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Grau Canét-Wittkampf C, Trippenzee M, Jaarsma D, Diemers A. Candid insights and overlooked facets: what medical students write about patient-centeredness in diaries on longitudinal patient contacts. MEDICAL EDUCATION ONLINE 2024; 29:2363611. [PMID: 38861676 PMCID: PMC11168331 DOI: 10.1080/10872981.2024.2363611] [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: 11/03/2023] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
Despite students' exposure to patient-centered care principles, their dedication to patient-centeredness often experiences a wane throughout their academic journey. The process of learning patient-centeredness is complex and not yet fully understood. Therefore, in our study, we sought to explore what aspects of patient-centeredness students spontaneously document in their diaries during interactions with actual patients. This investigation will help to identify gaps in the current educational practices and better prepare future clinicians to deliver patient-centered healthcare. We analyzed 92 diaries of 28 third-year undergraduate medical students at UMC Utrecht in the Netherlands who participated in an educational intervention, following four patients each as companions over a two-year period early in their clerkships. We conducted thematic analysis, using inductive and deductive coding, within a social-constructionist paradigm. We identified four key themes: communication, the person behind the patient, collaboration and organization in healthcare, and students' professional development. Within these themes, we observed that students spontaneously documented 9 of 15 dimensions of patient-centeredness as outlined in the model of Scholl : 'clinician-patient communication', 'patient as unique person', 'biopsychological perspective', 'essential characteristics of the clinician', 'clinician-patient relationship', 'involvement of family and friends', 'patient-information', 'emotional support' and 'coordination and continuity of care' (mainly principles of patient-centeredness). Conversely, we noted that students underreported six other dimensions (enablers and activities): 'access to care', 'integration of medical and non-medical care', 'teamwork and teambuilding', 'patient involvement in care', 'patient empowerment' and 'physical support'. Throughout their longitudinal journey of following patients as non-medical companions, students spontaneously documented some aspects of patient-centeredness in their diaries. Additionally, students reflected on their own professional development. Our findings suggest that incorporating education on the broadness of the concept of patient-centeredness coupled with enhanced guidance, could potentially enable students to learn about the complete spectrum of patient-centeredness within their medical education.
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Affiliation(s)
- Christel Grau Canét-Wittkampf
- Wenckebach Institute for Education and Training, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miranda Trippenzee
- Department of Health Psychology, Health Sciences, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie Jaarsma
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
- LEARN (Lifelong Learning, Education and Assessment), University Medical Center Groningen, Groningen, The Netherlands
| | - Agnes Diemers
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
- LEARN (Lifelong Learning, Education and Assessment), University Medical Center Groningen, Groningen, The Netherlands
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Chorya H, Coloma HS, Cortiana V, Joshi M, Menon GP, Balasubramanian M, Park CH, Leyfman Y. The Potential of Lifestyle Medicine: Strategies to Optimize Health and Well-Being in Oncology Care with Dr. Amy Comander. Cancers (Basel) 2023; 15:5323. [PMID: 38001584 PMCID: PMC10670222 DOI: 10.3390/cancers15225323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
The field of lifestyle medicine in cancer care and survivorship is undergoing significant transformation, presenting both challenges and opportunities. This collection of insights and reflections by an esteemed speaker aims to address critical facets of this evolving landscape and the intersection of healthcare, lifestyle, and cancer. With a focus on optimizing the health of cancer survivors, the speaker emphasizes the correlation between general population health and strategies for mitigating cancer risk. Evidence-based resources have a key role in their comprehensive insights into lifestyle changes' role in cancer prevention and survivorship. Lifestyle interventions also have a promising role in mitigating the late effects in the pediatric context. Therefore, encouraging the early adoption of healthy practices in childhood cancer survivors emerges as a pivotal strategy. Furthermore, challenges in enhancing education and access to lifestyle medicine are addressed. This highlights the importance of patient-centered communication, motivational interviewing, and personalized guidance in facilitating lifestyle changes with patients. Finally, the role of nutritionists in advising breast cancer patients to consider calorie restriction to lower IGF-1 levels is explored. This collection underscores the multifaceted nature of lifestyle medicine in cancer care, highlighting challenges, opportunities, and the transformative power of passion and curiosity in shaping healthcare careers.
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Affiliation(s)
| | | | - Viviana Cortiana
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy
| | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi 0186, Georgia
| | | | | | | | - Yan Leyfman
- Icahn School of Medicine at Mount Sinai South Nassau, Oceanside, NY 11572, USA
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Grilo AM, Vinagre G, dos Santos MC, Martinho JF, Gomes AI. Attitudes toward Patient-Centred Care, Empathy, and Assertiveness among Students in Rehabilitation Areas: A Longitudinal Study. Healthcare (Basel) 2023; 11:2803. [PMID: 37893877 PMCID: PMC10606137 DOI: 10.3390/healthcare11202803] [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: 06/28/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
This study assessed attitudes toward patient-centred care, empathy, assertiveness, and subjective perception of communication skills and technical knowledge among Portuguese undergraduate students in healthcare. These students may develop rehabilitation activities with patients in their person-oriented or technique-oriented professions. Portuguese nursing and allied health students from two public higher education schools completed questionnaires in the first and third academic years: Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy, Scale for Interpersonal Behaviour, and a subjective perception of technical knowledge and communication skills. A total of 183 students completed the surveys. In the first year, students showed moderate to high scores on patient-centredness attitudes, empathy, and assertiveness and perceived themselves as having good communication skills. Students from person-oriented programmes significantly improved their Total and shared patient-centred attitudes in the third year compared with students attending technique-oriented professions. Significant differences in empathy were found between groups in the third year. Distress associated with assertive behaviours increased significantly across time in students from technique-oriented programmes compared with their peers in person-oriented programmes. The results suggest that the health profession's orientation and the programmes' specific curriculum might have a role in how some dimensions evolved in the two groups of students. The increasing assertiveness-related discomfort highlighted the importance of assessing and monitoring students' emotional wellbeing during their initial interactions with patients.
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Affiliation(s)
- Ana Monteiro Grilo
- H&TRC—Health & Technology Research Center, Escola Superior de Tecnologia da Saúde, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
| | - Graça Vinagre
- Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1990-096 Lisboa, Portugal;
| | - Margarida Custódio dos Santos
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
- Escola Superior de Tecnologia da Saúde, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Joana Ferreira Martinho
- Câmara Municipal de Oliveira do Bairro, Ed. Paços do Concelho, Praça do Município, 3770-851 Oliveira do Bairro, Portugal;
| | - Ana Isabel Gomes
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
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Ferla JBDS, de Araujo CM, de Oliveira MH, Carnevale LB, Berberian AP. Patient-centered care - evidence in the context of professional health practice. Rev Bras Enferm 2023; 76:e20220448. [PMID: 37820125 PMCID: PMC10561417 DOI: 10.1590/0034-7167-2022-0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/24/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES to analyze patient-centered attitudes in care and sharing practices of nursing, speech therapy, dentistry and medicine professionals. METHODS cross-sectional research was used with 411 professionals, and the Patient-Practitioner Orientation Scale instrument was applied as a measure of outcome. RESULTS physicians presented higher mean scores, reflecting a patient-centered orientation, shared control, and focus on the person, with statistical difference for all domains (p<0.02). Dentists were the professionals who presented lower scores, especially in the sharing domain, with statistical difference in relation to nurses, speech therapists, and physicians (p<0.05). CONCLUSIONS finally, the attitudes of professionals in the health areas studied indicated self-reported preference for centrality in patients. In this context, patient-centered care can be an important resource in health care when committed to overcoming the object man.
