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Zhao T, Cai X, Zhang S, Wang M, Chen L, Wang J, Yu Y, Tao L, Xu X, Luo J, Wang C, Du J, Liu Y, Lu Q, Cui F. Differences in Vaccination Consultation Preferred by Primary Health Care Workers and Residents in Community Settings. Vaccines (Basel) 2024; 12:534. [PMID: 38793785 PMCID: PMC11126119 DOI: 10.3390/vaccines12050534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE To evaluate the preference of primary HCWs and residents on vaccination consultation in community health services to provide evidence for vaccine hesitancy intervention strategies. METHODS A discrete choice model (DCM) was constructed to evaluate the preference difference between primary HCWs and residents on vaccination consultation in community health services in China during May-July 2022. RESULTS A total of 282 residents and 204 HCWs were enrolled in this study. The residents preferred consulting with an HCW-led approach (β = 2.168), with specialized content (β = 0.954), and accompanied by telephone follow-up (β = 1.552). In contrast, the HCWs preferred face-to-face consultation (β = 0.540) with an HCW-led approach (β = 0.458) and specialized content (β = 0.409), accompanied by telephone follow-up (β = 0.831). College residents and residents with underlying self-reported disease may be near-critically inclined to choose traditional consultation (an offline, face-to-face consultation with standardized content and more prolonged duration) rather than a new-media consulting group (an online consultation with specialized content within 5 min). Urban HCWs preferred long-term consultation groups (the resident-led offline consultation with follow-up lasting more than 5 min). In contrast, rural HCWs preferred efficient consultation (the HCW-led, short-duration, standardized offline consultation mode). CONCLUSION The selection preference for vaccine consultation reveals a gap between providers and demanders, with different groups exhibiting distinct preferences. Identifying these targeted gaps can help design more acceptable and efficient interventions, increasing their likelihood of success and leading to better resource allocation for policymakers to develop targeted vaccination policies.
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Affiliation(s)
- Tianshuo Zhao
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Xianming Cai
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Sihui Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Mingting Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Linyi Chen
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Juan Wang
- Jiuzhaigou Center for Disease Control and Prevention, Ngawa 623099, China;
| | - Yajie Yu
- Yilan Center for Disease Control and Prevention, Harbin 154899, China
| | - Liandi Tao
- Longxi Center for Disease Control and Prevention, Longxi 748199, China
| | - Xiaoxia Xu
- Chengguan Center for Disease Control and Prevention, Lanzhou 730030, China;
| | - Jing Luo
- Suzhou Center for Disease Control and Prevention, Suzhou 234099, China
| | - Chao Wang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Yaqiong Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Qingbin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
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Li Q, Zhao Z, Yang C, Lu B, Yang C, Qiao J, Huang D, Chen Z, Yin W. Comparative analysis of village doctors' relative deprivation: based on two cross-sectional surveys. BMC PRIMARY CARE 2024; 25:133. [PMID: 38664696 PMCID: PMC11044418 DOI: 10.1186/s12875-024-02385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Village doctors are the main health service providers in China's rural areas. Compared with other rural groups, they will have a sense of relative deprivation, which has an impact on their practice mentality and job stability. This study aims to analyze the changes and causes of relative deprivation among village doctors, so as to improve the stability of them. METHODS The data were collected from two surveys conducted in Shandong Province in 2015 and 2021. In 2015, 322 village doctors were surveyed and 307 questionnaires were collected, with a recovery rate of 95.3%. In 2021, 394 village doctors were surveyed and 366 questionnaires were collected, with a recovery rate of 92.9%. Descriptive and univariate analysis were used to compare the changes before and after the survey. RESULTS The scores of vertical deprivation of village doctors increased from 2.77 ± 0.81 in 2015 to 3.04 ± 0.83 in 2021, with a statistically significant difference (P < 0.001). The reference group selected by village doctors changed from village teachers to ordinary villagers. Compared to village teachers, the horizontal deprivation score of village doctors increased from 3.47 ± 0.87 to 3.97 ± 0.77, with a statistically significant difference (P < 0.001). Compared to villagers, only the professional reputation deprivation score increased, from 2.38 ± 0.93 to 2.68 ± 0.76, with a statistically significant difference (P < 0.05). CONCLUSIONS As time goes by, village doctors fail to reach the expected level in terms of economic income, social status, professional reputation and living standards, resulting in a sense of relative deprivation. This may have a negative impact on village doctors' work motivation and behavior, and will fail to guarantee the sustainability of the team. We should pay attention to this unbalanced mentality of village doctors.
