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Rahaman RR, Motilal MS, Khan R, Maharaj RG. Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases. BMC PRIMARY CARE 2023; 24:215. [PMID: 37865738 PMCID: PMC10589933 DOI: 10.1186/s12875-023-02149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/03/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement. METHOD A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12. RESULTS There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025). CONCLUSION Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.
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Affiliation(s)
- Reisa R Rahaman
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - M Shastri Motilal
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Raveed Khan
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Rohan G Maharaj
- Faculty of Medical Sciences, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.
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Sardessai-Nadkarni AA, Street RL. Understanding the pathways linking patient-centered communication to cancer survivors' emotional health: examining the mediating roles of self-efficacy and cognitive reappraisal. J Cancer Surviv 2023; 17:1266-1275. [PMID: 35167049 DOI: 10.1007/s11764-022-01170-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Many cancer survivors commonly face psychological health issues upon cancer diagnosis, both during and after treatment. Patient-centered communication can play an important role in improving health outcomes among cancer survivors across the cancer continuum. The current study examined the influence of patient-centered communication on self-efficacy in managing health, cognitive reappraisal, and emotional distress among cancer survivors. METHODS The analysis was conducted on a subsample of 809 cancer survivors acquired from a nationally representative 2019 Health Information National Trends Survey 5 (Cycle 3). Multivariate regression analysis was conducted to explore the pathways through which patient-centered communication can be associated with cancer survivors' emotional distress, mediated by self-efficacy and cognitive reappraisal. RESULTS The results indicated that effective patient-centered provider communication led to higher self-efficacy in managing health, greater involvement in cognitive reappraisal, and decreased emotional distress among cancer survivors. Additionally, the results revealed that the effect of patient-centered communication that led to decreased emotional distress was fully mediated through self-efficacy and cognitive reappraisal. CONCLUSIONS Although patient-centered communication positively relates to various emotional health outcomes among cancer survivors, it does not affect their emotional health directly. Self-efficacy and cognitive reappraisal play a crucial role in explaining the underlying mechanisms of such effects. IMPLICATIONS FOR CANCER SURVIVORS Future interventions to promote patient-centered communication in cancer care should give more emphasis to managing patients' emotions. Providers should not only recognize, elicit, and respond to patient's emotions, but also develop emotional regulation skills among patients, and improve their ability to cope with emotional distress.
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Affiliation(s)
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Richardson MK, Coslov N, Woods NF. Seeking Health Care for Perimenopausal Symptoms: Observations from The Women Living Better Survey. J Womens Health (Larchmt) 2023; 32:434-444. [PMID: 36656145 PMCID: PMC10079240 DOI: 10.1089/jwh.2022.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: The perimenopausal health care interaction can be challenging both for those seeking care and health care professionals (HCPs). We explore the factors that contribute to making these health care interactions either satisfying or unsatisfying for a midlife person with ovaries who consults an HCP about bothersome symptoms. Materials and Methods: Respondents to the Women Living Better (WLB) survey were asked about 61 symptoms often associated with the menopausal transition. They were then asked whether they sought health care for their most bothersome one. Of the 1024 participants who consulted an HCP, 964 provided a response to the open-ended question "how did that go?" We used conventional content analysis to code the responses and identify themes. Results: We identified six codes reflecting positive health care interactions which we then grouped into five themes suggesting satisfaction with these health care interactions. These included: validating experiences; having matching explanatory models; being supported by a team; engaging in shared decision-making; and having symptoms addressed. We identified 13 codes reflecting negative health care interactions which we then group into 4 themes suggesting dissatisfaction. These included: invalidating experiences, a mismatch in expectations between care recipients and HCP, barriers to treatment, and not feeling helped. Conclusions: Those seeking health care for bothersome symptoms on the path to menopause responded with both positive and negative comments about health care interactions in the WLB survey. Studying these comments identifies opportunities to improve midlife care.
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Affiliation(s)
- Marcie K Richardson
- Department of Obstetrics and Gynecology, Atrius Health and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nina Coslov
- Women Living Better, Cambridge, Massachusetts, USA
| | - Nancy Fugate Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
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Wong YK, Low KL, Pooke TG. Factors Associated With Dimensions of Patients' Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study. J Chiropr Med 2022; 21:83-96. [PMID: 35774631 PMCID: PMC9237594 DOI: 10.1016/j.jcm.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to investigate the association between patients' sociodemographic factors (age, sex, ethnicity, and education background) and dimensions of patients' trust in chiropractic doctors in Malaysia. Methods This cross-sectional study was conducted in the International Medical University Healthcare Chiropractic Center with a total of 302 respondents. Self-administered questionnaires were enclosed in an envelope and passed to participants by the researchers. Descriptive statistics are presented in tables and figures. Each dimension of the patients' trust was compared against the sociodemographic factors. The variables included were sex, age, ethnicity, and education background, along with their dimensions of trust. Results There were 106 male respondents (35.1%) and 196 female respondents (64.9%) between 21 and 40 years of age. In all of the trust dimensions, education background was the only statistically significant variable (P < .05). Conclusion Several sociodemographic factors were associated highly with the trust dimensions explored. Patients' education background was the only sociodemographic factor to show a statistically significant relationship to all 10 trust dimensions. Sex, age, and ethnicity showed significant associations with some of the trust dimensions explored in this study.