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Affiliation(s)
- Josiane Bernart da Silva Ferla
- Universidade Tuiuti do Paraná. Curitiba, Paraná, Brazil
- Instituto Federal de Educação Ciência e Tecnologia do Paraná. Curitiba, Paraná, Brazil
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Barbato KBG, Carvalho LSD, Barreira Marangoni V, Souza FD, Vaena MMDV. Core Competencies Self-Assessment and Patient-Practitioner Orientation during the First Year of a Brazilian Orthopedic Residency. Rev Bras Ortop 2023; 58:e742-e749. [PMID: 37908538 PMCID: PMC10615602 DOI: 10.1055/s-0043-1768621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/18/2022] [Indexed: 11/02/2023] Open
Abstract
Objective Training a competent physician requires to direct the resident profile of graduate students for practice activities. We sought to identify the doctor-patient relationship orientation and the self-assessment of the core competencies, which they pointed out needed to be developed. Methods All 56 orthopedic residents admitted between 2016 and 2019 participated in the present prospective observational study. The Patient Practitioner Orientation Scale (PPOS) and a self-assessment questionnaire were answered at the beginning and end of the first year of residency (R1) in Orthopedics and Traumatology. We calculated mean and standard deviation for PPOS items and scores and analyzed them through the paired t-test. Self-Assessment Questionnaire answer options were "yes" or "I need to improve it" and skills were classified in decreasing order of the frequency of "I need to improve it" responses with description of absolute number and percentage. We compared frequencies using Fisher Test. P-values < 0.05 were considered statistically significant. GraphPad Prism 8.4.3 (GraphPad Software, San Diego, CA, USA) and Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) were used for statistical analysis. Results In the period between the beginning and the end of R1, the total PPOS mean score significantly decreased from 4.63 to 4.50 ( p = 0.024), more biomedical-focused. Around one-third of the residents identified competencies of patient care, practice-based learning and improvement, and interpersonal and communication skills as needed to improve. Conclusions The PPOS and self-assessment activities could promote reflection practices and are possible tools for learner-centered competency assessment. Biomedical guidance tends to prevail as the training of physicians progresses, and periodic self-assessments can be worked on to build a growth mindset.
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Affiliation(s)
- Kelly Biancardini Gomes Barbato
- Área de Medicina Interna, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Escola de Medicina Souza Marques, Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, RJ, Brasil
| | - Luciana Santos de Carvalho
- Unidade de Educação Permanente, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Viviani Barreira Marangoni
- Unidade de Educação Permanente, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Atividade integradora – Ciclo Básico, Centro Universitário Arthur Sa Earp Neto, Rio de Janeiro, RJ, Brasil
| | - Fábio de Souza
- Área de Medicina Interna, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
- Departamento de Cardiologia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marcella Martins de Vasconcelos Vaena
- Coordenação Diagnóstica e Terapêutica de Hemoterapia, Instituto Nacional de Saúde da mulher, da criança e do adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Departamento de Hemoterapia, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
- Divisão Campus Cittá, Instituto de Educação Médica Estácio de Sá, Universidade Estácio de Sá, Rio de Janeiro, RJ, Brasil
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Lee M, Song Y, You M, Park SY, Ihm J. Dentists' attitudes toward patient-centered care and its predictors: a cross-sectional study in South Korea. BMC Oral Health 2023; 23:75. [PMID: 36747198 PMCID: PMC9903426 DOI: 10.1186/s12903-023-02791-9] [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: 10/24/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patient-centered care (PCC) has been one of medical practice's most frequently discussed principles. However, attitudes toward PCC among dentists remain underexplored. This study focuses on examining dentists' patient-centered attitudes and investigating their predictors. METHODS The Patient-Practitioner Orientation Scale which consists of Sharing and Caring subscales was used to assess patient-centered attitudes. The statistical analysis included 217 dentists from South Korea. Hierarchical linear regression analysis was performed to examine the predictors such as sociodemographic aspects, academic factors, work-related factors, and empathy. RESULTS A patient-centered attitude of Caring subscale (M = 4.29, SD = 0.56) emerged, but the provider-centered attitude was higher in Sharing subscale (M = 3.40, SD = 0.48). Work year, academic track, and empathy were associated significantly with an overall caring aspect of patient-centered attitude, while the gender effect remained insignificant. Empathy had a critical and significant impact on the patient-centered attitude. CONCLUSIONS Efforts to enhance patient-centeredness in Sharing are needed; post-graduate education and transition to a more patient-centered health system are recommended. Moreover, empathy still matters as it was found to be a significant predictor of patient-centered attitudes. The findings of this study support the need for efforts to enhance patient-centered attitudes among dentists, which will help generate discussion on improving the curriculum of post-graduate education and health system reform.
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Affiliation(s)
- Minjung Lee
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Youngha Song
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Preventive and Social Dentistry, Seoul National University, Seoul, South Korea
| | - Myoungsoon You
- grid.31501.360000 0004 0470 5905Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Shin-Young Park
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Dental Education, Seoul National University, Seoul, South Korea ,grid.459982.b0000 0004 0647 7483Predoctoral Treatment Center, Seoul National University Dental Hospital, Seoul, South Korea
| | - Jungjoon Ihm
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea. .,Department of Dental Education, Seoul National University, Seoul, South Korea. .,Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, Korea.
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Adam P, Mauksch LB, Brandenburg DL, Danner C, Ross VR. Optimal training in communication model (OPTiCOM): A programmatic roadmap. PATIENT EDUCATION AND COUNSELING 2023; 107:107573. [PMID: 36410312 DOI: 10.1016/j.pec.2022.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Teaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. METHODS We created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. RESULTS Our model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. CONCLUSIONS OPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills. Practice Implications Residency faculty can use OPTiCOM for self-assessment, program creation and revision.
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Affiliation(s)
- Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Larry B Mauksch
- Emeritus - Department of Family Medicine, University of Washington, Home, 6026 30th Ave NE, Seattle, WA 98115, USA.
| | - Dana L Brandenburg
- Department of Family Medicine and Community Health, University of Minnesota, Smiley's Clinic, 2020 East 28th Street, Minneapolis, MN 55407, USA.
| | - Christine Danner
- Department of Family Medicine and Community Health, University of Minnesota, Bethesda Clinic, 580 Rice St, St Paul, MN 55103, USA.
| | - Valerie R Ross
- University of Washington Department of Family Medicine, Family Medicine Residency Program, Box 356390, 331 N.E. Thornton Place, Seattle, WA 98125, USA.
