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Kimura T, Chiba H, Nomura K, Mizukami J, Saka S, Kakei K, Ishikawa J, Yamadera S, Sakato K, Fujitani N, Takagi H, Ishikawa H. Communication between physicians, patients, their companions and other healthcare professionals in home medical care in Japan. PATIENT EDUCATION AND COUNSELING 2024; 123:108239. [PMID: 38484599 DOI: 10.1016/j.pec.2024.108239] [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: 09/27/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To examine communication in home medical care. METHODS Conversations that happened during home medical care involving physicians at nine clinics were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Additional categories were developed to code aspects of home medical care. RESULTS Overall, 55 conversations were analyzed. The mean age of the patients was 82.9 ± 10.1 years old. The most common triad was physician, patient, and patient's companion. Information about home medical care professionals who were not present during the conversation was provided by the physician in 21 cases (38.2%), the patient in nine cases (16.4%), and companions in 21 (39.6%) cases. CONCLUSION In home medical care, the participants mentioned home medical care professions who were not present at the time, suggesting that these conversations may have facilitated interprofessional collaboration. PRACTICE IMPLICATIONS Physicians should be aware that during home medical care, the presence of multiple attendants and other medical professionals contributing to communicate with the patient.
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Affiliation(s)
- Takuma Kimura
- Home Medical Care Communication Research Group, Japan; Department of R&D Innovation for Home Care Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan.
| | - Hiroki Chiba
- Home Medical Care Communication Research Group, Japan; Department of Medical Education, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kyoko Nomura
- Home Medical Care Communication Research Group, Japan; Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | | | - Shohei Saka
- Home Medical Care Communication Research Group, Japan
| | - Kotaro Kakei
- Home Medical Care Communication Research Group, Japan
| | | | | | | | | | | | - Hirono Ishikawa
- Home Medical Care Communication Research Group, Japan; Teikyo University Graduate School of Public Health, Tokyo, Japan
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Stenman T, Rönngren Y, Näppä U, Melin-Johansson C. "Unless someone sees and hears you, how do you know you exist?" Meanings of confidential conversations - a hermeneutic study of the experiences of patients with palliative care needs. BMC Nurs 2024; 23:336. [PMID: 38762496 PMCID: PMC11102614 DOI: 10.1186/s12912-024-01988-9] [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: 09/12/2023] [Accepted: 05/02/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs. METHODS In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations. RESULTS The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life's challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences. CONCLUSIONS Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients' suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients' varying preferences.
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Affiliation(s)
- Tove Stenman
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, S-831 25, Sweden.
| | - Ylva Rönngren
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, S-831 25, Sweden
| | - Ulla Näppä
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, S-831 25, Sweden
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Rosburg T, von Allmen DY, Langewitz H, Weber H, Bunker EB, Langewitz W. Patient-centeredness in psychiatric work disability evaluations and the reproducibility of work capacity estimates. PATIENT EDUCATION AND COUNSELING 2024; 119:108093. [PMID: 38061142 DOI: 10.1016/j.pec.2023.108093] [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: 07/10/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates. METHODS In our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patient-centeredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant's WC on a scale from 0% to 100%. RESULTS Patient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant's emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility. CONCLUSIONS Many of the experts' questions addressed the claimant's lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. PRACTICE IMPLICATIONS Patient-centeredness in work disability evaluations should find its entry in continuing education of experts.
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Affiliation(s)
- Timm Rosburg
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland.
| | - David Y von Allmen
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland
| | - Helena Langewitz
- Johannes Gutenberg University Mainz, Institute of Art History and Musicology, Mainz, Germany
| | - Heidemarie Weber
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
| | | | - Wolf Langewitz
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
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Stortenbeker I, Salm L, Olde Hartman T, Stommel W, Das E, van Dulmen S. Coding linguistic elements in clinical interactions: a step-by-step guide for analyzing communication form. BMC Med Res Methodol 2022; 22:191. [PMID: 35820827 PMCID: PMC9277943 DOI: 10.1186/s12874-022-01647-0] [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: 02/21/2022] [Accepted: 05/31/2022] [Indexed: 05/31/2023] Open
Abstract
Background The quality of communication between healthcare professionals (HCPs) and patients affects health outcomes. Different coding systems have been developed to unravel the interaction. Most schemes consist of predefined categories that quantify the content of communication (the what). Though the form (the how) of the interaction is equally important, protocols that systematically code variations in form are lacking. Patterns of form and how they may differ between groups therefore remain unnoticed. To fill this gap, we present CLECI, Coding Linguistic Elements in Clinical Interactions, a protocol for the development of a quantitative codebook analyzing communication form in medical interactions. Methods Analyzing with a CLECI codebook is a four-step process, i.e. preparation, codebook development, (double-)coding, and analysis and report. Core activities within these phases are research question formulation, data collection, selection of utterances, iterative deductive and inductive category refinement, reliability testing, coding, analysis, and reporting. Results and conclusion We present step-by-step instructions for a CLECI analysis and illustrate this process in a case study. We highlight theoretical and practical issues as well as the iterative codebook development which combines theory-based and data-driven coding. Theory-based codes assess how relevant linguistic elements occur in natural interactions, whereas codes derived from the data accommodate linguistic elements to real-life interactions and contribute to theory-building. This combined approach increases research validity, enhances theory, and adjusts to fit naturally occurring data. CLECI will facilitate the study of communication form in clinical interactions and other institutional settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01647-0.
