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Padrós-Cuxart M, Crespo-López A, Lopez de Aguileta G, Jarque-Mur C. Impact on mental health and well-being of the dialogic literary gathering among women in a primary healthcare centre. Int J Qual Stud Health Well-being 2024; 19:2370901. [PMID: 38938089 PMCID: PMC11216242 DOI: 10.1080/17482631.2024.2370901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
There is strong scientific evidence on the academic, cognitive, social, and emotional benefits of Dialogic Literary Gatherings (DLG) for diverse people in a wide range of settings. However, the transference of DLG to a primary healthcare centre has not yet been studied. To address this gap a case study was conducted on the impact of a DLG in a primary healthcare centre on participants' mental health and wellbeing from the perception of participants and professionals involved in it. To that end, four daily life stories and a focus group with women participating in the DLG, most of them over 75 years old with no higher education, were conducted, as well as two in-depth interviews, one with the DLG facilitator and one with the director of the health centre. Results show that participants perceived their mental health and wellbeing improved thanks to the functioning and type of dialogue in the DLG, promoting friendships, support and solidarity. Participants also reported that, by being aware of their capabilities in the DLG, they became agents of transformation within their families and environments, turning relationships between healthcare professionals and patients more egalitarian. These findings hold implications for public health and healthcare centres.
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Affiliation(s)
- Maria Padrós-Cuxart
- Department of Didactics and School Organization, University of Barcelona, Barcelona, Spain
| | - Alba Crespo-López
- Department of Theory and History of Education, University of Barcelona, Barcelona, Spain
| | | | - Carla Jarque-Mur
- Department of Sociology, University of Barcelona, Barcelona, Spain
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2
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Malmartel A, Ravaud P, Tran VT. Discordances in patients' and physicians' perspectives on which contextual factors should be accounted for during smoking cessation. Fam Pract 2024; 41:846-850. [PMID: 39093609 DOI: 10.1093/fampra/cmae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Smoking cessation interventions requires attending to the circumstances and needs of individual patients. We aimed at highlighting the discordances between patients' and physicians' perspectives on contextual factors that should be considered during smoking cessation. METHODS We identified 36 contextual factors identified that should be considered during smoking cessation using PubMed and interviewing general practitioners. Physicians recruited through social networks campaigns and smoker or former smoker patients from the ComPaRe cohort selected the factors they considered most relevant in two online paired comparison experiment. Bradley Terry Luce models estimated the ability of each factor (i.e. the probability to be preferred). We calculated the Pearson's correlation and the intraclass correlation coefficients for the contextual factor from each perspective and compared the ranking of the 10 contextual factors with the highest abilities. RESULTS Seven hundred and ninety-three patients' and 795 physicians' perspectives estimated the ability (i.e., importance) of the contextual factors in 11 963 paired comparisons. We found a high correlation between physicians' and patients' perspectives of the contextual factors to be considered for smoking cessation (r = 0.76, P < 0.0001). However, the agreement between the abilities of contextual factors was poor (ICC = 0.42 [-0.10; 0.75]; P = 0.09). Fine-grain analysis of participants' answers revealed many discrepancies. For example, 40% factors ranked in the top 10 most important for physicians were not in patients' top 10 ranking. CONCLUSION Our results highlight the importance of patient-centered care, the need to engage discussions about patients' values, beyond what is thought to be important, to avoid overlooking their real context.
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Affiliation(s)
- Alexandre Malmartel
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004, Paris, France
- Université Paris Cité, Département de médecine générale, F-75014, Paris, France
| | - Philippe Ravaud
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004, Paris, France
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, F-75014, Paris, France
| | - Viet-Thi Tran
- Université Paris Cité, METHODS Team, CRESS, INSERM, INRA, F-75004, Paris, France
- Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel-Dieu, F-75014, Paris, France
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3
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Giorgi F, Fanali A, Tramonti F. A critical evaluation of choice negotiation for patient-centred medicine and psychotherapy. J Eval Clin Pract 2024; 30:1169-1175. [PMID: 38308615 DOI: 10.1111/jep.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/11/2024] [Indexed: 02/05/2024]
Abstract
STUDY AIMS The present paper aimed at discussing how the process of decision-making should be taken care of in healthcare services. METHODS This is a position paper based on a review of the relevant literature about meaning-making processes in medical encounters and psychotherapy. DISCUSSION Authors argued that choice options could be perceived as meaningful by patients if their uncertainties were taken into account and grounded on mutual understanding and reciprocal trust. To this end, any decision-making process should satisfy the patient's legitimate expectations by making choices and habits compatible. CONCLUSION In depht analysis of meaning-making processes is crucial for better refining good practices of shared decision-making.
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Hafid S, Isenberg SR, Fernandes A, Gallagher E, Webber C, Joseph M, Sood MM, Bruni A, Davis JL, Warmels G, Downar J, Gayowsky A, Jones A, Manuel D, Tanuseputro P, Howard M. End-of-Life Care Among Patients With Kidney Failure on Maintenance Dialysis: A Retrospective Population-Based Study. Can J Kidney Health Dis 2024; 11:20543581241280698. [PMID: 39315345 PMCID: PMC11418337 DOI: 10.1177/20543581241280698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/23/2024] [Indexed: 09/25/2024] Open
Abstract
Background Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience. Objective The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis. Design Retrospective cohort study using population-level health administrative data. Setting & Participants Outpatient and inpatient care during the last year of life among patients who died between 2017 and 2019, receiving maintenance dialysis in Ontario, Canada. Measurements The primary exposure is patterns of physician specialties providing outpatient care in the last year of life. Outcomes include outpatient encounters in the last year of life, acute care visitation in the last month of life, and place of death. Methods We reported the count and percentage of categorical outcomes and the median (interquartile range) for numeric outcomes. We produced time series plots of the mean monthly percentage of encounters to different specialties stratified by physician specialty patterns. We evaluated differences in outcomes by physician specialty patterns using analysis of variance (ANOVA) and Pearson's chi-square tests (P < .05, two-tailed). Results Among 6866 patients, the median age at death was 73, 36.1% were female, and 87.8% resided in urban regions. Three patterns emerged: a primary care, nephrology, and palliative care triad (25.5%); a primary care and nephrology dyad (59.3%); and a non-primary care pattern (15.2%). Palliative care involvement is concentrated near death. Of all, 81.4% spent at least 1 day in hospital or emergency department in the last month, but those with primary care, palliative care, and nephrology involvement had the fewest acute care deaths (65.8%). Limitations Outpatient care patterns were defined using physician billing codes, potentially missing care from other providers. Conclusions Nephrology and primary care predominantly manage outpatient care in the last year of life for patients with KF on maintenance dialysis, with consistent acute care use across care patterns except for the place of death. Future research should explore associations between patterns of care and end-of-life outcomes to identify the most optimal model of care for patients with KF on maintenance dialysis.