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Affiliation(s)
- Yi Kai Wong
- Chiropractic Department, Centre for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Ka Lok Low
- Chiropractic Department, Centre for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Tamara Gien Pooke
- Chiropractic Department, Centre for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
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Hack SM, Muralidharan A, Abraham CR. Between and within race differences in patient-centeredness and activation in mental health care. PATIENT EDUCATION AND COUNSELING 2022; 105:206-211. [PMID: 34045090 DOI: 10.1016/j.pec.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of this study was to compare Black and White mental health care patients' perceptions of their providers' and their own participation in patient-centered mental health care. Perceptions of patient-centered care (PCC) in relation to the Multidimensional Model of Racial Identity were explored. METHODS Black and White veterans receiving mental health care (n = 82) completed surveys assessing patient activation, involvement in care, perceptions of PCC, and therapeutic alliance. Black participants (n = 40) also completed the Multidimensional Inventory of Black Identity. RESULTS There were no differences by race in perceived PCC, though Black participants had lower levels of therapeutic alliance with their mental health care provider and were less activated. Black identity centrality, private regard, and public regard were positively related to PCC and elements of PCC such as patient information seeking/sharing. CONCLUSIONS Intragroup identity variables such as racial centrality, regard, and ideology influenced perceived PCC among Black participants. Race identity variables should be explored in future research on racial disparities and PCC. PRACTICE IMPLICATIONS Mental health care providers serving Black patients should create opportunities to discuss racial identity and race-related experiences as part of their efforts to improve therapeutic alliance and increase the patient-centeredness of care.
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Affiliation(s)
- Samantha M Hack
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, USA; School of Social Work, University of Maryland-Baltimore, Baltimore, USA.
| | - Anjana Muralidharan
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, USA; Department of Psychiatry, University of Maryland-Baltimore, Baltimore, USA
| | - Carol R Abraham
- College of Arts and Sciences, University of Baltimore, Baltimore, USA
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Gabay G, Bokek-Cohen Y. Infringement of the right to surgical informed consent: negligent disclosure and its impact on patient trust in surgeons at public general hospitals - the voice of the patient. BMC Med Ethics 2019; 20:77. [PMID: 31660956 PMCID: PMC6819415 DOI: 10.1186/s12910-019-0407-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/06/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence. METHODS Informants were 12 Israelis (6 men and 6 women), aged 29-81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process upon discharge. RESULTS Our empirical evidence indicates an infringement of patients' right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants' moral agency and dignity. DISCUSSION Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons. CONCLUSIONS Patient experiences attest to the infringement of a patient's right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient's needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent.
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Affiliation(s)
- Gillie Gabay
- Behavioral Sciences and Psychology, College of Management Academci studies, 7 Rabin Blvd, 97150 Rishon Letzion, Israel
| | - Yaarit Bokek-Cohen
- Nursing Sciences, Tal-Aviv Jaffa Academic College, 7 Rabin Blvd, 97150 Rishon Letzion, Israel
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Nelson KL, Purtle J. Perceptions of patient-provider communication and receipt of mental health treatment among older adults with depressive symptoms. Aging Ment Health 2019; 23:485-490. [PMID: 29338318 DOI: 10.1080/13607863.2018.1426719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to: (1) determine if and how perceptions towards healthcare providers differ between older adults with and without clinically signifcant depressive symptoms (CSDS), and (2) assess whether perceptions towards providers are associated with receipt of mental health treatment among older adults with CSDS. METHODS Data from the 2013 and 2014 Medical Expenditure Panel Survey were used to examine CSDS prevalence, receipt of mental health treatment, and perceptions of provider communication among community-dwelling adults ≥ age 65 (N = 6,936) using four of the 'How Well Doctors Communicate' composite items from the Consumer Assessment of Healthcare Providers and Systems(CAHPS). Multivariate logistic regression was used. RESULTS CSDS are associated with greater odds of having 'poor' perceptions of provider communication on all four CAHPS communication measures. Perceptions of provider communication are similar among older adults with CSDS who received and did not receive mental health treatment, except on an item measuring a provider's ability to explain information in ways patients understand. CONCLUSION Older adults with CSDS have more negative perceptions of the quality of their communication with healthcare providers than their peers. Healthcare systems should consider how to accommodate these patients' unique needs and communication preferences to ensure receipt of quality care.
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Affiliation(s)
- Katherine L Nelson
- a Department of Health Management and Policy, Dornsife School of Public Health , Drexel University , Philadelphia , PA , USA
| | - Jonathan Purtle
- a Department of Health Management and Policy, Dornsife School of Public Health , Drexel University , Philadelphia , PA , USA
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Toubassi D, Singwi A, Waters I. Implementation of a patient-based feedback tool to assess the CanMEDS-FM communicator role. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:778-779. [PMID: 30315024 PMCID: PMC6184951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Diana Toubassi
- Assistant Professor, in the Department of Family and Community Medicine at the University of Toronto in Ontario and Toronto Western Hospital in the University Health Network.
| | - Amita Singwi
- Lecturer, in the Department of Family and Community Medicine at the University of Toronto in Ontario and Toronto Western Hospital in the University Health Network
| | - Ian Waters
- Assistant Professor, in the Department of Family and Community Medicine at the University of Toronto in Ontario and Toronto Western Hospital in the University Health Network
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Toubassi D, Singwi A, Waters I. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e468-e470. [PMID: 30315039 PMCID: PMC6184968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Diana Toubassi
- Professeure adjointe, au Département de médecine familiale et communautaire de l'Université de Toronto en Ontario et au Toronto Western Hospital dans le réseau de santé universitaire (University Health Network).
