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Johnson KM, Luff D, Macharia A, Troutman M, Lamberto A, Marchand K, Hacker MR, Brown S, O'Brien B. Clinician communication after discovery of a soft marker of aneuploidy during pregnancy: A mixed methods assessment of a communication workshop. J Gynecol Obstet Hum Reprod 2023; 52:102652. [PMID: 37633360 PMCID: PMC10615874 DOI: 10.1016/j.jogoh.2023.102652] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Soft markers of aneuploidy are common findings on obstetric ultrasounds but disclosure often increases patient anxiety. It is unknown whether communication training affects patient experience of soft marker disclosure. Our objective was to evaluate clinician experience of a simulation-based communication workshop and assess workshop influence on patient anxiety, understanding, and perception of communication quality. METHODS We implemented a communication workshop for clinicians at an academic institution in 2019, and assessed clinician anxiety and confidence with counseling before and after. To assess effect of the workshop on patients, we surveyed pregnant people before and after workshop implementation for whom an echogenic intracardiac focus, choroid plexus cyst, or urinary tract dilation was identified. The primary outcome was anxiety. Some respondents completed a semi-structured interview. Interviews were analyzed using thematic analysis. RESULTS Twelve clinicians participated. Twenty-one out of 49 eligible patients (43%) completed a survey before the workshop and 40 out of 90 eligible patients (44%) completed a survey after. The risk of high anxiety after was similar to before the workshop (aRR 1.7, 95% CI 0.6-4.2). Twenty patients were recruited for an interview. Qualitative analysis revealed that patients' backgrounds, emotional impact of the conversation and clinician manner influenced perception of communication quality. CONCLUSION While a single clinician workshop did not affect patient anxiety, clinician manner and personalization play a large role in perception of counseling about soft markers of aneuploidy.
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Affiliation(s)
- Katherine M Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Donna Luff
- Boston Children's Hospital Immersive Design Systems, Center for Life Sciences Building, 18th Floor, 3 Blackfan Circle, Boston, MA 02115, USA; Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Boston Children's Hospital, Boston MA 02115, USA
| | - Annliz Macharia
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Michele Troutman
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Anderson Lamberto
- Boston Children's Hospital Immersive Design Systems, Center for Life Sciences Building, 18th Floor, 3 Blackfan Circle, Boston, MA 02115, USA
| | - Karen Marchand
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Stephen Brown
- Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Barbara O'Brien
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Bou Khalil R, Sleilaty G, El-Khoury J, Nemr E. Teaching the use of framing and decontextualization to address context-based bias in psychiatry. Asian J Psychiatr 2020; 54:102276. [PMID: 32653853 DOI: 10.1016/j.ajp.2020.102276] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
The framing effect in medical decision making is a type of cognitive bias that can lead a medical trainee at undergraduate and graduate level to reach a diagnosis or take action based on emotional states induced by the frame in which the information has been approached. This literature review on the framing effect in medical decision making will be done in the context of a case presentation in which the framing of scientific information may lead to conflicting decisions in psychiatry. As a matter of fact, debiasing techniques which help medical students/residents become aware of the fact that they might be easily influenced by the frame used in scientific data, have started to be implemented in medical teaching programs. It is important to incorporate exercises that improve debiasing skills in the curriculum at all levels of medical education. An example of such exercises is decontextualization which consists of improving problem-solving in a non-medical context in order to consolidate the use of the same schema of critical thinking in a medical context afterwards.
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Affiliation(s)
- Rami Bou Khalil
- Saint Joseph University, Department of Psychiatry, Beirut, Lebanon.
| | - Ghassan Sleilaty
- Saint Joseph University, Department of Cardiothoracic Surgery, Beirut, Lebanon; Saint Joseph University, Head of Clinical Research Center, Beirut, Lebanon
| | - Joseph El-Khoury
- American University of Beirut, Department of Psychiatry, Beirut, Lebanon
| | - Elie Nemr
- Saint Joseph University, Department of Urology, Beirut, Lebanon
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