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Afzal N, Merchant AAH, Shaikh NQ, Noorali AA, Ahmad R, Ahmed S, Khan AA, Bakhshi SK, Abdul Rahim K, Mahmood SBZ, Lakhdir MPA, Khan MR, Tariq M, Haider AH. Patient-resident physician communication - a qualitative study to assess the current state, challenges and possible solutions. BMC Health Serv Res 2024; 24:917. [PMID: 39128993 PMCID: PMC11318183 DOI: 10.1186/s12913-024-11387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Patients perceive effective patient-doctor communication as an important metric when evaluating their satisfaction with health systems. Hence, optimal patient-physician communication is fundamental for quality healthcare. High-income countries (HICs) have extensively studied patient-resident communication. However, there is a dearth of similar studies in low- and middle-income countries (LMICs). Therefore, we aimed to explore the current state of and barriers to practicing good patient-resident communication and explore possible solutions to mitigate these challenges at one of the largest Academic Medical Centers in an LMIC. METHODS This study employed an exploratory qualitative study design and was conducted at the Aga Khan University Hospital in Pakistan. Through purposive maximum variation sampling, 60 healthcare workers from diverse cohorts, including attendings, fellows, residents, and medical students, participated in eight focus group discussions. RESULTS We identified three key themes from the data: Status-quo of residents' communication skills and learning (Poor verbal and non-verbal communication, inadequate training programs, and variable sources of learning), Barriers to effective communication (Institutional barriers such as lack of designated counselling spaces, lack of resident insight regarding effective communication and deficits in intra-team communication), and the need for developing a communication skills curriculum (Design, implementation and scaling to other cohorts of healthcare workers). CONCLUSIONS Findings from this study show that multifaceted factors are responsible for inadequate patient resident-physician communication, highlighting the need for and importance of developing a formal communication skills training curriculum for residents. These insights can be used to create standardized training for equipping residents with adequate skills for effectively communicating with patients which can improve healthcare service delivery and patient outcomes.
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Affiliation(s)
- Noreen Afzal
- Department of Surgery, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | | | | | - Ali Aahil Noorali
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, United States
| | - Rida Ahmad
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Department of Surgery, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Muhammad Rizwan Khan
- Department of Surgery, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Muhammad Tariq
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan
| | - Adil H Haider
- Department of Surgery, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
- Dean's Office, Medical College, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
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Islam MA, Benzir M, Siddique MKB, Awal MA, Chowdhury MAK, Joarder T. Validation of the Bangla version of the Communication Skills Attitude Scale with the medical students of Bangladesh. Health Sci Rep 2024; 7:e2274. [PMID: 39100714 PMCID: PMC11294438 DOI: 10.1002/hsr2.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background Effective communication skill of physicians is an important component of high-quality healthcare delivery and safe patient care. Communication is embedded in the social and cultural contexts where it takes place. An understanding of medical students' attitudes and learning communication skills would help to design and deliver culturally appropriate medical education. The Communication Skills Attitude Scale (CSAS) is a widely used and validated tool to measure the attitude of medical students toward learning communication skills in different populations, settings, and countries. However, there is no culturally adapted and validated scale in Bangla in the Bangladesh context. This study aims to culturally adapt the CSAS into Bangla, and validate it in a cohort of medical students in Bangladesh. Methods This study used a cross-sectional survey design to collect data from purposively selected 566 undergraduate medical students from the Rajshahi division. The survey was conducted from January to December 2023. Descriptive statistics like frequency distribution and measures of central tendency were used to measure perception regarding communication skills. The sample adequacy was measured through the Kaiser-Meyer-Olkin test. The internal consistency of the items was identified using Cronbach's alpha (α) coefficients. Result The results of the study show that the Bangla version of the scale is feasible, valid, and internally consistent in the context of a developing country, Bangladesh. The overall internal consistency of the Bangla version is good since the value of Cronbach's alpha (α) is 0.882. For PAS, the internal consistency is 0.933. While, for NAS, the value is 0.719. The item-wise average scores in the PAS indicate that female medical students are more willing to learn communication skills compared with male students (α = 0.933). While, the scores in the NAS indicate that the male students tend to have more negative attitude toward learning communication skills compared with female students (α = 0.719). Conclusion The CSAS-Bangla is a valid and reliable tool for assessing communication skill attitudes among Bangla speaking medical students. This scale can be used in future studies to measure the attitude of students, designing and evaluating communication skills training programs in medical colleges.
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Affiliation(s)
- Mohammad Aminul Islam
- Department of Media Studies and JournalismUniversity of Liberal Arts BangladeshDhakaBangladesh
| | - Maskura Benzir
- Department of AnatomyTMSS Medical CollegeBoguraBangladesh
| | | | - Md. Abdul Awal
- Department of Public HealthVarendra UniversityRajshahiBangladesh
| | | | - Taufique Joarder
- Global Health EvaluationSingHealth Duke‐NUS Global Health InstituteSingaporeSingapore
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Sensky T. The Person-Centred Clinical Interview. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:237-243. [PMID: 38830341 DOI: 10.1159/000539055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Tom Sensky
- Centre for Mental Health, Department of Brain Sciences, Imperial College London, London, UK
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Akinrolie O, Ripat J, Strachan S, Webber SC, Barclay R. Virtual Motivational Interviewing (VIMINT) to support physical activity: Experiences of older adults and counsellors. J Health Psychol 2024:13591053241235094. [PMID: 38414103 DOI: 10.1177/13591053241235094] [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: 02/29/2024] Open
Abstract
The aim of this study was to explore the experiences of older adults and counsellors involved in virtual motivational interviewing (MI). This study was part of the Virtual Motivational INTerviewing (VIMINT) feasibility trial of virtual MI for physical activity in older adults. A descriptive qualitative design utilized content analysis. Seven older adults and three counsellors were interviewed. Four categories were developed: (i) Benefits and limitations of using technology (ii) Relationships between older adults and counsellors (iii) MI skills and spirit and (iv) Effects of virtual MI. Older adults and counsellors reported that receiving/delivering MI virtually was convenient and flexible. They described reduced non-verbal communication in virtual MI. Virtual MI facilitates interpersonal relationships, and counsellors reported that MI skills and spirit can be applied virtually. This study showed that virtual MI offers potential benefits with some limitations. The findings could inform future research involving virtual delivery of MI.
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Buhr CR, Smith H, Huppertz T, Bahr-Hamm K, Matthias C, Blaikie A, Kelsey T, Kuhn S, Eckrich J. ChatGPT Versus Consultants: Blinded Evaluation on Answering Otorhinolaryngology Case-Based Questions. JMIR MEDICAL EDUCATION 2023; 9:e49183. [PMID: 38051578 PMCID: PMC10731554 DOI: 10.2196/49183] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/20/2023] [Accepted: 10/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Large language models (LLMs), such as ChatGPT (Open AI), are increasingly used in medicine and supplement standard search engines as information sources. This leads to more "consultations" of LLMs about personal medical symptoms. OBJECTIVE This study aims to evaluate ChatGPT's performance in answering clinical case-based questions in otorhinolaryngology (ORL) in comparison to ORL consultants' answers. METHODS We used 41 case-based questions from established ORL study books and past German state examinations for doctors. The questions were answered by both ORL consultants and ChatGPT 3. ORL consultants rated all responses, except their own, on medical adequacy, conciseness, coherence, and comprehensibility using a 6-point Likert scale. They also identified (in a blinded setting) if the answer was created by an ORL consultant or ChatGPT. Additionally, the character count was compared. Due to the rapidly evolving pace of technology, a comparison between responses generated by ChatGPT 3 and ChatGPT 4 was included to give an insight into the evolving potential of LLMs. RESULTS Ratings in all categories were significantly higher for ORL consultants (P<.001). Although inferior to the scores of the ORL consultants, ChatGPT's scores were relatively higher in semantic categories (conciseness, coherence, and comprehensibility) compared to medical adequacy. ORL consultants identified ChatGPT as the source correctly in 98.4% (121/123) of cases. ChatGPT's answers had a significantly higher character count compared to ORL consultants (P<.001). Comparison between responses generated by ChatGPT 3 and ChatGPT 4 showed a slight improvement in medical accuracy as well as a better coherence of the answers provided. Contrarily, neither the conciseness (P=.06) nor the comprehensibility (P=.08) improved significantly despite the significant increase in the mean amount of characters by 52.5% (n= (1470-964)/964; P<.001). CONCLUSIONS While ChatGPT provided longer answers to medical problems, medical adequacy and conciseness were significantly lower compared to ORL consultants' answers. LLMs have potential as augmentative tools for medical care, but their "consultation" for medical problems carries a high risk of misinformation as their high semantic quality may mask contextual deficits.
