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Mishra V, Sarraju A, Kalwani NM, Dexter JP. Evaluation of Prompts to Simplify Cardiovascular Disease Information Generated Using a Large Language Model: Cross-Sectional Study. J Med Internet Res 2024; 26:e55388. [PMID: 38648104 DOI: 10.2196/55388] [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: 12/11/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 04/25/2024] Open
Abstract
In this cross-sectional study, we evaluated the completeness, readability, and syntactic complexity of cardiovascular disease prevention information produced by GPT-4 in response to 4 kinds of prompts.
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Affiliation(s)
- Vishala Mishra
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Neil M Kalwani
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Joseph P Dexter
- Data Science Initiative, Harvard University, Allston, MA, United States
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States
- Institute of Collaborative Innovation, University of Macau, Taipa, Macao
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2
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Chawak S, Chittem M, Dhillon H, Huligol N, Butow P. Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers. Psychooncology 2024; 33:e6295. [PMID: 38282221 DOI: 10.1002/pon.6295] [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: 08/01/2023] [Revised: 12/08/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIM We aimed to develop two question prompt lists (QPLs), one for Indian cancer patients undergoing radiation therapy and the second for their primary family caregivers. METHODS The study comprised three phases: (1) qualitative interviews with patients (n = 65) and PFCs (n = 39) to identify their information needs, queries and concerns regarding RT; (2) development of draft QPLs using conventional content analysis and translation into Hindi and Marathi using European Organisation Research and Treatment of Cancer guidelines; and, (3) A readability analysis, and acceptability study with patients (n = 22), PFCs (n = 26) and Radiation Oncology (RO) staff (n = 20) exploring barriers to QPL implementation. RESULTS AND DISCUSSION Analysis in Phase I identified questions patients and PFCs asked or wanted to ask their physician. A list of 125 and 136 questions were generated for patients and PFCs, respectively. After five iterations, the draft QPLs were finalised, translated, and back-translated from English into Hindi and Marathi (Phase II). In Phase III, most patients and PFCs reported the QPLs were easy to read, they did not find it difficult to ask the questions, and the questions were not emotionally upsetting. Conversely, RO staff reported concerns that patients may find it difficult to discuss the questions with their physician. CONCLUSION The study highlights the need to empower patients and PFCs to ask questions and for staff to feel comfortable answering them. Implementing physician-endorsed QPLs could achieve these aims.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
- Jindal School of Psychology and Counselling, O P Jindal Global University, Haryana, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nagraj Huligol
- Department of Radiation Oncology, Dr Balabhai Nanavati Hospital, Mumbai, India
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based, Decision-making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Bernard L, Wang AR, Menez S, Henderson JM, Dighe A, Roberts GV, Stutzke C, Tuttle KR, Miller RT. Kidney Biopsy Utility: Patient and Clinician Perspectives from the Kidney Precision Medicine Project. Kidney Med 2023; 5:100707. [PMID: 37771916 PMCID: PMC10522985 DOI: 10.1016/j.xkme.2023.100707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Rationale & Objective Limited data exist on patient perspectives of the implications of kidney biopsies. We explored patients' perspectives alongside those of clinicians to better understand how kidney biopsies affect patients' viewpoints and the clinical utility of biopsies. Study Design Prospective Cohort Study. Setting & Participants Patient participants and clinicians in the Kidney Precision Medicine Project, a prospective cohort study of patients who undergo a research protocol biopsy, at 9 recruitment sites across the United States. Surveys were completed at enrollment before biopsy and additional timepoints after biopsy (participants: 28 days, 6 months; clinicians: 2 weeks). Analytical Approach Kappa statistics assessed prebiopsy etiology concordance between clinicians and participants. Participant perspectives after biopsy were analyzed using a thematic approach. Clinician ratings of clinical management value were compared to prebiopsy ratings with Wilcoxon matched-pairs signed-rank tests and paired t tests. Results A total of 167 participants undergoing biopsy (124 participants with chronic kidney disease [CKD], 43 participants with acute kidney injury [AKI]) and 58 clinicians were included in this study. CKD participants and clinicians had low etiology concordance for the 2 leading causes of CKD: diabetes (k = 0.358) and hypertension (k = 0.081). At 28 days postbiopsy, 46 (84%) participants reported that the biopsy affected their understanding of their diagnosis, and 21 (38%) participants reported that the results of the biopsy affected their medications. Participants also shared biopsy impressions in free-text responses, including impacts on lifestyle and concurrent condition management. The biopsy positively shifted clinician perceptions of the procedure's clinical management benefits, while perceptions of prognostic value decreased and diagnostic ratings remained unchanged. Limitations Our study did not have demographic data of clinicians and could not provide insight into postbiopsy experiences for participants who did not respond to follow-up surveys. Conclusions Participant perspectives of the personal implications of kidney biopsy can be integrated into shared decision-making between clinicians and patients. Enhanced biopsy reports and interactions between nephrologists and pathologists could augment the management and prognostic value of kidney biopsies. Plain-Language Summary The utility of kidney biopsy is debated among clinicians, and patients' perspectives are even less explored. To address these gaps, we synthesized perspectives from clinicians and patient participants of the Kidney Precision Medicine Project (KPMP). Both before and after biopsy, clinicians were surveyed on how the procedure affected their clinical management, diagnosis, and prognosis. After biopsy, participants shared how the procedure affected their diagnosis, medication, and lifestyle changes. Clinicians and patients shared an appreciation for the biopsy's impact on medical management but diverged in their takeaways on diagnosis and prognosis. These findings highlight the need for greater collaboration between patients and clinicians, particularly as they navigate shared decision-making when considering kidney biopsy.
