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Bajwa NM, Perron NJ, Braillard O, Achab S, Hudelson P, Dao MD, Lüchinger R, Mazouri-Karker S. Has telemedicine come to fruition? Parents' and pediatricians' perceptions and preferences regarding telemedicine. Pediatr Res 2024:10.1038/s41390-024-03172-w. [PMID: 38555380 DOI: 10.1038/s41390-024-03172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Telemedicine has increasingly become a viable option for patient care and may increase access to care. The aim of our study was to evaluate both parent and pediatrician perceptions, preferences, and acceptability regarding the use of different telemedicine modalities. METHODS We conducted a cross-sectional survey of both parents and pediatricians in Geneva, Switzerland in 2021. The questionnaire focused on digital literacy, preferences, acceptability, advantages, and disadvantages regarding telemedicine (phone, email, video, and instant message). Descriptive statistics and comparisons of preferences and perceptions (Pearson Chi2 and logistic regression) were performed. RESULTS Two hundred and twenty-two parents and 45 pediatricians participated. After face-to-face consultations, parents and pediatricians preferred the phone for simple medical advice, discussion of parameters, acute or chronic problems, and psychological support. Email was preferred for communication of results and prescription renewal. Main reasons for using telemedicine were avoiding travel and saving time. Disadvantages were lack of physical examination, technical problems, and unsuitability of the reason for consultation. CONCLUSIONS Understanding the factors that influence acceptance and satisfaction with telemedicine is vital for its successful implementation. Convenience, quality of care, trust, strong pediatrician-parent relationships, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping parent and pediatrician attitudes toward telemedicine. IMPACT The COVID-19 pandemic spurred the expansion of the use of telemedicine in pediatric care. Few studies have addressed parent and pediatrician perceptions and preferences regarding telemedicine. Both parents and pediatricians consider certain telemedicine modalities (phone, email, video, and instant message) pertinent in only specific clinical situations. Advantages of telemedicine outweigh disadvantages with parents and pediatricians appreciating the increased access to care, time savings, and avoiding transport. However, the lack of a physical examination remains a significant disadvantage. Convenience, quality of care, trust, strong pediatrician-parent relationship, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping attitudes towards telemedicine.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
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Mazouri-Karker S, Lüchinger R, Braillard O, Bajwa N, Achab S, Hudelson P, Dominicé Dao M, Junod Perron N. Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians. JMIR Hum Factors 2023; 10:e50740. [PMID: 37934574 PMCID: PMC10664018 DOI: 10.2196/50740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directory, Geneva University Hospitals, Geneva, Switzerland
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Mazouri-Karker S, Braillard O, Lüchinger R, Bajwa N, Achab S, Hudelson P, Dao MD, Junod-Perron N. Patients preferences for communication during video consultations. Patient Educ Couns 2023; 115:107894. [PMID: 37480793 DOI: 10.1016/j.pec.2023.107894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations METHODS: We conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred RESULTS: 417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician's statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). CONCLUSION: Our results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician's statements. PRACTICE IMPLICATIONS: Given the increasing use of video consultations, video communication "best practices"should be systematically addressed in physician training.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland.
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Bajwa
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sophia Achab
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; ReConnecte Unit, Addiction Division, University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Mélissa Dominicé Dao
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod-Perron
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Gisselbaek M, Hudelson P, Savoldelli GL. A systematic scoping review of published qualitative research pertaining to the field of perioperative anesthesiology. Can J Anaesth 2021; 68:1811-1821. [PMID: 34608588 PMCID: PMC8563559 DOI: 10.1007/s12630-021-02106-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/18/2021] [Accepted: 08/02/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Qualitative research (QR) take advantage of a wide range of methods and theoretical frameworks to explore people’s beliefs, perspectives, experiences, and behaviours and has been applied to many areas of healthcare. The aim of this review was to explore how QR has contributed to the field of perioperative anesthesiology. Source We performed a systematic scoping review of published QR studies pertaining to the field of perioperative anesthesiology in three databases (CINAHL, Pubmed, and Embase), published between January 2000 and June 2018. We extracted data regarding publication and researchers’ characteristics, main study objectives, and methodological details. Descriptive statistics were generated for each data extraction category. Principal findings A total of 107 articles fulfilled our inclusion criteria. We identified 13 main research topics addressed by the included studies. Topics such as “patient safety,” “barriers to evidence-base medicine,” “patient experiences under local/regional anesthesia,” “training in practice,” “experiences of care,” and “implementation of changes in clinical practice” were commonly tackled. Others, such as “interprofessional communication”, “work environment,” and “patients’/healthcare professionals’ interactions” were less common. Qualitative research was often poorly reported and methodological details were frequently missing. Conclusion Qualitative research has been used to explore an array of issues in perioperative anesthesiology. Some areas may benefit from further primary research, such as interprofessional communication or patient-centred care, while other areas may deserve a detailed systematic knowledge synthesis. We identified suboptimal reporting of qualitative methods and their link to study findings. Increased attention to quality criteria and reporting standards in QR is called for. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02106-y.
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Affiliation(s)
- Mia Gisselbaek
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Patricia Hudelson
- Department of Primary Care, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L Savoldelli
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.,Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Chuat M, Alcoba G, Eyong J, Wanda F, Comte E, Nkwescheu A, Chappuis F, Hudelson P. Dealing with snakebite in rural Cameroon: A qualitative investigation among victims and traditional healers. Toxicon X 2021; 9-10:100072. [PMID: 34337385 PMCID: PMC8313737 DOI: 10.1016/j.toxcx.2021.100072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Snakebite is a neglected tropical disease (NTD) affecting rural and remote populations globally, who are additionally burdened by poverty and the lack of effective healthcare systems. Delayed healthcare and use of traditional treatments are very frequent. The purpose of our study was to explore perceptions of snakes, impact of snakebite, and knowledge and opinions of different snakebite treatments with the aim of identifying opportunities for improving snakebite management. METHODS This is a qualitative descriptive study based on semi-structured interviews with 21 snakebite victims and 4 traditional healers in 4 villages of Akonolinga health district, Center Region, Cameroon. Analysis focused on describing participants' perceptions of snakes, the impact of snakebite on the victims' lives, and their opinions of different treatment options. RESULTS Respondents were fearful of snakes and knowledgeable about envenoming symptoms and treatments. The experience of snakebite led to increased vigilance and avoidance behaviours, which sometimes resulted in financial loss for the victims. A range of traditional treatments were described, including tourniquets, black-stone application and medicinal plant decoctions. However, opinions were ambivalent regarding their efficacy, depending especially on previous personal experiences. Still, traditional treatments were said to be more available and cheaper than hospital care, and in particular, than antivenom. Nevertheless, most victims preferred hospital treatment if the financial and transportation barriers were lifted. Both snakebite victims and traditional healers were of the opinion that collaboration between health services and traditional healers could help to improve snakebite management and outcomes. CONCLUSION Our study shows that snakebite victims are in favour of using antivenom for the treatment of snakebite and would welcome better access to it. However, its current unavailability and high cost pushes them to turn to traditional treatments. On the other hand, traditional healers are in favour of collaborating with health facilities. These results are very encouraging for the improvement of snakebite management in Cameroon along the lines of the WHO Snakebite Envenoming Strategy for Prevention and Control: ensuring access to safe and effective treatment, and increasing partnership and coordination between communities, traditional healers, and conventional caregivers.
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Affiliation(s)
- Manon Chuat
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Genève, Geneva, Switzerland
| | - Gabriel Alcoba
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Geneva, Switzerland
- Medical Department, Médecins Sans Frontières, Rue de Lausanne 78, 1211, Genève, Geneva, Switzerland
| | - Justin Eyong
- Centre International de Recherches, D'Enseignements et de Soins en Milieu Tropical (CIRES), CIRES BP 11, Akonolinga, Akonolinga, Cameroon
- Cameroon Society of Epidemiology (CaSE), Yaoundé, BP, 1411, Yaoundé, Cameroon
| | - Franck Wanda
- Centre International de Recherches, D'Enseignements et de Soins en Milieu Tropical (CIRES), CIRES BP 11, Akonolinga, Akonolinga, Cameroon
| | - Eric Comte
- Centre International de Recherches, D'Enseignements et de Soins en Milieu Tropical (CIRES), CIRES BP 11, Akonolinga, Akonolinga, Cameroon
| | - Armand Nkwescheu
- Cameroon Society of Epidemiology (CaSE), Yaoundé, BP, 1411, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé 1, Melen, Yaoundé, BP, 1364, Yaoundé, Yaoundé, Cameroon
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Geneva, Switzerland
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Escher M, Nendaz MR, Cullati S, Hudelson P. Physicians' perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study. BMJ Open 2021; 11:e046268. [PMID: 34020978 PMCID: PMC8144032 DOI: 10.1136/bmjopen-2020-046268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians' admission decisions in situations of potentially non-beneficial intensive care. DESIGN This is a secondary analysis of a qualitative study exploring the triage process. In-depth interviews were analysed using an inductive approach to thematic content analysis. SETTING Data were collected in a Swiss tertiary care centre between March and June 2013. PARTICIPANTS 12 intensive care unit (ICU) physicians and 12 internists routinely involved in ICU admission decisions. RESULTS Physicians struggled to understand the request for intensive care for patients with advanced disease and full code status. Physicians considered patients' long-term vital and functional prognosis, but they also resorted to shortcuts, that is, a priori consensus about reasons for admitting a patient. Family pressure and unexpected critical events were determinants of admission to the ICU. Patient preferences, ICU physician's expertise and collaborative decision making facilitated refusal. Physicians were willing to admit a patient with advanced disease for a limited amount of time to fulfil a personal need. CONCLUSIONS In situations of potentially non-beneficial intensive care, the influence of shortcuts or context-related factors suggests that practice variations and inappropriate admission decisions are likely to occur. Institutional guidelines and timely goals of care discussions with patients with advanced disease and their families could contribute to ensuring appropriate levels of care.