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Affiliation(s)
- Christoph Raphael Buhr
- Department of Otorhinolaryngology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Harry Smith
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | - Tilman Huppertz
- Department of Otorhinolaryngology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina Bahr-Hamm
- Department of Otorhinolaryngology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrew Blaikie
- School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Tom Kelsey
- School of Computer Science, University of St Andrews, St Andrews, United Kingdom
| | - Sebastian Kuhn
- Institute of Digital Medicine, Philipps-University Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Jonas Eckrich
- Department of Otorhinolaryngology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Devillers L, Subts A, De Bandt D, Druais PL, Gilles de la Londe J. Patients' experiences of being touched by their general practitioner: a qualitative study. BMJ Open 2023; 13:e071701. [PMID: 37524558 PMCID: PMC10391798 DOI: 10.1136/bmjopen-2023-071701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE This study aimed to explore patients' experiences and perceptions of touch, as practised by their general practitioner during their medical appointment. DESIGN Qualitative study using grounded theory method, based on individual interviews. Data collection and analysis occurred iteratively; themes were identified using constant comparison. SETTING Recruitment among general practitioners' private practices and health centres in Ile-de-France. PARTICIPANTS Twenty-one patients aged 19-88 years old, interviewed between June 2018 and May 2019. RESULTS Physical examination was described as a ritual enabling the establishment of patients' and doctors' roles, the verification of the doctor's skills and the construction of a caring experience. Touch was also a media for the doctor to exercise power that the patient authorised. Finally, it had relational and emotional value. DISCUSSION AND CONCLUSION Physical examination is so internalised by the patients that it becomes unquestionable. It may be inappropriate when this touch does not belong to physical examination or on the contrary represents a proof of the doctor's humanity. The patient is not necessarily aware of the relational dimension that underpins touching and, in particular, clinical examination. This raises the question of why should doctor use it and how they can communicate about it, so that it may become an active tool in favour of trust and the construction of the relationship.
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Affiliation(s)
- Louise Devillers
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
- CESP, UVSQ, INSERM U1018, Primary Care and Prevention Team, University Paris-Saclay, Villejuif, France
| | - Amélie Subts
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
| | - David De Bandt
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
| | - Pierre-Louis Druais
- Department of General Medicine, Versailles Saint-Quentin-en-Yvelines University, Montigny-Le-Bretonneux, France
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AlFaris E, Irfan F, Abouammoh N, Zakaria N, Ahmed AM, Kasule O, Aldosari DM, AlSahli NA, Alshibani MG, Ponnamperuma G. Physicians' professionalism from the patients' perspective: a qualitative study at a single-family practice in Saudi Arabia. BMC Med Ethics 2023; 24:39. [PMID: 37287002 DOI: 10.1186/s12910-023-00918-9] [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: 06/15/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a qualitative study exploring physician professionalism from the patients' perspective. METHODS Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software. RESULTS Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not. DISCUSSION/CONCLUSIONS The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.
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Affiliation(s)
- Eiad AlFaris
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia.
| | - Farhana Irfan
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Nasriah Zakaria
- Ehealth Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- College of applied science, Al maarefa university Riyadh Saudi Arabia, Riyadh, Saudi Arabia
| | - Abdullah Ma Ahmed
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Omar Kasule
- Academic and Training Affairs, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dina M Aldosari
- King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nora A AlSahli
- King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Ghatar Alshibani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gominda Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Russo E, Giombi F, Paoletti G, Heffler E, Canonica GW, Pirola F, Mercante G, Spriano G, Malvezzi L, Keber E, SGCP, Giua C. Use, Abuse, and Misuse of Nasal Medications: Real-Life Survey on Community Pharmacist’s Perceptions. J Pers Med 2023; 13:jpm13040579. [PMID: 37108966 PMCID: PMC10142332 DOI: 10.3390/jpm13040579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/18/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their query through the pharmacist’s perception. Methods: In the pilot phase, a preliminary survey was developed by a team of researchers and tested on a small sample of practitioners to assess usability and intelligibility. Eventual amendments were made according to the feedback obtained, and the final version was submitted to practitioners working in 376 pharmacies evenly distributed over the Italian territory. Results: Two groups of customers (18–30 years old and 60–75 years old) were the ones who most frequently purchased topical decongestants. The dosage applied for sympathomimetic amines was higher than recommended in up to 44.4% and the duration of use longer than 5 days in up to 31.9% of the cases. Patients’ queries of alpha agonists and topical corticosteroids resulted in significantly higher numbers than practitioners’ prescriptions. Allergic rhinitis was the most common disease affecting patients seeking sympathomimetic amines. Conclusions: The prolonged use of sympathomimetic amines in patients suffering from rhinology diseases is a significant problem that requires greater attention in terms of social education and surveillance.
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Rahim KA, Lakhdir MPA, Afzal N, Merchant AAH, Shaikh NQ, Noorali AA, Tariq U, Ahmad R, Bakhshi SK, Mahmood SBZ, Khan MR, Tariq M, Haider AH. Leveraging the vantage point - exploring nurses' perception of residents' communication skills: a mixed-methods study. BMC MEDICAL EDUCATION 2023; 23:148. [PMID: 36869344 PMCID: PMC9985286 DOI: 10.1186/s12909-023-04114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Effective communication is key to a successful patient-doctor interaction and improved healthcare outcomes. However, communication skills training in residency is often subpar, leading to inadequate patient-physician communication. There is a dearth of studies exploring the observations of nurses - key members of healthcare teams with a special vantage point to observe the impact of residents' communication with patients. Thus, we aimed to gauge the perceptions of nurses regarding residents' communication skills expertise. METHODS This study employed a sequential mixed-methods design, and was conducted at an academic medical center in South Asia. Quantitative data was collected via a REDCap survey using a structured validated questionnaire. Ordinal logistic regression was applied. For qualitative data, In-depth interviews were conducted with nurses using a semi-structured interview guide. RESULTS A total of 193 survey responses were obtained from nurses hailing from various specialties including Family Medicine (n = 16), Surgery (n = 27), Internal Medicine (n = 22), Pediatrics (n = 27), and Obstetrics/Gynecology (n = 93). Nurses rated long working hours, infrastructural deficits, and human failings as the main barriers to effective patient-resident communication. Residents working in in-patient settings were more likely to have inadequate communication skills (P-value = 0.160). Qualitative data analysis of nine in-depth interviews revealed two major themes: existing status-quo of residents' communication skills (including deficient verbal and non-verbal communication, bias in patient counselling and challenging patients) and recommendations for improving patient-resident communication. CONCLUSION The findings from this study highlight significant gaps in patient-resident communication from the perception of nurses and identify the need for creating a holistic curriculum for residents to improve patient-physician interaction.
