widely used and well-validated patient-rated measure in English. A Japanese version of the CARE Measure has undergone preliminary validation, but its ability to differentiate between individual doctors has not been established. The current study sought to investigate the reliability of the Japanese version of the CARE Measure in terms of discrimination between doctors. Methods We conducted secondary analysis of a dataset involving 252 patients assessed by nine attending General Practitioners. The intra-cluster correlation coefficient was evaluated as an index of the reliability of the Japanese version of the CARE Measure for discriminating between doctors. With a criterion of intra-cluster correlation coefficient = 0.8, we conducted a decision (D) study using generalizability theory to determine the required number of patients for reliable CARE Measure estimates. Results The ability of the CARE Measure to discriminate between doctors increased with the number of patients assessed per doctor. A sample size of 38 or more patients provided an average intra-cluster correlation coefficient of 0.8. Conclusions The Japanese CARE Measure appears to reliably discriminate between doctors with a feasible number of patient-ratings per doctor. Further studies involving larger numbers of doctors with a multicenter analysis are required to confirm the results of the current study, which was conducted at a single institution.
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Affiliation(s)
- Takaharu Matsuhisa
- Department of General Medicine/Family & Community Medicine Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
| | - Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, Japan
| | - Muneyoshi Aomatsu
- Department of Medical Education, Saku Central Hospital, 197 Usuda, Saku, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, Japan
| | - Jo Nishino
- Department of Biostatistics Nagoya University Graduate School of Medicine, 65 Turumai-cho, Showa-ku, Nagoya, Japan
| | - Nobutaro Ban
- Medical Education Center, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Japan
| | - Stewart W Mercer
- Department of Primary Care Research in General Practice and Primary Care, Institute for Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland
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Monsalve-Reyes CS, San Luis-Costas C, Gómez-Urquiza JL, Albendín-García L, Aguayo R, Cañadas-De la Fuente GA. Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2018; 19:59. [PMID: 29747579 PMCID: PMC5944132 DOI: 10.1186/s12875-018-0748-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses. METHODS We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017. RESULTS After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment. CONCLUSIONS Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.
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Affiliation(s)
- Carolina S. Monsalve-Reyes
- Departamento de Ciencias Sociales, Universidad Católica de La Santísima Concepción, Concepción, Chile
- Doctorado en Psicología de la Salud, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | | | - Jose L. Gómez-Urquiza
- Nursing Department, University of Granada, Granada, Spain
- Faculty of Health Sciences, University of Granada, Cortadura del Valle Street S/N, 51001 Ceuta, Spain
| | | | - Raimundo Aguayo
- Psychology Department, University of Granada, Granada, Spain
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Arigliani M, Castriotta L, Pusiol A, Titolo A, Petoello E, Brun Peressut A, Miorin E, Elkina I, Marzona F, Cucchiaro D, Spanghero E, Pavan M, Arigliani R, Mercer SW, Cogo P. Measuring empathy in pediatrics: validation of the Visual CARE measure. BMC Pediatr 2018; 18:57. [PMID: 29439733 PMCID: PMC5812057 DOI: 10.1186/s12887-018-1050-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/06/2018] [Indexed: 12/30/2022] Open
Abstract
Background Empathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED). Methods The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and the 10Q–Parent questionnaire to parents of children younger than 7. The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated. Results Seven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor. Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires (Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93). Conclusions The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics.
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Affiliation(s)
- Michele Arigliani
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy.
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, ASUI Udine, Istituto Igiene, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Anna Pusiol
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Annachiara Titolo
- University of Udine School of Medicine, Piazzale M. Kolbe, 3 - 33100 Udine, 33100, Udine, Italy
| | - Enrico Petoello
- University of Udine School of Medicine, Piazzale M. Kolbe, 3 - 33100 Udine, 33100, Udine, Italy
| | - Alberto Brun Peressut
- Department of Surgery, University Hospital of Udine, ASUI Udine, Clinica Chirurgica, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elisabetta Miorin
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Iana Elkina
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Federico Marzona
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Davide Cucchiaro
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Elisa Spanghero
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
| | - Matteo Pavan
- University of Trieste, Facoltà di Medicina e Chirurgia dell'Università degli Studi di Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Raffaele Arigliani
- Pediatric Primary Care, ASL Benevento, Via Giuseppe Piermarini, 12, 82100, Benevento, Italy
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, Scotland
| | - Paola Cogo
- Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, ASUI Udine, Pediatria, P.zzale S. Maria Misericordia 1, 33100, Udine, Italy
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Dambha-Miller H, Silarova B, Irving G, Kinmonth AL, Griffin SJ. Patients' views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years. Br J Gen Pract 2018; 68:e36-e43. [PMID: 29203681 PMCID: PMC5737318 DOI: 10.3399/bjgp17x693917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/18/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient-practitioner interactions might be changing. AIM To explore the views of patients with type 2 diabetes on factors that are of significance to them in patient-practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease. DESIGN AND SETTING A longitudinal qualitative analysis over 10 years in UK primary care. METHOD The study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics. RESULTS At the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time. CONCLUSION This study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.