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Burke G, Melvin L, Ginsburg S. "Patients Are the People Who Teach Me the Most": Exploring the Development of Communication Skills During Internal Medicine Residency. J Grad Med Educ 2023; 15:59-66. [PMID: 36817542 PMCID: PMC9934842 DOI: 10.4300/jgme-d-22-00433.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Physician-patient communication training is a vital component of medical education, yet physicians do not always achieve the communication expertise expected of them. Despite extensive literature on the efficacy of various training interventions, little is known about how residents believe they learn to communicate. OBJECTIVE To understand residents' perspectives on the development of their communication skills. METHODS Between November 2020 and January 2021 recruitment emails were sent to all 225 internal medicine residents at the University of Toronto; one-on-one interviews were conducted with 15 residents. Participants were asked to reflect on communication skills development. Interviews were conducted and analyzed using constructivist grounded theory. RESULTS Participants credited the majority of their skills development to unsupervised interactions with patients, without explicit guidance from an attending physician. Attendings' contributions were primarily seen through role modeling, with little perceived learning coming from feedback on observed interactions. This was partly explained by residents' proclivity to alter their communication styles when observed, rendering feedback less relevant to their authentic practice, and by receiving generically positive feedback lacking in constructive features. Time constraints led to communication styles that prioritized efficiency at the cost of patient-centeredness. CONCLUSIONS These findings suggest that current models of communication training and assessment may fall short due to overreliance on observation by attendings and examiners, which may fail to unearth the authentic and largely self-taught communication behaviors of residents. Further research is required to ascertain the feasibility and potential value of other forms of communication training and assessment, such as through patient feedback.
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Affiliation(s)
- Gabriel Burke
- All authors are with the University of Toronto, Toronto, Ontario, Canada
- Gabriel Burke, MD, is a PGY-4 Resident in Respirology, Department of Medicine, Temerty Faculty of Medicine
| | - Lindsay Melvin
- All authors are with the University of Toronto, Toronto, Ontario, Canada
- Lindsay Melvin, MD, MHPE, is Assistant Professor and Toronto Western Hospital Site Program Director for Internal Medicine, Department of Medicine, Temerty Faculty of Medicine
| | - Shiphra Ginsburg
- All authors are with the University of Toronto, Toronto, Ontario, Canada
- Shiphra Ginsburg, MD, MEd, PhD, is Professor of Medicine, Department of Medicine, Sinai Health System and Temerty Faculty of Medicine, and Scientist, Wilson Centre for Research in Education, and Canada Research Chair in Health Professions Education
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Alomran A, Alyousefi N. Attitudes of Family Medicine Trainees Towards Patient-Centeredness Practice. Int J Gen Med 2023; 16:329-336. [PMID: 36726363 PMCID: PMC9885767 DOI: 10.2147/ijgm.s400820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The interaction between physicians and patients is essential in clinical practice. Patient-centered care (PCC) is becoming popular in healthcare and provides an approach to deliver high-quality healthcare to yield positive clinical outcomes. This study explores family medicine residents' attitudes toward the physician-patient relationship and patient-centered care and the possible influence of demographic characteristics, level of training, school of graduation, and previous training. Methods A cross-sectional study was conducted among family medicine residents in Riyadh. They were invited to enroll in a web-based survey that includes demographic data, training details, and the "Patient Practitioner Orientation Scale (PPOS).". Results A total of 114 family medicine residents completed the survey. There were 68 (59.6%) males and 46 (40.4%) female residents. The overall PPOS was 4.23 ± 0.53. The mean score for sharing domain was 3.97 ± 0.66. The caring domain scored 4.49 ± 0.57. No correlations were found between the residents' demographic data and other included variables, and the means of sharing domain, caring domain, and overall score. Conclusion Family medicine residents were found to have positive attitudes toward patient-centeredness. Integrating patient-centered training early in the curriculum can improve healthcare students' and trainees' attitudes toward patient-centered care. Future research can explore the possible interventions in systematic assessment and training programs that can improve PCP.
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Affiliation(s)
- Amal Alomran
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,Correspondence: Amal Alomran, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, 11362, Saudi Arabia, Tel +966114670836, Email
| | - Nada Alyousefi
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Family and Community Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Jiang Y, Wei J, Shi L, Cao J, Zhu B, Hong X. A 4-factor perspective of the patient-practitioner orientation scale (PPOS): a deeper understanding of patient-centredness. BMC MEDICAL EDUCATION 2022; 22:818. [PMID: 36447203 PMCID: PMC9706840 DOI: 10.1186/s12909-022-03867-w] [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: 06/08/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although patient-centred medical services are widely recognized and accepted, how to define and evaluate them remains a controversial topic. OBJECTIVES This study attempts to evaluate the underlying structure of the Patient-Practitioner Orientation Scale (PPOS) with a homogenous population and clarify the connotation of patient-centredness. METHODS In this cross-sectional study, 279 7th year Chinese medical students in were selected to examine the internal structure of the PPOS by means of internal consistency, exploratory, and confirmatory factor analyses. RESULTS Both the two-factor model and the four-factor model showed acceptable internal consistency and structural validity. The four-factor model that endorsed the implicit attitude towards the doctor-patient relationship outperformed the two-factor model in terms of adaptability. CONCLUSIONS The PPOS has good psychometric attributes, as evaluated by Chinese medical students. This article attempts to explore patient-centredness from the perspective of implicit attitudes that affect the doctor-patient relationship and resummarizes the four factors. These four dimensions may suggest a deeper attitude towards the doctor-patient relationship, while "sharing information" or "caring about" the "patient" is the behaviour and preference expressed on the basis of these four attitudes, which is the result rather than the cause. PRACTICE IMPLICATIONS Understanding the underlying attitudes towards the doctor-patient relationship can help to construct a patient-centred medical service concept and improve the doctor-patient relationship in medical education courses and the system design of medical activities.
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Affiliation(s)
- Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Boheng Zhu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
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Williams AR, Hines AL, Dow AW, Sabo RT, Thomson MD. Are primary care providers' nutrition care and food insecurity screening practices associated with their perceptions of team-based care? Fam Pract 2022; 39:860-867. [PMID: 35325099 DOI: 10.1093/fampra/cmac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI screening and nutrition care practices (counselling, referrals, and time spent counselling) and test for associations with scored measures of their perceptions of team-based care (care continuity, patient-centredness, coordination with external providers and resources) and nutrition competence (confidence counselling and attitudes towards nutrition). METHODS Cross-sectional online survey data of primary care providers were described and analysed for associations using Wilcoxon rank sum tests. RESULTS Of provider respondents (N = 92), 35% (n = 32) worked in clinics that screen for FI and had higher team perceptions (P = 0.006) versus those who do not. Those who reported counselling >30% patients about nutrition (57%, n = 52) and referring >10% patients to nutrition professionals (24%, n = 22) had significantly better attitudes towards nutrition (P = 0.013 and P = 0.04, respectively) compared with those with lower counselling and referral rates. Half (n = 46) of the providers reported spending >3-min counselling each patient about nutrition and had higher patient-centred care (P = 0.004) and nutrition competence (P < 0.001) compared with those who spent less time counselling. CONCLUSION Providers in clinics that screen for FI had higher overall perceptions of team-based care, but their nutrition competence was not significantly different. Meanwhile, reported more time counselling was associated with a culture of patient-centredness. Promoting team-based care may be a mechanism for improving FI screening and nutrition care.