| | - Amita Singwi
- Conférencière, au Département de médecine familiale et communautaire de l'Université de Toronto en Ontario et au Toronto Western Hospital dans le réseau de santé universitaire (University Health Network)
| | - Ian Waters
- Professeur adjoint, au Département de médecine familiale et communautaire de l'Université de Toronto en Ontario et au Toronto Western Hospital dans le réseau de santé universitaire (University Health Network)
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Avanecean D, Calliste D, Contreras T, Lim Y, Fitzpatrick A. Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. ACTA ACUST UNITED AC 2018; 15:3006-3048. [PMID: 29219876 DOI: 10.11124/jbisrir-2016-003331] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Unintentional falls during hospitalization remain a concern for healthcare institutions globally despite implementation of various improvement strategies. Although the incidence of falls has been of heightened focus for many years and numerous studies have been done evaluating different approaches for fall prevention, fall rates remain high in acute care settings. Patient fall risk scales tend to address only particular intrinsic and extrinsic factors but do not adequately assess a patient's current fall risk status, subsequently warranting more patient-centered risk assessments and interventions. OBJECTIVES To evaluate the effectiveness of patient-centered interventions on falls in the acute care setting. INCLUSION CRITERIA TYPES OF PARTICIPANTS All adult patients admitted to medical or surgical acute care units for any condition or illness. TYPES OF INTERVENTION(S) Patient-centered intervention strategies to reduce falls compared to usual care. TYPES OF STUDIES Randomized control trials. TYPES OF OUTCOMES Primary outcome: fall rates or number of falls. Secondary outcome: fall-related injuries. SEARCH STRATEGY A comprehensive search strategy aimed to find relevant published and unpublished quantitative, English language studies from the inception of databases through July 30, 2016 was undertaken. Databases searched included: PubMed, CINAHL, Embase and Health Source: Nursing/Academic Edition. A search for unpublished studies was also performed using ProQuest Dissertations and Theses, the New York Academy of Medicine and the Virginia Henderson e-Repository. METHODOLOGICAL QUALITY Reviewers evaluated the included studies for methodological quality using the standardized critical appraisal instrument form from the Joanna Briggs Institute. DATA EXTRACTION Quantitative data were extracted from papers included in the review using the standardized data extraction form from the Joanna Briggs Institute. DATA SYNTHESIS Due to clinical and methodological heterogeneity among the included studies, a meta-analysis was not possible. The findings of this review have been presented in narrative form. RESULTS Five randomized control trials were included. Three studies demonstrated statistically significant reductions in fall rates (p < 0.04) while two studies showed no difference in fall rates between groups (p > 0.5). In the three studies that demonstrated reduced fall rates, personalized care plans and patient-centered education based on patients' fall risk results were utilized. Three studies measured the secondary outcome of fall-related injuries; however, results demonstrated no difference in fall-related injuries between groups (p > 0.5). CONCLUSIONS Evidence of this review indicates patient-centered interventions in addition to tailored patient education may have the potential to be effective in reducing falls and fall rates in acute care hospitals. There is limited high quality evidence demonstrating the effectiveness of patient-centered fall prevention interventions so novel solutions are urgently needed and warrant more rigorous, larger scale randomized trials for more robust estimates of effect.
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Affiliation(s)
- Donna Avanecean
- Pace University, College of Health Professions, New York, USA
| | - Dawn Calliste
- Pace University, College of Health Professions, New York, USA
| | | | - Yeogyeong Lim
- Pace University, College of Health Professions, New York, USA
| | - Aileen Fitzpatrick
- Pace University, College of Health Professions, New York, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
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Avanecean D, Calliste D, Contreras T, Lim Y, Fitzpatrick A. Effectiveness of patient-centered interventions on falls in the acute care setting: a quantitative systematic review protocol. ACTA ACUST UNITED AC 2018; 15:55-65. [PMID: 28085727 DOI: 10.11124/jbisrir-2016-002981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVE The quantitative objective of this review is to identify the effectiveness of patient-centered interventions on fall rates in adult patients in the acute care setting.
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Affiliation(s)
- Donna Avanecean
- 1College of Health Professions, Pace University, New York, New York, USA 2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence, Newark, New Jersey, USA
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Han CJ, Chi NC, Han S, Demiris G, Parker-Oliver D, Washington K, Clayton MF, Reblin M, Ellington L. Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits. J Pain Symptom Manage 2018; 55:1296-1303. [PMID: 29360571 PMCID: PMC5899943 DOI: 10.1016/j.jpainsymman.2018.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
CONTEXT Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs. OBJECTIVES We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised. METHODS Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges. RESULTS From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges. CONCLUSION To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes.
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Affiliation(s)
- Claire J Han
- Biobehavioral Cancer Prevention and Control Training Program, University of Washington, School of Public Health, Seattle, Washington, USA.