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Affiliation(s)
- Shuaib Hafid
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sarina R Isenberg
- Department of Medicine, University of Ottawa, ON, Canada
- Bruyère Research Institute, University of Ottawa, ON, Canada
| | - Aleisha Fernandes
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Erin Gallagher
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Colleen Webber
- Bruyère Research Institute, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Meera Joseph
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Manish M Sood
- Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Adrianna Bruni
- Division of Palliative Care, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Janet L Davis
- Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Grace Warmels
- Division of Palliative Care, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - James Downar
- Division of Palliative Care, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | | | - Aaron Jones
- ICES McMaster, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Doug Manuel
- Bruyère Research Institute, University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, ON, Canada
- ICES uOttawa, University of Ottawa, ON, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, University of Ottawa, ON, Canada
- Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
- ICES uOttawa, University of Ottawa, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Porcerelli JH, Richardson LA, Huprich SK. The Role of Object Relations in the Physician-Patient Relationship in a Primary Care Setting. J Nerv Ment Dis 2024; 212:507-512. [PMID: 39207293 DOI: 10.1097/nmd.0000000000001799] [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: 09/04/2024]
Abstract
ABSTRACT A good physician-patient relationship is essential for the delivery of quality health care and is associated with better health outcomes. This study explored the association between patients' object relations and the physician-patient relationship. Primary care patients (n = 72) and physicians (n = 21) participated in the study. Patients' early memories were obtained prior to their medical visit and were coded with the Social Cognition and Object Relations-Global Method (SCORS-G). Patients and physicians independently rated the quality of the physician-patient encounter. Results indicated that object relations (SCORS-G Cognitive-structural and Self factors) incrementally predicted physician-patient relationship ratings, as rated by the patient, above and beyond psychological distress, somatization, and level of physician training. Patient education, psychological distress, and level of physician training predicted physician ratings of the medical encounter. The authors discuss the discrepancy between physician and patient ratings as they relate to patients' object relations.
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Affiliation(s)
| | - Laura A Richardson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Jing FF, Zhou J, Ge J, Wang X, Tang M, Zhao S, Cui Y, Bai L, Xia X, Chen Y, Shen D, Chen H, Wen J, Hu L, Lu R. A repeated cross-sectional pilot study of the relationship between perceived a community with shared future for doctor-patient and benefit finding: the mediating role of health self-consciousness and moderating role of anxiety. BMC Psychol 2024; 12:430. [PMID: 39118145 PMCID: PMC11308305 DOI: 10.1186/s40359-024-01910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE Since January 8, 2023, China has managed COVID-19 as a Class-B infectious disease, marking the epidemic's transition to a low-level stage. This study analyzes the relationship between the public's perceived a community with shared future for doctor-patient (PCSF), health self-consciousness, benefit finding, and anxiety in this stage. Additionally, it compares changes in these variables across different stages of COVID-19. METHODS Using a repeated cross-sectional design, three surveys were conducted respectively in three different stages of COVID-19 in China. Specifically, the first survey was conducted in Beijing, Dalian, Zhengzhou, Heihe, and Shangrao from November 13 to 20, 2021 in the outbreak stage of COVID-19, yielding 1,252 valid responses out of 1,534 collected questionnaires. The second survey was conducted in Dalian, Zhengzhou, Heihe, Shangrao, and Lanzhou from December 1 to 19, 2021 in the stable stage of COVID-19, with 872 valid responses obtained from 1,075 collected questionnaires. The third survey was conducted in Beijing, Dalian, Zhengzhou, Heihe, Shangrao, Lanzhou, and Chengdu from January 29 to February 4, 2023 in the low epidemic level stage of COVID-19, achieving 2,113 valid responses from the 2,461 questionnaires collected. RESULTS Unlike in the outbreak stage but similar to the stable stage, the public's anxiety, health self-consciousness and benefit finding decreased while PCSF was improved in the low epidemic level stage. Consistent with both the outbreak and stable stage, PCSF, health self-consciousness, benefit finding, and anxiety showed positive correlations in the low epidemic level stage, with health self-consciousness partially mediating the positive impact of PCSF on benefit finding. Unlike in the stable stage but similar to the outbreak stage, anxiety did not moderate the relationship between PCSF and health self-consciousness in the low epidemic level stage. CONCLUSIONS The public's health self-consciousness, benefit finding, and anxiety decreased, while PCSF increased in the low epidemic level stage. Furthermore, PCSF had a greater impact on benefit finding, and anxiety's impact on health self-consciousness was significantly reduced. Across different stages of COVID-19, PCSF directly increased benefit finding and also enhanced benefit finding by improving health self-consciousness. Thus, comprehensive intervention measures are beneficial in the low epidemic level stage.
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Affiliation(s)
- Fenwick Feng Jing
- School of Management, Qufu Normal University, Rizhao, Shandong, 276826, China
| | - Jing Zhou
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Jiaying Ge
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Xiaoyu Wang
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Mengjiao Tang
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Shenyu Zhao
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Yanqiu Cui
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Lijing Bai
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Xiyang Xia
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Yang Chen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Dan Shen
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Haiying Chen
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China
| | - Juan Wen
- Nanjing Maternity and Child Health Care Institute, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, 210000, China.
| | - Lingmin Hu
- Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
| | - Renjie Lu
- Changzhou Third People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
- Changzhou Institute for Advanced Study of Public Health, Nanjing Medical University, Changzhou, Jiangsu, 213000, China.
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7
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Schattner A. Comprehensive Evidence-Based Health Maintenance. Am J Med 2024; 137:706-711. [PMID: 38582322 DOI: 10.1016/j.amjmed.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
The potential of primary prevention to prevent, delay, or ameliorate disease is immense. However, the total spending on preventive services in the United States remains astoundingly small and represents a meager 3.5% of total health care spending. Moreover, training focused on prevention in medical schools is often neglected, and time-constrained primary providers frequently omit effective preventive and early detection measures, or perform them perfunctorily. Indeed, preventable conditions of serious consequences including "premature" mortality, cardiovascular events, and major organ failure are ubiquitous with the global obesity and diabetes epidemics, and the ongoing high prevalence of noxious habits and drug abuse. Although each aspect has been the subject of extensive research, a succinct evidence-based summary is scarce. We have conducted a review of high-quality evidence (systematic reviews, meta-analyses, and practice guidelines) over the last 20 years to extract the best updated recommendations on comprehensive disease prevention and approved screening, briefly citing significant risk reductions by lifestyle interventions, pharmacological prevention, cancer screening, other endorsed screening, immunizations, and issues in the patient-provider interface.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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8