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Affiliation(s)
- Hajira Dambha-Miller
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge
| | - Barbora Silarova
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge
| | - Greg Irving
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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Bikker AP, Fitzpatrick B, Murphy D, Forster L, Mercer SW. Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses' consultations. BMC Nurs 2017; 16:71. [PMID: 29204104 PMCID: PMC5702142 DOI: 10.1186/s12912-017-0265-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Increasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses. Methods Patient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland. Results Female patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses. Conclusions Within this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.
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Affiliation(s)
- Annemieke P Bikker
- Usher Institute for Population Sciences and Informatics, The University of Edinburgh, 9 BioQuarter, Little France Road, Edinburgh, EH16 4UX UK
| | - Bridie Fitzpatrick
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
| | - Douglas Murphy
- School of Medicine, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
| | - Lorraine Forster
- Sandyford Sexual Health Services, 2-6 Sandyford Place, Glasgow, G3 7NB UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX UK
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Desborough J, Phillips C, Mills J, Korda R, Bagheri N, Banfield M. Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement. J Adv Nurs 2017; 74:564-578. [DOI: 10.1111/jan.13461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Christine Phillips
- Australian National University Medical School; Australian National University; Canberra ACT Australia
| | - Jane Mills
- College of Health; Massey University; Palmerston North New Zealand
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health; Research School of Population Health; Australian National University; Canberra ACT Australia
| | - Nasser Bagheri
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Research School of Population Health; Australian National University; Canberra ACT Australia
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Foley H, Steel A. Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boyer L, Baumstarck K, Alessandrini M, Hamidou Z, Testart J, Serres M, Arquillière P, Auquier P, Leroy T, Zendjidjian X. Emotional intelligence and coping strategies as determinants of quality of life in depressed patient-caregiver dyads: An actor-partner interdependence analysis. Compr Psychiatry 2017; 74:70-79. [PMID: 28110224 DOI: 10.1016/j.comppsych.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Patients with major depressive disorder (MDD) and their natural caregivers experience major lifestyle difficulties. Little is known concerning dyadic (i.e., patient and natural caregiver) characteristics' impact on quality of life. In a sample of depressed patient-caregiver dyads, we examined quality of life (QoL) levels compared with the general population and whether QoL is influenced by emotional intelligence (EI) and coping strategies using the actor-partner interdependence model (APIM). METHODS This cross-sectional study involved 79 patient-caregiver dyads. The self-reported data, completed by patients and their primary caregivers, included QoL (SF-36), EI (TEIQue-SF) and coping strategies (BriefCope). The QoL of patients and caregivers was compared with 158 French age-sex-matched healthy controls. The dyadic interactions were analyzed using structural equation modeling. RESULTS Patients and their caregivers experienced lower QoL levels than French age-sex-matched controls. The EI findings showed actor (degree to which the person's EI was associated with his/her own QoL) and partner (degree to which the person's EI was associated with QoL of the other member of the dyad) effects for patients and caregivers. The coping strategies (i.e., problem solving, positive thinking, avoidance and social support) revealed only actor effects. CONCLUSION QoL is seriously impaired in depressed patients and their primary caregivers and is associated with EI and coping strategies. Targeted interventions focusing on EI and coping strategies could be offered to improve QoL in dyads.
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Affiliation(s)
- L Boyer
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France.