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Affiliation(s)
- Komal Abdul Rahim
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
- Internal Medicine, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
| | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Noreen Afzal
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | | | - Namra Qadeer Shaikh
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Ali Aahil Noorali
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Umar Tariq
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Rida Ahmad
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Saqib Kamran Bakhshi
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Saad Bin Zafar Mahmood
- Dean's Office, Medical College, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | | | | | - Adil H Haider
- Medical College, Aga Khan University, Karachi, Pakistan
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Kobayashi M, Katayama M, Hayashi T, Hashiyama T, Iyanagi T, Une S, Honda M. Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study. BMJ Open 2023; 13:e065477. [PMID: 36868602 PMCID: PMC9990644 DOI: 10.1136/bmjopen-2022-065477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES To quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and to qualitatively explore the educational benefits of this training programme. DESIGN A convergent mixed-methods study, including an intervention trial with a quasi-experimental design, was conducted to quantitatively analyse the communication skills of physicians. Qualitative data were collected via physicians' responses to an open-ended questionnaire administered after the training. SETTING An acute care hospital. PARTICIPANTS A total of 23 physicians. INTERVENTIONS In a 4-week multimodal comprehensive care communication skills training programme, including video lectures and bedside instruction, from May to October 2021, all the participants examined a simulated patient in the same scenario before and after their training. These examinations were video recorded by an eye-tracking camera and two fixed cameras. Then, the videos were analysed for communication skills by AI. MAIN OUTCOME MEASURES The primary outcomes were the physicians' eye contact, verbal expression, physical touch and multimodal communication skills with a simulated patient. The secondary outcomes were the physicians' empathy and burnout scores. RESULTS The proportion of the duration of the participants' single and multimodal types of communication significantly increased (p<0.001). The mean empathy scores and the personal accomplishment burnout scores also significantly increased after training. We developed a learning cycle model based on the six categories that changed after training from the physicians' perspective: multimodal comprehensive care communication skills training; increasing awareness of and sensitivity to changes to geriatric patients' condition; changes in clinical management; professionalism; team building and personal accomplishments. CONCLUSIONS Our study showed that multimodal comprehensive care communication skills training for physicians increased the proportions of time spent performing single and multimodal communication skills by video analysis through AI. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000044288; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050586).
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Affiliation(s)
- Masaki Kobayashi
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Division of Geriatric Medicine, Rochester Regional Health System, Rochester, New York, USA
| | - Mitsuya Katayama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Tomofumi Hayashi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Takuhiro Hashiyama
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Toshinori Iyanagi
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Saki Une
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
| | - Miwako Honda
- Department of Geriatric Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
- Department of General Internal Medicine, National Hospital Organization Tokyo Medical Centre, Meguro-ku, Japan
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Berg J, Lipponen E, Sailas E, Soininen P, Varpula J, Välimäki M, Lahti M. Nurses' perceptions of nurse-patient communication in seclusion rooms in psychiatric inpatient care: A focus group study. J Psychiatr Ment Health Nurs 2023. [PMID: 36718606 DOI: 10.1111/jpm.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/16/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse-patient communication is highlighted. However, research related to nurses' perceptions of nurse-patient communication during seclusion is scant. AIM The aim of this study was to describe nurses' perceptions of nurse-patient communication during patient seclusion and the ways nurse-patient communication can be improved. METHOD A qualitative study design using focus group interviews was adopted. Thirty-two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. RESULTS Nurses aimed to communicate in a patient-centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. DISCUSSION Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communication skills to provide ethically sound care. CONCLUSION Improved nurse-patient communication may contribute to shorter seclusion times and a higher quality of care. Improving nurses' communication skills may help support the dignity of the secluded patients. Safewards practices, such as respectful communication and recognizing the effect of non-verbal behaviour, could be considered when developing nurse-patient communication in seclusion events. RELEVANCE STATEMENT This study deepens the understanding of nurse-patient communication during seclusion events from the perspective of nurses. Caring for patients in seclusion presents challenging situations for nurses and demands that they have good communication skills. To enhance their communication skills in seclusion events, nurses require opportunities to take part in further training after education related to communication skills for demanding care situations. Knowing the appropriate ways to interact with individual patients during seclusion can help nurses create and maintain communication with patients. For mental health nursing, nurses' enhanced communication may promote increased use of noncoercive practices in psychiatric settings. For patients, improving nurses' communication skills may help support dignity and autonomy during seclusion and shorten the time spent in seclusion, resulting in a better quality of care and more positive patient experiences related to care offered in seclusion. In this, the perspectives of people with lived experience of mental health problems should be acknowledged. Components of Safewards practices, such as using respectful and individual communication and paying attention to one's non-verbal communication (Soft Words), could be useful when developing nurse-patient communication in seclusion events.
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Affiliation(s)
- Johanna Berg
- Turku University of Applied Sciences, Turku, Finland
| | | | - Eila Sailas
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland
| | - Päivi Soininen
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya Nursing School, Central South University, Changsha, China
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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12
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De Micco F, Fineschi V, Banfi G, Frati P, Oliva A, Travaini GV, Picozzi M, Curcio G, Pecchia L, Petitti T, Alloni R, Rosati E, De Benedictis A, Tambone V. From COVID-19 Pandemic to Patient Safety: A New “Spring” for Telemedicine or a Boomerang Effect? Front Med (Lausanne) 2022; 9:901788. [PMID: 35783642 PMCID: PMC9240206 DOI: 10.3389/fmed.2022.901788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022] Open
Abstract
During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.
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Affiliation(s)
- Francesco De Micco
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
- *Correspondence: Vittorio Fineschi
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mario Picozzi
- Department of Biotechnology and Science of Life, Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Tommasangelo Petitti
- Hygiene, Public Health and Statistics, Campus Bio-Medico University of Rome, Rome, Italy
- Department of Medical Affairs, Fondazione Don Carlo Gnocchi Onlus, Rome, Italy
| | - Rossana Alloni
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Enrico Rosati
- Casa di Cura “Auxologico Roma–Buon Pastore”, Rome, Italy
| | - Anna De Benedictis
- Nursing Science Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittoradolfo Tambone
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Chu K, Sathanandan S. The virtual Clinical Assessment of Skills and Competence: the impact and challenges of a digitised final examination. BJPsych Bull 2021; 47:110-115. [PMID: 34937596 PMCID: PMC10063989 DOI: 10.1192/bjb.2021.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 pandemic has affected how clinical examinations are conducted, resulting in the Royal College of Psychiatrists delivering the Clinical Assessment of Skills and Competence virtually. Although this pragmatic step has allowed for progression of training, it has come at the cost of a significantly altered examination experience. This article aims to explore the fairness of such an examination, the difference in trainee experience, and the use of telemedicine to consider what might be lost as well as gained at a time when medical education and delivery of healthcare are moving toward the digitised frontier.
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Affiliation(s)
- Kenny Chu
- St Pancras Hospital, Camden and Islington NHS Foundation Trust, UK
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14
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Matsuhisa T, Takahashi N, Takahashi K, Yoshikawa Y, Aomatsu M, Sato J, Mercer SW, Ban N. Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care. BMC FAMILY PRACTICE 2021; 22:59. [PMID: 33789572 PMCID: PMC8011374 DOI: 10.1186/s12875-021-01416-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
Background There is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy. Methods This was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy. Results A total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000). Conclusions This study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully. Trial registration Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749). The study was prospectively registered.
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Affiliation(s)
- Takaharu Matsuhisa
- Department of General Medicine/Family & Community Medicine, Nagoya University Hospital, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan.
| | - Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Kunihiko Takahashi
- M&D Data Science Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yuki Yoshikawa
- Department of General Medicine/Family & Community Medicine, Nagoya University Hospital, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan
| | - Muneyoshi Aomatsu
- Department of Medical Education, Saku Central Hospital, 197 Usuda, Saku, 385-0051, Japan
| | - Juichi Sato
- Department of General Medicine/Family & Community Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Nobutaro Ban
- Medical Education Center, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan
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15
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Efficient Clinical Counseling for Sickle Cell Disease. J Natl Med Assoc 2021; 113:382-387. [PMID: 33610309 DOI: 10.1016/j.jnma.2021.01.006] [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: 07/24/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Adherence to national guidelines such as the National Heart Lung and Blood Institute (NHLBI) Expert Panel Report on the Evidence-Based Management of Sickle Cell Disease can be challenging to both the clinician and the patient. Utilizing effective communication strategies with patients and their families can improve clinician/patient relationships, as well as adherence to national guidelines. Aims of this overview are to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.