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Shaw NM, Hills N, Holler J, Fernandez A, Davis D, Palmer NR, Sliwka D, Breyer BN. The Impact of Patient-Physician Racial and Gender Concordance on Patient Satisfaction with Outpatient Clinic Visits. J Racial Ethn Health Disparities 2024; 11:2083-2092. [PMID: 37341950 DOI: 10.1007/s40615-023-01676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Patient and provider race and gender concordance (patient and physician identify as the same race/ethnicity or gender) may impact patient experience and satisfaction. OBJECTIVE We sought to examine how patient and physician racial and gender concordance effect patient satisfaction with outpatient clinical encounters. Furthermore, we examined factors that changed satisfaction among concordant and discordant dyads. DESIGN Consumer Assessment of Healthcare Provider and Systems (CAHPS) Patient Satisfaction Survey Scores were collected from outpatient clinical encounters between January 2017 and January 2019 at the University of California, San Francisco. PARTICIPANTS Patients who were seen in the eligible time period, who voluntarily provided physician satisfaction scores. Providers with fewer than 30 reviews and encounters with missing data were excluded. MAIN MEASURES Primary outcome was rate of top satisfaction score. The provider score (1-10 scale) was dichotomized as "top score (9-10)" and "low scores (<9)." KEY RESULTS A total of 77,543 evaluations met inclusion criteria. Most patients identified as White (73.5%) and female (55.4%) with a median age of 60 (IQR 45, 70). Compared to White patients, Asian patients were less likely to give a top score even when controlling for racial concordance (OR: 0.67; CI 0.63-0.714). Telehealth was associated with increased odds of a top score relative to in-person visits (OR 1.25; CI 1.07-1.48). The odds of a top score decreased by 11% in racially discordant dyads. CONCLUSIONS Racial concordance, particularly among older, White, male patients, is a nonmodifiable predictor of patient satisfaction. Physicians of color are at a disadvantage, as they receive lower patient satisfaction scores, even in race concordant pairs, with Asian physicians seeing Asian patients receiving the lowest scores. Patient satisfaction data is likely an inappropriate means of determining physician incentives as such may perpetuate racial and gender disadvantages.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jordan Holler
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Denise Davis
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Diane Sliwka
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
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9
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Sarwar F, Ring D, Donovan E. Clinician communication strategies to navigate differences of opinion with patients. PATIENT EDUCATION AND COUNSELING 2024; 123:108185. [PMID: 38340633 DOI: 10.1016/j.pec.2024.108185] [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: 06/06/2023] [Revised: 01/20/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE We investigated communication strategies clinicians reported using to navigate differences of opinion with patients regarding medical decisions. METHODS Twenty physicians of various specialties participated in semi-structured interviews regarding their strategies for maintaining mutual respect when disagreeing with a patient. Reflexive thematic analysis was applied. Enrollment concluded upon theme saturation. RESULTS In an attempt to limit disagreements, physicians learned to gauge patient values, often deferring to clinicians being the expert on medicine and patients being the expert on themselves. Physicians noticed that disagreements were reinforced by prioritizing educational approaches. Strengthening the relationship by validating patient emotions was seen as a more effective strategy. Clinicians found it difficult to weigh relative potential for benefit to the relationship and feelings of moral distress in capitulating to patient preferences they disagreed with. CONCLUSION Physicians recognized the value of moving from educational to relationship building strategies to help limit and navigate disagreements. Key strategies include prioritizing gauging the patient's values and validating their emotions. PRACTICE IMPLICATIONS Anticipating disagreement, training clinicians to limit teaching, and instead prioritize a strong relationship to maintain trust and collaboration has the potential to improve patient health, with more limited resource use, and better experiences of care.
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Affiliation(s)
- Faiza Sarwar
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA.
| | - Erin Donovan
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Austin, TX 78712, USA
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10
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Stine JG, Medic N, Pettersson B, Venerus M, Blau JE. The health care experience of adults with metabolic dysfunction-associated steatohepatitis and influence of PNPLA3: A qualitative study. Hepatol Commun 2024; 8:e0451. [PMID: 38780312 PMCID: PMC11124700 DOI: 10.1097/hc9.0000000000000451] [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] [Received: 12/21/2023] [Accepted: 03/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive form of metabolic dysfunction-associated steatotic liver disease, for which there is limited information about patient experience, including the patient journey. METHODS In this study, we conducted interviews with patients with MASH to qualitatively evaluate the patient journey and help elucidate the experiences of this patient population. We also investigated if the patatin-like phospholipase domain-containing protein 3 (PNPLA3) I148M variant (non-Hispanic) or being of Hispanic ethnicity may influence patient experiences because these 2 subgroups develop advanced liver disease more frequently than other patient groups. RESULTS One-to-one interviews were conducted with 28 adults (with PNPLA3 I148M genetic variant, n = 10; Hispanic, n = 8) living in the United States who had been diagnosed with MASH with liver fibrosis. Patients were asked open-ended questions about their experiences before, at, and after their diagnosis. The data collected found that patients experienced a long process of misdiagnoses before their diagnosis of MASH, a lack of clear information provided by clinicians, and limited accessibility to support groups. Hispanic patients reported "impact on family/friends" (75%) and "fear of disease progression" (75%) more frequently than the other patient cohorts interviewed. This is the first report of "fear of progression" in patients with MASH. No patients who were White and had the PNPLA3 I148M variant reported nausea/vomiting, in contrast to other patient cohorts. CONCLUSIONS This qualitative study identified key aspects of the patient journey that are important for clinical providers and medical teams to recognize. We also propose a new algorithm that could be developed to help screen relatives of patients who are found to carry the PNPLA3 I148M variant.
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Affiliation(s)
- Jonathan G. Stine
- Department of Medicine, Division of Gastroenterology and Hepatology, The Pennsylvania State University Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Fatty Liver Program, Pennsylvania State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, The Pennsylvania State University Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Cancer Institute, The Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Nenad Medic
- Patient Centered Science, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Billie Pettersson
- Patient Centered Science, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | | | - Jenny E. Blau
- Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
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11
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Jindal JA, Lungren MP, Shah NH. Ensuring useful adoption of generative artificial intelligence in healthcare. J Am Med Inform Assoc 2024; 31:1441-1444. [PMID: 38452298 PMCID: PMC11105148 DOI: 10.1093/jamia/ocae043] [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: 12/22/2023] [Revised: 02/01/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES This article aims to examine how generative artificial intelligence (AI) can be adopted with the most value in health systems, in response to the Executive Order on AI. MATERIALS AND METHODS We reviewed how technology has historically been deployed in healthcare, and evaluated recent examples of deployments of both traditional AI and generative AI (GenAI) with a lens on value. RESULTS Traditional AI and GenAI are different technologies in terms of their capability and modes of current deployment, which have implications on value in health systems. DISCUSSION Traditional AI when applied with a framework top-down can realize value in healthcare. GenAI in the short term when applied top-down has unclear value, but encouraging more bottom-up adoption has the potential to provide more benefit to health systems and patients. CONCLUSION GenAI in healthcare can provide the most value for patients when health systems adapt culturally to grow with this new technology and its adoption patterns.
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Affiliation(s)
- Jenelle A Jindal
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA 94305, United States
| | - Matthew P Lungren
- Health and Life Sciences, Microsoft Corporation, Redmond, WA 98052, United States
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, United States
- Department of Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, United States
| | - Nigam H Shah
- Department of Medicine, Stanford School of Medicine, Stanford, CA 94304, United States
- Clinical Excellence Research Center, Stanford School of Medicine, Stanford, CA 94304, United States
- Technology and Digital Solutions, Stanford Health Care, Palo Alto, CA 94304, United States
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12
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Bell SG, Althouse AD, Belin SC, Arnold RM, Smith KJ, White DB, Chu E, Schenker Y, Thomas TH. Associations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer. J Palliat Med 2024; 27:515-520. [PMID: 38574330 PMCID: PMC11265618 DOI: 10.1089/jpm.2023.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 04/06/2024] Open
Abstract
Introduction: Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. Methods and Materials: This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. Results: Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. Conclusions: Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229.