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Affiliation(s)
- Monica Escher
- Division of Palliative Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
- Population Health Laboratory, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Patricia Hudelson
- Department of Primary Care, University Hospitals of Geneva, Geneva, Switzerland
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Janakiram AA, Bouillon P, Gerlach J, Hudelson P, Spechbach H. [I'm having trouble communicating with my patient at the emergency unit: what tools are available ?]. Rev Med Suisse 2021; 17:995-998. [PMID: 34009759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Today's healthcare systems are increasingly confronted with communication problems between allophone patients and health care staff. Geneva, due to its cosmopolitan character, is at the core of this phenomenon. Several studies attest to the negative effects of the language barrier and its consequences on the quality of care, ethics, safety and financial costs. Different tools, such as semi-professional interpreters or translation applications, make it possible to deal with situations where a lack of communication can be crucial. However, they have many drawbacks. Therefore, the Geneva University Hospitals, in collaboration with the Faculty of Translation and Interpretation, have developed a reliable and innovative tool for the translation of medical language.
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Affiliation(s)
| | - Pierrette Bouillon
- Faculté de traduction et d'interprétation, Université de Genève, 1205 Genève
| | - Johanna Gerlach
- Faculté de traduction et d'interprétation, Université de Genève, 1205 Genève
| | - Patricia Hudelson
- Consultation transculturelle et interprétariat, Département de médecine de premier recours, HUG, 1211 Genève 14
| | - Hervé Spechbach
- Unité des urgences ambulatoires, Département de médecine communautaire, HUG, 1211 Genève 14
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Bochatay N, Kuna Á, Csupor É, Pintér JN, Muller-Juge V, Hudelson P, Nendaz MR, Csabai M, Bajwa NM, Kim S. The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches. Acad Med 2021; 96:134-141. [PMID: 33394664 DOI: 10.1097/acm.0000000000003604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The combination of power and conflict is frequently reported to have a detrimental impact on communication and on patient care, and it is avoided and perceived negatively by health care professionals. In view of recent recommendations to explicitly address power and conflict in health professions education, adopting more constructive approaches toward power and conflict may be helpful. This study examined the role of power in conflicts between health care professionals in different cultural contexts to make recommendations for promoting more constructive approaches. METHOD The authors used social bases of power (positional, expert, informational, reward, coercive, referent) identified in the literature to examine the role of power in conflicts between health care professionals in different cultural settings. They drew upon semistructured interviews conducted from 2013 to 2016 with 249 health care professionals working at health centers in the United States, Switzerland, and Hungary, in which participants shared stories of conflict they had experienced with coworkers. The authors used a directed approach to content analysis to analyze the data. RESULTS The social bases of power tended to be comparable across sites and included positional, expert, and coercive power. The rigid hierarchies that divide health care professionals, their professions, and their specialties contributed to negative experiences in conflicts. In addition, the presence of an audience, such as supervisors, coworkers, patients, and patients' families, prevented health care professionals from addressing conflicts when they occurred, resulting in conflict escalation. CONCLUSIONS These findings suggest that fostering more positive approaches toward power and conflict could be achieved by using social bases of power such as referent power and by addressing conflicts in a more private, backstage, manner.
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Affiliation(s)
- Naike Bochatay
- N. Bochatay is a postdoctoral scholar, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-6098-4262
| | - Ágnes Kuna
- Á. Kuna is assistant professor, Department of Applied Linguistics and Phonetics, Eötvös Loránd University, Budapest, Hungary
| | - Éva Csupor
- É. Csupor is a clinical psychologist, Department of Child and Adolescent Psychiatry, Pediatric Clinic, University of Szeged, Szeged, Hungary
| | - Judit Nora Pintér
- J.N. Pintér is associate professor, Department of Psychology of Counseling, Eötvös Loránd University, Budapest, Hungary; ORCID: https://orcid.org/0000-0002-2580-588X
| | - Virginie Muller-Juge
- V. Muller-Juge is an associate specialist, School of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-2346-8904
| | - Patricia Hudelson
- P. Hudelson is a medical anthropologist, Department of Primary Care, Geneva University Hospitals, and lecturer, Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-2601-7479
| | - Mathieu R Nendaz
- M.R. Nendaz is professor and vice-dean, Department of Medicine and Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0003-3795-3254
| | - Marta Csabai
- M. Csabai is professor and head of department, Department of Personality, Clinical, and Health Psychology, University of Szeged, Szeged, Hungary
| | - Nadia M Bajwa
- N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, and faculty member, Unit of Development and Research in Medical Education, University of Geneva, Geneva, Switzerland; ORCID: https://orcid.org/0000-0002-1445-4594
| | - Sara Kim
- S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-6623-5393
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Amstutz D, Gonçalves D, Hudelson P, Stringhini S, Durieux-Paillard S, Rolet S. Nutritional Status and Obstacles to Healthy Eating Among Refugees in Geneva. J Immigr Minor Health 2020; 22:1126-1134. [PMID: 32940816 PMCID: PMC7683482 DOI: 10.1007/s10903-020-01085-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 12/02/2022]
Abstract
Refugees face various nutritional challenges during and after migration. This cross-sectional, mixed-methods study seeks to investigate the prevalence of undernutrition and obesity among refugees in Geneva, and to identify barriers to healthy eating. Anthropometric measurements of 354 adult refugees were collected between 2017 and 2019 by trained nurses and dietitians. Seven focus group discussions totaling 51 participants, refugees and social workers, investigated conceptions and needs regarding diet. The mean Body Mass Index is 24.6 ± 4.8 kg/m2. Women are disproportionately affected by obesity compared to men (p < 0.001). Weight gain post-migration is correlated positively with length of stay in Geneva (p < 0.001). Major obstacles to healthy eating are economic and linguistic. For participants, cooking workshops and free physical activities are highly needed interventions. Post-migration lifestyle interventions should be implemented to prevent weight gain in this population. Such interventions must be multi-level, to overcome structural, social and behavioral barriers to healthy eating.
