Patient perspectives on how to demonstrate respect: Implications for clinicians and healthcare organizations

Reimagining the approach for advancing maternal health equity through authentic patient engagement and research practices

High maternal mortality and morbidity rates continue to significantly impact the United States, with Black birthing individuals being two to three times more likely to die from pregnancy related causes compared to other races. Ongoing discussions are crucial to improving care delivery and amplifying the experiences and needs of marginalized survivors of pregnancy-related psychological harm. Thus, this commentary leverages current literature and vignettes to deliver recommendations on authentically engaging patients in the cross-sectoral process of dismantling harmful clinical and research practices, thus building a safe, equitable future for maternal health.

How patients experience respect in healthcare: findings from a qualitative study among multicultural women living with HIV

BACKGROUND

Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients' views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians.

METHODS

We analyzed 57 semi-structured interviews conducted at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant's language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about "respect." After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes.

RESULTS

Results from this study grouped into two overarching classifications: respect manifested in physicians' orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider's orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy.

CONCLUSIONS

Findings suggest a more robust conception of what 'respect for persons' entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery.

Lebanese nursing students' perceptions of barriers to the implementation of person-centered care in clinical settings: A qualitative study

AIM

This study aims to investigate how Lebanese nursing students perceive the challenges of implementing person-centered care in clinical settings.

DESIGN

A qualitative descriptive design was adopted for this study.

METHODS

At one of Lebanon's top universities, a qualitative descriptive study design was used with 18 nursing students from various academic levels. Content analysis was used to generate the results after three focus group discussions. The Consolidated Criteria for Reporting Qualitative Research were used to report this study.

RESULTS

The content analysis gave rise to four main themes, namely, "overload", "challenges with education", "unawareness", "establishing connection", and "lack of initiatives related to policy". The results showed a number of obstacles that Lebanese nursing students believed were in the path of providing person-centered care. These obstacles included organisational issues like time restraints and an intense workload, as well as interaction difficulties with patients and healthcare teams, and educational issues like insufficient instruction in person-centered care concepts during nursing programs.

Fear of dying dirty: Intimate care encounters during COVID-19 pandemic in South African context

Background

Physical distancing, personal protective equipment (PPE) and hand hygiene were encouraged during the pandemic of COVID-19. However, personal hygiene procedures for patients admitted to hospitals, such as assisted baths, oral care and elimination, were neglected.

Aim

This study aimed to describe intimate care and touch experiences for patients admitted to the hospital during the COVID-19 pandemic lockdown.

Setting

This study was conducted in the medical and surgical units of two hospitals in Gauteng province.

Methods

A generic qualitative approach was used to explore and describe the patients' intimate care and touch experiences during the COVID-19 hard lockdown. In-patient individuals above 18 years were purposively sampled. Twelve patients aged between 28 and 60 years participated in semi-structured interviews. Data were analysed using thematic analysis.

Results

Three central themes emerged from the data: (1) Keeping away from the body, (2) Who is touching my body? and (3) Fear of dying dirty - a sense of losing bodily dignity. The participants felt that the nurses were trying to avoid them, as they were seen as potential carriers of the COVID-19 pandemic.

Conclusion

The cleanliness of a patient's body gives them a sense of self-respect and dignity. Nurses should find ways to ensure that patients receive quality intimate care and touch, even during situations such as the pandemic.

Contribution

Patients' religious or cultural beliefs and anxieties about dying dirty should be acknowledged and respected in nursing care to provide quality bodily care for all patients.

Racial and ethnic disparities in the perception of respect from physicians among skin cancer patients in the United States

Background

Racial and ethnic minority groups are at increased risk of poor skin cancer outcomes. Successful patient-physician communication is linked to better health outcomes, but it is unknown whether disparities in perceived care exist among skin cancer patients.

Objective

To investigate whether there are racial and ethnic disparities in the perception of physicians showing respect, listening, and explaining during clinical encounters.