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Affiliation(s)
- Sarah G. Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew D. Althouse
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shane C. Belin
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M. Arnold
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth J. Smith
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas B. White
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Department of Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Teresa H. Thomas
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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13
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Monfared A, Javadi-Pashaki N, Dehghan Nayeri N, Jafaraghaee F. Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study. Ann Med Surg (Lond) 2024; 86:1967-1976. [PMID: 38576922 PMCID: PMC10990328 DOI: 10.1097/ms9.0000000000001706] [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: 02/15/2023] [Accepted: 12/31/2023] [Indexed: 04/06/2024] Open
Abstract
Background Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI. Materials and methods A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding. Results From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance". Conclusion The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.
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Affiliation(s)
- Arezoo Monfared
- School of Nursing and Midwifery, Guilan University of Medical Sciences
| | - Nazila Javadi-Pashaki
- School of Nursing and Midwifery, Guilan University of Medical Sciences
- Social Determinants of Health Research Center (SDHRC), Guilan University of Medical Sciences
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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14
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Mahadevan A, Rivera R, Najhawan M, Saadat S, Strehlow M, Rao GVR, Youm J. Assessing the Efficacy of a Novel Massive Open Online Soft Skills Course for South Asian Healthcare Professionals. J Med Syst 2024; 48:32. [PMID: 38509201 PMCID: PMC10954989 DOI: 10.1007/s10916-024-02051-5] [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: 12/13/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
In healthcare professions, soft skills contribute to critical thinking, decision-making, and patient-centered care. While important to the delivery of high-quality medical care, soft skills are often underemphasized during healthcare training in low-and-middle-income countries. Despite South Asia's large population, the efficacy and viability of a digital soft skills curriculum for South Asian healthcare practitioners has not been studied to date. We hypothesized that a web-based, multilingual, soft skills course could aid the understanding and application of soft skills to improve healthcare practitioner knowledge, confidence, attitudes, and intent-to-change clinical practice.In September 2019 a needs assessment observing soft skills practices was conducted in several Indian states. We developed a communication-focused soft skills curriculum that comprised seven 10-minute video lectures, recorded in spoken English and Hindi. Participants consisted of any practicing healthcare professionals and trainees in select South Asian countries age 18 and over. Participant knowledge, confidence, attitudes, and intent-to-change clinical practice were evaluated using pre- and post-course tests and surveys. Statistical analyses were performed using STATA and SPSS.From July 26, 2021 to September 26, 2021, 5750 registered and attempted the course, 2628 unique participants completed the pre-test, and 1566 unique participants completed the post-test. Participants demonstrated small but statistically significant gains in confidence (𝑝<0.001), attitudes toward course topics relevance (𝑝<0.001), and intent-to-change clinical practice (𝑝<0.001). There was no statistically significant gain in knowledge. A digital soft-skills massive open online course for healthcare practitioners in South Asia could serve as a viable approach to improve the quality of soft skills training in low-to-middle income countries.
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Affiliation(s)
- Aditya Mahadevan
- University of California Irvine School of Medicine, Irvine, CA, USA.
| | - Ronald Rivera
- Department of Emergency Medicine, University of California Irvine Medical Center, Orange, CA, USA
| | - Mahan Najhawan
- University of Queensland-Ochsner School of Medicine, New Orleans, LA, USA
| | - Soheil Saadat
- Department of Emergency Medicine, University of California Irvine Medical Center, Orange, CA, USA
| | - Matthew Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - G V Ramana Rao
- Department of Emergency Medicine Learning Centre and Research, Emergency Management and Research Institute, Hyderabad, Telangana, India
| | - Julie Youm
- Department of Medical Education, University of California Irvine School of Medicine, Irvine, CA, USA
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15
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Waselewski M, Amaro X, Huerto R, Berger J, Spinelli da Silva M, Siroky K, Torres A, Chang T. Youth preferences for healthcare providers and healthcare interactions: a qualitative study. BMC PRIMARY CARE 2024; 25:63. [PMID: 38383303 PMCID: PMC10882742 DOI: 10.1186/s12875-024-02300-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers. METHODS We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes. RESULTS 944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers. CONCLUSION Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.
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Affiliation(s)
- Marika Waselewski
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA
| | | | - Ryan Huerto
- Department of Adult and Family Medicine, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jessica Berger
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA
- University of Michigan, Ann Arbor, MI, USA
| | | | - Kate Siroky
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Tammy Chang
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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16
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Feo R, Young JA, Urry K, Lawless M, Hunter SC, Kitson A, Conroy T. 'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships. Health Expect 2024; 27:e13871. [PMID: 37858980 PMCID: PMC10726062 DOI: 10.1111/hex.13871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition. DESIGN A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis. PARTICIPANTS Participants were 35 healthcare recipients and 37 carers (n = 72 total). RESULTS Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts. CONCLUSION The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships. PATIENT OR PUBLIC CONTRIBUTION The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Jessica A. Young
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Kristi Urry
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- School of PsychologyUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael Lawless
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Sarah C. Hunter
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Alison Kitson
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Tiffany Conroy
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
- Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
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17
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Woolf B, Vinson AH. Cultural health capital and patient partner recruitment into healthcare improvement work. Soc Sci Med 2024; 341:116500. [PMID: 38134712 DOI: 10.1016/j.socscimed.2023.116500] [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: 07/13/2023] [Revised: 10/21/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes.
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Affiliation(s)
- Becky Woolf
- Department of Learning Health Sciences, University of Michigan, USA.
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18
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Messer J, Tzartzas K, Marion-Veyron R, Cohidon C. A Cross-Sectional Study of the Prevalence and Determinants of Common Mental Health Problems in Primary Care in Switzerland. Int J Public Health 2023; 68:1606368. [PMID: 38162336 PMCID: PMC10756069 DOI: 10.3389/ijph.2023.1606368] [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: 07/03/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Objective: This study investigated the prevalence of the most common mental health symptoms in a large primary care patient population and characterized their determinants. Methods: Data came from a 2015-16 cross-sectional study of a primary care population in Switzerland. An investigator presented the study to patients in waiting rooms, and 1,103 completed a tablet-based questionnaire measuring stress in daily life, sleep disorders and anxiety and depressive symptoms. Diagnoses and treatments were recorded. Results: Moderate-to-high anxiety and depressive symptoms concerned 7.7% of patients; 27.6% felt stressed at least once a week; 17.2% had severe sleep disorders. Sociodemographic determinants were associated with psychiatric symptoms: female sex, young age, and frequency of consultations with a GP. Participants taking psychotropics had high levels of mental distress. Conclusion: Even though most patients were regularly monitored by their GP, a significant number of mental health problems were found. GPs should be provided with concrete tools to manage these patients better. Collaboration with mental health specialists should be encouraged in primary care settings.