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Affiliation(s)
- Delphine Amstutz
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Daniela Gonçalves
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Durieux-Paillard
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvie Rolet
- Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland.,Care Directorate, Geneva University Hospitals, Geneva, Switzerland
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Bajwa NM, Bochatay N, Muller-Juge V, Cullati S, Blondon KS, Junod Perron N, Maître F, Chopard P, Vu NV, Kim S, Savoldelli GL, Hudelson P, Nendaz MR. Intra versus interprofessional conflicts: implications for conflict management training. J Interprof Care 2019; 34:259-268. [PMID: 31329474 DOI: 10.1080/13561820.2019.1639645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interprofessional collaboration and conflict management training are necessary in health sciences curricula. Characteristics of conflicts occurring within intraprofessional or between interprofessional teams can vary and are poorly understood. We sought to compare and contrast characteristics of intra- versus interprofessional conflicts to inform future training programs. An exploratory study was conducted through semi-structured interviews with 82 healthcare professionals working in a tertiary hospital. Interviews focused on sources, consequences, and responses to conflicts. Conflict situations were analyzed with conventional content analysis. Participants shared more intra- than interprofessional situations. Intraprofessional conflicts were caused by poor relationships, whereas interprofessional conflicts were associated with patient-related tasks and social representations. Avoiding and forcing were the most commonly mentioned responses to intraprofessional conflicts. The theme of power impacted all aspects of conflict both intra- and interprofessional. Intraprofessional conflicts were found to be as important as interprofessional conflicts. Differences in the sources of conflict and similarities regarding consequences of and responses to conflicts support integration of authentic clinical situations in interprofessional training. Understanding similarities and differences between intra- and interprofessional conflicts may help educators develop conflict management training that addresses the sources, consequences, and responses to conflicts in clinical settings.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, University Hospitals of Geneva, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Naïke Bochatay
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Virginie Muller-Juge
- Unit of Primary Care (UIGP), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | | | - Noëlle Junod Perron
- Institute of Primary Care, University Hospitals of Geneva, and faculty member at the Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V Vu
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Kim
- Department of Surgery at the School of Medicine, University of Washington, Seattle, Washington, USA
| | - Georges L Savoldelli
- Division of Anesthesiology at the University Hospitals of Geneva and in the Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, and Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
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11
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Cullati S, Bochatay N, Maître F, Laroche T, Muller-Juge V, Blondon KS, Junod Perron N, Bajwa NM, Viet Vu N, Kim S, Savoldelli GL, Hudelson P, Chopard P, Nendaz MR. When Team Conflicts Threaten Quality of Care: A Study of Health Care Professionals' Experiences and Perceptions. Mayo Clin Proc Innov Qual Outcomes 2019; 3:43-51. [PMID: 30899908 PMCID: PMC6408685 DOI: 10.1016/j.mayocpiqo.2018.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/21/2018] [Accepted: 11/30/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore professionals' experiences and perceptions of whether, how, and what types of conflicts affected the quality of patient care. PATIENTS AND METHODS We conducted 82 semistructured interviews with randomly selected health care professionals in a Swiss teaching hospital (October 2014 and March 2016). Participants related stories of team conflicts (intra-/interprofessional, among protagonists at the same or different hierarchical levels) and the perceived consequences for patient care. We analyzed quality of care using the dimensions of care proposed by the Institute of Medicine Committee on Quality of Health Care in America (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity). RESULTS Seventy-seven of 130 conflicts had no perceived consequences for patient care. Of the 53 conflicts (41%) with potential perceived consequences, the most common were care not provided in a timely manner to patients (delays, longer hospitalization), care not being patient-centered, and less efficient care. Intraprofessional conflicts were linked with less patient-centered care, whereas interprofessional conflicts were linked with less timely care. Conflicts among protagonists at the same hierarchical level were linked with less timely care and less patient-centered care. In some situations, perceived unsatisfactory quality of care generated team conflicts. CONCLUSION Based on participants' assessments, 4 of 10 conflict stories had potential consequences for the quality of patient care. The most common consequences were failure to provide timely, patient-centered, and efficient care. Management of hospitals should consider team conflicts as a potential threat to quality of care and support conflict management programs.
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Affiliation(s)
- Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Switzerland
| | - Naike Bochatay
- Institute of Sociological Research, University of Geneva, Switzerland
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, University Hospitals of Geneva, Switzerland
| | - Thierry Laroche
- Division of Anaesthesiology, University Hospitals of Geneva, Switzerland
| | - Virginie Muller-Juge
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
| | - Katherine S. Blondon
- Division of General Internal Medicine, University Hospitals of Geneva, Switzerland
- Interprofessional Simulation Centre, University of Geneva, Switzerland
| | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
- Department of Community Medicine, Primary and Emergency Care, University Hospitals of Geneva, Switzerland
| | - Nadia M. Bajwa
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
- Department of General Paediatrics, University Hospitals of Geneva, Switzerland
| | - Nu Viet Vu
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
| | - Sara Kim
- Department of Surgery, University of Washington, Seattle
| | - Georges L. Savoldelli
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
- Division of Anaesthesiology, University Hospitals of Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary and Emergency Care, University Hospitals of Geneva, Switzerland
| | - Pierre Chopard
- Quality of Care Service, University Hospitals of Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
| | - Mathieu R. Nendaz
- Unit of Development and Research in Medical Education, University of Geneva, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Switzerland
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12
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Aebischer Perone S, Nikolic R, Lazic R, Dropic E, Vogel T, Lab B, Lachat S, Hudelson P, Matis C, Pautex S, Chappuis F. Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients' perceptions and expectations. BMC Palliat Care 2018; 17:123. [PMID: 30454032 PMCID: PMC6245800 DOI: 10.1186/s12904-018-0377-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources. METHODS We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients' experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach. RESULTS While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients' main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and - occasionally - from health workers. CONCLUSIONS Our findings suggest a wide gap between patients' end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.
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Affiliation(s)
- S Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland.
| | - R Nikolic
- Primary Health Care Center, Dom zdravja Doboj, Nemanjina 18, 74000, Doboj, Bosnia and Herzegovina
| | - R Lazic
- Primary Health Care Center, Dom zdravja Doboj, Nemanjina 18, 74000, Doboj, Bosnia and Herzegovina
| | - E Dropic
- Fondacija fami, Kralja Aleksandra 52, 74000, Doboj, Bosnia and Herzegovina
| | - T Vogel
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - B Lab
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - S Lachat
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Avenue de Beau-Séjour 22, Geneva, Switzerland
| | - P Hudelson
- Transcultural consultation and interpretation, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - C Matis
- Geriatrics and community palliative care unit, Geneva University Hospitals, Avenue Cardinal-Mermillod 36, 1227, Carouge, Switzerland
| | - S Pautex
- Geriatrics and community palliative care unit, Geneva University Hospitals, Avenue Cardinal-Mermillod 36, 1227, Carouge, Switzerland
| | - F Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205, Geneva, Switzerland
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13
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Escher M, Ricou B, Nendaz M, Scherer F, Cullati S, Hudelson P, Perneger T. ICU physicians' and internists' survival predictions for patients evaluated for admission to the intensive care unit. Ann Intensive Care 2018; 8:108. [PMID: 30430269 PMCID: PMC6236006 DOI: 10.1186/s13613-018-0456-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/09/2018] [Indexed: 11/29/2022] Open
Abstract
Background A higher chance of survival is a key justification for admission to the intensive care unit (ICU). This implies that physicians should be able to accurately estimate a patient’s prognosis, whether cared for on the ward or in the ICU. We aimed to determine whether physicians’ survival predictions correlate with the admission decisions and with patients’ observed survival. Consecutive ICU consultations for internal medicine patients were included. The ICU physician and the internist were asked to predict patient survival with intensive care and with care on the ward using 5 categories of probabilities (< 10%, 10–40%, 41–60%, 61–90%, > 90%). Patient mortality at 28 days was recorded. Results Thirty ICU physicians and 97 internists assessed 201 patients for intensive care. Among the patients, 140 (69.7%) were admitted to the ICU. Fifty-eight (28.9%) died within 28 days. Admission to intensive care was associated with predicted survival gain in the ICU, particularly for survival estimates made by ICU physicians. Observed survival was associated with predicted survival, for both groups of physicians. The discrimination of the predictions for survival with intensive care, measured by the area under the ROC curve, was 0.63 for ICU physicians and 0.76 for internists; for survival on the ward the areas under the ROC curves were 0.69 and 0.74, respectively. Conclusions Physicians are able to predict survival probabilities when they assess patients for intensive care, albeit imperfectly. Internists are more accurate than ICU physicians. However, ICU physicians’ estimates more strongly influence the admission decision. Closer collaboration between ICU physicians and internists is needed. Electronic supplementary material The online version of this article (10.1186/s13613-018-0456-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland. .,Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Bara Ricou
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Scherer
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Patricia Hudelson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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14
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Escher M, Cullati S, Hudelson P, Nendaz M, Ricou B, Perneger T, Dayer P. Admission to intensive care: A qualitative study of triage and its determinants. Health Serv Res 2018; 54:474-483. [PMID: 30362106 DOI: 10.1111/1475-6773.13076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine physicians' decision making and its determinants about admission to intensive care. DATA SOURCES/STUDY SETTING ICU physicians (n = 12) and internists (n = 12) working in a Swiss tertiary care hospital. STUDY DESIGN We conducted in-depth interviews. DATA COLLECTION/EXTRACTION METHODS Interviews were analyzed using an inductive thematic approach. PRINCIPAL FINDINGS Admission decisions regarding seriously ill or elderly patients with comorbidities are complex. Nonmedical factors such as ICU beds availability, health care resources on the ward, information about patient preferences, and family behavior determine the decision. Code status and the quality of interaction between physicians are key determinants. The absence of code status or poor documentation of code status discussions makes decisions more difficult and laden emotionally, as physicians feel they are making a life-death decision. Mutual respect and collaborative decision making facilitate the decision. Tensions arise due to ICU physicians' postponing the decision because of lack of beds, ICU physicians' dismissive attitudes, perceived shortcomings in the other physician's completion of expected tasks, and preconceptions about the other physician. CONCLUSIONS Systematic documentation of code status, and fostering collaboration between ICU physicians and internists would facilitate ICU admission decisions in complex clinical situations.