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Affiliation(s)
- Lauren Bernard
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ashley R. Wang
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Steven Menez
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joel M. Henderson
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Ashveena Dighe
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - Glenda V. Roberts
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
- Kidney Precision Medicine Project Patient Partner, Seattle, WA
| | - Christine Stutzke
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
- Kidney Precision Medicine Project Patient Partner, Seattle, WA
| | - Katherine R. Tuttle
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
| | - R. Tyler Miller
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
| | - Kidney Precision Medicine Project
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pathology & Laboratory Medicine, Boston University School of Medicine, Boston, MA
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA
- Kidney Precision Medicine Project Patient Partner, Seattle, WA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
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Summers KM, Scherer A, Chasco EE, Ryan GL. Defining infertility: a qualitative interview study of patients and physicians. J Reprod Infant Psychol 2023:1-15. [PMID: 37288784 DOI: 10.1080/02646838.2023.2221277] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate if infertility patients and physicians apply a traditional biomedical model of disease in their conceptualisation of infertility, examine any contradictions and conflicts in conceptualisations, and examine areas of concordance and discordance between physicians and patients. METHODS Semi-structured interviews were conducted with 20 infertility patients and 18 infertility physicians between September 2010 and April 2012. Interviews were analysed qualitatively to determine physician and patient conceptualisations of infertility, reactions to the definition of infertility as a disease, and potential benefits and concerns related to application of a disease label to the condition. RESULTS Most physicians (n = 14/18) and a minority of patients (n = 6/20) were supportive of defining infertility as a disease. Many of the patients who agreed with classifying infertility as a disease expressed that they had not personally defined it as such previously. Physicians (n = 14) and patients (n = 13) described potential benefits of a disease label, including increases in research funding, insurance coverage, and social acceptability. Some patients (n = 10) described potential stigma as a negative consequence. When describing appraisals of infertility, both physicians (n = 7) and patients (n = 8) invoked religious/spiritual concepts. The potential for religious/spiritual appraisal to contribute to stigmatising or de-stigmatising infertility was discussed. CONCLUSION Our findings contradict the assumption that infertility physicians and patients are fully supportive of defining infertility as a disease. While potential benefits of the disease label were recognised by both groups, caution against potential for stigmatisation and unsolicited invocation of religion/spirituality suggest a more holistic model may be appropriate.
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Affiliation(s)
- K M Summers
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - A Scherer
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - E E Chasco
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - G L Ryan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Washington Medical Center Montlake, Seattle, WA, USA
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Fahmy LM, Schreidah CM, Geskin LJ. Racial and ethnic disparities in the perception of respect from physicians among skin cancer patients in the United States. JAAD Int 2023; 11:78-82. [PMID: 36941912 PMCID: PMC10023859 DOI: 10.1016/j.jdin.2023.01.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/30/2023] Open
Abstract
Background Racial and ethnic minority groups are at increased risk of poor skin cancer outcomes. Successful patient-physician communication is linked to better health outcomes, but it is unknown whether disparities in perceived care exist among skin cancer patients. Objective To investigate whether there are racial and ethnic disparities in the perception of physicians showing respect, listening, and explaining during clinical encounters. Methods A cross-sectional study was conducted using data from participants with a self-reported skin cancer history from the 2008 to 2017 and 2019 Medical Expenditure Panel Survey. Race and ethnicity were self-identified. Results Of 5570 participants, 5263 were non-Hispanic White and 307 were racial and ethnic minority individuals. Racial and ethnic minority participants were less likely to report that their doctors show them respect, listen to, and explain to them than non-Hispanic White participants, even when adjusting for age, sex, insurance type, health status, and survey year. Among racial and ethnic minority participants, perceptions of physicians listening and explaining were strongly associated with perceived respect. Limitations Lack of disaggregated racial and ethnic subgroup analysis. Conclusions Our findings suggest racial and ethnic disparities in perceived care among skin cancer patients. Future research is warranted to determine whether such perceptions contribute to disparities in skin cancer care and/or outcomes.
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Affiliation(s)
- Lauren M. Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Celine M. Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Larisa J. Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
- Correspondence to: Larisa J. Geskin, MD, Department of Dermatology, Columbia University Irving Medical Center, 161 Fort Washington Ave, 12th Floor, New York, NY 10032.
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Festl-Wietek T, Erschens R, Griewatz J, Zipfel S, Herrmann-Werner A. How to communicate with patients in written asynchronous online conversations: an intervention study with undergraduate medical students in a cross-over design. Front Med (Lausanne) 2023; 10:1026096. [PMID: 37275354 PMCID: PMC10232748 DOI: 10.3389/fmed.2023.1026096] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction The patient-physician encounter is the core element in the treatment of patients and the diagnosis of disease. In these times of digitalization, patient-physician communication is increasingly taking place online: patients embrace new possibilities offered digitally, and physicians are encouraged to adapt accordingly. Since a huge part of online communication is written, this study aims to investigate how medical students communicate with patients online by focusing on their written competencies and whether an intervention might improve their competencies. Methods This study was performed in an explanatory cross-sectional manner with a cross-over design. Second-year medical students participated. An intervention was developed on how to formulate an appropriate written response to a patient's request and integrated a longitudinal communication class. The intervention consists of education on general set-up (e.g., greetings), syntax, spelling, content and kind of communication (e.g., appreciative attitude). After meeting a patient in a simulated role play medical students received the patient's request via a digital platform. The control group had the same simulated role play and the same task but they received the intervention on communication afterwards. Intervention and control group were statistically compared based on a checklist. Results Twenty-nine medical students took part in the study. The results showed that the medical students had basic competencies in dealing with written communication independent if they received the intervention (CG: M = 3.86 ± 1.23 vs. IG: M = 4.07 ± 1.03; p = 0.625). Similar results were also for the emotional competency ratings (MCG = 3.36 ± 1.08; MIG = 3.67 ± 0.98; p = 0.425).The intervention was able to lead to a more appreciative response toward patient. Discussion Intervention on basic competencies such as simple language and clear presentation might not be needed as an integral part in medical education. However, medical students should learn how to present empathic and authentic behavior in written online communication.
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Affiliation(s)
- Teresa Festl-Wietek
- TIME–Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jan Griewatz
- TIME–Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
- Deanery of Students’ Affairs, Faculty of Medicine, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Anne Herrmann-Werner
- TIME–Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Borowsky HM, Willis A, Bullock JL, Fuentes‐Afflick E, Palmer NRA. Opportunities and challenges in discussing racism during primary care visits. Health Serv Res 2023; 58:282-290. [PMID: 36524295 PMCID: PMC10012223 DOI: 10.1111/1475-6773.14118] [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] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To understand how patients and primary care practitioners (PCPs) discuss racism and their perspectives on having these conversations during primary care visits. DATA SOURCES/STUDY SETTING We conducted semi-structured interviews from September 2020-March 2021 at a Federally Qualified Health Center in the San Francisco Bay Area. STUDY DESIGN We conducted an inductive qualitative descriptive pilot study using one-on-one, semi-structured interviews with 5 members of a Patient Advisory Council and 10 internal medicine PCPs. DATA COLLECTION/EXTRACTION METHODS Interviews were conducted via video conferencing, recorded, and transcribed. An iterative analytic process was used to thematically assess participants' experiences and perspectives and identify key themes. PRINCIPAL FINDINGS Patients and PCPs identified benefits from engaging in conversations about racism during primary care visits and noted challenges and concerns. Patients and PCPs highlighted strategies to advance communication about racism in primary care. CONCLUSIONS Initiating conversations about racism with patients in primary care can be meaningful, but also has risks. More research is needed for deeper exploration of patients' perspectives and development of trainings. Improving how PCPs communicate with patients about racism represents an opportunity to advance antiracism in medicine and improve health outcomes for individuals who have historically been poorly served by our health care system.