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Affiliation(s)
- Juliane Messer
- Department of Family Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Konstantinos Tzartzas
- Department of Ambulatory Care and Community Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Régis Marion-Veyron
- Department of Ambulatory Care and Community Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Christine Cohidon
- Department of Family Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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19
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Mehawej J, Tran KVT, Filippaios A, Paul T, Abu HO, Ding E, Mishra A, Dai Q, Hariri E, Howard Wilson S, Asaker JC, Mathew J, Naeem S, Mensah Otabil E, Soni A, McManus DD. Self-reported efficacy in patient-physician interaction in relation to anxiety, patient activation, and health-related quality of life among stroke survivors. Ann Med 2023; 55:526-532. [PMID: 36724401 PMCID: PMC9897757 DOI: 10.1080/07853890.2022.2159516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Early detection of AF is critical for stroke prevention. Several commercially available smartwatches are FDA cleared for AF detection. However, little is known about how patient-physician relationships affect patients' anxiety, activation, and health-related quality of life when prescribed smartwatch for AF detection. METHODS Data were used from the Pulsewatch study (NCT03761394), which randomized adults (>50 years) with no contraindication to anticoagulation and a CHA2DS2-VASc risk score ≥2 to receive a smartwatch-smartphone app dyad for AF monitoring vs. conventional monitoring with an ECG patch (Cardea SoloTM) and monitored participants for up to 45 days. The Perceived Efficacy in Patient-Physician Interactions survey was used to assess patient confidence in physician interaction at baseline with scores ≥45 indicating high perceived efficacy in patient-provider interactions. Generalized Anxiety Disorder-7 Scale, Consumer Health Activation Index, and Short-Form Health Survey were utilized to examine anxiety, patient activation, and physical and mental health status, at baseline, 14, and 44 days, respectively. We used mixed-effects repeated measures linear regression models to assess changes in psychosocial outcomes among smartwatch users in relation to self-reported efficacy in physician interaction over the study period. RESULTS A total of 93 participants (average age 64.1 ± 8.9 years; 43.0% female; 88.2% non-Hispanic white) were included in this analysis. At baseline, fifty-six (60%) participants reported high perceived efficacy in patient-physician interaction. In the fully adjusted models, high perceived efficacy (vs. low) at baseline was associated with greater patient activation and perceived mental health (β 12.0, p-value <0.001; β 3.39, p-value <0.05, respectively). High perceived self-efficacy was not associated with anxiety or physical health status (β - 0.61, p-value 0.46; β 0.64, p-value 0.77) among study participants. CONCLUSIONS Higher self-efficacy in patient-physician interaction was associated with higher patient activation and mental health status among stroke survivors using smartwatches. Furthermore, we found no association between anxiety and smartwatch prescription for AF in participants with high self-efficacy in patient-physician interaction. Efforts to improve self-efficacy in patient-physician interaction may improve patient activation and self-rated health and subsequently may lead to better clinical outcomes.KEY MESSAGESHigher self-efficacy in patient-physician interaction was associated with higher patient activation and mental health status among stroke survivors using smartwatches.No association between anxiety and smartwatch prescription for AF in participants with high self-efficacy in patient-physician interaction.Efforts to improve self-efficacy in patient-physician interaction may improve patient activation and self-rated health and subsequently may lead to better clinical outcomes.
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Affiliation(s)
- Jordy Mehawej
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Khanh-Van T. Tran
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | | | - Tenes Paul
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Hawa O. Abu
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Eric Ding
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Ajay Mishra
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Qiying Dai
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Essa Hariri
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Joanne Mathew
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Syed Naeem
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | | | - Apurv Soni
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - David D. McManus
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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20
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Shaw NM, Abbasi B, Odisho AY, Hills N, Holler J, Sliwka D, Breyer BN. The Impact of Patient Travel Distance on Outpatient Visit Satisfaction: Comparison of Telehealth and Traditional In-Person Visits. Telemed J E Health 2023; 29:1897-1900. [PMID: 37172307 DOI: 10.1089/tmj.2023.0001] [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] [Indexed: 05/14/2023] Open
Abstract
Introduction: Patient satisfaction has been shown to changes based on the distance a patient to see their physician. We sought to examine the effects of telehealth on patient satisfaction. Methods: We examined patient satisfaction survey scores from outpatient clinics at University of California, San Francisco. Patient home and clinic addresses were used to calculate distance in kilometers (km). Outcomes were "top scores (9-10)" and "low scores (<9)." Results: Of 103,124 evaluations that met inclusion criteria, those where patient traveled >100 km for in-person visits had more top scores (84%) than those traveled <10 km (80.2%). Relative to in-person visits, telehealth was associated with an increased odds (odds ratio [OR]: 1.48) of receiving a top score at all distances. Those traveling >100 km had the highest odds of top score for telehealth (OR: 1.86). Conclusions: Patients receiving care through telehealth, particularly those far from the outpatient clinic, are more likely to provide high patient satisfaction scores for the visit provider.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Behzad Abbasi
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Anobel Y Odisho
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, California, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Jordan Holler
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Diane Sliwka
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, Francisco, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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21
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Wu JH, Varkhedi V, Saseendrakumar BR, Acuff K, Weinreb RN, Baxter SL. Social and Health Care Utilization Factors Associated With Ophthalmic Visit Nonadherence in Glaucoma: An All of Us Study. J Glaucoma 2023; 32:1029-1037. [PMID: 37671531 PMCID: PMC10840877 DOI: 10.1097/ijg.0000000000002300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023]
Abstract
PRCIS In a diverse nationwide cohort, lower education and income levels, cost saving on medications, fewer past-year medical/specialist visits, and concerns regarding dissimilarity with health care providers were risk factors for ophthalmic visit nonadherence among glaucoma patients. PURPOSE The purpose of this study was to characterize social and health care utilization factors associated with nonadherence with ophthalmic visits among patients with glaucoma. MATERIALS AND METHODS Glaucoma patients in the All of Us database who completed the Healthcare Access and Utilization Survey were included and categorized into "visit" and "nonvisit" groups based on visit adherence, defined by self-reported past-year encounters with eyecare providers (yes/no). Data regarding potential factors affecting ophthalmic visit adherence, including past-year medical visits, inabilities to afford health care, and self-reported reasons for delayed care, were extracted. χ 2 tests and logistic regression were used to compare the 2 groups. Odds ratios (ORs) of visit adherence were analyzed for potential risk factors. RESULTS Of 5739 glaucoma patients, 861 (15%) were in the nonvisit group. More participants in the visit group reported past-year general doctor/specialist visits (94%/65%; vs. nonvisit group: 89%/49.3%; P <0.05). The nonvisit group reported greater difficulty in affording medical care and learning about medical conditions, and higher rates of delayed/missed health care access for various concerns ( P <0.05). Older age (OR=1.02, 1.01-1.03), higher education (OR=1.25, 1.13-1.40), and income level (OR=1.06, 1.01-1.11), not employed for wages (OR=1.28, 1.08-1.53), and higher health care utilization in general medical/specialist visits (ORs range:1.08-1.90) were associated with visit adherence ( P <0.05). Visit nonadherence was associated with cost saving on medication (OR=0.62, 0.40-0.97) and delaying/avoiding seeing health care providers because of dissimilarity (OR=0.84, 0.71-0.99) ( P <0.05). CONCLUSIONS This study builds on prior literature by identifying potentially modifiable factors associated with visit nonadherence and underutilization of eyecare in glaucoma. These may inform strategies to improve real-world ophthalmic visit adherence and identify patients who might benefit from additional support.