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Affiliation(s)
- Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.,Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Bara Ricou
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Dayer
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
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15
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Lanier C, Cerutti B, Dominicé Dao M, Hudelson P, Junod Perron N. What factors influence the use of electronic health records during the first 10 minutes of the clinical encounter? Int J Gen Med 2018; 11:393-398. [PMID: 30349347 PMCID: PMC6183548 DOI: 10.2147/ijgm.s178672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The use of electronic health records (EHRs) by physicians during the consultation is common and can be problematic. Factors influencing the use of EHRs during clinical encounters include physician and patient characteristics, consultation type as well as spatial organization of the room and type of EHR template. Their relative importance is however not well known. This study aimed to explore to what extent several physician, patient and consultation factors were associated with EHR use during the first 10 minutes of primary care consultations. Methods We examined EHR use of 17 residents in 142 videotaped consultations at the Primary Care Division of the Geneva University Hospitals, Switzerland. We conducted univariable and multivariable analyses with patient, physician and consultation variables to predict EHR use: sex and age of the patient; physician’s sex, age, postgraduate experience and EHR-use self-perception; and language, type of consultation (new/follow-up) and content of the consultation using the Roter interaction analysis system (RIAS), the main variable being the percentage of utterances in relation to EHR use during the first 10 minutes. Results Male physicians (residents) and those with less clinical experience and conducting a new consultation or addressing biomedical content were positively correlated with EHR use (+5.3% for male physicians, P=0.101; +0.6% per year of experience, P=0.021; +6.0% for new consultation, P=0.097; +0.4% per 1% of biomedical content increase; P=0.018). Conclusion Only a small number of physician, patient and consultation factors appear to have an impact on the use of EHR during primary care consultations, and this impact remains modest. Given the influence of EHR use on physician–patient relationship, further research should explore what other factors are implicated in EHR use and whether they can be changed or improved.
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Affiliation(s)
- Cédric Lanier
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland,
| | - Bernard Cerutti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergencies, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergencies, Geneva University Hospitals, Geneva, Switzerland
| | - Noëlle Junod Perron
- Department of Community Medicine, Primary Care and Emergencies, Geneva University Hospitals, Geneva, Switzerland
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16
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Cullati S, Hudelson P, Ricou B, Nendaz M, Perneger TV, Escher M. Internists' and intensivists' roles in intensive care admission decisions: a qualitative study. BMC Health Serv Res 2018; 18:620. [PMID: 30089526 PMCID: PMC6083517 DOI: 10.1186/s12913-018-3438-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions. METHODS Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach. RESULTS Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner. CONCLUSIONS Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.
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Affiliation(s)
- Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Bara Ricou
- Intensive Care Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas V. Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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17
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Dominicé Dao M, Inglin S, Vilpert S, Hudelson P. 6.2-O2The benefits of a transcultural consultation for complex clinical situations in Switzerland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - S Inglin
- Geneva University Hospitals, Switzerland
| | | | - P Hudelson
- Geneva University Hospitals, Switzerland
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18
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Dominicé Dao M, Inglin S, Vilpert S, Hudelson P. The relevance of clinical ethnography: reflections on 10 years of a cultural consultation service. BMC Health Serv Res 2018; 18:19. [PMID: 29325569 PMCID: PMC5765648 DOI: 10.1186/s12913-017-2823-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/28/2017] [Indexed: 11/30/2022] Open
Abstract
Background Training health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients’ social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient’s explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the “real-world” context of medical practice may impose barriers to such patient-centered interviewing. Creating opportunities for role modeling and critical reflection may help overcome some of these barriers, and contribute to improved intercultural communication in healthcare. We report and reflect on a retrospective analysis of 10 years experience with a “cultural consultation service” (CCS) whose aim is to provide direct support to clinicians who encounter intercultural difficulties and to model the usefulness of clinical ethnographic interviewing for patient care. Methods We analyzed 236 cultural consultation requests in order to identify key patient, provider and consultation characteristics, as well as the cross cultural communication challenges that motivate health care professionals to request a cultural consultation. In addition, we interviewed 51 clinicians about their experience and satisfaction with the CCS. Results Requests for cultural consultations tended to involve patient care situations with complex social, cultural and medical issues. All patients had a migration background, two-thirds spoke French less than fluently. In over half the cases, patients had a high degree of social vulnerability, compromising illness management. Effective communication was hindered by language barriers and undetected or underestimated patient/provider differences in health-related knowledge and beliefs. Clinicians were highly satisfied with the CCS, and appreciated both the opportunity to observe how clinical ethnographic interviewing is done and the increased knowledge they gained of their patients’ context and perspective. Conclusions A cultural consultation service such as ours can contribute to institutional cultural competence by drawing attention to the challenges of caring for diverse patient populations, identifying the training needs of clinicians and gaps in resource provision, and providing hands-on experience with clinical ethnographic interviewing.
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Affiliation(s)
- Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland. .,Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | | | - Sarah Vilpert
- Institute of social and preventive medicine, University of Lausanne, Lausanne, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Institute of Primary Care Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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19
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Bochatay N, Bajwa NM, Cullati S, Muller-Juge V, Blondon KS, Junod Perron N, Maître F, Chopard P, Vu NV, Kim S, Savoldelli GL, Hudelson P, Nendaz MR. A Multilevel Analysis of Professional Conflicts in Health Care Teams: Insight for Future Training. Acad Med 2017; 92:S84-S92. [PMID: 29065028 DOI: 10.1097/acm.0000000000001912] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Without a proper understanding of conflict between health care professionals, designing effective conflict management training programs for trainees that reflect the complexity of the clinical working environment is difficult. To better inform the development of conflict management training, this study sought to explore health care professionals' experiences of conflicts and their characteristics. METHOD Between 2014 and early 2016, 82 semistructured interviews were conducted with health care professionals directly involved in first-line patient care in four departments of the University Hospitals of Geneva. These professionals included residents, fellows, certified nursing assistants, nurses, and nurse supervisors. All interviews were transcribed verbatim, and conventional content analysis was used to derive conflict characteristics. RESULTS Six conflict sources were identified. Among these sources, disagreements on patient care tended to be the primary trigger of conflict, whereas sources related to communication contributed to conflict escalation without directly triggering conflict. A framework of workplace conflict that integrates its multidimensional and cyclical nature was subsequently developed. This framework suggests that conflict consequences and responses are interrelated, and might generate further tensions that could affect health care professionals, teams, and organizations, as well as patient care. Findings also indicated that supervisors' responses to contentious situations often failed to meet health care professionals' expectations. CONCLUSIONS Understanding conflicts between health care professionals involves several interrelated dimensions, such as sources, consequences, and responses to conflict. There is a need to strengthen health care professionals' ability to identify and respond to conflict and to further develop conflict management programs for clinical supervisors.
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Affiliation(s)
- Naike Bochatay
- N. Bochatay is a research assistant, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, and PhD candidate, Institute of Sociological Research, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-6098-4262. N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, University Hospitals of Geneva, and faculty member, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-1445-4594. S. Cullati is a medical sociologist, Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, and Institute of Sociological Research, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-3881-446X. V. Muller-Juge is a scientific collaborator, Unit of Primary Care (UIGP), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-2346-8904. K.S. Blondon is junior faculty, Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-9407-8516. N. Junod Perron is coordinator, Institute of Primary Care, University Hospitals of Geneva, and faculty member, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-9124-8663. F. Maître is quality officer, Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland. P. Chopard is director, Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland. N.V. Vu is emeritus professor, Faculty of Medicine, University of Geneva, Geneva, Switzerland. S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington. G.L. Savoldelli is associate professor and attending physician, Division of Anesthesiology, University Hospitals of Geneva, and Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-8968-6920. P. Hudelson is a medical anthropologist, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland. M.R. Nendaz is full professor and director, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, and attending physician, Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0003-3795-3254
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Bochatay N, Muller-Juge V, Scherer F, Cottin G, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. Are role perceptions of residents and nurses translated into action? BMC Med Educ 2017; 17:138. [PMID: 28821252 PMCID: PMC5563059 DOI: 10.1186/s12909-017-0976-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/07/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Effective interprofessional collaboration (IPC) has been shown to depend on clear role definitions, yet there are important gaps with regard to role clarity in the IPC literature. The goal of this study was to evaluate whether there was a relationship between internal medicine residents' and nurses' role perceptions and their actual actions in practice, and to identify areas that would benefit from more specific interprofessional education. METHODS Fourteen residents and 14 nurses working in internal medicine were interviewed about their role perceptions, and then randomly paired to manage two simulated clinical cases. The authors adopted a general inductive approach to analyze the interviews. They identified 13 different role components that were then compared to data from simulations. Descriptive and kappa statistics were used to assess whether there was a relationship between role components identified in interviews and those performed in simulations. Results from these analyses guided a further qualitative evaluation of the relationship between role perceptions and actions. RESULTS Across all 13 role components, there was an overall statistically significant, although modest, relationship between role perceptions and actions. In spite of this relationship, discrepancies were observed between role components mentioned in interviews and actions performed in simulations. Some were more frequently performed than mentioned (e.g. "Having common goals") while others were mentioned but performed only weakly (e.g. "Providing feedback"). CONCLUSIONS Role components for which perceptions do not match actions point to role ambiguities that need to be addressed in interprofessional education. These results suggest that educators need to raise residents' and nurses' awareness of the flexibility required to work in the clinical setting with regard to role boundaries.