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Affiliation(s)
- April R Williams
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Anika L Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Alan W Dow
- School of Medicine, IPE Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.,C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
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12
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Santiago LM, Mendes T, Carvalho C. General Practice/Family Medicine Portuguese doctors: "technicists" or "systemics"? Aten Primaria 2022; 54:102315. [PMID: 35525083 PMCID: PMC9079775 DOI: 10.1016/j.aprim.2022.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. "Technicists" doctors, only classifying "P" codes and "Systemics" classifying "P+Z" or only "Z" ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were "technicists", for Assessment n=93 (40.8%) were "technicists" and for P chapter classification 56.8% were "technicists". For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more "systemic" for the S and A chapters of the SOAP model, And "technicists" in the P chapter.
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Affiliation(s)
| | - Thais Mendes
- Faculty of Medicine, University of Coimbra, Portugal
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13
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Voultsos P, Chatzinikolaou F, Papana A, Deliligka A. Reliability of Greek version of the Toronto empathy questionnaire in medical students and associations with sociodemographic and lifestyle factors. BMC Psychol 2022; 10:113. [PMID: 35501889 PMCID: PMC9063083 DOI: 10.1186/s40359-022-00824-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/26/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Empathy is an important key driver of any therapeutic relationship. It is beneficial for both physicians and patients. Enhancing physician's empathy should be an important goal of medical education. As there was a literature gap regarding the topic of empathy among medical students in Greece, this study aimed to contribute to filling this gap. METHODS A cross-sectional study was conducted. A socio-demographic questionnaire and the 52-item Greek version of the Toronto composite empathy scale (TCES) for measuring the cognitive and emotional aspects of empathy in both personal and professional life was administered to all the medical students in the Aristotle University of Thessaloniki, in Greece. Descriptive statistics were displayed for demographics. The associations of the variables were quantified by Chi-2 independence tests and Pearson's Correlation Coefficient. The reliability and validity of the questionnaire was determined by Cronbach's α, Hotelling's T-Squared Test, and Pearson correlation. Paired and Independent Sample T-Tests and One-way ANOVAs indicated statistically significant mean differences among the variables or subgroups of the variables. RESULTS The 52-item TCES, 26 for the personal (Per) setting and another 26 for professional (Pro) life, equally divided into cognitive (Cog) and emotional (Emo) empathy in each case. The overall reliability of the TCES questionnaire was found to be high (Cronbach's α = 0.895, significant positive correlations between the subscales). The mean total score of empathy showed that students had a moderately high empathy. Further, there was a statistically significant difference in means between the Per-Cog and Per-Emo settings (p < 0.001), the Pro-Cog and Pro-Emo (p < 0.001), the Per-Cog and Pro-Cog (p = 0.004), and the Per-Emo and Pro-Emo (p < 0.001). Females had significantly higher empathy scores (mean score 208.04) than males (192.5) on the Per-Cog, Per-Emo and Pro-Emo subscales. Furthermore, a positive correlation was found between empathy and factors such as love for animals, interest in medical ethics, belief in God, having an ill person in the family, class year or carrier intention. CONCLUSIONS The TCES is applicable to medical students. For the most part our findings were consistent with previous literature. However, we identified some nuances that might draw researchers' attention. The results of this study may contribute to plan interventions in the curriculum to enhance empathy in the medical students.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece.
| | - Fotios Chatzinikolaou
- Laboratory of Forensic Medicine and Toxicology (Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University, University Campus, 541 24, Thessaloniki, Greece
| | - Angeliki Papana
- Department of Economics, School of Economics and Regional Studies, University of Macedonia, Egnatia Str 156, 546 36, Thessaloniki, Greece
| | - Aspasia Deliligka
- AHEPA University Hospital, Kiriakidi Str 1, 546 21, Thessaloniki, Greece
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14
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Bansal A, Greenley S, Mitchell C, Park S, Shearn K, Reeve J. Optimising planned medical education strategies to develop learners' person-centredness: A realist review. MEDICAL EDUCATION 2022; 56:489-503. [PMID: 34842290 PMCID: PMC9306905 DOI: 10.1111/medu.14707] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 05/31/2023]
Abstract
CONTEXT Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful. METHODS A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness. RESULTS Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness. CONCLUSION Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.
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Affiliation(s)
- Aarti Bansal
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
| | - Sarah Greenley
- Institute of Clinical and Applied Health ResearchUniversity of HullHullUK
| | - Caroline Mitchell
- Academic Unit of Medical EducationSam Fox House, Northern General HospitalSheffieldUK
| | - Sophie Park
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Katie Shearn
- Health and Wellbeing Research Institute – Postgraduate Research CentreSheffield Hallam UniversitySheffieldUK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
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15
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Orrego C, Perestelo-Pérez L, González-González AI, Ballester-Santiago M, Koatz D, Pacheco-Huergo V, Rivero-Santana A, Ramos-García V, Fernández NM, Torres-Castaño A, Bermejo-Caja C. A Virtual Community of Practice to Improve Primary Health Care Professionals' Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial. Ann Fam Med 2022; 20:204-210. [PMID: 35606139 PMCID: PMC9199051 DOI: 10.1370/afm.2799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We aimed to evaluate the effectiveness of a virtual community of practice (vCoP) in improving primary health care professionals' (HCPs') attitudes toward empowering patients with chronic disease. METHODS We conducted a cluster randomized controlled trial. Practices were units of randomization, and primary HCPs and patients were units of analysis. Sixty-three practices in Madrid, Catalonia, and the Canary Islands were randomly allocated to the intervention or control groups. Randominzation of practices was performed after HCP and patient recruitment. The patients and statistician were anonymized to group allocation; it was not possible to anonymize HCPs. The intervention was a 12-month multicomponent tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was Patient-Provider Orientation Scale (PPOS) score at baseline and at 12 months. The secondary outcome was the Patient Activation Measure (PAM) score. RESULTS A total of 321 HCPs and 1,921 patients were assessed. The intervention had a positive effect on PPOS total score (0.14 points higher in the vCoP arm; 95% CI, 0.03-0.25; P = .011) and the PPOS Sharing subscale (0.3 points higher in the vCoP arm; 95% CI, 0.15-0.44; P < .001). No effect was found for the PPOS Caring subscale, and no significant differences were found for PAM scores. CONCLUSIONS A vCoP led to a minor increase in the PPOS Sharing component and the total score but not in the Caring component. However, considerable uncertainty remains, given the observed attrition and other limitations of the study. Further research is needed on the effectiveness of the vCoP model and on how to improve HCP engagement.VISUAL ABSTRACT.