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Affiliation(s)
- Qiusha Li
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Zixuan Zhao
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Chunxiao Yang
- School of Public Health, Shandong Second Medical University, Weifang, Shandong, China
| | - Bei Lu
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Chenxiao Yang
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Jiahui Qiao
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Dongmei Huang
- School of Management, Shandong Second Medical University, Weifang, Shandong, China
| | - Zhongming Chen
- School of Management, Shandong Second Medical University, Weifang, Shandong, China.
| | - Wenqiang Yin
- School of Management, Shandong Second Medical University, Weifang, Shandong, China.
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Wang X, Chu J, Zhao D, Gao T, Luo J, Wang X, Chai S, Li J, Sun J, Li P, Zhou C. The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter? BMC PRIMARY CARE 2024; 25:130. [PMID: 38658816 PMCID: PMC11040762 DOI: 10.1186/s12875-024-02383-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China. METHODS We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services. RESULTS The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81). CONCLUSIONS Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.
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Affiliation(s)
- Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jie Chu
- Shandong Center for Disease Control and Prevention, Jinan, 250012, China.
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
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Mi J, Du X, Aili Y, Li M, Liu Y. Unveiling Patient Trust in Physicians Across China: Insights from a Nationwide Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:1039-1052. [PMID: 38680478 PMCID: PMC11055546 DOI: 10.2147/rmhp.s456585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/23/2024] [Indexed: 05/01/2024] Open
Abstract
Background Trust is a major factor affecting patient-physician relationship and healthcare quality. However, there has been a lack of comprehensive study on the extent of and major factors affecting patient trust in healthcare providers of China, the world's largest developing country. The objective of this study is to elucidate the current status of outpatient trust in physicians in China and its influencing factors, providing empirical evidence to enhance doctor-patient trust and improve doctor-patient relationships. Methods Between December 2017 and January 2018, 28,760 patients seeking care at the outpatient departments of 136 tertiary hospitals were interviewed, where they were asked to rate their trust in physicians. We applied a multilevel logistic regression model to explore the association between patients trust and characteristics of hospitals, physicians and patient characteristics. We conducted a series of sensitivity analysis to check the robustness of our findings. Results Among 28,760 participants included in this study, 91.54% expressed trust in their physicians, while 7.52% showed moderate trust. Only 0.94% expressly distrusted or strongly distrusted their physicians. Outpatients of hospitals with convenient payment, volunteer guidance and enough seats available in the rest and waiting area showed higher levels of trust. Physicians who had a senior title, showed patience and protection of the patient's privacy were more likely to be trusted by their patients in the outpatient setting. Compared to their female counterparts, male outpatients showed a higher degree of trust. Conclusion While this study highlights an overall high level of Trust in physicians (TIP) among patients in China's tertiary hospitals, it is found to vary with patient demographic factors as well as provider's attributes. Hospitals with a more keen sense of protecting patients privacy and better meeting patients' need for efficient and caring service provision process appeared to yield a higher level of trust.