Methods

A cross-sectional study was conducted using data from participants with a self-reported skin cancer history from the 2008 to 2017 and 2019 Medical Expenditure Panel Survey. Race and ethnicity were self-identified.

Results

Of 5570 participants, 5263 were non-Hispanic White and 307 were racial and ethnic minority individuals. Racial and ethnic minority participants were less likely to report that their doctors show them respect, listen to, and explain to them than non-Hispanic White participants, even when adjusting for age, sex, insurance type, health status, and survey year. Among racial and ethnic minority participants, perceptions of physicians listening and explaining were strongly associated with perceived respect.

Limitations

Lack of disaggregated racial and ethnic subgroup analysis.

Conclusions

Our findings suggest racial and ethnic disparities in perceived care among skin cancer patients. Future research is warranted to determine whether such perceptions contribute to disparities in skin cancer care and/or outcomes.

Toward Meeting the Obligation of Respect for Persons in Pragmatic Clinical Trials

Research ethics oversight systems have traditionally emphasized the informed consent process as the primary means by which to demonstrate respect for prospective subjects. Yet how researchers can best fulfill the ethical obligations of respect for persons in pragmatic clinical trials (PCTs)-particularly those that may alter or waive informed consent-remains unknown. We propose eight dimensions of demonstrating respect in PCTs: (1) engaging patients and communities in research design and execution, (2) promoting transparency and open communication, (3) maximizing agency, (4) minimizing burdens and promoting accessibility, (5) protecting privacy and confidentiality, (6) valuing interpersonal interactions with clinicians and study team members, (7) providing compensation, and (8) maximizing social value. While what respect requires in the context of PCTs will vary based on the nature of the PCT in question, the breadth of these dimensions demonstrates that respect obligations extend beyond informed consent processes.

Perceptions of Respect From Clinicians by Patients in Racial and Ethnic Minority Groups With Eye Disease

Importance

The perception of being treated with respect by clinicians may be a driver of disparities in individuals in racial and ethnic minoritie groups with eye diseases. Understanding these drivers may help identify potential interventions to reduce eye health disparities to prevent vision loss and blindness.

Objective

To evaluate the association between racial and ethnic minority status and the perception of being treated with respect by clinicians.

Design, Setting, and Participants

This cross-sectional analysis of a nationally representative cohort study using data from the National Health Interview Survey (NHIS) included participants in the 2017 survey with complete data on outcomes, associated factors, and covariates. Data analysis took place from January 2021 to February 2021. Using a population-based survey conducted in the US in 2017 by the US census bureau on behalf of the National Center for Health Statistics, NHIS study participants (age ≥18 years) who self-reported having an eye disease (macular degeneration, diabetic retinopathy [DR], glaucoma, cataracts) were included, and patients who self-reported as Black, Asian, other/multiple races, or Hispanic ethnicity were considered to be in racial and ethnic minority groups.

Main Outcomes and Measures

Multivariable logistic regression models were used to evaluate the association of minority status with self-reported "always" being treated with respect by clinicians and self-reported "always" being asked about opinions/beliefs about medical care.

Results

Participants in racial and ethnic minority groups had 23% lower odds of reporting being treated with respect compared with non-Hispanic White patients (adjusted odds ratio [AOR], 0.77; 95% CI, 0.61-0.97; P = .03). A minority of participants had 66% higher odds of reporting being asked about their beliefs (AOR, 1.66; 95% CI, 1.39-1.98; P < .001). For all patients, being asked about opinions/beliefs by their clinician was associated with a 5.8 times higher odds of reporting being treated with respect (AOR, 5.80; 95% CI, 4.35-7.74; P < .001).

Conclusions and Relevance

In this nationally representative US population of patients with eye diseases, being a patient in a racial or ethnic minority group was associated with feeling less respected by health care professionals compared with non-Hispanic White patients. Asking about opinions and beliefs, regardless of race or ethnicity, is associated with patients feeling that they are treated with respect.