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Affiliation(s)
- Jo-Hsuan Wu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Varsha Varkhedi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Kaela Acuff
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Robert N. Weinreb
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
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Zuckerman S, Kimsma GK, Devisch I. Surprising pandemic experiences: A confrontation between principle-based and virtue ethics, and a plea for virtue ethics training for medical students and residents. A rudimentary outline of a four-step model. J Eval Clin Pract 2023; 29:1100-1107. [PMID: 37073505 DOI: 10.1111/jep.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND In past years, physicians have, with a certain continuity, reported increasing numbers of burnout, depression and compassion fatigue in their daily practice. These problems were attributed, not only but also, to a loss of public trust and an increase in violent behaviour of patients and family members towards medical professionals in all walks of life. Recently, however, during the breakout of the coronavirus disease 2019 (COVID-19) pandemic in 2020, there were public expressions of appreciation and respect for health care workers that almost universally have been assessed as indications of a re-establishment of public trust in physicians and appreciation for the medical professions' commitments. In other words, shared experiences of what society was in need of: the experience of a 'common good'. Those responses during the COVID-19 pandemic increased positive feelings among practicing physicians, such as commitment, solidarity, competency, and experiences concerning obligations for the common good and a sense of belonging to one and the same community for all. Essentially, these responses of raised self-awareness of commitment and solidarity between (potential) patients and medical personal point towards the social importance and power of these values and virtues. This shared domain in ethical sources of behaviour seems to hold a promise of overcoming gaps between the different spheres of doctors and patients. That promise justifies stressing the relevance of this shared domain of Virtue Ethics in the training of physicians. METHODS In this article, therefore, we shall make a plea for the relevance of Virtue Ethics before proposing an outline of an educational programme for Virtue Ethics training for medical students and residents. Let us start by very briefly presenting on Aristotelian virtues and its relevance to modern medicine in general, and during the current pandemic in particular. RESULTS We shall follow up this short presentation by a Virtue Ethics Training Model and the respective settings in which it takes place. This model has four steps as follows: (a) include moral character literacy in the formal curriculum; (b) provide ethics role modelling and informal training in moral character in the healthcare setting by senior staff; (c) create and apply regulatory guidelines regarding virtues and rules; and (d) assess success of training by evaluation of moral character of physicians. CONCLUSION Applying the four-step model may contribute to strengthening the development of moral character in medical students and residents, and decrease the negative consequences of moral distress, burnout and compassion fatigue in health care personnel. In the future, this model should be empirically studied.
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Affiliation(s)
- Shlomit Zuckerman
- Bioethics and Law Center, Department of Disaster Management, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gerrit K Kimsma
- Department of Philosophy and Medical Ethics (Formerly), Vrije Universiteit, Amsterdam, The Netherlands
| | - Ignaas Devisch
- Philosophy of Medicine & Ethics, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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23
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Pandit AA, Li C. Types of usual sources of care and their association with healthcare outcomes among cancer survivors: a Medical Expenditure Panel Survey (MEPS) study. J Cancer Surviv 2023; 17:748-758. [PMID: 35687273 PMCID: PMC10016387 DOI: 10.1007/s11764-022-01221-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess associations between usual source of care (USC) type and health status, healthcare access, utilization, and expenses among adult cancer survivors. METHODS This retrospective cross-sectional analysis using 2013-2018 Medical Expenditure Panel Survey included 2690 observations representing 31,953,477 adult cancer survivors who were currently experiencing cancer and reporting one of five USC types: solo practicing physician (SPP), a specific person in a non-hospital facility, a specific person in a hospital-based facility, a non-hospital facility, and a hospital-based facility. We used logistic regressions and generalized linear models to determine associations of USC type with health status, healthcare access, utilization, and expenses, adjusting for patient demographic and clinical characteristics. RESULTS All non-SPP USC types were associated with reporting more difficulties contacting USC by telephone during business hours (p < 0.05). Compared to SPP, non-hospital facility was associated with more difficulty getting needed prescriptions (OR: 1.81, p = 0.036) and higher annual expenses ($5225, p = 0.028), and hospital-based facility was associated with longer travel time (OR: 1.61, p = 048), more ED visits (0.13, p = 0.049), higher expenses ($6028, p = 0.014), and worse self-reported health status (OR: 1.93, p = 0.001), although both were more likely to open on nights/weekends (p < 0.05). Cancer survivors with a specific person in a hospital-based facility (vs. SPP) as USC were > twofold as likely (p < 0.05) to report difficulty getting needed prescriptions and contacting USC afterhours. CONCLUSIONS Among adult cancer survivors who were currently experiencing cancer, having a non-SPP type of UCS was associated with reporting more difficulties accessing care, worse health, more ED visits, and higher total expenses. IMPLICATIONS FOR CANCER SURVIVORS Transitioning to SPP type of USC may result in better healthcare outcomes.
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Affiliation(s)
- Ambrish A. Pandit
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR-72205 USA
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR-72205 USA
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24
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Engler NJ, Steinhäuser J, Strumann C. Psychometric properties of the GP-Patient Relationship Questionnaire as an instrument for quality improvement in Germany. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:41-47. [PMID: 36959066 DOI: 10.1016/j.zefq.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Since the patient-doctor relationship (PDR) plays a crucial role in patient primary health care and management, the evaluation of the PDR from both, the patients' and primary care physicians', perspectives is an important approach to improve the quality of primary care. However, although there are a variety of questionnaires surveying the patients' view of the PDR, only few consider the physicians' perspective. The purpose of this study was to develop a questionnaire that adds the physicians' perspective to an existing PDR instrument and thus enables a mutual assessment of the relationship. METHODS This study was embedded in a German project aiming at enhancing the adherence in patients with hypertension. Patients and primary care physicians were asked to complete a questionnaire concerning their PDR. The Patient-Doctor Relationship Questionnaire (PDRQ-9) was used to assess the patients' perspective. For the physicians, the PDRQ-9 items were adapted to the physicians' perspective resulting in the GP-Patient Relationship Questionnaire (GPPR). The Helping Alliance Questionnaire (HAQ) was used for external validation. RESULTS A total of 60 physician questionnaires and 50 matched pairs of questionnaires from physicians and patients were included in the analyses. Within the analysis, notable deviations were found for one Item, nevertheless the calculated Cronbach's α of 0.89 showed a high internal consistency of the 9-item questionnaire. External validation showed a high correlation of the GPPR with the HAQ, confirming the good psychometric properties demonstrated for the overall instrument. DISCUSSION Overall, this initial validation study revealed good psychometric properties of the GPPR. A retest will be performed in the course of the overall project to confirm the reliability of the newly developed questionnaire. CONCLUSION A new questionnaire to assess the physicians' perspectives on the PDR was successfully developed to improve adherence depending processes of quality improving in primary care.