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Affiliation(s)
- Jiarun Mi
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xinyu Du
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yilixiati Aili
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Mingkun Li
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China
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Li H, Zhang C, Li L, Liu T, Zhang L, Hao J, Sun J. Bibliometric and visualization analysis of risk management in the doctor-patient relationship: A systematic quantitative literature review. Medicine (Baltimore) 2024; 103:e37807. [PMID: 38640335 PMCID: PMC11029958 DOI: 10.1097/md.0000000000037807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/21/2024] Open
Abstract
OBJECTIVES This paper analyzed the research on risk management in the doctor-patient relationship (DPR) based on a systematic quantitative literature review approach using bibliometric software. It aims to uncover potential information about current research and predict future research hotspots and trends. METHODS We conducted a comprehensive search for relevant publications in the Scopus database and the Web of Science Core Collection database from January 1, 2000 to December 31, 2023. We analyzed the data using CiteSpace 6.2.R2 and VOSviewer 1.6.19 software to examine the annual number of publications, countries/regions, journals, citations, authors, and keywords in the field. RESULTS A total of 553 articles and reviews that met the criteria were included in this study. There is an overall upward trend in the number of publications issued; in terms of countries/regions, the United States and the United Kingdom are the largest contributors; Patient Education and Counseling is the most productive journal (17); Physician communication and patient adherence to treatment: a meta-analysis is the most cited article (1637); the field has not yet to form a stable and obvious core team; the analysis of high-frequency keywords revealed four main research directions: the causes of DPR risks, coping strategies, measurement tools, and research related to people prone to doctor-patient risk characteristics; the causes of DPR risks, coping strategies, measurement tools, and research related to people prone to doctor-patient risk characteristics; the keyword burst analysis revealed several shifts in the research hotspots for risk management in the DPR, suggesting that chronic disease management, is a future research direction for the continued development of risk management in the DPR. CONCLUSIONS The visualization analysis of risk management literature in the DPR using CiteSpace and VOSviewer software provides insights into the current research status and highlights future research directions.
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Affiliation(s)
- Hui Li
- Health Management College, Anhui Medical University, Hefei, China
| | - Chenchen Zhang
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Limin Li
- Health Management College, Anhui Medical University, Hefei, China
| | - Tong Liu
- Health Management College, Anhui Medical University, Hefei, China
| | - Liping Zhang
- School of Marxism, Anhui Medical University, Hefei, China
| | - Jiqing Hao
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Jiangjie Sun
- Health Management College, Anhui Medical University, Hefei, China
- Clinical Medical College, Anhui Medical University, Hefei, China
- School of Management, Hefei University of Technology, Hefei, China
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Haruta J, Nakajima R, Monkawa T. Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey. BMC MEDICAL EDUCATION 2024; 24:399. [PMID: 38600531 PMCID: PMC11007881 DOI: 10.1186/s12909-024-05386-2] [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: 02/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. METHODS This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. RESULTS Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. CONCLUSIONS Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.
| | - Rika Nakajima
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Toshiaki Monkawa
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
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Kruskie ME, Byram JN, Mussell JC. Near-Peer Teaching Opportunities Influence Professional Identity Formation as Educators in Future Clinicians. MEDICAL SCIENCE EDUCATOR 2023; 33:1515-1524. [PMID: 38188376 PMCID: PMC10766879 DOI: 10.1007/s40670-023-01951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Abstract
Teaching is a key role of a physician. Despite this, medical students are rarely exposed to the necessary skills and techniques throughout the duration of their education to prepare them for this component of their training. The gross anatomy lab provides a safe environment for students serving as near-peer educators to teach and learn to manage unexpected and uncomfortable situations. Students acting in near-peer teaching roles see a range of benefits from addressing personal weaknesses to improving communication skills and enhancing their anatomy and clinical knowledge, but there remains a lack of insight on how these experiences shape students' professional identity. This study examined how the professional identities of second-year medical students are shaped by serving as peer educators (PEs) in a gross anatomy laboratory. Gross anatomy PEs from the 2022 and 2025 cohorts recorded audio diary reflections at the end of each week they served as a PE highlighting how this role impacted how they view themselves as future physicians. Audio diary recordings were transcribed verbatim and analyzed using the framework method which includes familiarization, code application, and interpretation. A total of 26 audio diaries averaging 4 min in length were recorded across 11 PEs. Themes included Balancing Workload, Role of a Near Peer, Learning to Communicate, Learning to Collaborate, and Learning through Teaching. Students recognized that in addition to reinforcing their didactic training, serving as a peer educator in the gross anatomy lab helped them build skills necessary to fulfil their future role as a physician educator.