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Kelly M, Nixon L, Rosenal T, Crowshoe L, Harvey A, Tink W, Dornan T. Being Vulnerable: A Qualitative Inquiry of Physician Touch in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1893-1899. [PMID: 32379142 DOI: 10.1097/acm.0000000000003488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Effective nonverbal communication is associated with empathic behavior and improved patient outcomes. Touch, as a form of nonverbal communication, is relatively unexplored in medical education. This study sought to gain in-depth insights into physicians' experiences communicating with touch and to examine how these insights could inform communication skills curricula. METHOD Collaborative inquiry, a form of action research, was used. Six experienced physician-educators from the University of Calgary met 8 times between 2015 and 2018 to critically reflect on their experiences of touch in clinical practice, teaching, and learning. Data comprised meeting transcripts, individual narrative accounts, and digital recordings of role-plays. Interpretative phenomenology, the study of lived experience, guided analysis. RESULTS Two themes were identified-touch as presence and touch as risk. Participants used touch to demonstrate presence and a shared humanity with patients, to express "being with" a patient. Risk was not associated with the physical experience of touch but, rather, with its social meaning, interpreted through gender, culture, relationships, and context. Individual experiences were open to many interpretations. Participants expressed tension between their personal experience communicating with touch to express empathy and formal curricular structures. Reflection, role-modeling, and clinical debriefs were suggested as ways to encourage situational awareness and sensitive use of touch. CONCLUSIONS Touch is a powerful means to communicate with patients but is highly subjective. Rather than avoiding touch for fear of misinterpretation, encouraging dialogue about its complexity could promote a more balanced understanding of touch and its potential to convey empathy and help physicians more effectively manage risk when using touch.
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Affiliation(s)
- Martina Kelly
- M. Kelly is associate professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: http://orcid.org/0000-0002-8763-709
| | - Lara Nixon
- L. Nixon is assistant professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0002-3505-6587
| | - Tom Rosenal
- T. Rosenal is associate professor emeritus, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Crowshoe
- L. Crowshoe is associate professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Harvey
- A. Harvey is clinical associate professor, Departments of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wendy Tink
- W. Tink is assistant professor, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0001-5932-119X
| | - Tim Dornan
- T. Dornan is professor of medical education, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom, and Maastricht University, Maastricht, The Netherlands; ORCID: https://orcid.org/0000-0001-7830-0183
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Cristancho S, Field E. Qualitative investigation of trace-based communication: how are traces conceptualised in healthcare teamwork? BMJ Open 2020; 10:e038406. [PMID: 33148735 PMCID: PMC7643497 DOI: 10.1136/bmjopen-2020-038406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This interview-based qualitative study aims to explore how healthcare providers conceptualise trace-based communication and considers its implications for how teams work. In the biological literature, trace-based communication refers to the non-verbal communication that is achieved by leaving 'traces' in the environment and other members sensing them and using them to drive their own behaviour. Trace-based communication is a key component of swam intelligence and has been described as a critical process that enables superorganisms to coordinate work and collectively adapt. This paper brings awareness to its existence in the context of healthcare teamwork. DESIGN Interview-based study using Constructivist Grounded Theory methodology. SETTING This study was conducted in multiple team contexts at one of Canada's largest acute-care teaching hospitals. PARTICIPANTS 25 clinicians from across professions and disciplines. Specialties included surgery, anesthesiology, psychiatry, internal medicine, geriatrics, neonatology, paramedics, nursing, intensive care, neurology and emergency medicine. INTERVENTION Not relevant due to the qualitative nature of the study. PRIMARY AND SECONDARY OUTCOME Not relevant due to the qualitative nature of the study. RESULTS The dataset was analysed using the sensitising concept of 'traces' from Swarm Intelligence. This study brought to light novel and unique elements of trace-based communication in the context of healthcare teamwork including focused intentionality, successful versus failed traces and the contextually bounded nature of the responses to traces. While participants initially felt ambivalent about the idea of using traces in their daily teamwork, they provided a variety of examples. Through these examples, participants revealed the multifaceted nature of the purposes of trace-based communication, including promoting efficiency, preventing mistakes and saving face. CONCLUSIONS This study demonstrated that clinicians pervasively use trace-based communication despite differences in opinion as to its implications for teamwork and safety. Other disciplines have taken up traces to promote collective adaptation. This should serve as inspiration to at least start exploring this phenomenon in healthcare.
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Affiliation(s)
- Sayra Cristancho
- Department of Surgery, Faculty of Education and Centre for Education Research & Innovation, Western University, London, Ontario, Canada
| | - Emily Field
- Centre for Education Research & Innovation, Western University, London, Ontario, Canada
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18
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Green C, Vandall-Walker V, Rysdale L, Stevens M, Feldmann H, Tymura S, Stojkovic K. You Can't Touch…or Can You? Dietitians' Perceptions of Expressive Touch in Client Encounters. CAN J DIET PRACT RES 2020; 81:112-119. [PMID: 32072833 DOI: 10.3148/cjdpr-2020-005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: We explored Registered Dietitians' (RDs') perceptions about expressive touch (ET) as a means to provide client-centred care, a practice unreported to date. For this study, ET is defined as relatively spontaneous, responsive, and affective contact by dietitians. Methods: This exploratory study used an explanatory sequential mixed-methods approach. RDs in Northern Ontario were surveyed (54% response, n = 135) and these results were further explored in interviews with a subset of participants (n = 17). Analysis included descriptive and association statistics and qualitative description. Results: Most RDs considered ET a useful tool for effective client communication (66%-77%), yet they were hesitant to enact the practice (81%). Analysis of interviews revealed ET to be "situationally beneficial" with uptake influenced by an interplay of factors, described as: perceived client openness to touch, the environment, and RD comfort with touch. Greater uptake was reported among RDs working with distressed clients and clients in ambulatory clinics and long-term care. ET practice was limited by personal safety concerns, unknown client customs, and client misinterpretation. Conclusion: ET was valued by many RDs as an enhancement to client-centred care. Selective use of ET is influenced by the context of dietetic practice and by perceived client and RD comfort with the use of ET.
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Affiliation(s)
- Cara Green
- Northern Ontario Dietetic Internship Program, Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON
| | | | - Lee Rysdale
- Northern Ontario Dietetic Internship Program, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON
| | - Michelle Stevens
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Heather Feldmann
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Stacey Tymura
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
| | - Kelsey Stojkovic
- Northern Ontario Dietetic Internship Program, Northern Ontario School of Medicine, Thunder Bay, ON
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Samarasekara K. 'Masking' emotions: doctor-patient communication in the era of COVID-19. Postgrad Med J 2020; 97:406. [PMID: 32611775 DOI: 10.1136/postgradmedj-2020-138444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 11/03/2022]
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Kelly M, Svrcek C, King N, Scherpbier A, Dornan T. Embodying empathy: A phenomenological study of physician touch. MEDICAL EDUCATION 2020; 54:400-407. [PMID: 31793673 DOI: 10.1111/medu.14040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Empathic physician behaviour is associated with improved patient outcomes. One way to demonstrate empathy is through the use of non-verbal communication (NVC) including touch. To date, research on NVC, and specifically touch, has been relatively limited in medicine, which is surprising given the central role it plays in conveying affective and empathic messages. To inform curriculum development on NVC, this study aimed to examine physicians' experiences of communicating by touch. METHODS We conducted an interpretative phenomenological study. A total of 15 physicians (seven women and eight men) from different specialties, including both recent graduates and experienced doctors, described in detail specific instances of touch drawn from their clinical practices. Interview prompts encouraged participants to recall exact details such as the context, their relationship with the patient they touched and their physical experience of touching. Interviews (45-100 minutes) were analysed with template analysis, followed by a process of dialectic questioning, moving back and forth between the data and researchers' personal reflections on them, drawing on phenomenological literature to synthesise a final interpretation. RESULTS Participants described two dimensions of the experience of touch: 'choosing and inviting touch' and 'expressing empathy.' Touch was a personal and fragile process. Participants interpreted non-verbal patient cues in order to determine whether or not touch was appropriate. They interpreted facial expressions and body language in the present to make meaning of patients' experiences. They used touch to share emotions, and to demonstrate empathy and presence. Participants' experiences of touch framed it as a form of embodied empathic communication. CONCLUSIONS Touch is a powerful form of NVC that can establish human connection. Phenomenological accounts of empathy, which emphasise its embodied intersubjective nature, can be used to theoretically enrich pedagogical approaches to touch in medical education and to deepen our understanding of empathy.