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Affiliation(s)
- Naïke Bochatay
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | | | | | - Stéphane Cullati
- Quality of Care Service, Geneva University Hospitals, Geneva, Switzerland
| | - Katherine S Blondon
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nu V Vu
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
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Blondon KS, Chan KCG, Muller-Juge V, Cullati S, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. A concordance-based study to assess doctors' and nurses' mental models in Internal Medicine. PLoS One 2017; 12:e0182608. [PMID: 28792524 PMCID: PMC5549723 DOI: 10.1371/journal.pone.0182608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional’s roles. Our objective was to identify factors influencing concordance on the expectations of doctors’ and nurses’ roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196), we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario). In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender). Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73), for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62), and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65). Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions.
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Affiliation(s)
- Katherine S. Blondon
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
- * E-mail:
| | - K. C. Gary Chan
- Department of Biostatistics and Department of Health Services, University of Washington, Seattle, United States of America
| | - Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V. Vu
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L. Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R. Nendaz
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Lanier C, Dominicé Dao M, Hudelson P, Cerutti B, Junod Perron N. Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents. BMC Fam Pract 2017; 18:69. [PMID: 28549460 PMCID: PMC5446676 DOI: 10.1186/s12875-017-0640-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/16/2017] [Indexed: 11/16/2022]
Abstract
Background The Electronic Health Record (EHR) is now widely used in clinical encounters. Because its use can negatively impact the physician-patient relationship, several recommendations on the “patient-centered” use of the EHR have been published. However, the impact of training to improve EHR use during clinical encounters is not well known. The aim of this study was to assess the impact of training on residents’ EHR-related communication skills and explore whether they varied according to the content of the consultation. Methods We conducted a pre-post intervention study at the Primary Care Division of the Geneva University Hospitals, Switzerland. Residents were invited to attend a 3-month training course that included 2 large group sessions and 2–4 individualized coaching sessions based on videotaped encounters. Outcomes were: 1) residents’ perceptions regarding the use of EHR, measured through a self-administered questionnaire and 2) objective use of the EHR during the first 10 min of patient encounters. Changes in practice were measured pre and post intervention using the Roter interaction analysis system (RIAS) and EHR specific items. Results Seventeen out of 27 residents took part in the study. Participants used EHR in about 30% of consultations. After training, they were less likely to consider EHR to be a barrier to the physician-patient relationship, and felt more comfortable using the EHR. After training, participants increased the use of signposting when using the EHR (pre: 0.77, SD 1.69; post: 1.80, SD3.35; p 0.035) and decreased EHR use when psychosocial issues appeared (pre: 24.5% and post: 9.76%, p < 0.001). Conclusions This study suggests that training can improve residents’ EHR-related communication skills, especially in situations where patients bring up sensitive psychosocial issues. Future research should focus on patients’ perceptions of the relevance and usefulness of such skills.
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Affiliation(s)
- Cédric Lanier
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland. .,Primary care unit, University of Geneva, Centre Médical Universitaire de Genève, Geneva, Switzerland.
| | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Bernard Cerutti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland
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Barrelet C, Dominicé Dao M, Hudelson P, Janssens JP. P222 Practices regarding isolation for non-MDR pulmonary tuberculosis: a TB-NET survey of specialists from 44 countries. Chest 2017. [DOI: 10.1016/j.chest.2017.04.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Blondon KS, Maître F, Muller-Juge V, Bochatay N, Cullati S, Hudelson P, Vu NV, Savoldelli GL, Nendaz MR. Interprofessional collaborative reasoning by residents and nurses in internal medicine: Evidence from a simulation study. Med Teach 2017; 39:360-367. [PMID: 28379080 DOI: 10.1080/0142159x.2017.1286309] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical reasoning has been studied in residents or nurses, using interviews or patient-provider encounters. Despite a growing interest in interprofessional collaboration, the notion of collaborative reasoning has not been well studied in clinical settings. Our study aims at exploring resident-nurse collaborative reasoning in a simulation setting. We enrolled 14 resident-nurse teams from a general internal medicine division in a mixed methods study. Teams each managed one of four acute case scenarios, followed by a stimulated-recall session. A qualitative, inductive analysis of the transcripts identified five dimensions of collaborative reasoning: diagnostic reasoning, patient management, patient monitoring, communication with the patient, and team communication. Three investigators (two senior physicians, one nurse) assessed individual and team performances using a five-point Likert scale, and further extracted elements supporting the collaborative reasoning process. Global assessment of the resident-nurse team was not simply an average of individual performances. Qualitative results underlined the need to improve situational awareness, particularly for task overload. Team communication helped team members stay abreast of each other's thoughts and improve their efficiency. Residents and nurses differed in their reasoning processes, and awareness of this difference may contribute to improving interprofessional collaboration. Understanding collaborative reasoning can provide an additional dimension to interprofessional education.
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Affiliation(s)
- K S Blondon
- a Division of General Internal Medicine , University Hospitals of Geneva , Geneva , Switzerland
| | - F Maître
- a Division of General Internal Medicine , University Hospitals of Geneva , Geneva , Switzerland
| | - V Muller-Juge
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - N Bochatay
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - S Cullati
- c Quality of Care Service , University Hospitals of Geneva , Geneva , Switzerland
- d Institute of Sociological Research, University of Geneva , Geneva , Switzerland
| | - P Hudelson
- e Department of Community Medicine, Primary Care and Emergency Medicine , University Hospitals of Geneva , Geneva , Switzerland
| | - N V Vu
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - G L Savoldelli
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
- f Division of Anaesthesiology , University Hospitals of Geneva , Geneva , Switzerland
| | - M R Nendaz
- a Division of General Internal Medicine , University Hospitals of Geneva , Geneva , Switzerland
- b Unit of Development and Research in Medical Education (UDREM) , Faculty of Medicine, University of Geneva , Geneva , Switzerland
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Hudelson P, Dogra N, Hendrickx K, Verdonk P, Essink-Bot ML, Suurmond J. The challenges of integrating cultural competence into undergraduate medical curricula across Europe: experience from the C2ME “Culturally competent in medical education” project. MedEdPublish 2016. [DOI: 10.15694/mep.2016.000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. Providing high quality care to socially and culturally diverse populations is challenging. Many organizations concerned with quality and equity in health care have called for physician training in cross cultural communication as one strategy for ensuring patient-centered health care for all, but little is known about how to effectively and sustainably integrate such teaching into the medical school curriculum.The C2ME "Culturally Competent in Medical Education" is a European project whose aim was to contribute to the integration of cultural competence teaching in undergraduate medical curricula across Europe. In order to foster exchange among medical schools about cultural competence training, C2ME organized a symposium at the 2014 European Association for Communication in Health Care (EACH) conference. The symposium highlighted the variety of teaching approaches and methods that are used to teach cultural competence as well as the the institutional challenges that make integration of cultural competence into the curricula difficult. There is a need for greater exchange of experiences and best practices among European medical schools to overcome these challenges.
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Saillant S, Hudelson P, Dominicé Dao M, Junod Perron N. The primary care physician/psychiatrist joint consultation: A paradigm shift in caring for patients with mental health problems? Patient Educ Couns 2016; 99:279-283. [PMID: 26341942 DOI: 10.1016/j.pec.2015.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Thirty to forty percent of patients seen in primary care medicine suffer from mental health problems, but primary care physicians (PCPs) often feel unprepared to deal with their patients' mental health problems. Joint consultations conducted with a liaison psychiatrist can help. The purpose of this study was to evaluate the experience of joint consultations in a primary care service in Geneva, Switzerland. METHODS We retrospectively analyzed reports of psychiatric evaluations conducted between October 2010 and August 2012 (n=182), in the Primary Care Service of the Geneva University Hospitals. We also carried out 4 focus groups with 23 physicians-in-training to explore their experiences and perceptions of the joint consultations. RESULTS Seventy two percent of the evaluations resulted in a psychiatric diagnosis. Psychiatric follow-up was not considered necessary in 61% of cases. Focus groups revealed that prior to experiencing joint consultations, PCPs considered mental health problems to be the domain of psychiatrists and outside their own area of competence. Joint consultations helped to demystify the role of psychiatrists, reduce their anxiety and increase PCPs' confidence in dealing with patients' mental health problems. CONCLUSION Joint consultations enabled PCPs to shift away from a dichotomous view of somatic versus mental health problems and their management, and towards a more integrated view. IMPLICATIONS FOR PRACTICE Joint consultations provide a useful strategy for training primary care physicians in the management of mental health problems. Integrated management of somatic and mental health problems can lead to a better understanding of the patient and improve the therapeutic relationship.
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Affiliation(s)
- S Saillant
- Centre for Psychiatric Emergencies and Liaison Psychiatry, Neuchâtel Psychiatry Center (CNP), Maladière 45, CH-2000 Neuchâtel, Switzerland.
| | - P Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, CH-1211 Geneva 14, Switzerland.
| | - M Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, CH-1211 Geneva 14, Switzerland.
| | - N Junod Perron
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, CH-1211 Geneva 14, Switzerland.