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Affiliation(s)
- Hannah M. Borowsky
- Department of MedicineBrigham and Women's HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Aubrey Willis
- Division of Pediatric Pulmonary Asthma and Sleep MedicineStanford Medicine Children's Health, Lucille Packard Children's HospitalPalo AltoCaliforniaUSA
| | - Justin L. Bullock
- Division of Nephrology, Department of Internal MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Elena Fuentes‐Afflick
- Department of Pediatrics, Zuckerberg San Francisco General HospitalUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Nynikka R. A. Palmer
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General HospitalUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
- Helen Diller Family Comprehensive Cancer CenterUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of UrologyUniversity of California, San Francisco School of MedicineSan FranciscoCaliforniaUSA
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Elston Lafata J, Nguyen B, Staresinic C, Johnson M, Gratie D, Muluneh B. Interpersonal communication-, education- and counselling-based interventions to support adherence to oral anticancer therapy: a systematic review. J Oncol Pharm Pract 2023; 29:358-369. [PMID: 35048768 DOI: 10.1177/10781552211073576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/04/2023]
Abstract
Background. Many factors contribute to oral anti-cancer therapy adherence, including counselling and educational support. Objective. We systematically review the literature evaluating the effectiveness of interpersonal communication-, counselling- and education-based interventions on patient adherence to oral anticancer therapy. Methods. Using search terms pertaining to medication adherence, oral anticancer therapy, and communication, education, and counselling, we conducted a systematic search for full-text, original research articles prior to 3/13/20. Two reviewers independently reviewed each paper for inclusion and charted study information. Results. Twenty-four articles were included. All considered the use of oral anticancer therapy between two defined time points. Four studies also considered the length of time a patient persisted on therapy. Half (n = 12) of the studies reported a statistically significant relationship between the intervention and medication adherence, with no consistent pattern among intervention structure/content and effectiveness. Programmes offering in-person counselling and those targeting patients with chronic myeloid leukemia (CML), tended to report positive findings. Most studies faced substantial risk of bias, and only two reported using a behavioural theory to guide interventional content. Conclusions. Findings highlight the infancy of evidence base and need for rigorous and large-scale studies grounded in established behavioural theories to advance patient-targeted educational and counselling practices supporting adherence to oral anti-cancer therapy.
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Muecke R, Dubois C, Micke O, Keinki C, Huebner J. Vitamin D during treatment for breast cancer - the perspective of active self-help group leaders. Breast Dis 2023; 41:503-511. [PMID: 36641650 DOI: 10.3233/bd-210070] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND In breast cancer patients, there is an elevated risk of developing osteoporosis during treatment which should be addressed by optimizing 25(OH) levels. OBJECTIVE The aim was to assess the prescription, information and physician-patient communication on vitamin D and bone density in Germany. METHODS We developed a standardized questionnaire concerning bone density measurement, vitamin D (blood level testing, prescription), information and communication regarding vitamin D. The questionnaire was distributed at the annual meeting of all group leaders of the Women's Cancer Support Association to all participants. RESULTS Overall, 224 participants completed the questionnaire; 77.7% reported having had at least one bone density measurement test. The number was 84.4% in patients treated with aromatase inhibitor and 43.7% reported that their bone density was too low. In total, 51.3% patients reported at least one vitamin D blood test and 45.1% reported that vitamin D had been primarily addressed by a physician. As many as 74.1% of those reporting a test result had a deficiency; 91.6% of those with a low level got a prescription and 28.4% took vitamin D autonomously. CONCLUSIONS The awareness on risk of osteoporosis, prevention, early diagnosis and treatment are insufficiently addressed in a patient group with high risk of osteoporosis. More attention should be paid to the phenomenon of vitamin D deficiency or insufficiency in routine care.
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Affiliation(s)
- Ralph Muecke
- Department of Radiotherapy and Radiation Oncology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany.,Radiotherapy RheinMainNahe, Bad Kreuznach, Germany
| | - Clara Dubois
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital, Bielefeld, Germany
| | - Christian Keinki
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | - Jutta Huebner
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
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Tenfelde K, Bol N, Schoonman GG, Bunt JEH, Antheunis ML. Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction. Digit Health 2023; 9:20552076231203887. [PMID: 37780066 PMCID: PMC10540607 DOI: 10.1177/20552076231203887] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations. Methods A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed. Results Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication. Conclusions Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.
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Affiliation(s)
- Kim Tenfelde
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Guus G Schoonman
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
- Department of Neurology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jan Erik H Bunt
- Department of Pediatrics, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Marjolijn L Antheunis
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
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Sterie AC, Castillo C, Jox RJ, Büla CJ, Rubli Truchard E. "If I Become a Vegetable, Then no": A Thematic Analysis of How Patients and Physicians Refer to Prognosis When Discussing Cardiopulmonary Resuscitation. Gerontol Geriatr Med 2023; 9:23337214231208824. [PMID: 37954661 PMCID: PMC10634265 DOI: 10.1177/23337214231208824] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023] Open
Abstract
Background: Documenting decisions about the relevance cardiopulmonary resuscitation (CPR) is a standard practice at hospital admission yet a complex task. Objective: Our aim was to explore how physicians approach and discuss CPR prognosis with older patients recently admitted to a post-acute care unit. Method: We recorded 43 conversations between physicians and patients about the relevancy of CPR that took place at admission at the geriatric rehabilitation service of a Swiss university hospital. Thematic analysis determined (i) who initiated the talk about CPR prognosis, (ii) at what point in the conversation, and (iii) how prognosis was referred to. Results: Prognosis was mentioned in 65% of the conversations. We categorized the content of references to CPR prognosis in five themes: factors determining the prognosis (general health, age, duration of maneuvers); life (association of CPR with life, survival); proximal adverse outcomes (broken ribs, intensive care); long-term adverse outcomes (loss of autonomy, suffering a stroke, pain, generic, uncertainty); and being a burden. Discussion and conclusion: Discussing CPR is important to all patients, including those for whom it is not recommended. Information about CPR prognosis is essential to empower and support patients in expressing their expectations from life-prolonging interventions and attain shared decision-making.