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Affiliation(s)
- Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Clark Svrcek
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nigel King
- Department of Applied Psychology, University of Huddersfield, Huddersfield, UK
| | - Albert Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Montilla-Pérez M, Zafra Anta MÁ, Palacios-Ceña D. Hospitalization due to bronchiolitis: factors influencing parents' experience. ENFERMERIA CLINICA 2018; 28:292-299. [PMID: 30030054 DOI: 10.1016/j.enfcli.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 05/30/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
AIM To describe the experience of the parents of children hospitalized due to bronchiolitis. METHOD Phenomenological qualitative study. Purposeful sampling was undertaken of parents with children diagnosed with bronchiolitis, from December 7, 2015 to January 8, 2016, and admitted to the paediatric department of a public hospital of the Madrid Health Service. Data collection strategies included focus groups and researchers' field notes. Afterwards, the data were analyzed using thematic analysis. We included 10 parents, aged between 30 and 39 years. Five themes were explored: perception of monitoring, need to know, perception of child fragility, coping strategies, and reorganization of the family environment. RESULTS Oxygen saturation monitoring through devices produced dependence and uncertainty in the parents. In addition, there was a need to know and understand the technical language, which encouraged searching for information on the Internet. The parents perceived the fragility of the hospitalized child through their appearance and physical state. In addition, they developed different coping strategies to seek and confirm information, to approach professionals and be present with their children. Finally, the family was reorganised to maintain the constant presence of the parents during hospitalization. CONCLUSIONS The results obtained can help paediatric professionals manage the information given to parents and thus empower them.
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Affiliation(s)
| | | | - Domingo Palacios-Ceña
- Facultad Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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22
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Laughey W, Sangvik Grandal N, M Finn G. Medical communication: the views of simulated patients. MEDICAL EDUCATION 2018; 52:664-676. [PMID: 29600570 DOI: 10.1111/medu.13547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/21/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Simulated patients (SPs) are extensively used in the teaching of medical communication, both for students and doctors. They occupy a unique middle ground between patients and physicians: although free from the prejudices that medical training brings, they work closely with clinical tutors to promote the principles of patient-centred consulting. Despite this, there is relatively little research around their views on what makes for good communication practice. This study aims to address this gap in the literature through a qualitative analysis of SPs' opinions, especially in the context of medical student communication. METHODS Eighteen SPs from two medical schools, Hull York Medical School and Durham, were interviewed, using an in-depth, one-to-one, semi-structured approach. Data, transcribed verbatim, were thematically analysed. RESULTS Three global themes were identified: (i) listening and empathy and showing it, (ii) continual human connection and (iii) information flow from the patient. These three themes, termed the communication triad, form a type of virtuous circle, each facilitating the other. Listening and empathy were facilitated through attributes, including attentive non-verbal communication, and through responding to cues, including making effective empathetic statements. Continual human connection was facilitated through successful beginnings, including preferring open questions to 'robotic' tick-list questions and allowing patients time to have their say. Mirroring, professional appearance, appropriate physical contact and a human approach were amongst other factors facilitating connection with patients. Information flow was encouraged by factors including showing an interest in the patient and use of silence; flow was curtailed by undesirable attributes, including interrupting, dismissive communication and making assumptions about aspects such as sexuality. CONCLUSION This first in-depth study of SPs' views on medical consulting identifies a communication triad that both affirms and builds on the current literature base. Five novel teaching points emerge, with clear relevance for best practice communication teaching and curricula design.
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Kelly MA, Nixon L, McClurg C, Scherpbier A, King N, Dornan T. Experience of Touch in Health Care: A Meta-Ethnography Across the Health Care Professions. QUALITATIVE HEALTH RESEARCH 2018; 28:200-212. [PMID: 29235944 DOI: 10.1177/1049732317707726] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Touch mediates health professionals' interactions with patients. Different professionals have reported their practices but what is currently lacking is a well-theorized, interprofessional synthesis. We systematically searched eight databases, identified 41 studies in seven professions-nursing (27), medicine (4), physiotherapy (5), osteopathy (1), counseling (2), psychotherapy (1), dentistry (1)-and completed a meta-ethnographic line-of-argument synthesis. This found that touch is caring, exercises power, and demands safe space. Different professions express care through the medium of touch in different ways. They all, however, expect to initiate touch rather than for patients to do so. Various practices negotiate boundaries that define safe spaces between health care professions and patients. A metaphor-the waltz-integrates the practice of touch. Health care professionals connect physically with patients in ways that form strong relationships between them while "dance steps" help manage the risk that is inherent in such an intimate form of connection.
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Affiliation(s)
| | - Lara Nixon
- 1 University of Calgary, Calgary, Alberta, Canada
| | | | | | - Nigel King
- 3 University of Huddersfield, Huddersfield, United Kingdom
| | - Tim Dornan
- 2 Maastricht University, Maastricht, The Netherlands
- 4 Queen's University Belfast, Belfast, United Kingdom
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Deschepper R, Six S, Vandeweghe N, De Couck M, Gidron Y, Depoorter AM, Bilsen J. Linking numbers to perceptions and experiences: Why we need transdisciplinary mixed-methods combining neurophysiological and qualitative data. METHODOLOGICAL INNOVATIONS 2017. [DOI: 10.1177/2059799117703119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Today, more and more problems that scientists need to tackle are complex problems. Many examples of these can be found in the health sciences, medicine and ecology. Typical features of complex problems are that they cannot be studied by one discipline and that they need to take into account subjective data as well as objective data. Two promising responses to deal with complex problems are Transdisciplinary and Mixed Method approaches. However, there is still a lacuna to fill, with transdisciplinary studies bridging the social sciences and biomedical sciences. More specifically, we need more and better studies that combine qualitative data about subjective experiences, perception and so on with objective, quantitative, neurophysiological data. We believe that the combination of qualitative and neurophysiological data is a good example of what we would like to call transdisciplinary mixed methods. In this article, we aim to explore the opportunities of transdisciplinary mixed-methods studies in which qualitative and neurophysiological data are used. We give a brief overview of what is characteristic for this kind of studies and illustrate this with examples; we point out strengths and limitations and propose an agenda for the future. We conclude that transdisciplinary mixed-methods studies in which qualitative and neurophysiological data are used have the potential to improve our knowledge about complex problems. A main obstacle seems to be that most scientists from the biomedical sciences are not familiar with the (qualitative) methods from the social sciences and vice versa. To end this ‘clash of paradigms’™, we urgently need to cultivate transdisciplinary thinking.