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Affiliation(s)
- Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain .,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Lilisbeth Perestelo-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain.,Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
| | - Ana Isabel González-González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain.,Institute of General Practice, Goethe University, Frankfurt, Germany.,Subdirección General de Investigación Sanitaria y Documentación, Dirección General Investigación, Docencia y Documentación, Consejería de Sanidad, Madrid, Spain
| | - Marta Ballester-Santiago
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Débora Koatz
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Valeria Pacheco-Huergo
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Centro de Atención Primaria Turó, Instituto Catalán de la Salud, Barcelona, Spain
| | - Amado Rivero-Santana
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | - Vanesa Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | - Nuria Mora Fernández
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carlos Bermejo-Caja
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Unidad de Apoyo Técnico, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
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16
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Kerr AM, Thompson CM. A longitudinal study of third-year medical students' communication competence, communication anxiety, and attitudes toward patient-centered care. PATIENT EDUCATION AND COUNSELING 2022; 105:1298-1304. [PMID: 34538464 DOI: 10.1016/j.pec.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We investigated changes in medical students' communication competence and communication anxiety during their third year of training when they are immersed in formative clinical experiences that shape their patient-centered care and communication skills. METHODS We invited 282 students to complete a longitudinal, four-phase online survey during their third-year. Our response rate was 62.8% at Phase I (n = 177), 34.0% at Phase II (n = 96), 37.9% at Phase III (n = 107), and 48.9% at Phase IV (n = 138). Measures included communication competence, communication anxiety, and patient-centered attitudes and orientation. We employed hierarchical linear modeling to analyze the data. RESULTS Students' communication competence and anxiety improved over time. Female students reported greater communication anxiety and less competence related to information giving. At each phase, patient-centered attitudes significantly predicted communication competence and communication anxiety. CONCLUSION Students' competence and anxiety regarding communication during medical encounters improve during their third year and are significantly influenced by their attitudes and orientation towards patient-centered care and communication. PRACTICE IMPLICATIONS Schools should integrate curriculum that fosters positive attitudes toward patient-centered communication and provides opportunities to practice complex communication skills, which may increase competence and recognition that patient-centered communication is an important clinical skill.
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Affiliation(s)
- Anna M Kerr
- Department of Primary Care, Ohio University, Athens, OH, USA.
| | - Charee M Thompson
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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17
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Ventosa-Ruiz A, Moreno-Poyato A, Lluch-Canut T, Vaquerizo-Cubero A, Vidal-Pascual X, Gil-Guiñón F, Puig-Llobet M. Impact of collaborative nursing care on the recovery process of mental health day hospital users: a mixed-methods study protocol. BMJ Open 2022; 12:e057969. [PMID: 35354640 PMCID: PMC8968539 DOI: 10.1136/bmjopen-2021-057969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Very few collaborative nursing care interventions have been studied and shown to be effective in the context of the paradigm shift towards recovery in mental health nursing. Understanding the changes produced in the recovery process of people with mental health problems can contribute to the design and implementation of new methodologies to offer effective and person-centred care. METHODS AND ANALYSIS This is a mixed-methods study, which is structured in three phases. In phase one (baseline) and phase three (follow-up), quantitative data will be collected from patients at a mental health day hospitals based on a two-armed, parallel-design, non-randomised trial. In phase two, two groups will be established: an intervention group in which the intervention based on collaborative nursing care will be carried out through the codesign and implementation of activities through Participatory Action Research, and a control group in which the usual care dynamics will be continued. All the users of three mental health day hospitals who agree to participate in the study will be studied consecutively until the necessary sample size is reached. The outcomes used to evaluate the impact of the intervention will be the stage of the recovery process, the quality of the therapeutic relationship and the patient's level of positive mental health. ETHICS AND DISSEMINATION This study has been approved by the institutional review board of the reference hospital, FIDMAG Hermanas Hospitalarias (PR-2020-10) in July 2020. All participants will be able to voluntarily withdraw from the study at any time. For this reason, users will be given a sheet with all the precise information about the study to be carried out and written consent will be requested. Preliminary and final results will be published in peer-reviewed journals and presented at national and international congresses. TRIAL REGISTRATION NUMBER NCT04814576.
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Affiliation(s)
- Ana Ventosa-Ruiz
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, Barcelona, Catalunya, Spain
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Catalunya, Spain
| | - Antonio Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | | | - Xavier Vidal-Pascual
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Catalunya, Spain
| | - Ferran Gil-Guiñón
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Catalunya, Spain
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, Barcelona, Catalunya, Spain
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18
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Bányai G, Dombrádi V, Katona C, Boruzs K, Dezső G, Nagy A, Bíró K. Preference for patient-centered communication among the citizens of the Visegrad countries. PATIENT EDUCATION AND COUNSELING 2021; 104:3086-3092. [PMID: 33958254 DOI: 10.1016/j.pec.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider. METHODS The patient-practitioner orientation scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed. RESULTS Being female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries. CONCLUSIONS Key demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries. PRACTICE IMPLICATIONS These findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.
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Affiliation(s)
- Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Cintia Katona
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gréta Dezső
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Attila Nagy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
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[How to assess Person-Centered Care according to professionals? A Delphi study]. Aten Primaria 2021; 54:102232. [PMID: 34800871 PMCID: PMC8605066 DOI: 10.1016/j.aprim.2021.102232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
Objetivos Conocer la perspectiva de profesionales sobre aspectos y dimensiones que deberían formar parte indispensable de la Atención Centrada en la Persona (ACP). Diseño Técnica Delphi. Emplazamiento Atención Primaria. Participantes Setenta y cuatro expertos médicos especialistas en medicina familiar y comunitaria (MF), tutores docentes, psicólogos y sociólogos distribuidos por todo el territorio nacional (enero-junio 2015). Métodos Respondieron a tres cuestionarios: primero sobre aspectos que debería tener en cuenta un MF para realizar ACP en todas sus dimensiones. En el segundo se preguntó sobre el grado de acuerdo con cada ítem y dimensión en que lo clasificaba. Las respuestas se priorizaron en un tercer cuestionario (escala Likert, rango de puntuación 1-10). Resultados La tasa de respuesta (TR) al primer cuestionario fue de 54,05%, obteniéndose 84 ítems, los más frecuentes Respeto y Atención Integral. El 2.° cuestionario con TR = 48,6%, obtuvo 52 ítems con acuerdo superior al 75%. La TR del tercer cuestionario fue de 52,7%, obteniendo 21 ítems con puntuación > 9. Los valores más altos correspondieron a aspectos esenciales de la ACP: respeto, atención integral, enfoque biopsicosocial, autonomía del paciente y participación en la toma de decisiones. Conclusiones Se identificaron nuevas dimensiones: Prevención y promoción de la salud, Gestión de Recursos y Competencia Clínica; añadidas a las previamente descritas: Perspectiva biopsicosocial, Médico como persona, Paciente como persona, Relación médico-paciente y Poder y Responsabilidad compartidas. El respeto, la atención integral, el enfoque biopsicosocial, la autonomía del paciente y su participación en la toma de decisiones, son los aspectos más valorados entre los seleccionados por los profesionales participantes.