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Affiliation(s)
| | - Clara Castillo
- Lausanne University Hospital and Lausanne University, Switzerland
| | - Ralf J. Jox
- Lausanne University Hospital and Lausanne University, Switzerland
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Huang AK, Campbell PA, Chaudhary MJ, Soklaridis S, Miller D, Dinizulu S, Stolbach B, Cosey Gay F, Washington S, Olivera Perez H, Chalmers K, Tessema F, Henry M, Slidell M, Richardson J, Bailey Z, Owens T, Wilkins E, Burgest V, Hardaway C, Francis MX, Asom A, Lopez Hinojosa I, Roggin J, Hamzat I, Zakrison T. "We're playing on the same team": Communication (dis)connections between trauma patients and surgical residents. J Trauma Acute Care Surg 2023; 94:93-100. [PMID: 35546248 PMCID: PMC10443400 DOI: 10.1097/ta.0000000000003663] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-physician communication is key to better clinical outcomes and patient well-being. Communication between trauma patients and their physicians remains relatively unexplored. We aimed to identify and characterize the range of strengths and challenges in patient-physician communication in the setting of trauma care. METHODS A qualitative, grounded theory approach was used to explore communication strengths and challenges for patients and residents. Patients previously admitted to the trauma service for violent injuries were recruited and interviewed in-person during their trauma clinic appointments. Surgical residents were recruited via email and interviewed virtually via Zoom. Anonymous, semistructured interviews were conducted until thematic saturation was reached. RESULTS Twenty-nine interviews with patients and 14 interviews with residents were conducted. Patients reported feeling ignored and misunderstood and having inadequate communication with physicians. Residents cited lack of time, patients' lack of health literacy, differences in background, and emotional responses to trauma as barriers to effective communication with patients. Patients and residents reported an understanding of each other's stressors, similar emotional experiences regarding traumatic stress, and a desire to communicate with each other in greater depth both inside and outside of the hospital. CONCLUSION Trauma patients and residents can feel disconnected due to the lack of time for thorough communication and differences in background; however, they understand each other's stressors and share similar emotional responses regarding trauma and a desire for increased communication, connection, and solidarity. Leveraging these shared values to guide interventions, such as a resident curriculum, may help bridge disconnects and improve their communication. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Anna K Huang
- From the University of Chicago, Pritzker School of Medicine (A.K.H., P.-A.C., S.W., H.O.P., K.C., F.T., A.A., I.L.H., I.H.), Chicago, Illinois; Department of Surgery (M.J.C.), University of California San Francisco-East Bay, Oakland, California; Department of Psychiatry and Department of Family and Community Medicine (S.S.), University of Toronto, Toronto, ON, Canada; Department of Medicine (D.M.), University of Chicago; Department of Psychiatry and Behavioral Neurosciences (S.D.), Department of Pediatrics (B.S.), Crown School of Social Work (F.C.G.), Section of Pediatric Surgery, Department of Surgery (M.H., M.S., D.M., S.D., B.S., F.C.G.), University of Chicago, Chicago, Illinois; Department of Anthropology (J.R.), University of Maryland, College Park, Maryland; Miller School of Medicine (Z.B.), University of Miami, Miami, Florida; and Section of Trauma and Acute Care Surgery, Department of Surgery (T.O., E.W., V.B., C.H., M.X.F., J.R., T.Z.), University of Chicago, Chicago, Illinois
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13
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Wu D, Lowry PB, Zhang D, Tao Y. Patient Trust in Physicians Matters-Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study. J Med Internet Res 2022; 24:e42941. [PMID: 36538351 PMCID: PMC9776535 DOI: 10.2196/42941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/13/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health and, thus, is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence. OBJECTIVE This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies. METHODS This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data. RESULTS The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process. CONCLUSIONS Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context.
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Affiliation(s)
- Dezhi Wu
- Department of Integrated Information Technology, University of South Carolina, Columbia, SC, United States
| | - Paul Benjamin Lowry
- Department of Business Information Technology, Virginia Tech, Blacksburg, VA, United States
| | - Dongsong Zhang
- Department of Business Information Systems & Operations Management, The University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Youyou Tao
- Department of Information Systems and Business Analytics, Loyola Marymount University, Los Angeles, CA, United States
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14
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Mavragani A, Yin C, Meno M, Abe J, Pagano I, Tamashiro S, Fujinaga K, Braun-Inglis C, Fukui J. Racial Disparities in Patient-Provider Communication During Telehealth Visits Versus Face-to-face Visits Among Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer: Cross-sectional Analysis. JMIR Cancer 2022; 8:e37272. [PMID: 36485021 PMCID: PMC9789492 DOI: 10.2196/37272] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Telehealth visits increase patients' access to care and are often rated as "just as good" as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups. OBJECTIVE Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients. METHODS We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors. RESULTS Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree "[y]our physician listened carefully to you"). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits. CONCLUSIONS Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration.