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Affiliation(s)
- Reginald Deschepper
- Mental Health and Wellbeing Research Group, Centre for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefaan Six
- Mental Health and Wellbeing Research Group, Centre for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Marijke De Couck
- Mental Health and Wellbeing Research Group, Centre for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yori Gidron
- Scalab Unit, Université Lille 3, Villeneuve d’Ascq, France
| | - Anne-Marie Depoorter
- Mental Health and Wellbeing Research Group, Centre for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Centre for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
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Lindsay E, Renyi R, Wilkie P, Valle F, White W, Maida V, Edwards H, Foster D. Patient-centred care: a call to action for wound management. J Wound Care 2017; 26:662-677. [DOI: 10.12968/jowc.2017.26.11.662] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E. Lindsay
- Life President of the Lindsay Leg Club Foundation and Chair of the World Union of Wound Healing Societies (WUWHS) International Panel on Patient Advocacy, The Lindsay Leg Club Foundation, Ipswich, PO Box 689, IP1 9BN
| | - R. Renyi
- Communications Consultant and Chair of the Lindsay Leg Club Foundation (2014–2017), The Lindsay Leg Club Foundation, Ipswich, PO Box 689, IP1 9BN
| | - P. Wilkie
- President and Chairman, National Association for Patient Participation, UK, National Association for Patient Participation, UK
| | - F. Valle
- University of Maryland School of Nursing, Baltimore, US
| | - W. White
- Director Educator & Advanced Practice Nurse (WM), Wendy White WoundCare, New South Wales, Australia
| | - V. Maida
- Associate Professor, University of Toronto; Assistant Clinical Professor, McMaster University, Hamilton; Division of Palliative Medicine, William Osler Health System, Toronto, Canada
| | - H. Edwards
- Professor, Faculty of Health, Queensland University of Technology, Australia
| | - D. Foster
- Chair, The Lindsay Leg Club Foundation, The Lindsay Leg Club Foundation, Ipswich, PO Box 689, IP1 9BN
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Konstantynowicz J, Marcinowicz L, Abramowicz P, Abramowicz M. What Do Children with Chronic Diseases and Their Parents Think About Pediatricians? A Qualitative Interview Study. Matern Child Health J 2017; 20:1745-52. [PMID: 27008175 PMCID: PMC4935739 DOI: 10.1007/s10995-016-1978-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives The aim of this study was to determine how pediatric patients and their parents perceive health care during hospital stays, what are their expectations of doctor behaviors, and which components of care do they consider to be the most important. Methods A qualitative descriptive study was carried out using the open interview technique. Twenty-six parents and 22 children undergoing hospital treatment participated. Results Our analysis identified two major themes: (1) doctor verbal and non-verbal behaviors, which included informing and explaining, conversations on topics other than the illness, tone of voice and other behaviors; and (2) perceived strategies used by doctors. This category included claims of doctors’ intentional use of medical jargon to avoid addressing parental questions directly. Parents admitted that they did not understand medical vocabulary, but they also thought they might understand more of the medical issues if the doctor spoke using terms comprehensible to them. Conlcusions Our study shows the importance of interpersonal relationship affecting patient perception of quality of pediatric care. Parents of pediatric patients perceive that doctors behave in ways that deflect parents’ questions and avoid providing them with medical information. Such behaviors include doctors excusing themselves by saying they are busy and using medical jargon. Medical students and doctors should be trained to communicate effectively with patients and their parents and develop skills to convey information in a simple and comprehensible way.
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Affiliation(s)
- Jerzy Konstantynowicz
- />Department of Pediatrics and Developmental Disorders, Ludwik Zamenhof Children’s Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Białystok, Poland
| | - Ludmiła Marcinowicz
- />Department of Family Medicine and Community Nursing, Medical University of Bialystok, Białystok, Poland
| | - Paweł Abramowicz
- />Department of Pediatrics and Developmental Disorders, Ludwik Zamenhof Children’s Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Białystok, Poland
| | - Magdalena Abramowicz
- />Department of Pediatrics and Developmental Disorders, Ludwik Zamenhof Children’s Hospital, Medical University of Bialystok, Waszyngtona Street 17, 15-274 Białystok, Poland
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Qidwai W. Challenges in Providing Compassionate Health Care in Current Modern Era of Advanced Technology. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:185-186. [PMID: 30787783 PMCID: PMC6298381 DOI: 10.4103/sjmms.sjmms_37_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Waris Qidwai
- Department of Family Medicine, Aga Khan University, Karachi 74800, Pakistan,Correspondence: Prof. Waris Qidwai, Department of Family Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan. E-mail:
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Marcinowicz L, Abramowicz P, Zarzycka D, Abramowicz M, Konstantynowicz J. How hospitalized children and parents perceive nurses and hospital amenities: A qualitative descriptive study in Poland. J Child Health Care 2016; 20:120-8. [PMID: 25336237 DOI: 10.1177/1367493514551313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A qualitative descriptive design using an interview guide approach was adopted to investigate the patient-nurse relationship and paediatric ward amenities from the perspective of parents and hospitalised children in Poland. The study included 26 parents or caregivers of hospitalised children (between 13 months and 15 years old) and 22 children (from 10 to 16 years old). Qualitative content analysis was used to analyse the recorded verbal data. Data from patients' transcripts were coded and classified in terms of topics on the patient-nurse relationship and hospital care. We identified five main topics. 1. Nurse qualities; 2. Nurse verbal behaviour; 3. Nurse tone of voice and non-verbal behaviour; 4. Hospital amenities; 5. Parents' expectations towards nurses. Our study contributes to increased understanding of parents' and children's experiences of paediatric hospital care.
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Affiliation(s)
- Ludmiła Marcinowicz
- Department of Family Medicine and Community Nursing, Medical University of Bialystok, Bialystok, Poland
| | - Paweł Abramowicz
- Department of Pediatrics and Developmental Disorders, Medical University of Bialystok, Bialystok, Poland
| | - Danuta Zarzycka
- Chair and Department of Pediatric Nursing, Medical University of Lublin, Lublin, Poland
| | - Magdalena Abramowicz
- Department of Pediatrics and Developmental Disorders, Medical University of Bialystok, Bialystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics and Developmental Disorders, Medical University of Bialystok, Bialystok, Poland
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Martin L, Gitsels-van der Wal JT, Pereboom MTR, Spelten ER, Hutton EK, van Dulmen S. Clients' psychosocial communication and midwives' verbal and nonverbal communication during prenatal counseling for anomaly screening. PATIENT EDUCATION AND COUNSELING 2016; 99:85-91. [PMID: 26298217 DOI: 10.1016/j.pec.2015.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study focuses on facilitation of clients' psychosocial communication during prenatal counseling for fetal anomaly screening. We assessed how psychosocial communication by clients is related to midwives' psychosocial and affective communication, client-directed gaze and counseling duration. METHODS During 184 videotaped prenatal counseling consultations with 20 Dutch midwives, verbal psychosocial and affective behavior was measured by the Roter Interaction Analysis System (RIAS). We rated the duration of client-directed gaze. We performed multilevel analyses to assess the relation between clients' psychosocial communication and midwives' psychosocial and affective communication, client-directed gaze and counseling duration. RESULTS Clients' psychosocial communication was higher if midwives' asked more psychosocial questions and showed more affective behavior (β=0.90; CI: 0.45-1.35; p<0.00 and β=1.32; CI: 0.18-2.47; p=0.025, respectively). Clients "psychosocial communication was not related to midwives" client-directed gaze. Additionally, psychosocial communication by clients was directly, positively related to the counseling duration (β=0.59; CI: 0.20-099; p=0.004). CONCLUSIONS In contrast with our expectations, midwives' client-directed gaze was not related with psychosocial communication of clients. PRACTICE IMPLICATIONS In addition to asking psychosocial questions, our study shows that midwives' affective behavior and counseling duration is likely to encourage client's psychosocial communication, known to be especially important for facilitating decision-making.
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Affiliation(s)
- Linda Martin
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands.
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands; Faculty of Theology, VU University, Amsterdam, Netherlands
| | - Monique T R Pereboom
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands
| | - Evelien R Spelten
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and the EMGO(+) Institute for Health and Care Research, VU University Medical Centre, Amsterdam, Netherlands; Obstetrics & Gynecology, Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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Salsbury SA, DeVocht JW, Hondras MA, Seidman MB, Stanford CM, Goertz CM. Chiropractor interaction and treatment equivalence in a pilot randomized controlled trial: an observational analysis of clinical encounter video-recordings. Chiropr Man Therap 2014; 22:42. [PMID: 25478142 PMCID: PMC4255952 DOI: 10.1186/s12998-014-0042-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/03/2014] [Indexed: 01/31/2023] Open
Abstract
Background Chiropractic care is a complex health intervention composed of both treatment effects and non-specific, or placebo, effects. While doctor-patient interactions are a component of the non-specific effects of chiropractic, these effects are not evaluated in most clinical trials. This study aimed to: 1) develop an instrument to assess practitioner-patient interactions; 2) determine the equivalence of a chiropractor’s verbal interactions and treatment delivery for participants allocated to active or sham chiropractic groups; and 3) describe the perceptions of a treatment-masked evaluator and study participants regarding treatment group assignment. Methods We conducted an observational analysis of digital video-recordings derived from study visits conducted during a pilot randomized trial of conservative therapies for temporomandibular pain. A theory-based, iterative process developed the 13-item Chiropractor Interaction and Treatment Equivalence Instrument. A trained evaluator masked to treatment assignment coded video-recordings of clinical encounters between one chiropractor and multiple visits of 26 participants allocated to active or sham chiropractic treatment groups. Non-parametric statistics were calculated. Results The trial ran from January 2010 to October 2011. We analyzed 111 complete video-recordings (54 active, 57 sham). Chiropractor interactions differed between the treatment groups in 7 categories. Active participants received more interactions with clinical information (8 vs. 4) or explanations (3.5 vs. 1) than sham participants within the therapeutic domain. Active participants received more directions (63 vs. 58) and adjusting instrument thrusts (41.5 vs. 23) in the procedural domain and more optimistic (2.5 vs. 0) or neutral (7.5 vs. 5) outcome statements in the treatment effectiveness domain. Active participants recorded longer visit durations (13.5 vs. 10 minutes). The evaluator correctly identified 61% of active care video-recordings as active treatments but categorized only 31% of the sham treatments correctly. Following the first treatment, 82% of active and 11% of sham participants correctly identified their treatment group. At 2-months, 93% of active and 42% of sham participants correctly identified their group assignment. Conclusions Our findings show the feasibility of evaluating doctor-patient interactions in chiropractic clinical trials using video-recordings and standardized instrumentation. Clinical trial design and clinician training protocols should improve and assess the equivalence of doctor-patient interactions between treatment groups. Trial registration This trial was registered in ClinicalTrials.gov as NCT01021306 on 24 November 2009.