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Affiliation(s)
- Nicola Janine Engler
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christoph Strumann
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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25
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Rucinski K, Leary E, Crist BD, Cook JL. Orthopaedic trauma patient non-adherence to follow-up visits at a level 1 trauma center serving an urban and rural population. Injury 2023; 54:880-886. [PMID: 36725488 DOI: 10.1016/j.injury.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess key demographic and psychosocial variables that may be associated with non-adherence to clinic visits following orthopaedic trauma injuries to patients in an urban and rural population. METHODS This retrospective review included all operative and non-operative patients presenting to a Level I academic trauma center serving an urban and rural population in the Midwest following an orthopaedic injury. The study tracked patient attendance to scheduled orthopaedic trauma follow-up clinic visits after a scheduled visit in the clinic following a trauma-related injury. RESULTS Data were obtained for 5816 unique orthopaedic trauma patients who had 21,066 post-treatment follow-up visits scheduled. 1627 "no-show" appointments were recorded. Factors associated with no-shows included male sex, age between 26 and 35 years, self-reported race other than white, employment listed as disabled, household income below $25,000, education less than a high school level, uninsured, Medicaid insured, and relationship status reported as single. CONCLUSIONS In the present study, key demographic and psychosocial factors were significantly associated with patient adherence to scheduled follow-up appointments after treatment for orthopaedic trauma. Identifying patients at higher risk for nonadherence will allow healthcare teams to educate patients, providers, and staff, link patients to resources to enhance adherence, and work with their institutions to develop and implement protocols for improving adherence to follow-up appointments.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA.
| | - Emily Leary
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA
| | - James L Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia MO, USA
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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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27
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Lynch JM, van Driel M, Meredith P, Stange KC, Getz L, Reeve J, Miller WL, Dowrick C. The Craft of Generalism clinical skills and attitudes for whole person care. J Eval Clin Pract 2022; 28:1187-1194. [PMID: 34652051 DOI: 10.1111/jep.13624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Generalists manage a broad range of biomedical and biographical knowledge as part of each clinical encounter, often in multiple encounters over time. The sophistication of this broad integrative work is often misunderstood by those schooled in reductionist or constructivist approaches to evidence. There is a need to describe the practical and philosophically robust ways that understanding about the whole person is formed. In this paper we describe first principles of generalist approaches to knowledge formation in clinical practice. We name the Craft of Generalism. METHODS The newly described methodology of Transdisciplinary Generalism is examined by skilled generalist clinicians and translated into skills and attitudes useful for everyday generalist person-centred practice and research. RESULTS The Craft of Generalism defines the required scope, process, priorities, and knowledge management skills of all generalists seeking to care for the whole person. These principles are Whole Person Scope, Relational Process, Healing Orientation, and Integrative Wisdom. These skills and attitudes are required for whole person care. If any element of these first principles is left out, the resultant knowledge is incomplete and philosophically incoherent. CONCLUSIONS Naming the Craft of Generalism defines the generalist gaze and protects generalism from the colonization of a narrowed medical gaze that excludes all but reductionist evidence or constructivist experience. Defining the Craft of Generalism enables clear teaching of the sophisticated skills and attitudes of the generalist clinician. These philosophically robust principles encourage and defend the use of generalist approaches to knowledge in settings across the community - including health policy, education, and research.
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Affiliation(s)
- Johanna M Lynch
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia.,Integrate Place at Zest Infusion, Birkdale, Queensland, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
| | - Pamela Meredith
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Linn Getz
- Department of Public Health and Nursing, NTNU: Norwegian University of Science and Technology, Trondheim, Norway
| | - Joanne Reeve
- Primary Care Research, Hull York Medical School, Hull, UK
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.,Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Christopher Dowrick
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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28
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Damiano RF, Fricchione G, Miguel EC. Love, compassion, and attachment in psychiatric care: perspectives for research and clinical practice. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022; 46:e20220557. [PMID: 36355861 PMCID: PMC11332676 DOI: 10.47626/2237-6089-2022-0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/17/2022] [Indexed: 02/17/2024]
Affiliation(s)
- Rodolfo Furlan Damiano
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Gregory Fricchione
- Department of PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Euripedes Constantino Miguel
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Ngo SB, Clark PJ, Parr SE, Thomas AR, Dayal A, Sanker R, Hess BW, Stull DC. Moral Injury during the COVID-19 pandemic: A delphi model survey of family medicine residents. Int J Psychiatry Med 2022; 57:293-308. [PMID: 34961337 PMCID: PMC9209884 DOI: 10.1177/00912174211054385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective is to investigate the primary factors that created experiences leading to moral injury in family medicine residents during the COVID-19 pandemic and also to identify any barriers keeping these residents from seeking or receiving help when they experienced moral injury. METHOD A DELPHI model study utilizing three rounds of surveys was conducted at four family medicine residency programs in the United States. Resident responses to Survey 1 generated factors perceived to be causing them moral injury or constituting barriers to their seeking help. Thematic analysis identified common themes which were presented to residents in Survey 2 for rating and justification. Results and feedback from Survey 2 were shared with residents in Survey 3, where residents were prompted to reevaluate their ratings for factors and barriers for the purpose of generating consensus among themselves. A ranked list of factors and barriers was thereby created for the participating sites. RESULTS Residents shared several stories about the factors that most pressured them to violate their moral values. The most severe and frequent factors contributing to moral injury involved disruptions to doctor-patient relationships, patient-family relationships, and relationships with other healthcare professionals. Time was the major barrier to residents seeking help. CONCLUSION During times of crisis, moral injury among residents may be minimized by protecting and promoting important clinical and professional relationships with patients, colleagues, and other medical professionals. While residents report that lack of time was the most significant barrier to seeking help, it is unclear how this complicated and ubiquitous problem would be resolved or mitigated.
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Affiliation(s)
- Sean B Ngo
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Payson J Clark
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Sarah E Parr
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Abel R Thomas
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Akshat Dayal
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | - Richard Sanker
- Office of PreHealth Studies, Baylor University, Waco, TX, USA
| | | | - Dillon C Stull
- Stanford University School of Medicine, Stanford, CA, USA
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Ding L, Szymczak JE, Evans E, Canepa E, Martin AE, Contractor F, Aplenc R, Joseph G, Winestone LE. Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in depth qualitative interview study. BMC Cancer 2022; 22:531. [PMID: 35550034 PMCID: PMC9095817 DOI: 10.1186/s12885-022-09547-8] [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: 07/30/2021] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in outcomes for Black and Hispanic children with acute leukemia have been well documented, however little is known about the determinants of diagnostic delays in pediatric leukemia in the United States. The primary objective of this study is to identify factors contributing to delays preceding a pediatric leukemia diagnosis. METHODS This qualitative study utilized in-depth semi-structured interviews. Parents and/or patients within two years of receiving a new acute leukemia diagnosis were asked to reflect upon their family's experiences preceding the patient's diagnosis. Subjects were purposively sampled for maximum variation in race, ethnicity, income, and language. Interviews were analyzed using inductive theory-building and the constant comparative method to understand the process of diagnosis. Chart review was conducted to complement qualitative data. RESULTS Thirty-two interviews were conducted with a diverse population of English and Spanish speaking participants from two tertiary care pediatric cancer centers. Parents reported feeling frustrated when their intuition conflicted with providers' management decisions. Many felt laboratory testing was not performed soon enough. Additional contributors to delays included misattribution of vague symptoms to more common diagnoses, difficulties in obtaining appointments, and financial disincentives to seek urgent or emergent care. Reports of difficulty obtaining timely appointments and financial concerns were disproportionately raised among low-income Black and Hispanic participants. Comparatively, parents with prior healthcare experiences felt better able to navigate the system and advocate for additional testing at symptom onset. CONCLUSIONS While there are disease-related factors contributing to delays in diagnosis, it is important to recognize there are multiple non-disease-related factors that also contribute to delays. Evidence-based approaches to reduce outcome disparities in pediatric cancer likely need to start in the primary care setting where timeliness of diagnosis can be addressed.