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Affiliation(s)
| | - Chelsea Yin
- Kaiser Permanente, Oakland, CA, United States
| | - Michael Meno
- University of Washington, Seattle, WA, United States
| | - Justin Abe
- University of Southern California, Los Angeles, CA, United States
| | - Ian Pagano
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | | | | | | | - Jami Fukui
- University of Hawaii Cancer Center, Honolulu, HI, United States
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15
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Berger Z, Galasinski D, Scalia P, Dong K, Blunt HB, Elwyn G. The submissive silence of others: Examining definitions of shared decision making. Patient Educ Couns 2022; 105:1980-1987. [PMID: 34756474 DOI: 10.1016/j.pec.2021.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/03/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Our aim was to use critical discourse analysis (CDA) to examine the most widely cited definitions of shared decision making so that we can evaluate how language is used to position participants. Based on our conceptual understanding, we presumed that shared decision making involves acts of communication where processes are collaborative. METHODS We used a CDA lens to closely examine the phrases, semantics, syntax, implied functions, and the social actions proposed in SDM definition texts. We conducted a systematic search guided by the PRISMA guidelines, to identify the most widely cited definitions of SDM. RESULTS A total of 72 studies met our inclusion criteria. While SDM is not consistently defined, it was striking to find that clinicians are constructed as active whereas patients were viewed to be passive participants. The definitions construct SDM to be a gift that the clinician has the power to offer, and the relationship in the definitions appears asymmetric, in which only one party seems to speak. CONCLUSIONS The SDM definitions examined convey a process characterized by a clinician who speaks, while a patient mostly listens, and is invited to contribute. An alternative definition might be constructed through references to joint activity via sentences in active voice. PRACTICE IMPLICATIONS Clinicians may be influenced by definitions of SDM that reinforce the positionality of active speaker versus passive recipient. Clearer definitions that address the constructs of power and roles may help support the implementation of SDM.
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Affiliation(s)
- Zackary Berger
- Johns Hopkins School of Medicine, Division of General Internal Medicine, and Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
| | - Dariusz Galasinski
- Centre for Interdisciplinary Research into Health and Illness, University of Wroclaw, Poland.
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH 03756, USA.
| | | | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, 37 Dewey Field Road, Hanover, NH 03755, USA.
| | - Glyn Elwyn
- Centre for Interdisciplinary Research into Health and Illness, University of Wroclaw, Poland.
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16
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Delgado-Martinez R, Barry MF, Porras-Javier L, Thompson LR, Howard BJ, Sturner R, Halterman JS, Szilagyi PG, Okelo SO, Dudovitz RN. What Parents Want Doctors to Know: Responses to an Open-Ended Item on an Asthma Questionnaire. Acad Pediatr 2022; 22:657-666. [PMID: 34800723 DOI: 10.1016/j.acap.2021.11.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Unstructured parental comments could solicit important information about children's asthma, yet are rarely captured in clinical asthma questionnaires. This mixed-methods study describes parents' written responses to an open-ended question in a validated asthma questionnaire. METHODS The Pediatric Asthma Control and Communication Instrument (PACCI) asthma questionnaire was administered to parents of children with asthma symptoms presenting to 48 pediatric primary care offices (PPCP), 1 pediatric pulmonology office, and 1 emergency department (ED). Responses to the question, "Please write down any concern or anything else you would like your doctor to know about your child's asthma" were analyzed using a phenomenological approach until thematic saturation was achieved for each site. Logistic regressions tested whether sociodemographic and clinical characteristics were associated with responding to the open-ended question. RESULTS Of 7,988 parents who completed the PACCI, 954 (12%) responded to the open-ended question-2% in PPCP, 31% in the ED, and 50% in the pulmonary setting. More severe asthma was associated with higher odds of responding (odds ratio, 2.01; 95% confidence interval, 1.42-2.84). Based on responses provided, we identified 3 communication types: 1) clarifying symptoms, 2) asking questions, and 3) communicating distress. Responses also covered 5 asthma-related themes: 1) diagnostic uncertainty, 2) understanding asthma etiology and prognosis, 3) medication management, 4) impact on child function, and 5) personal asthma characteristics. CONCLUSION Parents of children with severe asthma provided clarifying details, asked questions, and relayed health concerns and distress. None of these topics may be easily captured by closed-ended asthma questionnaires.
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Affiliation(s)
- Roxana Delgado-Martinez
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif.
| | - Melanie Frances Barry
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Lorena Porras-Javier
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine (LR Thompson), Pasadena, Calif
| | - Barbara J Howard
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Raymond Sturner
- Department of Pediatrics, The Johns Hopkins University School of Medicine (BJ Howard and R Sturner), Baltimore, Md
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine (JS Halterman), Rochester, NY
| | - Peter G Szilagyi
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Sande O Okelo
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
| | - Rebecca N Dudovitz
- Department of Pediatrics, The David Geffen School of Medicine at UCLA (R Delgado-Martinez, M Venegas, F Barry, L Porras-Javier, PG Szilagyi, SO Okelo, and RN Dudovitz), Los Angeles, Calif
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Alsulamy N, Lee A, Thokala P. Healthcare professionals' views on factors influencing shared decision-making in primary health care centres in Saudi Arabia: A qualitative study. J Eval Clin Pract 2022; 28:235-246. [PMID: 34467591 DOI: 10.1111/jep.13616] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the perspectives of healthcare professionals regarding the implementation of Shared decision-making (SDM) in primary healthcare centres (PHCCs) in Saudi Arabia. METHODS Qualitative semi-structured interviews were conducted with a purposive and snowball sample of healthcare professionals in PHCCs. Interviews have been recorded, transcribed, translated and thematically analysed. Themes were mapped to the COM-B model. RESULTS Sixteen healthcare professionals were interviewed. The data analysis identified six themes and 14 sub-themes. The six themes are patient related factors, health professional related factors, environmental context and resources, patient-physician communication, patient-physician preferences toward SDM and physicians' perceived value and benefits of SDM. Physicians are unlikely to practice SDM in the context of time pressures, shortage of physicians, lack of treatment options, and decision-making aids. The findings also underscored the importance of building a trustworthy physician-patient relationship through the use of effective conversation techniques. CONCLUSIONS There are multiple barriers to SDM in primary care. Unless these barriers are addressed, it is unlikely that physicians will effectively or fully engage in SDM with patients.
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Affiliation(s)
- Nouf Alsulamy
- Public Health, The University of Sheffield, Sheffield, UK.,College of Business, University of Jeddah, Jeddah, Saudi Arabia
| | - Andrew Lee
- Public Health, The University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
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Tressler AB, Naples R, Barrios PA, Jia X, French JC, Lipman J. Digital Professionalism in Patient Care: A Case Based Survey of Patients. J Surg Educ 2022; 79:516-523. [PMID: 34642097 DOI: 10.1016/j.jsurg.2021.09.013] [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] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The objective of this study was to obtain the perception of patients on the use of portable digital media devices by providers during patient care and compare the findings to a previous study that examined providers' perceptions on the use of these devices. DESIGN This was a cross-sectional survey study. SETTING This study took place at a large tertiary referral center. PARTICIPANTS Participants were identified via inpatient lists from general surgery services. RESULTS Of those eligible to participate, 70% completed the questionnaire. While some situations were seen as less appropriate, the overall consensus from participants was that informing the patient of why the physician is using a digital media device made it more appropriate. CONCLUSION Patients recognize digital device use in healthcare is appropriate and professional when discussed with them in advance. Overall, patients and providers are in agreement that portable digital technology can improve patient care and open communication about the use improves the provider-patient relationship. There is some risk to patient trust in using digital devices in their presence.