| | - Nai-Ching Chi
- University of Iowa, College of Nursing, Iowa City, Iowa, USA
| | - Soojeong Han
- University of Washington, School of Nursing, Seattle, Washington, USA
| | - George Demiris
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
| | - Debra Parker-Oliver
- University of Missouri, School of Medicine, Family and Community Medicine, Columbia, Missouri, USA
| | - Karla Washington
- University of Missouri, School of Medicine, Family and Community Medicine, Columbia, Missouri, USA
| | | | - Maija Reblin
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Lee Ellington
- University of Utah, College of Nursing, Salt Lake City, Utah, USA
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Bastholm-Rahmner P, Gustafsson LL, Aggefors K, Ateva K, Elfving S, Eriksen J, Jirlow M, Juhasz-Haverinen M, Malmström RE, Nikpour-Ardaly M, Röjvall M, Vallin M, Andersén-Karlsson E, Ovesjö ML. Patients' knowledge and attitudes to the Wise List - a drug formulary from the Stockholm Drug and Therapeutic committee. BMC Health Serv Res 2018. [PMID: 29530028 PMCID: PMC5848508 DOI: 10.1186/s12913-018-2968-2] [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] [Indexed: 11/17/2022] Open
Abstract
Background Involving patients in decisions about their pharmacotherapy is crucial for a satisfactory treatment outcome. Information and opinions about medicines are available from a variety of sources. The Wise List is the drug formulary of recommended essential medicines for the Stockholm healthcare region and is issued by the Drug and Therapeutics Committee (DTC). To inform the public about treatment for common diseases and the concept of recommended medicines, a patient edition of the Wise List was developed. The aim of this study was to explore patients’ knowledge, needs and attitudes to the Wise List, DTC and information about medicines in general. Methods To examine patient knowledge about recommended medicines a survey (n = 312) was carried out at four large primary healthcare centres in Stockholm, Sweden. To further elucidate the patients’ needs of the information on recommended medicines and medicines in general, three focus group discussions (FGDs) were performed. Results Of the respondents 57% did not recognise the Wise List, 26% recognised but did not use it and 17% used it. A total of 63% reported that they search for information about medicines. The most common information source was “asking their doctor” (36%) followed by searching the internet (31%). The FGDs revealed that the patients were not interested in medicines in general, only in the medicines they use themselves. They did not understand the aim of the Wise List or how they could benefit from information about recommended medicines. The patients expressed a wish to access all information they need about their own care as well as public healthcare information at one location. Conclusion The intended aim of the DTC with providing information to the public was not achieved as the patients have difficulties to understand the information and how they should use it. The patients were not interested in medicines in general, they wanted information tailored to their specific needs. The findings highlight the importance of creating tools for patients in collaboration with them and evaluate the concept continuously.
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Affiliation(s)
- Pia Bastholm-Rahmner
- Medical Management Centre, LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Kristina Aggefors
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Kristina Ateva
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Susanne Elfving
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Malena Jirlow
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | | | - Rickard E Malmström
- Clinical Pharmacology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Solna, Sweden
| | | | - Magnus Röjvall
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Martina Vallin
- Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18A, Stockholm, Sweden
| | - Eva Andersén-Karlsson
- Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Marie-Louise Ovesjö
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
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Jonassaint CR, Beach MC, Haythornthwaite JA, Bediako SM, Diener-West M, Strouse JJ, Lanzkron S, Onojobi G, Carroll CP, Haywood C. The Association between Educational Attainment and Patterns of Emergency Department Utilization among Adults with Sickle Cell Disease. Int J Behav Med 2016; 23:300-309. [DOI: 10.1007/s12529-016-9538-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gabay G. Perceived control over health, communication and patient-physician trust. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30007-0. [PMID: 26187177 DOI: 10.1016/j.pec.2015.06.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Patient-physician trust is linked to higher medication adherence. To date, the relationship between trust and perceived control over health, a strong driver of patient health behavior, has not been tested. This study tested the contribution of patient perceived control over health to the explained variance in patient-physician trust, beyond the contribution of known antecedent. This study also tested the moderation effect of perceived control over health on the relationship between participative communication and patient-physician trust. METHODS This cross sectional study is based on a representative sample of 820 Israeli respondents with identical healthcare plans. Measures were used in previous studies and hold good psychometric properties. RESULTS Structural equation modeling supported study hypotheses. Patient perceived control over health uniquely contributed eight percent to the explained variance of trust. When perceived control over health was high and perceived communication was participative, trust was higher. CONCLUSION Communication with patients is to focus on the enhancement of patient perceived control over health. PRACTICAL IMPLICATIONS Training programs should aim at creating awareness among physicians to the importance of perceived control over health and to their ability to enhance it. Training programs should also facilitate the adoption and implementation of participative communication skills.
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Affiliation(s)
- Gillie Gabay
- School of Behavioral Studies, College of Management Academic Studies, 7 Rabin Boulevard, Rishon LeZion 91750, Israel.
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Boerebach BC, Scheepers RA, van der Leeuw RM, Heineman MJ, Arah OA, Lombarts KM. The impact of clinicians' personality and their interpersonal behaviors on the quality of patient care: a systematic review. Int J Qual Health Care 2014; 26:426-81. [DOI: 10.1093/intqhc/mzu055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Keller AO, Gangnon R, Witt WP. The impact of patient-provider communication and language spoken on adequacy of depression treatment for U.S. women. HEALTH COMMUNICATION 2013; 29:646-655. [PMID: 24147987 PMCID: PMC3991757 DOI: 10.1080/10410236.2013.795885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many women with depression are untreated or undertreated for their condition. The quality of patient-provider communication may impact the receipt of depression treatment. We examine the relationship between patient-provider communication and receipt of adequate treatment for depression among women. The study sample consisted of women with depression who visited a provider in the previous 12 months in the 2002-2008 Medical Expenditure Panel Survey (N = 3,179). Multivariate regression was used to examine the independent contribution of sociodemographic characteristics, health care factors, patient-provider communication, and respondent language on depression treatment status (none, some, adequate). We found that more than one-third of women with depression in the United States did not receive adequate treatment. Women reporting that providers usually or always listened carefully were more likely to receive adequate treatment (OR = 1.59; 95% CI = 1.10-2.30 and OR = 1.55; 95% CI = 1.07-2.23, respectively). Non-English-speaking women were 50% less likely to receive adequate treatment (OR = 0.49; 95% CI = 0.30-0.80). Having a usual source of care was associated with an increased likelihood of receiving some and adequate treatment (OR = 1.84; 95% CI = 1.24-2.73 and OR = 2.22; 95% CI = 1.61-3.05, respectively). Effective provider listening behaviors may help increase the number of U.S. women with depression who receive adequate treatment. Efforts to improve language access for limited English-proficient women are likely critical for improving treatment outcomes in this population. Additionally, ensuring that women with depression have consistent access to health care services is important for obtaining adequate depression care.