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Tan XH, Foo MA, Lim SLH, Lim MBXY, Chin AMC, Zhou J, Chiam M, Krishna LKR. Teaching and assessing communication skills in the postgraduate medical setting: a systematic scoping review. BMC MEDICAL EDUCATION 2021; 21:483. [PMID: 34503497 PMCID: PMC8431930 DOI: 10.1186/s12909-021-02892-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/17/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Poor communication skills can potentially compromise patient care. However, as communication skills training (CST) programs are not seen as a priority to many clinical departments, there is a discernible absence of a standardised, recommended framework for these programs to be built upon. This systematic scoping review (SSR) aims to gather prevailing data on existing CSTs to identify key factors in teaching and assessing communication skills in the postgraduate medical setting. METHODS Independent searches across seven bibliographic databases (PubMed, PsycINFO, EMBASE, ERIC, CINAHL, Scopus and Google Scholar) were carried out. Krishna's Systematic Evidence-Based Approach (SEBA) was used to guide concurrent thematic and content analysis of the data. The themes and categories identified were compared and combined where possible in keeping with this approach and then compared with the tabulated summaries of the included articles. RESULTS Twenty-five thousand eight hundred ninety-four abstracts were identified, and 151 articles were included and analysed. The Split Approach revealed similar categories and themes: curriculum design, teaching methods, curriculum content, assessment methods, integration into curriculum, and facilitators and barriers to CST. Amidst a wide variety of curricula designs, efforts to develop the requisite knowledge, skills and attitudes set out by the ACGME current teaching and assessment methods in CST maybe categorised into didactic and interactive methods and assessed along Kirkpatrick's Four Levels of Learning Evaluation. CONCLUSIONS A major flaw in existing CSTs is a lack of curriculum structure, focus and standardisation. Based upon the findings and current design principles identified in this SSR in SEBA, we forward a stepwise approach to designing CST programs. These involve 1) defining goals and learning objectives, 2) identifying target population and ideal characteristics, 3) determining curriculum structure, 4) ensuring adequate resources and mitigating barriers, 5) determining curriculum content, and 6) assessing learners and adopting quality improvement processes.
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Affiliation(s)
- Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Malia Alexandra Foo
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Shaun Li He Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Marie Bernadette Xin Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Block MD 6, 14 Medical Drive, #05-01, Singapore, 117599, Singapore
| | - Jamie Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Lien Centre of Palliative Care, Duke-NUS Graduate Medical School, 8College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Block MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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El-Sherbiny NA, Ibrahim EH, Sayed N. Medical students’ attitudes towards patient-centered care, Fayoum Medical School, Egypt. ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1936420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Eman H. Ibrahim
- Public Health Dept-Faculty of Medicine, Fayoum University, Al Fayyum, Egypt
| | - Nashwa Sayed
- Public Health Dept-Faculty of Medicine, Fayoum University, Al Fayyum, Egypt
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Lee M, Ihm J. Empathy and attitude toward communication skill learning as a predictor of patient-centered attitude: a cross-sectional study of dental students in Korea. BMC MEDICAL EDUCATION 2021; 21:225. [PMID: 33882935 PMCID: PMC8058758 DOI: 10.1186/s12909-021-02674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Enhancing medical students' practice of patient-centered care is a goal of medical schools. In addition to exploring the demographic and academic factors of the students, it is necessary to identify other attitudes and perceptions that may influence the student's patient-centered attitude and inclination toward communication skill learning. This study aimed to assess patient-centered attitudes among dental students in Korea and identify the association between the students' characteristics and empathy, communication skill learning attitude, and patient-centered attitude. METHODS Data were collected via a cross-sectional online survey, and 312 dental students were included in the analyses. The study participants completed the Patient-Practitioner Orientation Scale (PPOS), the Interpersonal Reactivity Index (IRI), and the Communication Skills Attitude Scale (CSAS). Analyses were performed using independent samples' t-tests, hierarchical multi-variable regression, and ANOVA with a post-hoc Tukey test. RESULTS The students tend to be moderately patient-oriented toward the sharing subscale of PPOS score (M = 3.78, standard deviation [SD] = 0.54) and slightly more patient-centered toward the caring subscale of PPOS score (M = 4.41, SD = 0.52) of patient-centered attitudes. Being a female and a shorter academic period in dentistry were associated with attitudes toward patient-centered care. Empathy and positive attitude toward learning communication skills were also related to a patient-centered attitude, and among aspects of empathy, "empathic concern" had the greatest significant impact on patient-centered attitude. CONCLUSIONS Gender, academic period, empathy, and attitudes on learning communication skills were important influencing factors of patient-centered attitudes. Patient-centered attitude can and must be taught. Education programs should focus on enhancing empathy, emphasizing positive attitudes on learning communication skills, and conducting follow-up educational sessions to prevent students from becoming less patient-centered with an increase in duration of their academic period.
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Affiliation(s)
- Minjung Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Office of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jungjoon Ihm
- Office of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea.
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, South Korea.
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Givron H, Desseilles M. Longitudinal study: Impact of communication skills training and a traineeship on medical students' attitudes toward communication skills. PATIENT EDUCATION AND COUNSELING 2021; 104:785-791. [PMID: 32951927 DOI: 10.1016/j.pec.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To study longitudinally students' attitudes towards communication skills (CS) in order to examine whether CS training (CST) has an enduring impact on medical students' attitudes toward being a lifelong learner of CS. METHODS 105 students completed the Communication Skills Attitude Scale at 4 times: before CST, after CST and before and after a traineeship. RESULTS Our final sample size is 105 students. CST improved the attitudes of our students toward CS, and the traineeship stabilised those attitudes. However, while the improvement in positive attitudes was sustained over time, negative attitudes increased 6 months after CST. CONCLUSION CST using experiential methods in a safe environment has the potential to improve students' attitudes towards CS. A short traineeship in general medicine allows students to quickly integrate CST into clinical practice, without deteriorating their attitudes toward CS. However, 6 months of medical lessons without CST reinforces students' negative attitudes. PRACTICE IMPLICATIONS To avoid the deterioration of attitudes over time, CST should be continuous or at least spaced at intervals less than 6 months and supported by the institutional authorities. In addition, placing the CST close to an observation traineeship in general practice seems an interesting way to prevent further deterioration of attitudes.