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Affiliation(s)
- Andrea Boyd Tressler
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Robert Naples
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Paola A Barrios
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Xue Jia
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Judith C French
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy Lipman
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
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19
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Chubachi K, Umihara J, Yoshikawa A, Nakamichi S, Takeuchi S, Matsumoto M, Miyanaga A, Minegishi Y, Yamamoto K, Seike M, Gemma A, Kubota K. Evaluation of a Tool that Enables Cancer Patients to Participate in the Decision-Making Process during Treatment Selection. J NIPPON MED SCH 2021; 88:273-282. [PMID: 32612013 DOI: 10.1272/jnms.jnms.2021_88-401] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient participation in decisions related to their treatment is strongly recommended. This study was conducted to develop and evaluate a support tool that can help patients make decisions related to their own treatment. METHODS Twenty cancer patients who were hospitalized for first-line treatment were enrolled. Before hospitalization, a 'Check sheet on treatment selection', which contained 14 questions, was distributed to patients and/or their families. After hospitalization, the attending physician explained the treatment while referring to the written check sheet. At discharge, patients' responses to the 'Questionnaire on check sheet and treatment selection' were collected to evaluate the utility of the check sheet. Finally, the 'Questionnaire of the check sheet' was handed to the attending physician to evaluate. RESULTS Of the fourteen patients who responded to the questionnaire, all indicated that the check sheets were helpful for decision-making and that using the sheets empowered them to ask their doctors questions. Only one person felt uncomfortable with compiling the check sheet. Physicians stated that the check sheet facilitated patient decision-making and improved communication with patients. However, some felt that this activity increased the administrative burden of medical professionals. CONCLUSION Almost all patients stated that the present check sheet was useful as a decision support tool and facilitated communication between doctors and patients. Before incorporation into general clinical practice, this increased benefit should be weighed against the potential extra administrative workload imposed on clinicians.
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Affiliation(s)
- Kumi Chubachi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | | | - Akiko Yoshikawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Susumu Takeuchi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Masaru Matsumoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Kazuo Yamamoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School
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20
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van de Water LF, van den Boorn HG, Hoxha F, Henselmans I, Calff MM, Sprangers MAG, Abu-Hanna A, Smets EMA, van Laarhoven HWM. Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study. J Med Internet Res 2021; 23:e27824. [PMID: 34448703 PMCID: PMC8433928 DOI: 10.2196/27824] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. Objective This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. Methods We designed a web-based, physician-assisted prediction tool—Source—to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds—a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. Results The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. Conclusions The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making.
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Affiliation(s)
- Loïs F van de Water
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Héctor G van den Boorn
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Florian Hoxha
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mart M Calff
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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21
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Helou S, Abou-Khalil V, Iacobucci R, El Helou E, Kiyono K. Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation. J Med Internet Res 2021; 23:e25218. [PMID: 33970117 PMCID: PMC8145082 DOI: 10.2196/25218] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background The study of doctor-patient-computer interactions is a key research area for examining doctor-patient relationships; however, studying these interactions is costly and obtrusive as researchers usually set up complex mechanisms or intrude on consultations to collect, then manually analyze the data. Objective We aimed to facilitate human-computer and human-human interaction research in clinics by providing a computational ethnography tool: an unobtrusive automatic classifier of screen gaze and dialogue combinations in doctor-patient-computer interactions. Methods The classifier’s input is video taken by doctors using their computers' internal camera and microphone. By estimating the key points of the doctor's face and the presence of voice activity, we estimate the type of interaction that is taking place. The classification output of each video segment is 1 of 4 interaction classes: (1) screen gaze and dialogue, wherein the doctor is gazing at the computer screen while conversing with the patient; (2) dialogue, wherein the doctor is gazing away from the computer screen while conversing with the patient; (3) screen gaze, wherein the doctor is gazing at the computer screen without conversing with the patient; and (4) other, wherein no screen gaze or dialogue are detected. We evaluated the classifier using 30 minutes of video provided by 5 doctors simulating consultations in their clinics both in semi- and fully inclusive layouts. Results The classifier achieved an overall accuracy of 0.83, a performance similar to that of a human coder. Similar to the human coder, the classifier was more accurate in fully inclusive layouts than in semi-inclusive layouts. Conclusions The proposed classifier can be used by researchers, care providers, designers, medical educators, and others who are interested in exploring and answering questions related to screen gaze and dialogue in doctor-patient-computer interactions.
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Affiliation(s)
- Samar Helou
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
| | | | - Riccardo Iacobucci
- Department of Urban Management, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Elie El Helou
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
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22
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Gebhardt C, Mehnert-Theuerkauf A, Hartung T, Zimmermann A, Glaesmer H, Götze H. COMSKIL: a communication skills training program for medical students. GMS J Med Educ 2021; 38:Doc83. [PMID: 34056072 PMCID: PMC8136352 DOI: 10.3205/zma001479] [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] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/30/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
Objectives: Training communication skills has come to be recognized as a vital aspect of medical school education. A medical communication course based on the COMSKIL Communication Skills Training (CST) Program was developed, integrated into the core curriculum, and evaluated at the Leipzig University Medical School. Methods: Between October 2016 and July 2017, 312 medical students (mean age 21.80 years; 62% male) participated in the medical communication course. Each course unit was evaluated via questionnaires specifically designed to address the theoretical and practical content of the curriculum. The items correspond to the material covered in each course unit. Students responded using a 5-point-Likert scale (1="not at all helpful", 5="extremely helpful") to rate the degree to which the course helped them learn about the subject matter and train the skills covered in the curriculum. Results: The average score for the first part of the course (theoretical foundations) was M=3.69 (SD=0.35). The second part received a similar rating (M=3.84; SD=0.73). The role play exercises with actor-patients received a score of M=4.27 (SD=0.62). In an overall evaluation at the end of the course, students rated the administration of the course (setting, etc), knowledge gained, and skills trained with a score of M=4.11 (SD=0.66). The role play exercises received an overall score of M=4.36 (SD=0.61). Conclusion: A new curriculum for teaching medical students patient-physician communication skills based on the COMSKIL CST program was established at the University of Leipzig. The goal of this course is to teach students about the kinds of communication scenarios they will encounter in their future working lives as care providers and equip them with the fundamental communication techniques and skills they need to successfully handle those situations. A formal evaluation of the program resulted in satisfactory findings, indicating that it is well suited for use in medical universities.