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Affiliation(s)
- Lucky Ding
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Julia E. Szymczak
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Erica Evans
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Emma Canepa
- grid.266102.10000 0001 2297 6811University of California San Francisco (UCSF) School of Medicine, San Francisco, CA USA
| | - Ashley E. Martin
- grid.239552.a0000 0001 0680 8770Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Farah Contractor
- grid.239552.a0000 0001 0680 8770Center for Childhood Cancer Research, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Richard Aplenc
- grid.239552.a0000 0001 0680 8770Center for Childhood Cancer Research, Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Galen Joseph
- grid.266102.10000 0001 2297 6811Department of Humanities and Social Sciences, UCSF, San Francisco, CA USA ,grid.511215.30000 0004 0455 2953UCSF Helen Diller Family Comprehensive Cancer Center, CA San Francisco, USA
| | - Lena E. Winestone
- grid.511215.30000 0004 0455 2953UCSF Helen Diller Family Comprehensive Cancer Center, CA San Francisco, USA ,Division of Allergy, Immunology & BMT, UCSF Benioff Children’s Hospitals, Mail Stop 0434, 550 16th St, 4th Floor, San Francisco, CA USA
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Wu Q, Jin Z, Wang P. The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust. J Gen Intern Med 2022; 37:1388-1393. [PMID: 34405348 PMCID: PMC9086002 DOI: 10.1007/s11606-021-07008-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A trusting physician-patient relationship is an essential component of high-quality care. OBJECTIVE To explore the relationship between the physician-patient relationship, physician empathy, and patient trust. DESIGN Cross-sectional survey. PARTICIPANTS A total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys. MAIN MEASURE Physician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed. KEY RESULTS There were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician's benevolence and competence, and the physician-patient relationship (r = 0.49-0.75, P < 0.01 for all). Patients' evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician's benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15-0.21) and that the mediation effect of patient trust in physician's benevolence was significant (β = 0.24, 95% CI: 0.20-0.28), though the mediation effect of patient trust in physician's competence was not (β = 0.01, 95% CI: -0.02 to 0.02). CONCLUSIONS Patients' perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician's benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients.
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Affiliation(s)
- Qing Wu
- Faculty of Education, East China Normal University, Shanghai, 200062, China.,School of Psychiatry, Wenzhou Medical University, Zhejiang Province, Wenzhou, 325035, China
| | - Zheyu Jin
- College of Education, Shanghai Normal University, Shanghai, 200234, China
| | - Pei Wang
- Faculty of Education, East China Normal University, Shanghai, 200062, China. .,School of Psychiatry, Wenzhou Medical University, Zhejiang Province, Wenzhou, 325035, China.
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Bianchi T, Wilson K, Yee A. Undoing structural racism in dentistry: Advocacy for dental therapy. J Public Health Dent 2022; 82 Suppl 1:140-143. [PMID: 35014051 PMCID: PMC9303238 DOI: 10.1111/jphd.12499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
Like other areas of health, structural racism has a deep impact on oral health and is a key driver of racial inequities in access to care and outcomes. Racism also structures the relationship between oral health and access to economic opportunities. As a result, communities of color, American Indian/Alaska Native (AI/AN) communities, and low-income populations experience the highest rates of the health, social, and economic costs of dental disease. This is compounded by issues of community-level dental fear/trauma resulting from receiving itinerate care. Dentistry has long struggled to equitably distribute care and diversify its overwhelmingly white and affluent workforce, resulting in many communities not having access to providers who represent their identity and/or live in their community. While multi-generational lack of access to dental care is not unique to Alaska, Alaska Native communities are the home to a reimagined, community-centered care delivery system that is improving health outcomes. For almost two decades, AI/AN leaders have recruited and trained community members to serve as dental therapists-dental team members who offer routine and preventive care responsive to local geographic and cultural/community norms. As members of the communities they serve, dental therapists are fluent in the language and cultural norms of their patients, improving patient-provider trust, access to care, and oral health outcomes. The communities that dental therapists serve are also now investing money and training in their community members, building educational opportunities, and professional wage jobs and directly countering the economic impact structural racism has on oral health.
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Affiliation(s)
| | | | - Albert Yee
- Community CatalystBostonMassachusettsUSA
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O'Conor KJ, Golden SH, Hughes MT, Sisson SD, Kachalia A. COVID-19 Vaccination: Health Care Organizations' Responsibility and Opportunity. Am J Public Health 2022; 112:213-215. [PMID: 35080955 PMCID: PMC8802584 DOI: 10.2105/ajph.2021.306633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Katie J O'Conor
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Sherita H Golden
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Mark T Hughes
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Stephen D Sisson
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Allen Kachalia
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
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Hauser J. What palliative care physicians wish neurologists knew. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:85-92. [PMID: 36055722 DOI: 10.1016/b978-0-323-85029-2.00013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This chapter describes several features of palliative care that we believe can assist neurologists in caring for patients with serious illness. These features include the importance of recognizing suffering, the central of total pain (including physical, emotional, spiritual, and existential aspects), structural features of palliative care such as the distinction been palliative care and hospice, and the concept of primary and specialty palliative care. Structural features of palliative care such as interdisciplinary teamwork, approaches to self-care, and a perspective on prognostic uncertainty are also considered. Throughout this chapter, the focus is on ways in which neurologists can integrate these approaches in caring for patients and their families.
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Affiliation(s)
- Joshua Hauser
- Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Northwestern University, Chicago, IL, United States.
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Moss JL, Popalis M, Ramirez SI, Reedy-Cooper A, Ruffin MT. Disparities in Cancer Screening: The Role of County-Level Metropolitan Status and Racial Residential Segregation. J Community Health 2021; 47:168-178. [PMID: 34550504 DOI: 10.1007/s10900-021-01035-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 12/21/2022]
Abstract
Mortality from cervical and colorectal cancers can be reduced through routine screening, which can often be accessed through primary care. However, uptake of screening in the US remains suboptimal, with disparities observed across geographic characteristics, such as metropolitan status or level of racial residential segregation. Little is known about the interaction of metropolitan status and segregation in their relationship with cancer screening. We conducted a quantitative survey of 474 women aged 45-65 in central Pennsylvania. The survey collected county-level characteristics and participant-level demographics, beliefs, cancer screening barriers, and cervical and colorectal cancer screening. We used bivariate and multivariable logistic regression to analyze relationships between metropolitan status and segregation with screening. For cervical cancer screening, 82.8% of participants were up-to-date, which did not differ by county type in the final analysis. Higher healthcare trust, higher cancer fatalism, and reporting cost as a barrier were associated with cervical cancer screening. For colorectal cancer screening, 55.4% of participants were up-to-date, which differed by county type. In metropolitan counties, segregation was not associated with colorectal cancer screening, but in non-metropolitan counties, segregation was associated with greater colorectal cancer screening. The relationship between metropolitan status and being up-to-date with colorectal, but not cervical, cancer screening varied by segregation. Other important beliefs and barriers to screening varied by county type. This research can guide future cancer screening interventions in primary care settings in underserved communities.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 134 Sipe Ave., #205, MC HS72, P.O. Box 850, Hershey, PA, 17033, USA.
| | - Madyson Popalis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Sarah I Ramirez
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Alexis Reedy-Cooper
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Mack T Ruffin
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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