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Affiliation(s)
- Hélène Givron
- Department of Psychology, Faculty of medicine, University of Namur, Namur, Belgium; Transitions Institute, University of Namur, Namur, Belgium.
| | - Martin Desseilles
- Department of Psychology, Faculty of medicine, University of Namur, Namur, Belgium; Transitions Institute, University of Namur, Namur, Belgium; Alexian Brothers Psychiatry Clinic, Henri-Chapelle, Belgium
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Hower KI, Vennedey V, Hillen HA, Stock S, Kuntz L, Pfaff H, Pförtner TK, Scholl I, Ansmann L. Is Organizational Communication Climate a Precondition for Patient-Centered Care? Insights from a Key Informant Survey of Various Health and Social Care Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218074. [PMID: 33147837 PMCID: PMC7662290 DOI: 10.3390/ijerph17218074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
Abstract
Health and social care organizations are under pressure of organizing care around patients' needs and preferences while complying with regulatory frameworks and constraint resources. To implement patient-centered care in health and social care organizations successfully, particular organizational preconditions need to be considered. Findings on the implementation of patient-centered care and its preconditions are rare and insufficiently account for the organizational context to explain differences. This study examines the implementation status of patient-centered care in diverse health and social care organizations and analyzes the communication climate as a precondition of successful implementation. In a cross-sectional postal key informant survey, decision makers in the highest leading positions from six different types of health and social care organizations in Cologne, Germany, were surveyed using a paper-pencil questionnaire. Patient-centered care implementation was operationalized by three categories (principles, activities, and enablers) including 15 dimensions. Organizational communication climate was operationalized by aspects of open and constructive communication, cooperation, and inclusion. Out of 1790 contacted organizations, 237 participated. In the analyses, 215 complete datasets were included. Descriptive analyses, Kruskal-Wallis test, post hoc pair-wise test, and linear regression modeling were performed. Results show that the implementation status of patient-centered care was perceived as high but differed between the various types of organizations and in terms of patient-centered care categories. Organizational communication climate was significantly associated with the implementation of patient-centered care. Especially in organizations with a higher number of employees, strategies to create a positive communication climate are needed to create a precondition for patient-centered care.
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Affiliation(s)
- Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany; (H.P.); (T.-K.P.)
- Correspondence:
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), 50935 Cologne, Germany; (V.V.); (S.S.)
| | - Hendrik Ansgar Hillen
- Department of Business Administration and Health Care Management, University of Cologne, 50931 Cologne, Germany; (H.A.H.); (L.K.)
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), 50935 Cologne, Germany; (V.V.); (S.S.)
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, 50931 Cologne, Germany; (H.A.H.); (L.K.)
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany; (H.P.); (T.-K.P.)
| | - Timo-Kolja Pförtner
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany; (H.P.); (T.-K.P.)
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany;
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25
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Perestelo-Pérez L, Rivero-Santana A, González-González AI, Bermejo-Caja CJ, Ramos-García V, Koatz D, Torres-Castaño A, Ballester M, Muñoz-Balsa M, Del Rey-Granado Y, Pérez-Rivas FJ, Canellas-Criado Y, Ramírez-Puerta AB, Pacheco-Huergo V, Orrego C. Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain. Health Expect 2020; 24:33-41. [PMID: 33124759 PMCID: PMC7879539 DOI: 10.1111/hex.13135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/18/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In recent decades, many self-report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person-centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) using a sample of primary care health-care professionals in Spain. METHODS Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item-to-scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2-factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). RESULTS Low inter-item correlations were observed, and the CFA 2-factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10-item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3-factor structure. Participants showed a patient-oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. CONCLUSION Although the 2-factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health-care professionals overall show a patient-oriented attitude, although less marked in issues such as patients' need for and management of medical information.
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Affiliation(s)
- Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Centre for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Amado Rivero-Santana
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Centre for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,Canary Islands Foundation and Institute for Health Research (FIISC), Tenerife, Spain
| | - Ana Isabel González-González
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Primary Care Centre Vicente Muzas, Community of Madrid Health Service, Madrid, Spain.,Institute of General Medicine, Johann Wolfgang Goethe University, Frankfurt-am-Main, Germany
| | - Carlos Jesús Bermejo-Caja
- Support Unit for Primary Care, Community of Madrid Health Service, Madrid, Spain.,Nursing Department, Autonomus University of Madrid, Madrid, Spain
| | - Vanesa Ramos-García
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Canary Islands Foundation and Institute for Health Research (FIISC), Tenerife, Spain
| | - Débora Koatz
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Avedis Donabedian Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Alezandra Torres-Castaño
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Canary Islands Foundation and Institute for Health Research (FIISC), Tenerife, Spain
| | - Marta Ballester
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Avedis Donabedian Institute, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Carola Orrego
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Avedis Donabedian Institute, Autonomous University of Barcelona, Barcelona, Spain
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Al-Hemiary NJ, Cucchi A, Al-Nuaimi AS, Al-Saffar H, Al-Ani K. Inter-personal versus content: assessment of communication skills in Iraqi physicians. Heliyon 2020; 6:e05145. [PMID: 33102835 PMCID: PMC7575849 DOI: 10.1016/j.heliyon.2020.e05145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives The current study sought to evaluate the communication skills of Iraqi physicians from a patient perspective, differentiating between “interpersonal” and “content” components of communication. In the past century, the doctor–patient relationship has changed considerably, shifting from a paternalistic, physician-dominated approach to a more dynamic and patient-centered. In such a context, effective communication skills have become even more crucial for good medical practice and most accreditation organizations urge medical schools to teach and evaluate communication skills. Methods A cross-sectional study was conducted at Baghdad Teaching Hospital's three major departments (Surgery, Medicine, Obs/ Gyne). The final sample included 270 participants. A factor analysis was performed and generated two dimensions ("interpersonal" and "content"). Statistical differences between the groups and between the two dimensions of the questionnaire were analysed through t-tests and ANOVA. In addition, a multiple linear regression model was used to study the effect of some variables on the dependent variable "communication". Results The study showed a significant difference between “interpersonal” and “content” communication, with patients reporting higher satisfaction for the former. Reported satisfaction rates varied amongst the three departments with the Surgery specialty scoring significantly lower than the Medicine and the Obs/Gyne department. The duration of care under the current physician, a higher rank of specialty and the settings (inpatients versus outpatients) were positively and significantly associated with a higher quality of communication skills. Conclusions These findings have significant implications for training institutions.