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Affiliation(s)
- Claudia Gebhardt
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Tim Hartung
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Zimmermann
- University Medical Center Leipzig, LernKlinik Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Heide Götze
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
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23
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Lakin JR, Gundersen DA, Lindvall C, Paasche-Orlow MK, Tulsky JA, Brannen EN, Pollak KI, Kennedy D, McLeggon JA, Stout JJ, Volandes A. A Yet Unrealized Promise: Structured Advance Care Planning Elements in the Electronic Health Record. J Palliat Med 2021; 24:1221-1225. [PMID: 33826860 DOI: 10.1089/jpm.2020.0774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
Background: Electronic health records (EHRs) may help enable reliable, rapid data management for many uses, such as facilitating communication of advance care planning (ACP). However, issues with validity and accuracy of EHRs hinder the use of ACP information for practical applications. Design: We present a cross-sectional pilot study of 433 older adults with cancer from three large health care systems, participating in an ongoing multisite pragmatic trial (4UH3AG060626-02). We compared data extracted from dedicated structured EHR fields for ACP to a chart review of corresponding ACP documentation contained in the medical chart. Results: Structured ACP data existed for 43.2% of patients and varied by site (25.7% -48.9%). Of the identified structured ACP data elements, 59.2% of recorded elements were correct, 23.7% were incorrect, and 17.1% were duplicates with heterogeneity across sites. Conclusion: Structured ACP data in EHRs were frequently incorrect. This represents a problem for patients and their families, as well as quality improvement and research efforts. Clinical Trials Registration: NCT03609177.
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Affiliation(s)
- Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Elise N Brannen
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.,Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina, USA
| | - Danielle Kennedy
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, North Carolina, USA
| | - Jody-Ann McLeggon
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | | | - Angelo Volandes
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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24
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Barr PJ, Ryan J, Jacobson NC. Precision Assessment of COVID-19 Phenotypes Using Large-Scale Clinic Visit Audio Recordings: Harnessing the Power of Patient Voice. J Med Internet Res 2021; 23:e20545. [PMID: 33556031 PMCID: PMC7899201 DOI: 10.2196/20545] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
COVID-19 cases are exponentially increasing worldwide; however, its clinical phenotype remains unclear. Natural language processing (NLP) and machine learning approaches may yield key methods to rapidly identify individuals at a high risk of COVID-19 and to understand key symptoms upon clinical manifestation and presentation. Data on such symptoms may not be accurately synthesized into patient records owing to the pressing need to treat patients in overburdened health care settings. In this scenario, clinicians may focus on documenting widely reported symptoms that indicate a confirmed diagnosis of COVID-19, albeit at the expense of infrequently reported symptoms. While NLP solutions can play a key role in generating clinical phenotypes of COVID-19, they are limited by the resulting limitations in data from electronic health records (EHRs). A comprehensive record of clinic visits is required—audio recordings may be the answer. A recording of clinic visits represents a more comprehensive record of patient-reported symptoms. If done at scale, a combination of data from the EHR and recordings of clinic visits can be used to power NLP and machine learning models, thus rapidly generating a clinical phenotype of COVID-19. We propose the generation of a pipeline extending from audio or video recordings of clinic visits to establish a model that factors in clinical symptoms and predict COVID-19 incidence. With vast amounts of available data, we believe that a prediction model can be rapidly developed to promote the accurate screening of individuals at a high risk of COVID-19 and to identify patient characteristics that predict a greater risk of a more severe infection. If clinical encounters are recorded and our NLP model is adequately refined, benchtop virologic findings would be better informed. While clinic visit recordings are not the panacea for this pandemic, they are a low-cost option with many potential benefits, which have recently begun to be explored.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States
| | - James Ryan
- Ryan Family Practice, Ludington, MI, United States
| | - Nicholas C Jacobson
- The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.,Department of Psychiatry, Geisel School of Medicine at Dartmouth and Dartmouth Hitchcock Health, Lebanon, NH, United States
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25
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Sato K, Kondo N, Murata C, Shobugawa Y, Saito K, Kondo K. Association of pneumococcal and influenza vaccination with patient-physician communication in older adults: A nationwide cross-sectional study from the JAGES 2016. J Epidemiol 2021; 32:401-407. [PMID: 33551389 PMCID: PMC9359899 DOI: 10.2188/jea.je20200505] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient–physician communication and whether this variable was associated with increased odds of vaccination. Methods We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination. Results Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians’ listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients’ questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination. Conclusion The results suggest that promotion of having a family physician, better patient–physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.
