Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico

The Potential Impact of Large Language Models on Doctor-Patient Communication: A Case Study in Prostate Cancer

BACKGROUND

In recent years, the integration of large language models (LLMs) into healthcare has emerged as a revolutionary approach to enhancing doctor-patient communication, particularly in the management of diseases such as prostate cancer.

METHODS

Our paper evaluated the effectiveness of three prominent LLMs-ChatGPT (3.5), Gemini (Pro), and Co-Pilot (the free version)-against the official Romanian Patient's Guide on prostate cancer. Employing a randomized and blinded method, our study engaged eight medical professionals to assess the responses of these models based on accuracy, timeliness, comprehensiveness, and user-friendliness.

RESULTS

The primary objective was to explore whether LLMs, when operating in Romanian, offer comparable or superior performance to the Patient's Guide, considering their potential to personalize communication and enhance the informational accessibility for patients. Results indicated that LLMs, particularly ChatGPT, generally provided more accurate and user-friendly information compared to the Guide.

CONCLUSIONS

The findings suggest a significant potential for LLMs to enhance healthcare communication by providing accurate and accessible information. However, variability in performance across different models underscores the need for tailored implementation strategies. We highlight the importance of integrating LLMs with a nuanced understanding of their capabilities and limitations to optimize their use in clinical settings.

Communicating the diagnosis of spinal muscular atrophy in endogamous vs. non-endogamous regions

INTRODUCTION

The high prevalence of endogamy, or inbreeding, in northeastern Brazil, is due to historical and cultural factors, with large families living in cities far from the coast and subject to low socioeconomic and infrastructure levels. This breeding practice results in low genetic variability with an increased prevalence of rare autosomal recessive and neurodegenerative diseases, such as spinal muscular atrophy (SMA).

OBJECTIVE

Understanding the impact of communicating the diagnosis of SMA on the mental health of patients and their families and the differences between the Northeast (endogamous region) and the other regions of Brazil (non-endogamous ones).

METHODS

Cross-sectional study obtained through a structured questionnaire about the moment of receiving the SMA diagnosis, containing the Impact of Event Scale-Revised.

RESULTS AND DISCUSSION

The sample consisted of 100 volunteers from all regions of Brazil, 47 patients diagnosed with SMA and 53 family members present at the time of the diagnosis. There was a predominance of females (83%) and homogeneity between the groups for the variables gender, age, color, education, religion, and SMA subtype (1, 2, 3, and 4). The Northeast region, representing 43% of the sample, despite being less economically favored, showed greater satisfaction with medical care and inclusion in health services, with less self-reported psychological trauma and fewer signs of post-traumatic stress disorder (PTSD) related to the moment of receiving the diagnosis. The non-endogamous regions, in turn, reported the presence of strong waves of emotion, sleep problems, feelings of irritability, anger, and the presence of bad thoughts related to this situation.

CONCLUSION

The feeling of inclusion in health services and satisfaction with medical care in the endogamous region had a positive impact on the mental health of those involved, reducing psychological trauma and signs of PTSD arising from the communication of the SMA diagnosis.

Challenges in Palliative Care in Latin America: A Narrative Review

In "graying" populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region's specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.

Patient-doctor interactions around alternative and complementary medicine in the context of oncology care in a Latin American country

OBJECTIVE

To characterize doctor-patient communication patterns around the use of complementary and alternative medicines (CAM) in the context of oncology care in Colombia.

METHODS

A qualitative study was conducted using snowball sampling until data saturation was reached. We included oncology specialists and cancer patients who were in active treatment. Semi-structured interviews were conducted following a guide designed for each group of participants. An analysis based on open coding was performed to identify thematic areas. The coherence of emerging categories was verified by contrasting the data set within the content of the participants' reports and existing literature.

RESULTS

In total, 10 oncologists and 16 cancer patients were included, representing diverse professional fields and cancer diagnoses, respectively. Communication patterns comprise themes regarding the beginning of the interaction (i.e., patient's anticipations), the patient-doctor relationship (i.e., confidence), the characteristics of the message (i.e., synthetic vs explanatory), the communication styles (i.e., confrontational vs conciliatory), and the closing of the interaction (i.e., continuity vs. end of communication). In addition, extrinsic factors influencing communication were found to be related to participants (i.e., knowledge, cultural background) and context (i.e., institutional procedures).

CONCLUSIONS

The low frequency of communication contrasts to the increasing use of CAM. Divergent perspectives between doctors and patients could limit shared decision-making on the use of CAM. Enhanced knowledge and education on CAM for both actors is fundamental to improve their interaction and to move away from paternalistic and confrontational communication, particularly in a world region with cultural backgrounds that influence the use of CAM.

Integrating an approach to personalised self-management support in stroke and neurorehabilitation service contexts: People1st - a quality improvement initiative

PURPOSE

People living with stroke and neurological conditions access rehabilitation at different times but self-management is often viewed as what happens post-discharge. Personalised models that integrate self-management support within everyday care are now advocated but this may require practitioners to change their behaviour to adopt and sustain new ways of working. The People1st project evaluated integration of an existing Supported Self-Management programme ("Bridges") across varied stroke and neurorehabilitation service contexts.