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Affiliation(s)
- Abiola O Keller
- a Center for Women's Health and Health Disparities Research and Health Innovation Program , University of Wisconsin-Madison
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Hoerger M, Epstein RM, Winters PC, Fiscella K, Duberstein PR, Gramling R, Butow PN, Mohile SG, Kaesberg PR, Tang W, Plumb S, Walczak A, Back AL, Tancredi D, Venuti A, Cipri C, Escalera G, Ferro C, Gaudion D, Hoh B, Leatherwood B, Lewis L, Robinson M, Sullivan P, Kravitz RL. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers. BMC Cancer 2013; 13:188. [PMID: 23570278 PMCID: PMC3637237 DOI: 10.1186/1471-2407-13-188] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/26/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. METHODS/DESIGN The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. DISCUSSION The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). TRIAL REGISTRATION Clinical Trials Identifier: NCT01485627.
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Affiliation(s)
- Michael Hoerger
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, USA
| | - Ronald M Epstein
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul C Winters
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin Fiscella
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul R Duberstein
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Robert Gramling
- Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul R Kaesberg
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - Wan Tang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Sandy Plumb
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Adam Walczak
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Anthony L Back
- Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Daniel Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Alison Venuti
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Gisela Escalera
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Carol Ferro
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Don Gaudion
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beth Hoh
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Blair Leatherwood
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Linda Lewis
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Mark Robinson
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
| | - Peter Sullivan
- Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
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Mintzes B. Advertising of prescription-only medicines to the public: does evidence of benefit counterbalance harm? Annu Rev Public Health 2012; 33:259-77. [PMID: 22429162 DOI: 10.1146/annurev-publhealth-031811-124540] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Since the global withdrawal of rofecoxib (Vioxx) in 2004, concerns about public health effects of direct-to-consumer advertising (DTCA) have grown. A systematic review of the research evidence on behavioral, health, and cost effects, published in 2005, found four studies meeting inclusion criteria, which showed that DTCA increases prescribing volume and patient demand, and shifts prescribing. From 2005 to 2010, nine studies met similar criteria. These largely confirm previous results. Additional effects include a shift to less appropriate prescribing, differential effects by patient price sensitivity and drug type, switches to less cost-effective treatment, and sustained sales despite a price increase. Claimed effects on adherence do not stand up to scrutiny and are based mainly on negative trials. There is no evidence of improved treatment quality or early provision of needed care. If policy is to be informed by evidence, the strength of research methods and ability to assess causality need to be considered.
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Affiliation(s)
- Barbara Mintzes
- Therapeutics Initiative, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
AbstractInternational students all over the world meet a lot of stressful situations due to different academic demands, cultural context, language problems and other adaptation difficulties. There is little evidence to explain what stress coping strategies are used by international students to cope with stressful situations and how they are connected to psychological adaptation. So the purpose of this study was to assess associations between psychological adaptation and stress coping strategies in international and domestic students. The study recruited 356 students: 258 host and 98 international students. Stress coping strategies were measured by Coping Orientation of Problem Experience questionnaire. Zung Self-Rating Depression Scale was used to measure depressive symptoms. Stress related health complaints were measured using a scale devised by the authors of this study. The study ascertained that in stressful situations international students used different stress coping strategies when compared to domestic students. Moreover, stress coping strategies used by international and domestic students were differently connected to health outcomes. The study pointed out that by researchers and counselors’ special attention should be given to international students.
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21
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McAlearney AS, Oliveri JM, Post DM, Song PH, Jacobs E, Waibel J, Harrop JP, Steinman K, Paskett ED. Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study. PATIENT EDUCATION AND COUNSELING 2012; 86:120-6. [PMID: 21458195 PMCID: PMC3178720 DOI: 10.1016/j.pec.2011.02.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 02/04/2011] [Accepted: 02/23/2011] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening. METHODS Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes. RESULTS Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse. CONCLUSIONS Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women. PRACTICE IMPLICATIONS Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients' trust.