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Affiliation(s)
- Stacie A Salsbury
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - James W DeVocht
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - Maria A Hondras
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Michael B Seidman
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - Clark M Stanford
- The University of Illinois, 801 South Paulina Street, 102c (MC621), Chicago, IL 60612 USA
| | - Christine M Goertz
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
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Diab P. Communication in diabetes management: overcoming the challenges. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/22201009.2012.10872274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- P Diab
- Department of Rural Health, University of KwaZulu-Natal, Durban
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Abstract
Older patients see their general practitioners (GPs) relatively often and so recognition of their preferences can lead to improvement of quality of care in general practice. This study aimed to identify which aspects of GPs' behaviour are the most important for older people in their assessment of the quality of their visits and to explore the application of Jung's taxonomy differentiating task and affective behaviour in this context. A qualitative approach to generating data was chosen. We conducted semi-structured interviews with a sample of 30 patients aged 65 and older using GP services in two demographically diverse big cities in Poland. Participants were interviewed in 2010 according to a pre-determined topic guide. This research showed that older people assess both 'task performance' and 'affective performance' behaviours of general practitioners. There were nearly twice as many patient comments concerning affective performance behaviour relative to task performance behaviour. Older people expect that their physicians will be demonstrably friendly, kind, able to joke and have enough time for the consultation.
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Patient Attitudes towards Physician Nonverbal Behaviors during Consultancy: Result from a Developing Country. ISRN FAMILY MEDICINE 2014; 2014:473654. [PMID: 24977140 PMCID: PMC4041264 DOI: 10.1155/2014/473654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022]
Abstract
Background. Nonverbal behaviors have a significant impact on patients during consultations. This study was undertaken to find out the attitudes and preferences of the patients regarding nonverbal communication during consultations with physicians, in a tertiary care hospital. Methods. A questionnaire based cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, Pakistan, during the months of January to March 2012. All patients (>18 years of age) coming for consultancy in the family medicine clinics were approached; out of 133, 120 agreed to participate. The subjects were asked questions regarding physician's comforting touch and eye contact and their responses were noted. The data were analyzed using SPSS and chi-square test was used to identify corelations. Results. Overall, 120 patients were enrolled. About 58.3% were men and 41.7% were women with a mean age of 34.9 ± 10.9 years. 95.8% were Muslims and 57.6% had more than 12 years of education. Among females 74% wanted supportive touch from doctors, used to comfort the patient (45%) or to show respect (27.5%) or as healing (30%). 86.1% of the respondents believe that establishing eye contact with the patient shows that the doctor is attentive towards his/her patient. The eye contact should be brief but regular (54.1%) and prolonged staring (36.7%) makes them uncomfortable. Conclusion. Nonverbal communication helps to strengthen the doctor-patient relation as patients do appreciate positive touch and eye contact from their physicians.
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McArthur ML, Fitzgerald JR. Companion animal veterinarians' use of clinical communication skills. Aust Vet J 2013; 91:374-80. [PMID: 23980830 DOI: 10.1111/avj.12083] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- ML McArthur
- School of Animal and Veterinary Science; University of Adelaide; South Australia; Australia
| | - JR Fitzgerald
- School of Medicine; University of Queensland; Brisbane; Queensland; Australia
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Rethinking the mental health treatment skills of primary care staff: a framework for training and research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 39:489-502. [PMID: 21915748 DOI: 10.1007/s10488-011-0373-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training.
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Cocksedge S, George B, Renwick S, Chew-Graham CA. Touch in primary care consultations: qualitative investigation of doctors' and patients' perceptions. Br J Gen Pract 2013; 63:e283-90. [PMID: 23540485 PMCID: PMC3609476 DOI: 10.3399/bjgp13x665251] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 08/21/2012] [Accepted: 10/10/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Good communication skills are integral to successful doctor-patient relationships. Communication may be verbal or non-verbal, and touch is a significant component, which has received little attention in the primary care literature. Touch may be procedural (part of a clinical task) or expressive (contact unrelated to a procedure/examination). AIM To explore GPs' and patients' experiences of using touch in consultations. DESIGN AND SETTING Qualitative study in urban and semi-rural areas of north-west England. METHOD Participating GPs recruited registered patients with whom they felt they had an ongoing relationship. Data were collected by semi-structured interviews and subjected to constant comparative qualitative analysis. RESULTS All participants described the importance of verbal and non-verbal communication in developing relationships. Expressive touch was suggested to improve communication quality by most GPs and all patients. GPs reported a lower threshold for using touch with older patients or those who were bereaved, and with patients of the same sex as themselves. All patient responders felt touch on the hand or forearm was appropriate. GPs described limits to using touch, with some responders rarely using anything other than procedural touch. In contrast, most patient responders believed expressive touch was acceptable, especially in situations of distress. All GP responders feared misinterpretation in their use of touch, but patients were keen that these concerns should not prevent doctors using expressive touch in consultations. CONCLUSION Expressive touch improves interactions between GPs and patients. Increased educational emphasis on the conscious use of expressive touch would enhance clinical communication and, hence, perhaps patient wellbeing and care.
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Affiliation(s)
- Simon Cocksedge
- Manchester Medical School, University of Manchester, Manchester, UK.
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Langewitz W. [Physician-patient communication in medical education: can it be learned?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1176-82. [PMID: 22936486 DOI: 10.1007/s00103-012-1533-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Based on a review of recent key articles, this paper demonstrates that many elements of physician-patient communication can be learned successfully during medical education. Methods of assessment and definition of success depend largely on the definition of teaching goals, which are usually based on the principles of a more egalitarian and non-paternalistic physician-patient communication. In this article another approach is suggested. Teaching objectives in patient-physician communication can also be deduced from the needs of clinical medicine, resulting in the following goals: students are able to gather relevant data from patients' history, they explicitly structure the consultation and the way they give information, they know how to respond to patients' emotions. The Objective Standardised Clinical Examination (OSCE) is discussed with its strengths and weaknesses. The inclusion of video-based feedback is presented as a teaching tool to improve students' self-reflection. Workplace-based assessment and Mini-CEX are promising educational tools that require a well-trained faculty, not only in the teaching and practice of communication but also in the art of giving constructive and yet honest feedback.
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Affiliation(s)
- W Langewitz
- Psychosomatik - Innere Medizin, Universitätsspital Basel, Hebelstr. 2, 4031, Basel, Schweiz.
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Montague E, Asan O. Physician Interactions with Electronic Health Records in Primary Care. Health Syst (Basingstoke) 2012; 1:96-103. [PMID: 24009982 PMCID: PMC3760434 DOI: 10.1057/hs.2012.11] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE It is essential to design technologies and systems that promote appropriate interactions between physicians and patients. This study explored how physicians interact with Electronic Health Records (EHRs) to understand the qualities of the interaction between the physician and the EHR that may contribute to positive physician-patient interactions. STUDY DESIGN Video-taped observations of 100 medical consultations were used to evaluate interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. METHODS Ten primary care physicians and 100 patients from five clinics participated in the study. Clinical encounters were recorded with video cameras and coded using a validated objective coding methodology in order to examine how physicians interact with electronic health records. RESULTS Three distinct styles were identified that characterize physician interactions with the EHR: technology-centered, human-centered, and mixed. Physicians who used a technology-centered style spent more time typing and gazing at the computer during the visit. Physicians who used a mixed style shifted their attention and body language between their patients and the technology throughout the visit. Physicians who used the human-centered style spent the least amount of time typing and focused more on the patient. CONCLUSION A variety of EHR interaction styles may be effective in facilitating patient-centered care. However, potential drawbacks of each style exist and are discussed. Future research on this topic and design strategies for effective health information technology in primary care are also discussed.