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Affiliation(s)
- Megan E. Kruskie
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Jessica N. Byram
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Jason C. Mussell
- 6146 MEB, Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA 70112 USA
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Shaughnessy AF, Vicini Sj A, Zgurzynski M, O'Reilly-Jacob M, Duggan AP. Indicators of the dimensions of trust (and mistrust) in early primary care practice: a qualitative study. BMC PRIMARY CARE 2023; 24:150. [PMID: 37468845 PMCID: PMC10357788 DOI: 10.1186/s12875-023-02098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Trust occurs when persons feel they can be vulnerable to others because of the sincerity, benevolence, truthfulness and sometimes the competence they perceive. This project examines the various types of trust expressed in written reflections of developing healthcare clinicians. Our goal is to understand the roles trust plays in residents' self-examination and to offer insight from relationship science to inform the teaching and clinical work for better trust in healthcare. METHODS We analyzed 767 reflective writings of 33 residents submitted anonymously, to identify explicit or implicit indicators attention to trust or relationship development. Two authors independently coded the entries based on inductively identified dimensions. Three authors developed a final coding structure that was checked against the entries. These codes were sorted into final dimensions. RESULTS We identified 114 written reflections that contained one or more indicators of trust. These codes were compiled into five code categories: Trust of self/trust as the basis for confidence in decision making; Trust of others in the medical community; Trust of the patient and its effect on clinician; Assessment of the trust of them exhibited by the patient; and Assessment of the effect of the patient's trust on the patient's behavior. DISCUSSION Broadly, trust is both relationship-centered and institutionally situated. Trust is a process, built on reciprocity. There is tacit acknowledgement of the interplay among what the residents do is good for the patient, good for themselves, and good for the medical institution. An exclusive focus on moments in which trust is experienced or missed, as well as only on selected types of trust, misses this complexity. CONCLUSION A greater awareness of how trust is present or absent could lead to a greater understanding and healthcare education for beneficial effects on clinicians' performance, personal and professional satisfaction, and improved quality in patients' interactions.
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Affiliation(s)
- Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Andrea Vicini Sj
- Theology Department, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, USA
| | - Mary Zgurzynski
- Undergraduate Student, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Monica O'Reilly-Jacob
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, USA
| | - Ashley P Duggan
- Department of Family Medicine, Tufts University School of Medicine, Boston, MA, USA.
- Communication Department, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, USA.
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Abd-Elsayed AA, Marcondes LP, Loris ZB, Reilly D. Painful Diabetic Peripheral Neuropathy - A Survey of Patient Experiences. J Pain Res 2023; 16:2269-2285. [PMID: 37425223 PMCID: PMC10329444 DOI: 10.2147/jpr.s409876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose An online survey was conducted in the USA to obtain information about the knowledge and experiences of patients with painful diabetic peripheral neuropathy (pDPN). Patients and Methods 506 adults with diabetes and pDPN affecting the feet for ≥6 months, for which pain medication had been prescribed for ≥6 months, completed an online survey questionnaire in March 2021. Results 79% of respondents had type 2 diabetes, 60% were male, 82% were Caucasian and 87% had comorbidities. Pain was significant to severe in 49% of respondents, and 66% had disability due to nerve pain. Anticonvulsants, over-the-counter pills and supplements were the most commonly used medications. Topical creams/patches were prescribed in 23% of respondents. 70% had tried multiple medications for their pain. 61% of respondents had to see ≥2 doctors before receiving a correct diagnosis of pDPN. 85% of respondents felt that the doctor understood their pain and its impact on their life. 70% had no difficulty finding the information they wanted. 34% felt insufficiently informed about their condition. A medical professional was the primary, and most trusted, source of information. Frustration, worry, anxiety and uncertainty were the most commonly reported emotions. Respondents were generally eager to find new medications for pain relief and desperate for a cure. Lifestyle changes because of nerve pain were most commonly associated with physical disabilities and sleep disturbance. Better treatments and freedom from pain were the overriding perspectives when considering the future. Conclusion Patients with pDPN are generally well informed about their pain and trust their doctor but remain unsatisfied with their current treatment and struggle to find a lasting solution for their pain. Early identification and diagnosis of pain in diabetics, and education about treatments, is important to minimize the impact of pain on quality of life and emotional well-being.
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Affiliation(s)
- Alaa A Abd-Elsayed
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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