| | - K Baumstarck
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France
| | - M Alessandrini
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France
| | - Z Hamidou
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France
| | - J Testart
- Department of Psychiatry, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005, Marseille, France
| | - M Serres
- Department of Psychiatry, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005, Marseille, France
| | - P Arquillière
- Department of Psychiatry, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005, Marseille, France
| | - P Auquier
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France
| | - T Leroy
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France; University of Lyon, Univ. Lyon 2, GRePS EA 4163, 69007, Lyon, France
| | - X Zendjidjian
- Aix Marseille University, SPMC EA 3279, 13385, Marseille, France; Department of Psychiatry, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005, Marseille, France
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Babar MG, Hasan SS, Yong WM, Mitha S, Al-Waeli HA. Patients’ Perceptions of Dental Students’ Empathic, Person-Centered Care in a Dental School Clinic in Malaysia. J Dent Educ 2017; 81:404-412. [DOI: 10.21815/jde.016.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Muneer Gohar Babar
- School of Dentistry, International Medical University; Kuala Lumpur Malaysia
| | - Syed Shahzad Hasan
- School of Pharmacy, International Medical University; Kuala Lumpur Malaysia
| | - Wong Mei Yong
- International Medical University; Kuala Lumpur Malaysia
| | - Shahid Mitha
- School of Dentistry, International Medical University; Kuala Lumpur Malaysia
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Foley H, Steel A. Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience. PATIENT EDUCATION AND COUNSELING 2017; 100:212-223. [PMID: 27693375 DOI: 10.1016/j.pec.2016.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This review aims to describe the prevalence of empathy, empowerment and patient-centred clinical care experienced by patients in complementary medicine (CM) consultations. METHODS A systematic review was undertaken of original research exploring patient perceptions of CM clinical care. Ten databases were searched: Alt HealthWatch, AMED, CINAHL Plus, MEDLINE Complete, Cochrane Library, PubMed, Proquest Medical Collection, PsycInfo, Social Sciences Citation Index and Psychology Collection. Studies were included which reported patient perceptions of consultation with CM practitioners and were excluded where experimental methods controlled the nature of consultation processes. RESULTS Findings of included studies (n=34) were categorised under the a priori themes of empathy, empowerment and patient-centred care. This produced a substantial pool of qualitative data detailing patient-reported experiences which consistently confirmed occurrence of these themes in CM consultation. Quantitative data was correlative, yet was insufficient to definitively describe prevalence of such experiences. CONCLUSION While it is evident that CM consultations provide a patient experience of empathy, empowerment and patient-centredness, further research is warranted to quantify this experience before it can be defined as characteristic of CM clinical care. PRACTICE IMPLICATIONS This review draws attention to the potential role of CM as a resource for patients' psychosocial health needs.
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Affiliation(s)
- Hope Foley
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia.
| | - Amie Steel
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Davoodvand S, Abbaszadeh A, Ahmadi F. Patient advocacy from the clinical nurses' viewpoint: a qualitative study. J Med Ethics Hist Med 2016; 9:5. [PMID: 27471588 PMCID: PMC4958925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/28/2016] [Indexed: 11/29/2022] Open
Abstract
One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients' health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy.
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Affiliation(s)
- Shirmohammad Davoodvand
- PhD Candidate in Nursing, Razi Nursing and Midwifery College, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Abbaszadeh
- Professor, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; ,Corresponding Author: Abbas Abbaszadeh. Address: Nursing and Midwifery College, Shahid Beheshti University of Medical Sciences, ValiAsr Street, Tehran, Iran. P.O. Box: 1996835119. Tel: 98 21 88202520. Fax: 98 21 88202521
| | - Fazlollah Ahmadi
- Professor, Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl R. Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships. Obes Sci Pract 2016; 2:128-135. [PMID: 27293804 PMCID: PMC4902272 DOI: 10.1002/osp4.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships. Methods This study consisted of an interviewer‐administered survey of 149 women with obesity (body mass index (BMI) > 30 kg m−2) immediately after their physician visit at four Federally Qualified Health Centers. Perceptions of weight stigma and physician empathy were measured using the Stigma Situations in Health Care instrument and Consultation and Relational Empathy (CARE) measure, respectively. Associations of CARE and Stigma scores with BMI and patient characteristics were analysed using Mantel–Haenszel chi‐squared test and ordinal logistic regression. Results The mean CARE score was 42.1 (standard deviation 8.4; range 11.0–50.0), and mean stigma score was 4.6 (standard deviation 7.6; range 0–43.0). Each increase in BMI category was associated with almost twofold increased odds of higher perception of stigma (odds ratio, 1.90, 95% confidence interval 1.30–2.78, P = 0.001). BMI was not associated with CARE. However, for each increase in stigma category, the odds of lower CARE score doubled (odds ratio, 0.52, 95% confidence interval 0.36–0.75, P = 0.0005). Conclusions While BMI was not associated with perception of physician empathy, higher frequency of weight stigmatizing situations was negatively associated with perception of physician empathy. Reducing weight stigma in primary care could improve doctor–patient relationships and quality of care in patients with obesity.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - KelliAnn Seaman
- Preliminary Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers-School of Public Health, Piscataway, New Jersey, USA
| | - Daniel Gundersen
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
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