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Affiliation(s)
- Jeanine Louise Suurmond
- Academic Medical Center/University of Amsterdam, Public Health, Amsterdam, 1100 DE, Netherlands.
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Nisha Dogra
- Greenwood Institute of Child Health, University of Leicester, Leicester, UK
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Bodenmann P, Bossart R, Di Bernardo N, Dominice Dao M, Durieux S, Faucherre F, Hudelson P, Keller M, Schuster S, Zellweger E, Houmard S. [Managing diversity in Swiss Health care]. Rev Med Suisse 2014; 10:2222-2225. [PMID: 25603570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The development of Migrant Friendly Hospitals is an important first step towards eliminating health care disparities in Switzerland and an important reminder to health policy makers and practitioners across the health care system of their responsibility to provide non-discriminatory quality health care to all patients.
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Affiliation(s)
- P Bodenmann
- Solothurne Spitäler AG et Hôpital cantonal d'Arau.
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Durieux-Paillard S, Dominicé Dao M, Decaillet-Lopez P, Hudelson P. The ‘migrants patients reference nurse’: an instutional response to improve the care of vulnerable patients in a university hospital. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku162.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hudelson P, Dominice Dao M, Perneger T, Durieux-Paillard S. A "migrant friendly hospital" initiative in Geneva, Switzerland: evaluation of the effects on staff knowledge and practices. PLoS One 2014; 9:e106758. [PMID: 25198063 PMCID: PMC4157774 DOI: 10.1371/journal.pone.0106758] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 08/09/2014] [Indexed: 11/30/2022] Open
Abstract
Background International migration poses important challenges to European health care systems. The development of “migrant friendly hospitals” has been identified as a priority in both Europe and Switzerland. Methods A multi-pronged initiative was developed at Geneva University Hospitals (HUG) to improve staff knowledge and use of existing “migrant friendly” resources. A self-administered questionnaire was sent pre and post-intervention to random samples of 4 major professional groups with direct patient contact at the HUG. The questionnaire assessed staff knowledge, attitudes and reported practices regarding the care of migrant patients. Results Overall response rate was 51% (N = 1460) in 2010 but only 19% (N = 761) in 2013 owing to an institutionally imposed change in survey method. Despite these difficulties, and after adjusting for sample differences, we found that respondents in 2013 were significantly more likely to have received training in how to organize an appointment with an interpreter, how to work with an interpreter and about health and social services available for migrant patients. Respondents were also significantly more likely to have used several Migrant Friendly structures at the HUG. Use of, preference for and perceived skill at working with professional interpreters all improved, and respondents were both more likely to be encouraged by their supervisors to use professional interpreters, and less likely to be encouraged to look for alternative solutions for communicating with non francophone patients. Finally, 2013 respondents encountered fewer difficulties caring for migrant patients, although lack of time and language barriers continued to be the most important sources of difficulty. Conclusion Our results suggest that an institution-wide information campaign may contribute to increased awareness and use of migrant friendly resources by clinical staff. Hospital commitment and financing, along with inter-departmental participation in all activities were important in creating and maintaining project visibility, and in contributing to a migrant friendly institutional culture.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
- * E-mail:
| | - Melissa Dominice Dao
- Primary Care Service, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Durieux-Paillard
- Programme Santé Migrants, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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Muller-Juge V, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality. PLoS One 2014; 9:e96160. [PMID: 24769672 PMCID: PMC4000227 DOI: 10.1371/journal.pone.0096160] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/04/2014] [Indexed: 11/18/2022] Open
Abstract
Background Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards. Objective To describe resident physicians’ and nurses’ actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward. Methods A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis). Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit. Results Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building. Conclusions Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional education should insist on better redefinition of respective roles and reinforce behaviours shown to enhance teamwork quality.
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Affiliation(s)
- Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland; Institute of Demographic and Life Course Studies, Faculty of Economic and Social Sciences, University of Geneva, Geneva, Switzerland
| | - Katherine S Blondon
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V Vu
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Junod Perron N, Cullati S, Hudelson P, Nendaz M, Dolmans D, van der Vleuten C. Impact of a faculty development programme for teaching communication skills on participants’ practice. Postgrad Med J 2014; 90:245-50. [DOI: 10.1136/postgradmedj-2012-131700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hudelson P, Dao MD, Perron NJ, Bischoff A. Interpreter-mediated diabetes consultations: a qualitative analysis of physician communication practices. BMC Fam Pract 2013; 14:163. [PMID: 24152539 PMCID: PMC4016471 DOI: 10.1186/1471-2296-14-163] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
Abstract
Background Patient-provider communication, in particular physicians’ ability to listen to their patients, and support them in making difficult lifestyle changes, is an essential component of effective diabetes care. Clinical communication around diabetes can be especially challenging when language barriers are present, and may contribute to poor diabetes management and outcomes. Clinicians need to be aware of and address potential communication difficulties associated with interpreter-mediated consultations. The purpose of our study was to explore how physicians communicate in interpreter-mediated consultations with diabetic patients, and how their communication behaviors may impact diabetes communication and care. Method We analyzed transcripts from 8 audio recorded, outpatient consultations at the Basel University Hospital general medicine outpatient clinic involving Turkish-speaking patients, German-speaking physicians, and Turkish-German interpreters (both community interpreters and family members). Results Clinicians used closed questions when asking about symptoms and glucose control. When providing information and explanation, they spoke in long and complex speech turns. They often directed their speech to interpreters or became sidetracked by family members’ questions or requests for information. Patients’ participation in the consultation was minimal, and limited to brief answers to clinicians’ questions. Conclusions Clinicians need to be aware of common pitfalls that diminish patient-centeredness during interpreter-mediated consultations, and learn strategies to avoid them. Attention to established guidelines on triadic communication is recommended, as is hands-on training with interpreters.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Novotny F, Haeny S, Hudelson P, Escher M, Finckh A. Primary prevention of rheumatoid arthritis: a qualitative study in a high-risk population. Joint Bone Spine 2013; 80:673-4. [PMID: 23835304 DOI: 10.1016/j.jbspin.2013.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
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Hudelson P, Dominicé Dao M, Durieux-Paillard S. Quality in practice: integrating routine collection of patient language data into hospital practice. Int J Qual Health Care 2013; 25:437-42. [PMID: 23696580 DOI: 10.1093/intqhc/mzt035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM Timely identification of patients' language needs can facilitate the provision of language-appropriate services and contribute to quality of care, clinical outcomes and patient satisfaction. INITIAL ASSESSMENT At the University Hospitals of Geneva, Switzerland, timely organization of interpreter services was hindered by the lack of systematic patient language data collection. CHOICE OF SOLUTION We explored the feasibility and acceptability of a procedure for collecting patient language data at the first point of contact, prior to its hospital-wide implementation. IMPLEMENTATION During a one-week period, receptionists and triage nurses in eight clinical services tested a new procedure for collecting patient language data. Patients were asked to identify their primary language and other languages they would be comfortable speaking with their doctor. Staff noted patients' answers on a paper form and provided informal feedback on their experience with the procedure. EVALUATION Registration staff encountered few difficulties collecting patient language data and thought that the two questions could easily be incorporated into existing administrative routines. Following the pilot test, two language fields with scroll-down language menus were added to the electronic patient file, and the subsequent filling-in of these fields has been rapid and hospital wide. LESSONS LEARNED Our experience suggests that routine collection of patient language data at first point of contact is both feasible and acceptable and that involving staff in a pilot project may facilitate hospital-wide implementation. Future efforts should focus on exploring the sensitivity and specificity of the proposed questions, as well as the impact of data collection on interpreter use.
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Affiliation(s)
- Patricia Hudelson
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
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Muller-Juge V, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. Interprofessional collaboration on an internal medicine ward: role perceptions and expectations among nurses and residents. PLoS One 2013; 8:e57570. [PMID: 23469027 PMCID: PMC3585159 DOI: 10.1371/journal.pone.0057570] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective interprofessional collaboration requires that team members share common perceptions and expectations of each other's roles. OBJECTIVE Describe and compare residents' and nurses' perceptions and expectations of their own and each other's professional roles in the context of an Internal Medicine ward. METHODS A convenience sample of 14 residents and 14 nurses volunteers from the General Internal Medicine Division at the University Hospitals of Geneva, Switzerland, were interviewed to explore their perceptions and expectations of residents' and nurses' professional roles, for their own and the other profession. Interviews were analysed using thematic content analysis. The same respondents also filled a questionnaire asking their own intended actions and the expected actions from the other professional in response to 11 clinical scenarios. RESULTS Three main themes emerged from the interviews: patient management, clinical reasoning and decision-making processes, and roles in the team. Nurses and residents shared general perceptions about patient management. However, there was a lack of shared perceptions and expectations regarding nurses' autonomy in patient management, nurses' participation in the decision-making process, professional interdependence, and residents' implication in teamwork. Results from the clinical scenarios showed that nurses' intended actions differed from residents' expectations mainly regarding autonomy in patient management. Correlation between residents' expectations and nurses' intended actions was 0.56 (p=0.08), while correlation between nurses' expectations and residents' intended actions was 0.80 (p<0.001). CONCLUSIONS There are discordant perceptions and unmet expectations among nurses and residents about each other's roles, including several aspects related to the decision-making process. Interprofessional education should foster a shared vision of each other's roles and clarify the boundaries of autonomy of each profession.