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Affiliation(s)
- Enid Montague
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Aguilar-Shea AL, López Neyra A, Aranda Hernández J, Vaño-Galván S. Preferencias de los pacientes en atención primaria. Aten Primaria 2012; 44:e23. [DOI: 10.1016/j.aprim.2011.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/19/2011] [Indexed: 11/16/2022] Open
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Kozłowska L, Doboszyńska A. Nurses’ nonverbal methods of communicating with patients in the terminal phase. Int J Palliat Nurs 2012; 18:40-6. [DOI: 10.12968/ijpn.2012.18.1.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Anna Doboszyńska
- Clinical Nursing Department, Medical University of Warsaw, 27 Erazma Ciołka Street, 01-445 Warsaw, Poland
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Poole R, Gamper A, Porter A, Egbunike J, Edwards A. Exploring patients' self-reported experiences of out-of-hours primary care and their suggestions for improvement: a qualitative study. Fam Pract 2011; 28:210-9. [PMID: 21059702 PMCID: PMC3062781 DOI: 10.1093/fampra/cmq090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Out-of-hours services for primary care provision are increasing in policy relevance. The aim of this qualitative study was to explore service users' recent experiences of out-of-hours services and to identify suggestions for improvement for services and practitioners involved. METHODS We used data from a cross-sectional survey of service users' self-reported experiences of 13 out-of-hours centres in Wales. Three hundred and forty-one respondents provided free-text comments focusing on suggestions for improvement within the survey instrument (the Out-of-hours Patient Questionnaire). A coding framework was based on previous literature focusing on patients' experiences of out-of-hours services, built upon and refined as it was systematically applied to the data. Emergent themes and subthemes were charted and interpreted to comprise the findings. RESULTS Central themes emerged from users' perspectives of the structure of out-of-hours services, process of care and outcomes for users. Themes included long waiting times, perceived quality of service user-practitioner communication, consideration for parents and children and accessibility of the service and medication. Suggestions for improving care were made across these themes, including triaging patients more effectively and efficiently, addressing specific aspects of practitioners' communication with patients, reconsidering the size of areas covered by services and number of professionals required for the population covered, extending GP and pharmacy opening times and medication delivery services. CONCLUSIONS It is important to consider ways to address service users' principal concerns surrounding out-of-hours services. Debate is required about prioritizing and implementing potential improvements to out-of-hours services in the light of resource constraints.
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Affiliation(s)
- Ria Poole
- Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
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Ye J, Shim R. Perceptions of health care communication: examining the role of patients' psychological distress. J Natl Med Assoc 2011; 102:1237-42. [PMID: 21287905 DOI: 10.1016/s0027-9684(15)30779-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We sought to gain a better understanding of the relationship between patients' serious psychological distress (SPD) and their perception of interactions with health care providers and their ratings of the health care quality. METHODS We analyzed data from 6286 adult respondents to the 2007 Health Information National Trends Survey. We conducted cross-tabulations to compare sociodemographic characteristics between those with SPD and those without SPD. Using odds ratios and 95% confidence intervals from logistic regression models, we assessed the association between psychological status and indicators of perceived health care communication and the overall health care quality after controlling for sociodemographic variables. RESULTS Patients with SPD were less likely to report that their provider "always" paid attention to their feelings and emotions, "always" ensured their understanding of the needed care, and "always" assisted them dealing with uncertain feelings. These distressed patients were also less satisfied with the overall health care quality. CONCLUSIONS Patients' psychological distress is negatively associated with their perceived quality of communication with health providers. Further knowledge on the health care need of patients with SPD would be important in improving health service delivery and optimizing the psychological care of medical patients.
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Affiliation(s)
- Jiali Ye
- National Center for Primary Care, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA 30310, USA.
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Kelly M, Egbunike JN, Kinnersley P, Hood K, Owen-Jones E, Button LA, Shaw C, Porter A, Snooks H, Bowden S, Edwards A. Delays in response and triage times reduce patient satisfaction and enablement after using out-of-hours services. Fam Pract 2010; 27:652-63. [PMID: 20671002 DOI: 10.1093/fampra/cmq057] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND several different models of out-of-hours primary care now exist in the UK. Important outcomes of care include users' satisfaction and enablement to manage their illness or condition, but the determinants of these outcomes in the unscheduled care domain are poorly understood. Aim. To identify predictors of user satisfaction and enablement across unscheduled care or GP out-of-hours service providers in Wales. The design of the study is a cross-sectional survey. The setting of the study is nine GP out-of-hours services, three Accident and Emergency units and an all Wales telephone advice service in Wales. METHODS postal survey using the Out-of-hours Patient Questionnaire. Logistic regression was used to fit both satisfaction and enablement models, based on demographic variables, service provider and treatment received and perceptions or ratings of the care process. RESULTS eight hundred and fifty-five of 3250 users responded (26% response rate, range across providers 14-41%, no evidence of non-response bias for age or gender). Treatment centre consultations were significantly associated with decreased patient satisfaction and decreased enablement compared with telephone advice. Delays in call answering or callback for triage and shorter consultations were significantly associated with lower satisfaction. Waiting more than a minute for initial call answering was associated with lower enablement. CONCLUSIONS giving users more time to discuss their illness in consultations may enhance satisfaction and enablement but this may be resource intensive. More simple interventions to improve access by quicker response and triage, and keeping users informed of waiting times, could also serve to increase satisfaction and ultimately impact on their enablement.
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Affiliation(s)
- Mark Kelly
- South East Wales Trials Unit, Department of Primary Care and Public Health, School of Medicine, Cardiff University, Second Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
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Kinnersley P, Egbunike JN, Kelly M, Hood K, Owen-Jones E, Button LA, Shaw C, Porter A, Snooks H, Bowden S, Edwards A. The need to improve the interface between in-hours and out-of-hours GP care, and between out-of-hours care and self-care. Fam Pract 2010; 27:664-72. [PMID: 20671001 DOI: 10.1093/fampra/cmq056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND considerable changes have occurred over the last 5 years in the organization of out-of-hours care in the UK. Users' experiences of their care are an important part of 'quality of care' and are valuable for identifying areas for improvement. AIM to identify strengths and weaknesses of out-of hours service provision in Wales. The design of the study is a cross-sectional survey. The setting of the study is nine GP services, three Accident and Emergency units and NHS Direct in Wales. METHOD survey using the validated Out-of-Hours questionnaire. We identified the four most and least favourably rated items regarding users' experience of care. These were analysed by type of care provided, telephone advice, treatment centre and home visit groups. RESULTS eight hundred and fifty-five of 3250 users responded (26% response rate). Across providers and types of care, consistent strengths were the 'manner of treatment by call operator' and the 'explanation of the next step by call operator'. Consistent weaknesses were the 'speed of call back by the clinician', the 'information provided by the GP', 'getting medication after the consultation' and 'when to contact the (in-hours) GP'. CONCLUSIONS users of out-of-hours care identify clear and consistent strengths and weaknesses of service provision across Wales. Specific areas for improvement concern the interface between in-hours care and out-of-hours care and between out-of-hours care and self-care. GP surgeries need to give better information on how to access the out-of-hours services. Out-of-hours providers should improve their advice on how and when to access in-hours surgeries and also improve the availability of medicines after out-of-hours consultations.
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Affiliation(s)
- Paul Kinnersley
- South East Wales Trials Unit, Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS
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Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer. Br J Gen Pract 2010; 60:76-8. [PMID: 20132698 DOI: 10.3399/bjgp10x482293] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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