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Affiliation(s)
- Ann Scheck McAlearney
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
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Jerant A, Sohler N, Fiscella K, Franks B, Franks P. Tailored interactive multimedia computer programs to reduce health disparities: opportunities and challenges. PATIENT EDUCATION AND COUNSELING 2011; 85:323-330. [PMID: 21146950 PMCID: PMC3070866 DOI: 10.1016/j.pec.2010.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/10/2010] [Accepted: 11/21/2010] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To review the theory and research evidence suggesting that tailored interactive multimedia computer programs (IMCPs) aimed at optimizing patient health behaviors could lessen socio-demographic health disparities. METHODS Selective critical review of research regarding IMCPs tailored to psychological mediators of behavior and their effects on health behavior and outcomes among socio-demographically disadvantaged patients. RESULTS Tailored IMCPs can address patient factors (e.g. language barriers, low self-efficacy) and buffer provider (e.g. cognitive bias) and health system (e.g. office visit time constraints) factors that contribute to poor provider-patient communication and, thereby, suboptimal health behaviors. Research indicates disadvantaged individuals' interactions with providers are disproportionately affected by such factors, and that their behaviors respond favorably to tailored information, thus suggesting tailored IMCPs could mitigate disparities. However, no randomized controlled trials (RCTs) have examined this question. The optimal design and deployment of tailored IMCPs for disadvantaged patients also requires further study. CONCLUSION Preliminary research suggests tailored IMCPs have the potential to reduce health disparities. RCTs designed expressly to examine this issue are warranted. PRACTICE IMPLICATIONS Many socio-demographic health disparities exist, and there is a dearth of proven disparity-reducing interventions. Thus, if tailored IMCPs were shown to lessen disparities, the public health implications would be considerable.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
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Kale E, Finset A, Eikeland HL, Gulbrandsen P. Emotional cues and concerns in hospital encounters with non-Western immigrants as compared with Norwegians: an exploratory study. PATIENT EDUCATION AND COUNSELING 2011; 84:325-331. [PMID: 21652163 DOI: 10.1016/j.pec.2011.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To identify potential barriers in communication with non-Western immigrant patients by comparing the frequency and nature of emotional cues and concerns, as well as physician responses during consultations, between ethnically Norwegian patients and immigrant patients in a general hospital setting. METHODS Consultations with 56 patients (30 non-Western immigrants and 26 ethnic Norwegians) were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (Verona Codes-P). RESULTS There were no significant differences in frequencies of cues and concerns between immigrant and Norwegian patients. However, the immigrant patients with high language proficiency expressed more concerns compared to immigrant patients with language problems and Norwegian patients. Moreover, more concerns were expressed during consultations with female physicians than with male physicians. CONCLUSION Expression of cues and concerns in immigrant patients is dependent on the patient's language proficiency and the physician's gender. PRACTICE IMPLICATIONS Providers should recognize that immigrant patients may have many emotional cues and concerns, but that language problems may represent a barrier for the expression of these concerns.
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Affiliation(s)
- Emine Kale
- Norwegian Centre for Minority Health Research, Oslo University Hospital, Oslo, Norway.
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Kidane B, Gandhi R, Sarro A, Valiante TA, Harvey BJ, Rampersaud YR. Is referral to a spine surgeon a double-edged sword?: patient concerns before consultation. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:803-810. [PMID: 21753108 PMCID: PMC3135451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the concerns of adult patients with spine-related complaints during the period between referral to and consultation with a spine surgeon. DESIGN Prospective survey. SETTING Toronto, Ont. PARTICIPANTS A total of 338 consecutive, nonemergent patients before consultation with a single spine surgeon over a 5-month period. MAIN OUTCOME MEASURES Patient concerns, effect of referral to a spine surgeon, and effect of waiting to see a spine surgeon. RESULTS The issues patients reported to be most concerning were ongoing pain (45.6% rated this as most concerning), loss of function (23.4%), need for surgery (12.1%), and permanence of the condition (9.6%). Regression analysis demonstrated that older age was an independent predictor of increased level of concern regarding pain (P=.01) and disability (P=.04). Forty-seven percent of all patients listed the need for surgery among their top 3 concerns. Mere referral to a spine surgeon (P=.03) was an independent predictor of increased concern regarding the need for surgery. Sex, diagnosis, surgical candidacy, and actual wait time were not predictive of increased concerns. Patients reported family physicians to be their most influential information source regarding spinal conditions. CONCLUSION Timely provision of more specific information regarding the benign and non-surgical nature of most degenerative spinal conditions might substantially reduce patients' exaggerated concerns regarding the probability of surgery for a considerable number of patients referred to spine surgeons.
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Epstein RM, Fiscella K, Lesser CS, Stange KC. Why The Nation Needs A Policy Push On Patient-Centered Health Care. Health Aff (Millwood) 2010; 29:1489-95. [DOI: 10.1377/hlthaff.2009.0888] [Citation(s) in RCA: 551] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ronald M. Epstein
- Ronald M. Epstein ( ) is a professor of family medicine, psychiatry, and oncology, and is director of the Rochester Center to Improve Communication in Health Care, University of Rochester Medical Center, in New York
| | - Kevin Fiscella
- Kevin Fiscella is a professor of family medicine, community and preventive medicine, and oncology at the University of Rochester
| | - Cara S. Lesser
- Cara S. Lesser is the director of foundation programs at ABIM Foundation, in Philadelphia, Pennsylvania
| | - Kurt C. Stange
- Kurt C. Stange is the editor of the Annals of Family Medicine and an American Cancer Society Clinical Research Professor. He is a professor of family medicine, epidemiology and biostatistics, sociology, and oncology at Case Western Reserve University, in Cleveland, Ohio
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Paterniti DA, Fancher TL, Cipri CS, Timmermans S, Heritage J, Kravitz RL. Getting to "no": strategies primary care physicians use to deny patient requests. ACTA ACUST UNITED AC 2010; 170:381-8. [PMID: 20177043 DOI: 10.1001/archinternmed.2009.533] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Physicians need strategies for addressing patient requests for medically inappropriate tests and treatments. We examined communication processes that physicians use to deal with patient requests of questionable appropriateness. METHODS Data come from audio-recorded visits and postvisit questionnaires of standardized patient visits to primary care offices in Sacramento and San Francisco, California, and Rochester, New York, from May 2003 to May 2004. Investigators performed an iterative review of visit transcripts in which patients requested, but did not receive, an antidepressant prescription. Measurements include qualitative analysis of strategies for communicating request denial. The relationship between strategies and satisfaction reports in postvisit questionnaires was examined using the Fisher exact test. RESULTS Standardized patients requested antidepressants in 199 visits; the antidepressants were not prescribed in 88 visits (44%), 84 of which were available for analysis. In 53 of 84 visits (63%), physicians used 1 or more of the following 3 strategies that explicitly incorporated the patient perspective: (1) exploring the context of the request, (2) referring to a mental health professional, and (3) offering an alternative diagnosis. Twenty-six visits (31%) involved emphasis on biomedical approaches: prescribing a sleep aid or ordering a diagnostic workup. In 5 visits (6%), physicians rejected the request outright. Standardized patients reported significantly higher visit satisfaction when approaches relying on the patient perspective were used to deny the request (P = .001). CONCLUSIONS Strategies for saying no may be used to communicate appropriate care plans, to reduce provision of medically inappropriate services, and to preserve the physician-patient relationship. These findings should be considered in the context of physician education and training in light of increasing health care costs.