MATERIALS AND METHODS

Mixed-method evaluation of training for groups of healthcare practitioners across 24 UK National Health Service (NHS) Trusts, exploring how learning from Bridges was assimilated and enacted in practice, on an individual and collective basis.

RESULTS

Staff growth in confidence and skill around supported self-management was demonstrated. Transformations to practice included changes to: the structure of, and language used in, patient interactions; induction/training processes to increase potential for sustainability; and sharing of successes. Bridges helped practitioners make changes that brought them closer to their professional ideals. Engaged leadership was considered important for successful integration.

CONCLUSIONS

Bridges was successfully integrated within a wide range of stroke and neurorehabilitation service contexts, enabled by an approach in line with practitioners' values-based motivations. Further work is required to explore sustainability and impact on service users. Implications for rehabilitationPersonalised models of care and support for self-management are advocated for people living with stroke and neurological conditions; this requires practitioners to be supported to change behaviour and practices to adopt and sustain new ways of working.Staff from a wide variety of backgrounds in neurorehabilitation and stroke can learn collaboratively about self-management practices via the Bridges programme and can integrate those practices into their service contexts.Bridges can take practitioners closer to their professional ideals of caring and making a difference and empowers them to initiate change.Organisational commitment and engaged leadership are required to facilitate a culture of support for self-management in practice.

Communication of the Diagnosis of Spinal Muscular Atrophy in the Views of Patients and Family Members, a Qualitative Analysis

INTRODUCTION

Communicating the diagnosis of a genetic and neurodegenerative disease, such as spinal muscular atrophy (SMA), requires a transmission centered on the patient and/or the family caregiver, ensuring autonomy to those involved and strengthening the doctor-patient relationship.

OBJECTIVE

Analyzing the communication of the SMA diagnosis from the perspective of patients and family members.

METHODS

This qualitative study was developed through semi-structured interviews, via teleconsultation. The analysis was developed by systematically condensing the answers and synthesizing them into four thematic axes (clarification of the diagnosis, communication of the prognosis, affective memory related to the event, and advice to physicians).

RESULTS AND DISCUSSION

Twenty-nine patients with SMA and 28 family caregivers of people with this condition, from all regions of Brazil, reported that individualized, clear, honest, and welcoming communication, emphasizing positive aspects, in the presence of family members and with the possibility of continuous monitoring, was important to meeting their communication needs. A lack of empathy, monitoring and guidance, and estimating life expectancy resulted in negative experiences.

CONCLUSIONS

The communication needs of patients and family members described during the clarification of the diagnosis and prognosis of SMA predominantly involve empathic factors related to the attitude of the attending physician throughout the evolution of the disease. Future research evaluating other neurodegenerative diseases and the development of research protocols are important to improving communication between physicians, patients, and family members.

Cultural Differences in Patients' Preferences for Paternalism: Comparing Mexican and American Patients' Preferences for and Experiences with Physician Paternalism and Patient Autonomy

Following up on previous research demonstrating the high level of care realized by a paternalistic Mexican physician, the present research further explored the hypothesis that there are cultural differences in preferences for and experiences with physician paternalism vs. patient autonomy in White American culture as compared with Mexican culture. In this research, we interviewed sixty (60) people including twenty (20) Mexican, twenty (20) Mexican American, and twenty (20) White American respondents. We asked these patients about their experiences with and attitudes towards paternalism and patient autonomy in healthcare interactions. With some caveats, our data showed strong support for both hypotheses while also suggesting a high level of care can be realized by paternalistic physicians when "paternalism" is understood in a cultural context. We close with a brief consideration of the implications of these findings.

“Some They Need Male, Some They Need Female”: A Gendered Approach for Breast Cancer Detection in Uganda

Introduction

There are several challenges associated with breast cancer detection in Uganda and other low-and-middle-income countries. One of the identified challenges is attributed to the health workers' gender, which facilitates gender disparities in access to breast cancer detection services. Although this challenge is well acknowledged in existing literature, there are hardly any studies on how it can be addressed. Therefore, drawing on an intersectionality lens, our study examined how to address gender disparities facilitated by health workers' gender in accessing breast cancer detection services in Uganda.

Materials and Methods

We collected qualitative data through semi-structured interviews with twenty participants comprising community health workers, primary health care practitioners, non-governmental organizations, district health team, and the Ministry of Health. For the data analysis, thematic analysis was conducted on NVivo using Braun and Clarke's non-linear 6-step process to identify the themes presented in the results section.

Results

Four themes emerged from the data analysis: understanding a woman's gender constructions; health workers' approachability; focus on professionalism, not sex; and change in organizational culture. These themes revealed participants' perceptions regarding how to address gender disparities relating to the role health workers' gender play in breast cancer detection. Through the intersectionality lens, our findings showed how gender intersects with other social stratifiers such as religious beliefs, familial control, health worker's approachability, and professionalism within the health workforce.

Conclusion

Our findings show that the solutions to address gender disparities in breast cancer detection are individually and socially constructed. As such, we recommend a gendered approach to understand and redress the underlying power relations perpetuating such constructions. We conclude that taking a gendered approach will ensure that breast cancer detection programs are context-appropriate, cognizant of the prevailing cultural norms, and do not restrict women's access to breast cancer detection services.