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Affiliation(s)
- Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
- Institute of Demographic and Life Course Studies, Faculty of Economic and Social Sciences, University of Geneva, Geneva, Switzerland
| | - Katherine S. Blondon
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V. Vu
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L. Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R. Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
- * E-mail:
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Hudelson P, Aguilar E, Charaly MD, Marca D, Herrera M. Improving the home management of childhood diarrhoea in bolivia. Int Q Community Health Educ 2012; 15:91-104. [PMID: 20841020 DOI: 10.2190/keb1-f3v0-9jhk-691t] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article reports on a rapid assessment of beliefs and practices related to child diarrhoea, conducted in the city of El Alto, Bolivia, and discusses its utility for developing communication activities aimed at improving home care of children with diarrhoea.
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Affiliation(s)
- P Hudelson
- London School of Hygiene and Tropical Medicine
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Hudelson P, Perneger T, Kolly V, Perron NJ. Self-assessed competency at working with a medical interpreter is not associated with knowledge of good practice. PLoS One 2012; 7:e38973. [PMID: 22715421 PMCID: PMC3370995 DOI: 10.1371/journal.pone.0038973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/15/2012] [Indexed: 11/29/2022] Open
Abstract
Background Specific knowledge and skills are needed to work effectively with an interpreter, but most doctors have received limited training. Self-assessed competency may not accurately identify training needs. Purposes The purpose of this study is to explore the association between self-assessed competency at working with an interpreter and the ability to identify elements of good practice, using a written vignette. Methods A mailed questionnaire was sent to 619 doctors and medical students in Geneva, Switzerland. Results 58.6% of respondents considered themselves to be highly competent at working with a professional interpreter, but 22% failed to mention even one element of good practice in response to the vignette, and only 39% could name more than one. There was no association between self-rated competency and number of elements mentioned. Conclusions Training efforts should challenge the assumption that working with an interpreter is intuitive. Evaluation of clinicians' ability to work with an interpreter should not be limited to self-ratings. In the context of large-scale surveys, written vignettes may provide a simple method for identifying knowledge of good practice and topics requiring further training.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Guittier MJ, Bonnet J, Jarabo G, Boulvain M, Irion O, Hudelson P. Breech presentation and choice of mode of childbirth: A qualitative study of women’s experiences. Midwifery 2011; 27:e208-13. [DOI: 10.1016/j.midw.2010.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 08/25/2010] [Accepted: 08/29/2010] [Indexed: 10/18/2022]
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Hudelson P, Perron NJ, Perneger T. Self-assessment of intercultural communication skills: a survey of physicians and medical students in Geneva, Switzerland. BMC Med Educ 2011; 11:63. [PMID: 21884609 PMCID: PMC3175208 DOI: 10.1186/1472-6920-11-63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/01/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physicians working with multicultural populations need to know how to elicit the patient's understanding of the illness; determine the patient's sociocultural context and identify any issues that might affect care; communicate effectively across patient-provider social and cultural differences; and collaborate effectively with an interpreter. Skills self-assessment can contribute to identifying training needs and monitoring skills development in these areas. METHODS As part of a larger study exploring the knowledge, attitudes and practices of Geneva physicians and medical students regarding the care of immigrant patients, we asked respondents to self-rate their ability to perform a range of common yet challenging intercultural communication tasks. RESULTS Overall, respondents rated themselves less competent at intercultural tasks than at basic medical skills and less competent at specific intercultural communication skills than at general intercultural skills. Qualified doctors (as opposed to students), those with greater interest in caring for immigrants, and those who rarely encountered difficulties with immigrants rated themselves significantly more competent for all clinical tasks. Having a higher percentage of immigrant patients and previous cultural competence training predicted greater self-rated intercultural communication skills. CONCLUSION Our self-assessment results suggest that students and physicians should be provided with the opportunity to practice intercultural skills with immigrant patients as part of their cultural competence training. To strengthen the validity of self-assessment measures, they should ideally be combined with more objective methods to assess actual skills.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Noelle Junod Perron
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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Hudelson P, Perron NJ, Perneger T. Using clinical vignettes to assess doctors' and medical students' ability to identify sociocultural factors affecting health and health care. Med Teach 2011; 33:e564-e571. [PMID: 21942493 DOI: 10.3109/0142159x.2011.602994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Methods are needed for assessing clinicians' cultural knowledge frameworks. METHOD We used a mail survey containing four short clinical vignettes to explore respondents' ability to identify sociocultural factors affecting health and health care. Participants included 299 physicians working at the University Hospitals of Geneva, 156 private physicians, and all 134 local medical students in their clinical years. Twenty-one sociocultural "domains" were identified through inductive coding of responses. For each vignette, we obtained the sum of codes as a measure of the respondent's awareness of sociocultural factors that might affect care in this particular situation. As internal consistency was reasonably high (0.68), we computed a single total score as the sum of responses given to all four vignettes. RESULTS Reponses correlated with factors that might be expected to impact clinicians' awareness of sociocultural factors affecting care. Medical students, females, respondents who had received cultural competence training, those with greater interest in caring for immigrant patients, and those with high self-assessed skills at exploring psychosocial and migration-related issues scored higher on the vignettes. CONCLUSIONS Brief clinical vignettes appear to be a relevant and feasible method for exploring physicians' knowledge of social and cultural factors affecting health and health care.
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Abstract
It is generally believed that culturally competent clinical practice depends in part on the development of positive attitudes toward the care of immigrant patients. However, few tools exist to measure such attitudes in physicians. The authors operationalized ‘‘culturally competent attitudes’’ to include a high level of interest in caring for immigrant patients, an acceptance of the responsibility of doctors and hospitals to adapt to immigrant patients’ needs, and the opinion that understanding the patient’s psychosocial context is particularly important when caring for immigrant patients. The authors then assessed these attitudes and opinions among a sample of 619 Geneva doctors and medical students using a self-administered questionnaire and explored their association to respondents’ personal characteristics and professional experience. The authors found that both personal characteristics and professional experience were associated with attitudes toward caring for immigrant patients. In particular, the perceived importance of understanding the psychosocial context when caring for migrants was higher among medical students, women, Swiss nationals, those with greater interest in caring for immigrant patients and those who had received training in cultural competence. However, it is unclear whether cultural competence training and clinical context lead to the development of more positive attitudes or whether medical students and physicians who already have positive attitudes are more likely to participate in such training.
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Abstract
BACKGROUND The importance of trained interpreters for ensuring adequate communication with limited English proficiency patients is well-established. However, in many contexts, health professionals continue to rely on ad hoc interpreters, such as bilingual employees or patients' relatives to provide linguistic assistance. This is worrisome because these strategies have been shown to be associated with poor quality health care. OBJECTIVE Examine attitudes and practices related to healthcare interpreting. DESIGN Mailed, self-administered questionnaire. SETTING AND PARTICIPANTS Convenience sample of medical and nursing department and service heads at the Geneva University Hospitals. OUTCOME MEASURES Adequacy of attitudes and practices related to interpreter use. RESULTS Ninety-nine questionnaires were completed and returned (66% response rate). Between 43% and 86% of respondents relied mainly on patients' relatives and bilingual employees for linguistic assistance, depending on the language in question. Professional interpreter use varied according to language (from 5% to 39%) and seems to reflect the availability of bilingual staff members for the different languages. Professional interpreters appear to be used only in the absence of other available options, due to cost concerns and scheduling difficulties. This practice is further reinforced by the belief that ad hoc interpreters are "good enough" even while recognizing the quality differential between trained and untrained interpreters (91.2% of respondents rated bilingual staff as satisfactory or good, and 79.5% rated family/friends as satisfactory or good). CONCLUSIONS Simply making professional interpreter services available to healthcare professionals does not appear to guarantee their use for limited French proficiency (LFP) patients. Future efforts should focus on developing procedures for systematically identifying patients needing linguistic assistance, linguistic assistance strategies that are responsive to provider and institutional contexts and constraints, and institutional directives to ensure use of qualified interpreters for all medically important communication with LFP patients.