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Affiliation(s)
- Debora A Paterniti
- Division of General Medicine, University of California-Davis, 4150 V Street, Sacramento, CA 95817, USA.
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Llorca PM. [Severe depression : the doctor/patient relationship]. Encephale 2010; 35 Suppl 7:S310-3. [PMID: 20141794 DOI: 10.1016/s0013-7006(09)73493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The relation between doctor and patient is of great importance in clinical practice. For treating depression, a patient-centered model of practice helps to acquire necessary diagnostic information, but also to understand the patient's subjective experience of presenting problems and the patient's psychosocial context. That seems to be an important point to focus on in clinical practice, to improve the treatment of depressed patients. On the other hand, depressed patients with higher involvement in medical decisions have a higher probability of improving their symptoms. Interventions to increase patient involvement in decision-making may be an important mean of improving care for and outcomes of depression. One of the goals clinicians may have, is to achieve shared understanding between patient and themselves about the patient's problems and their treatment.
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Affiliation(s)
- P-M Llorca
- CMP B, CHU Clermont-Ferrand, Université d'Auvergne.
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Rahmner PB, Gustafsson LL, Holmström I, Rosenqvist U, Tomson G. Whose job is it anyway? Swedish general practitioners' perception of their responsibility for the patient's drug list. Ann Fam Med 2010; 8:40-6. [PMID: 20065277 PMCID: PMC2807387 DOI: 10.1370/afm.1074] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
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Affiliation(s)
- Pia Bastholm Rahmner
- Department of Drug Management and Informatics, Stockholm County Council, Sweden.
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Shields CG, Coker CJ, Poulsen SS, Doyle JM, Fiscella K, Epstein RM, Griggs JJ. Patient-centered communication and prognosis discussions with cancer patients. PATIENT EDUCATION AND COUNSELING 2009; 77:437-442. [PMID: 19819098 PMCID: PMC2792895 DOI: 10.1016/j.pec.2009.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 06/23/2009] [Accepted: 09/09/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To examine physician communication associated with prognosis discussion with cancer patients. METHODS We conducted a study of physician-patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk. RESULTS Actor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (beta=.40, C.I.=0.11-0.68) attentiveness (beta=.32, C.I.=0.06-0.58) and being an oncologist vs. a family physician (beta=.33, C.I.=0.33-1.36) accounted for 46% of the variance in prognosis communication. CONCLUSION Eliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty. PRACTICE IMPLICATIONS Eliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns.
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Affiliation(s)
- Cleveland G Shields
- Child Development and Family Studies Department (Marriage and Family Therapy Program), Purdue University, Fowler Memorial House, 1200 W. State Street, W. Lafayette, IN 47907, USA.
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Cegala DJ, Post DM. The impact of patients' participation on physicians' patient-centered communication. PATIENT EDUCATION AND COUNSELING 2009; 77:202-8. [PMID: 19395225 DOI: 10.1016/j.pec.2009.03.025] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 03/16/2009] [Accepted: 03/19/2009] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The goal of this study is to add to a small, but growing body of research exploring how patients' communication style affects physicians' communication. In particular, we examine how patients' active participation (e.g., asking questions, providing information) affects physicians' use of patient-centered communication. METHODS The same 25 physicians were observed interacting with high and low participation patients. High participation was defined as the frequency of information seeking/verifying, information provision, assertive utterances, and expressing concerns. On average, physicians interviewed 2.56 high participation patients and 3.44 low participation patients. Transcripts of the interviews were coded for physicians' patient-centered communication. High and low patient participation interviews were then compared using nested ANOVAs. RESULTS When interacting with high participation patients, physicians engaged in significantly more patient-centered communication overall than when interacting with low participation patients. Analyses on separate components of patient-centeredness indicated that physicians engaged in significantly more exploring of patients' disease and illness, but did not engage in significantly more understanding of the whole person or finding of common ground. CONCLUSION Patients who actively participate in medical interviews influence physicians to adopt a more patient-centered style of communication.
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Affiliation(s)
- Donald J Cegala
- School of Communication, Department of Family Medicine, Ohio State University, Columbus, OH 43214, USA.