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Affiliation(s)
- Inge Stortenbeker
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - Lisa Salm
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Tim Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Wyke Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Enny Das
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.,NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands.,Faculty of Caring Science, University of Borås, Borås, Sweden
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Song J, Zolnoori M, Scharp D, Vergez S, McDonald MV, Sridharan S, Kostic Z, Topaz M. Do nurses document all discussions of patient problems and nursing interventions in the electronic health record? A pilot study in home healthcare. JAMIA Open 2022; 5:ooac034. [PMID: 35663115 PMCID: PMC9154272 DOI: 10.1093/jamiaopen/ooac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the overlap of information between electronic health record (EHR) and patient–nurse verbal communication in home healthcare (HHC). Methods Patient–nurse verbal communications during home visits were recorded between February 16, 2021 and September 2, 2021 with patients being served in an organization located in the Northeast United States. Twenty-two audio recordings for 15 patients were transcribed. To compare overlap of information, manual annotations of problems and interventions were made on transcriptions as well as information from EHR including structured data and clinical notes corresponding to HHC visits. Results About 30% (1534/5118) of utterances (ie, spoken language preceding/following silence or a change of speaker) were identified as including problems or interventions. A total of 216 problems and 492 interventions were identified through verbal communication among all the patients in the study. Approximately 50.5% of the problems and 20.8% of the interventions discussed during the verbal communication were not documented in the EHR. Preliminary results showed that statistical differences between racial groups were observed in a comparison of problems and interventions. Discussion This study was the first to investigate the extent that problems and interventions were mentioned in patient–nurse verbal communication during HHC visits and whether this information was documented in EHR. Our analysis identified gaps in information overlap and possible racial disparities. Conclusion Our results highlight the value of analyzing communications between HHC patients and nurses. Future studies should explore ways to capture information in verbal communication using automated speech recognition.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York, New York, USA
| | - Maryam Zolnoori
- Columbia University School of Nursing, New York, New York, USA
| | - Danielle Scharp
- Columbia University School of Nursing, New York, New York, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Zoran Kostic
- Fu Foundation School of Engineering and Applied Science, Department of Electrical Engineering, Columbia University, New York, New York, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, New York, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
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Saito A, Sato W, Yoshikawa S. Rapid detection of neutral faces associated with emotional value among older adults. J Gerontol B Psychol Sci Soc Sci 2022; 77:1219-1228. [PMID: 35137048 DOI: 10.1093/geronb/gbac009] [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: 08/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Previous studies using visual search paradigms have provided inconsistent results regarding rapid detection of emotional faces among older adults. Furthermore, it is uncertain whether the emotional significance of the faces contributes to efficient searches for emotional faces due to the possible confounding effects of visual saliency. We addressed this issue by excluding the influence of visual factors and examined older adults' ability to detect faces with emotional meaning. METHOD We used an associative learning procedure in which neutral faces were paired with monetary reward or punishment, such that the neutral faces acquired positive or negative emotional value. Older participants completed the associative learning task and then engaged in a visual search task, in which previously learned neutral faces were presented as discrepant faces among newly presented neutral distractor faces. Data of young adults from a previous study that used identical experimental procedures were also analyzed. RESULTS Older participants exhibited lower learning ability than young participants. However, older adults who were successful at learning were able to detect neutral faces associated with reward or punishment more rapidly than those without monetary outcomes, similar to the pattern observed for young adults. DISCUSSION The results suggest that acquired emotional value promotes the detection of value-associated neutral faces among older adults who succeed at learning. It is therefore possible that the ability to detect faces that evoke emotions is preserved in older adults.
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Affiliation(s)
- Akie Saito
- Psychological Process Research Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto 619-0288, Japan
| | - Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto 619-0288, Japan.,Field Science Education and Research Center, Kyoto University, Oiwake-cho, Kitashirakawa, Sakyo, Kyoto 606-8502, Japan
| | - Sakiko Yoshikawa
- Field Science Education and Research Center, Kyoto University, Oiwake-cho, Kitashirakawa, Sakyo, Kyoto 606-8502, Japan.,Faculty of Art and Design, Kyoto University of The Arts, 2-116 Uryuuzan, Kitashirakawa, Sakyo, Kyoto 606-8501, Japan
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