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Affiliation(s)
- Nesif J Al-Hemiary
- Psychiatry Unit, Department of Medicine, College of Medicine, University of Baghdad, Iraq
| | - Angie Cucchi
- Department of Psychotherapy & Counselling, Regent's University London, London, UK
| | - Ahmed Sameer Al-Nuaimi
- Department of Clinical Research-Directorate of Clinical Affairs-Primary Health Care Corporation, Qatar
| | - Hilal Al-Saffar
- Department of Medicine, College of Medicine, University of Baghdad, Iraq
| | - Kifah Al-Ani
- Department of Pathology, College of Medicine, University of Baghdad, Iraq
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27
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Wang D, Liu C, Zhang X. Do Physicians' Attitudes towards Patient-Centered Communication Promote Physicians' Intention and Behavior of Involving Patients in Medical Decisions? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176393. [PMID: 32887364 PMCID: PMC7503802 DOI: 10.3390/ijerph17176393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022]
Abstract
Promoting patient-centered communication among physicians is one core strategy for improving physician–patient relationships and patient outcomes. Our study aims to understand the physicians’ attitudes towards patient-centered communication and its effects on physicians’ intention and behavior of involving patients in medical decisions in primary care in China. One cross-sectional study was conducted in primary facilities in Hubei province, China, from December 2019 to January 2020, where physicians’ attitudes towards patient-centered communication were measured by the Chinese-revised patient–practitioner orientation scale. Multilevel ordinal logistic regression was conducted for estimating the effects of physicians’ attitudes on their intention and behavior of patient involvement in medical decisions. Six hundred and seventeen physicians were investigated for the main study. Physicians had a medium score of patient-centered communication (3.78, SD = 0.56), with relatively high caring subscale score (4.59, SD = 0.64), and low sharing subscale score (3.09, SD = 0.75). After controlling physicians’ covariates, physicians’ attitudes towards patient-centered communication was significantly associated with a higher intention of involving patients in medical decisions (OR > 1, p = 0.020). Physicians’ positive attitudes towards patient-centered communication affected their intention of involving patients in medical decisions, which implies the importance of taking the physicians’ attitudes into account for the accomplishment of patient involvement processes.
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28
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Harris M, Camenzind AL, Fankhauser R, Streit S, Hari R. Does a home-based interview with a chronically ill patient help medical students become more patient-centred? A randomised controlled trial. BMC MEDICAL EDUCATION 2020; 20:217. [PMID: 32652987 PMCID: PMC7353797 DOI: 10.1186/s12909-020-02136-y] [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: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND While patient-centred care improves patient outcomes, studies have shown that medical students become less patient-centred with time, so it is crucial to devise interventions that prevent this. We sought to determine whether first-year medical students who had a structured home-based interview with a chronically ill patient became more patient-centred than those who had a sham intervention. METHODS This randomised controlled trial assigned first-year students from the University of Bern, Switzerland, to either an interview with a chronically ill patient at the patient's home or to a sham comparator. We used the PPOS-D12 questionnaire to measure students' levels of patient-centredness at baseline, and changes in these levels during their longitudinal primary care clerkship. RESULTS A total of 317 students participated. Patient-centred attitudes increased during the study. A home-based interview with a chronically ill patient had no additional effect. Being female and having been exposed to patients before medical school were associated with being more patient-centred at baseline. Students were less patient-centred than their General Practitioner teachers. CONCLUSIONS A structured, home-based interview with a chronically ill patient did not change students' patient-centred attitudes, so cannot be recommended as a way to influence those attitudes. However, patient-centred attitudes increased during the students' first year of study, possibly because of their longitudinal primary care clerkship. TRIAL REGISTRATION Clinicaltrials.gov reference: NCT03722810 , registered 29th October 2018.
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Affiliation(s)
- Michael Harris
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
- Gore Cottage, Emborough, Radstock, BA3 4SJ UK
| | - Anna-Lea Camenzind
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rita Fankhauser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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29
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Hamano J, Hanari K, Tamiya N. Attitudes and Other Factors Influencing End-of-Life Discussion by Physicians, Nurses, and Care Staff: A Nationwide Survey in Japan. Am J Hosp Palliat Care 2019; 37:258-265. [PMID: 31564113 DOI: 10.1177/1049909119876568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Better understanding about the attitudes of health-care providers toward end-of-life discussion would facilitate the development of systematic strategies for improving end-of-life care. OBJECTIVE To clarify attitudes toward end-of-life discussion with patients near death and explore the factors influencing these attitudes among physicians, nurses, and care staff. METHODS This study was part of a nationwide cross-sectional anonymous survey of the public attitudes toward end-of-life medical care performed in December 2017. The participants were physicians, nurses, and care staff from randomly selected facilities, including hospitals, clinics, home-visit nursing offices, nursing homes, and long-term care facilities throughout Japan. The questionnaire was sent to 4500 physicians, 6000 nurses, and 2000 care staff. We assessed attitudes about end-of-life discussion with patients near death, identification of the proxy decision maker, and sharing documented information on end-of-life discussion with the multidisciplinary team. RESULTS We analyzed responses from 1012 physicians, 1824 nurses, and 749 care staff. The number of responders who considered they had adequate end-of-life discussion with patients near death was 281 (27.8%), 324 (17.8%), and 139 (18.6%), respectively. Participation in a nationwide education program and caring for at least 1 dying patient per month were factors that showed a significant association with adequate end-of-life discussion and identification of the proxy decision maker. CONCLUSIONS The percentages of physicians, nurses, and care staff involved in adequate end-of-life discussion with patients near death were not high. Participation in a structured education program might have a positive influence on end-of-life discussion with patients.
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Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Kyoko Hanari
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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30
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Hammerich K, Stuber K, Hogg-Johnson S, Abbas A, Harris M, Lauridsen HH, Lemeunier N, Maiers M, McCarthy P, Morales V, Myburgh C, Petrini V, Pohlman K, Mior S. Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey. Chiropr Man Therap 2019; 27:46. [PMID: 31528334 PMCID: PMC6739992 DOI: 10.1186/s12998-019-0263-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students’ attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs. Objective To assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide. Methods We conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students’ patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores. Results There were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17–58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals. Conclusion This is the first international study assessing students’ attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.
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Affiliation(s)
- Karin Hammerich
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Kent Stuber
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Sheilah Hogg-Johnson
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Anser Abbas
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Martin Harris
- 2Central Queensland University, Rockhampton, Australia
| | | | | | - Michele Maiers
- 5Northwestern Health Sciences University, Bloomington, USA
| | | | | | | | - Vanessa Petrini
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | | | - Silvano Mior
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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Tanaka K, Son D. Experiential learning for junior residents as a part of community-based medical education in Japan. EDUCATION FOR PRIMARY CARE 2019; 30:282-288. [DOI: 10.1080/14739879.2019.1625288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Rankin L, Fowler CJ, Stålnacke BM, Gallego G. What influences chronic pain management? A best-worst scaling experiment with final year medical students and general practitioners. Br J Pain 2019; 13:214-225. [PMID: 31656627 DOI: 10.1177/2049463719832331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students' and general practitioners' (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students' preferences with respect to a chronic pain condition, using a best-worst scaling (BWS) experiment, which is designed to rank alternatives. Methods BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management. Results All three cohorts considered the patients' pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students. Conclusion This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education.
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Affiliation(s)
- Linda Rankin
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | | | - Britt-Marie Stålnacke
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
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