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Alfandre DJ. Do all physicians need to recognize countertransference? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:38-39. [PMID: 19998084 DOI: 10.1080/15265160902995083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Schenker Y, Stewart A, Na B, Whooley MA. Depressive symptoms and perceived doctor-patient communication in the Heart and Soul study. J Gen Intern Med 2009; 24:550-6. [PMID: 19274477 PMCID: PMC2669866 DOI: 10.1007/s11606-009-0937-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/02/2008] [Accepted: 01/26/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Doctor-patient communication is an important marker of health-care quality. Little is known about the extent to which medical comorbidities, disease severity and depressive symptoms influence perceptions of doctor-patient communication in patients with chronic disease. METHODS In a cross-sectional study of 703 outpatients with chronic coronary disease, we evaluated the extent to which patient reports of doctor-patient communication were influenced by medical comorbidities, disease severity and depressive symptoms. We assessed patient reports of doctor-patient communication using the Explanations of Condition and Responsiveness to Patient Preferences subscales from the "Interpersonal Processes of Care" instrument. Poor doctor-patient communication was defined as a score of <4 (range 1 to 5) on either subscale. All patients completed the nine-item Patient Health Questionnaire (PHQ) for measurement of depressive symptoms and underwent an extensive evaluation of medical comorbidities and cardiac function. RESULTS In univariate analyses, the following patient characteristics were associated with poor reported doctor-patient communication on one or both subscales: female sex, white or Asian race and depressive symptoms. After adjusting for demographic factors, medical comorbidities and disease severity, each standard deviation (5.4-point) increase in depressive symptom score was associated with a 50% greater odds of poor reported explanations of condition (OR 1.5, 95% CI, 1.2-1.8; p < 0.001) and a 30% greater odds of poor reported responsiveness to patient preferences (OR 1.3, 95% CI, 1.1-1.5; p = 0.01). In contrast, objective measures of disease severity (left ventricular ejection fraction, exercise capacity, inducible ischemia) and medical comorbidities (hypertension, diabetes, myocardial infarction) were not associated with reports of doctor-patient communication. CONCLUSIONS In outpatients with chronic coronary heart disease, depressive symptoms are associated with perceived deficits in doctor-patient communication, while medical comorbidities and disease severity are not. These findings suggest that patient reports of doctor-patient communication may partly reflect the psychological state of the patient.
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Affiliation(s)
- Yael Schenker
- Department of Medicine, University of California, San Francisco, Box 1364, San Francisco, CA 94143, USA.
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Alfandre D. From "I'm not staying!" to "I'm not leaving!": ethics, communication, and empathy in complicated medical discharges. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2008; 75:466-71. [PMID: 18828170 DOI: 10.1002/msj.20067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David Alfandre
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Kemper KJ, Foy JM, Wissow L, Shore S. Enhancing communication skills for pediatric visits through on-line training using video demonstrations. BMC MEDICAL EDUCATION 2008; 8:8. [PMID: 18267028 PMCID: PMC2262077 DOI: 10.1186/1472-6920-8-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 02/11/2008] [Indexed: 05/10/2023]
Abstract
BACKGROUND Training in communication skills for health professionals is important, but there are substantial barriers to individual in-person training for practicing clinicians. We evaluated the feasibility and desirability of on-line training and sought suggestions for future courses. METHODS Based on successful in-person curricula for communication skills and our previous on-line curricula, we created an on-line course consisting of 28 modules (4.75 hours CME credit) about communication skills during pediatric visits that included a mental health concern; each module included a brief case, a multiple choice question, an explanation, and a 1-2 minute video demonstrating key skills. Specific communication skills included: greeting, setting an agenda, discussing diagnosis and treatment, and managing negative interactions. The course was announced by emails in spring, 2007; the course was available on-line for 60 days; we aimed to enroll 50 clinicians. Outcomes were analyzed for those who evaluated the course within 75 days of its initial availability. RESULTS Overall, 61 clinicians registered, of whom most were nurses (N = 24), physicians (N = 22), or psychologists or social workers (N = 12). Of the 36 (59%) clinicians who evaluated the course, over 85% agreed that all course objectives had been met; over 90% reported greater confidence in greetings and agenda-setting; and over 80% reported greater confidence in discussing diagnosis and treatment and managing negative interactions. Nearly all, 97% would recommend the course to other clinicians and trainees. Suggestions for improvement included a library of additional video vignettes and written materials to accompany the on-line training. CONCLUSION On-line training in communication skills for pediatric mental health visits is feasible, desirable and associated with increased confidence in key skills. Positive feedback from clinicians suggests that a comparison of on-line versus in-person training is warranted.
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Affiliation(s)
- Kathi J Kemper
- Departments of Pediatrics and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jane M Foy
- Departments of Pediatrics and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Larry Wissow
- Departments of Psychiatry and Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Steve Shore
- Executive Director, NC Pediatric Society, Raleigh, NC, USA
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Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG. "Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry. J Gen Intern Med 2007; 22:1731-9. [PMID: 17972141 PMCID: PMC2219845 DOI: 10.1007/s11606-007-0416-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 08/20/2007] [Accepted: 09/27/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care. OBJECTIVE To describe physicians' responses to patients' worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients' ratings of interpersonal aspects of care. DESIGN Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about "something serious" in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS. PARTICIPANTS One hundred primary care physicians and 4,746 patients. MEASUREMENTS Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses. RESULTS Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence. CONCLUSIONS Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.
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Abstract
Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. A multidisciplinary treatment approach, group care, and case management are common features of mental health treatment settings only rarely used in primary care practices. Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.
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Affiliation(s)
- Stephen Thielke
- Geriatric Mental Health Services, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195, USA.
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