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Perron NJ, Perneger T, Kolly V, Dao MD, Sommer J, Hudelson P. Use of a computer-based simulated consultation tool to assess whether doctors explore sociocultural factors during patient evaluation. J Eval Clin Pract 2009; 15:1190-5. [PMID: 20367726 DOI: 10.1111/j.1365-2753.2009.01302.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The delivery of patient-centred care to diverse populations requires that doctors identify sociocultural factors that may affect care. We adapted a computer-based simulated consultation tool and tested its utility for assessing whether doctors explore sociocultural factors during a patient evaluation, and whether they include such information in their case conclusions and follow-up recommendations. METHODS We developed two detailed patient 'stories' that involved sociocultural issues that doctors needed to identify and consider for adequate clinical management. They were incorporated into an existing 'Virtual Internet Patient Simulation' (VIPS) program designed to test clinical reasoning skills. Doctors and medical students (n = 618) were invited to access the program via Internet. For each consultation, participants were assigned a sociocultural score, corresponding to the number of sociocultural domains explored. Scores were then compared with subjective ratings of participants' performance by expert doctors. RESULTS 118 respondents completed at least one virtual consultation (19%), 92 conducted both. The mean number of sociocultural dimensions explored by doctors (i.e. sociocultural score) was 3.9 (standard deviation 2.6) for case 1, and 5.2 (standard deviation 2.3) for case 2. The two sociocultural scores were moderately correlated (Spearman r = 0.65, P < 0.001). Sociocultural scores correlated positively with experts' subjective ratings of participants' performance (Spearman r = 0.84 for case 1 and 0.78 for case 2, both P < 0.001). CONCLUSIONS The adapted computer-based simulated consultation tool provided a feasible means to assess doctors' exploration of sociocultural issues during a clinical evaluation. Further validation of this method should be conducted by comparing VIPS results with other skills assessment methods such as objective structured clinical examination or direct observation of clinical performance.
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Affiliation(s)
- Noëlle Junod Perron
- Academic Primary Care Physicians, Geneva University Hospitals, Genève, Switzerland.
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Hudelson P, Vilpert S. Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices. BMC Health Serv Res 2009; 9:187. [PMID: 19832982 PMCID: PMC2770464 DOI: 10.1186/1472-6963-9-187] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 10/15/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of available interpreter services by hospital clinical staff is often suboptimal, despite evidence that trained interpreters contribute to quality of care and patient safety. Examination of intra-hospital variations in attitudes and practices regarding interpreter use can contribute to identifying factors that facilitate good practice. The purpose of this study was to describe attitudes, practices and preferences regarding communication with limited French proficiency (LFP) patients, examine how these vary across professions and departments within the hospital, and identify factors associated with good practices. METHODS A self-administered questionnaire was mailed to random samples of 700 doctors, 700 nurses and 93 social workers at the Geneva University Hospitals, Switzerland. RESULTS Seventy percent of respondents encounter LFP patients at least once a month, but this varied by department. 66% of respondents said they preferred working with ad hoc interpreters (patient's family and bilingual staff), mainly because these were easier to access. During the 6 months preceding the study, ad hoc interpreters were used at least once by 71% of respondents, and professional interpreters were used at least once by 51%. Overall, only nine percent of respondents had received any training in how and why to work with a trained interpreter. Only 23.2% of respondents said the clinical service in which they currently worked encouraged them to use professional interpreters. Respondents working in services where use of professional interpreters was encouraged were more likely to be of the opinion that the hospital should systematically provide a professional interpreter to LFP patients (40.3%) as compared with those working in a department that discouraged use of professional interpreters (15.5%) and they used professional interpreters more often during the previous 6 months. CONCLUSION Attitudes and practices regarding communication with LFP patients vary across professions and hospital departments. In order to foster an institution-wide culture conducive to ensuring adequate communication with LFP patients will require both the development of a hospital-wide policy and service-level activities aimed at reinforcing this policy and putting it into practice.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine and Primary Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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Abstract
OBJECTIVE To identify sources of perceived discrimination during hospitalization and examine the relationship of perceived discrimination to patient and hospital stay characteristics, and to patient ratings of care. BACKGROUND Patient experiences of discrimination within the health-care system are associated with delays in care seeking, non-adherence to medical advice and poorer health status. Most research to date has focused on race and ethnicity-based discrimination, and few studies have included hospitalized patients. METHODS Questions about patients' experiences of discrimination were added to a regular patient opinion survey conducted at the Geneva University Hospitals. Participants were 1537 adult residents of Switzerland discharged from the hospital between 15 February and 15 March 2007. RESULTS A total of 171 (11.1%) respondents reported at least one source of discrimination. Most (93, 54.4%) reported a single cause of discrimination. The most frequent causes of discrimination were language, age, nationality and having a disease that is viewed negatively by others. Fifteen percentage of non-European respondents reported at least one of the following types of discrimination: language, nationality, religion and skin colour. Reporting discrimination from any cause was associated with higher Picker Patient Experience problem scores, and patients who reported discrimination were less likely to describe their care as very good or excellent and less likely to recommend the hospital to others. CONCLUSIONS Patient experiences of discrimination during hospitalization are relatively frequent and are associated with lower patient ratings of care. Collection of data on patient experiences of discrimination may contribute to the development of interventions aimed at ensuring respectful, quality care for all patients.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine and Primary Care, Geneva University Hospitals, Geneva, Switzerland.
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Perron NJ, Sommer J, Hudelson P, Demaurex F, Luthy C, Louis-Simonet M, Nendaz M, De Grave W, Dolmans D, van der Vleuten CPM. Clinical supervisors' perceived needs for teaching communication skills in clinical practice. Med Teach 2009; 31:e316-e322. [PMID: 19811140 DOI: 10.1080/01421590802650134] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Lack of faculty training is often cited as the main obstacle to post-graduate teaching in communication skills. AIMS To explore clinical supervisors' needs and perceptions regarding their role as communication skills trainers. METHODS Four focus group discussions were conducted with clinical supervisors from two in-patient and one out-patient medical services from the Geneva University Hospitals. Focus groups were audio taped, transcribed verbatim and analyzed in a thematic way using Maxqda software for qualitative data analysis. RESULTS Clinical supervisors said that they frequently addressed communication issues with residents but tended to intervene as rescuers, clinicians or coaches rather than as formal instructors. They felt their own training did not prepare them to teach communication skills. Other barriers to teach communication skills include lack of time, competing demands, lack of interest and experience on the part of residents, and lack of institutional priority given to communication issues. Respondents expressed a desire for experiential and reflective training in a work-based setting and emphasised the need for a non-judgmental learning atmosphere. CONCLUSIONS Results suggest that organisational priorities, culture and climate strongly influence the degree to which clinical supervisors may feel comfortable to teach communication skills to residents. Attention must be given to these contextual factors in the development of an effective communication skills teaching program for clinical supervisors.
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Junod Perron N, Sommer J, Hudelson P, Demaurex F, Luthy C, Louis-Simonet M, Nendaz M, De Grave W, Dolmans D, Van der Vleuten C. Residents' perceived needs in communication skills training across in- and outpatient clinical settings. Educ Health (Abingdon) 2009; 22:280. [PMID: 19953441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Residents' perceived needs in communication skills training are important to identify before designing context-specific training programmes, since learrners' perceived needs can influence the effectiveness of training. OBJECTIVES To explore residents' perceptions of their training needs and training experiences around communication skills, and whether these differ between residents training in inpatient and outpatient clinical settings. METHODS Four focus groups (FG) and a self-administered questionnaire were conducted with residents working in in- and outpatient medical service settings at a Swiss University Hospital. Focus groups explored residents' perceptions of their communication needs, their past training experiences and suggestions for future training programmes in communication skills. Transcripts were analysed in a thematic way using qualitative analytic approaches. All residents from both settings were asked to complete a questionnaire that queried their sociodemographics and amount of prior training in communication skills. FINDINGS In focus groups, outpatient residents felt that communication skills were especially useful in addressing chronic diseases and social issues. In contrast, inpatient residents emphasized the importance of good communication skills for dealing with family conflicts and end-of-life issues. Felt needs reflected residents' differing service priorities: outpatient residents saw the need for skills to structure the consultation and explore patients' perspectives in order to build therapeutic alliances, whereas inpatient residents wanted techniques to help them break bad news, provide information and increase their own well-being. The survey's overall response rate was 56%. Its data showed that outpatient residents received more training in communication skills and more of them than inpatient residents considered communication skills training to be useful (100% vs 74%). DISCUSSION Outpatient residents' perceived needs in communication skills were more patient-centered than the needs perceived by inpatient residents. Residents' perceived needs for communication skills may differ not only because of their differing service priorities but also because of differences in their previous experiences with communication skills training. These factors should be taken into account when designing a training programme in communication skills.
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Affiliation(s)
- Noelle Junod Perron
- Department of Community Medicine and Primary Care, Geneva University Hospitals, Switzerland.
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Hudelson P, Cleopas A, Kolly V, Chopard P, Perneger T. What is quality and how is it achieved? Practitioners' views versus quality models. Qual Saf Health Care 2008; 17:31-6. [DOI: 10.1136/qshc.2006.021311] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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