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Affiliation(s)
- Koryu Sato
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University.,Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University.,Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo
| | - Chiyoe Murata
- Department of Nutrition, School of Health and Nutrition, Tokai Gakuen University
| | - Yugo Shobugawa
- Department of Active Aging, Graduate School of Medical and Dental Sciences, Niigata University
| | - Kousuke Saito
- Department of Active Aging, Graduate School of Medical and Dental Sciences, Niigata University
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology
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26
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Ibilibor C, Moses KA. Putting nonverbal communication under a lens: An examination of the dynamic interplay of patient-provider interactions between Black patients and non-Black physicians. Cancer 2020; 127:1008-1009. [PMID: 33290591 DOI: 10.1002/cncr.33353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Christine Ibilibor
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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27
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Green AR, Boyd CM, Gleason KS, Wright L, Kraus CR, Bedoy R, Sanchez B, Norton J, Sheehan OC, Wolff JL, Reeve E, Maciejewski ML, Weffald LA, Bayliss EA. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study. J Gen Intern Med 2020; 35:3556-3563. [PMID: 32728959 PMCID: PMC7728901 DOI: 10.1007/s11606-020-06063-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. OBJECTIVES To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing. DESIGN Qualitative approach based on semi-structured interviews with patients, caregivers, and physicians. PARTICIPANTS Patients aged ≥ 65 years with claims-based diagnosis of dementia, ≥ 1 additional chronic condition, and ≥ 5 chronic medications were recruited from an integrated delivery system in Colorado and an academic medical center in Maryland. We included caregivers when present or if patients were unable to participate due to severe cognitive impairment. Physicians were recruited within the same systems and through snowball sampling, targeting areas with large African American and Hispanic populations. APPROACH We used constant comparison to identify and compare themes between patients, caregivers, and physicians. KEY RESULTS We conducted interviews with 17 patients, 16 caregivers, and 16 physicians. All groups said it was important to earn trust before deprescribing, frame deprescribing as routine and positive, align deprescribing with goals of dementia care, and respect caregivers' expertise. As in other areas of medicine, racial, ethnic, and language concordance was important to patients and caregivers from minority cultural backgrounds. Participants favored direct-to-patient educational materials, support from pharmacists and other team members, and close follow-up during deprescribing. Patients and caregivers favored language that explained deprescribing in terms of altered physiology with aging. Physicians desired communication tips addressing specific clinical situations. CONCLUSIONS Culturally sensitive communication within a trusted patient-physician relationship supplemented by pharmacists, and language tailored to specific clinical situations may support deprescribing in primary care for patients with dementia and MCC.
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Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kathy S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ruth Bedoy
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Bianca Sanchez
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Norton
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Linda A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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28
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Piscitello GM, Fukushima CM, Saulitis AK, Tian KT, Hwang J, Gupta S, Sheldon M. Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic. Am J Hosp Palliat Care 2020; 38:305-312. [PMID: 33207937 PMCID: PMC7859662 DOI: 10.1177/1049909120973431] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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] [Indexed: 11/15/2022] Open
Abstract
Purpose: Visitor restrictions during the COVID-19 pandemic limit in-person family
meetings for hospitalized patients. We aimed to evaluate the quantity of
family meetings by telephone, video and in-person during the COVID-19
pandemic by manual chart review. Secondary outcomes included rate of change
in patient goals of care between video and in-person meetings, the timing of
family meetings, and variability in meetings by race and ethnicity. Methods: A retrospective cohort study evaluated patients admitted to the intensive
care unit at an urban academic hospital between March and June 2020.
Patients lacking decision-making capacity and receiving a referral for a
video meeting were included in this study. Results: Most patients meeting inclusion criteria (N = 61/481, 13%) had COVID-19
pneumonia (n = 57/61, 93%). A total of 650 documented family meetings
occurred. Few occurred in-person (n = 70/650, 11%) or discussed goals of
care (n = 233/650, 36%). For meetings discussing goals of care, changes in
patient goals of care occurred more often for in-person meetings rather than
by video (36% vs. 11%, p = 0.0006). The average time to the first goals of
care family meeting was 11.4 days from admission. More documented telephone
meetings per admission were observed for White (10.5, SD 9.5) and
Black/African-American (7.1, SD 6.6) patients compared to Hispanic or Latino
patients (4.9, SD 4.9) (p = 0.02). Conclusions: During this period of strict visitor restrictions, few family meetings
occurred in-person. Statistically significant fewer changes in patient goals
of care occurred following video meetings compared to in-person meetings,
providing support limiting in-person meetings may affect patient care.
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Affiliation(s)
- Gina M Piscitello
- Section of Palliative Medicine, 12245Rush Medical College, Chicago, IL, USA
| | | | | | - Katherine T Tian
- Department of Medicine, 12245Rush Medical College, Chicago, IL, USA
| | | | | | - Mark Sheldon
- Department of Philosophy, 3270Northwestern University, Evanston, IL, USA
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29
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Satteson ES, Roe AK, Eppler SL, Yao J, Shapiro LM, Kamal RN. Development and Testing of a Question Prompt List for Common Hand Conditions: An Exploratory Sequential Mixed-Methods Study. J Hand Surg Am 2020; 45:1087.e1-1087.e10. [PMID: 32693988 PMCID: PMC8080683 DOI: 10.1016/j.jhsa.2020.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE A question prompt list (QPL) is a tool that lists possible questions a patient may want to ask their surgeon. Its purpose is to improve patient-physician communication and increase patient engagement. Although QPLs have been developed in other specialties, one does not exist for hand conditions. We sought to develop a QPL for use in the hand surgery clinic using a mixed-methods design. METHODS We drafted a QPL based on prior work outside of hand surgery and then used an exploratory sequential mixed-methods design (both qualitative and quantitative methods) to finalize the QPL. Qualitative evaluation included both a written questionnaire completed by a patient advisory board, hand therapists, and hand surgeons, as well as cognitive interviews conducted with clinic patients using the tool. Revisions to the QPL were made after each phase of qualitative analysis. The final QPL was then evaluated quantitatively using the system usability score (SUS) questionnaire to assess its usability. RESULTS A patient advisory board consisting of 6 patients, 5 hand therapists, and 6 hand surgeons completed the written questionnaire. Thirteen patients completed a cognitive interview of the QPL. We completed a content analysis of the qualitative data and incorporated the findings into the QPL. Twenty patients then reviewed the final QPL pamphlet and completed the SUS questionnaire. The resulting SUS score of 78.8 indicated above-average usability of the QPL tool. CONCLUSIONS The QPL developed in this study, from the perspective of multiple stakeholders, provides a usable tool to engage and prompt patients in asking questions during their visit with their hand surgeon with the potential to improve communication and patient-centered care. CLINICAL RELEVANCE This study provides clinicians with a QPL developed for use in the hand surgery clinic setting, aimed at facilitating more thorough patient-provider discussion.
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Affiliation(s)
- Ellen S Satteson
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Allison K Roe
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Sara L Eppler
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, CA; Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
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30
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Korzh O. Self-management Education in Type 2 Diabetes in Primary Care. Folia Med (Plovdiv) 2020. [PMID: 33009765 DOI: 10.3897/folmed.62.e48558.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Diabetes self-management education (DSME) is defined as a systematic intervention involving active participation of the individual in self-monitoring of health parameters and/or decision making using knowledge and skills. The goal of DSME is to create opportunities for people with diabetes to be informed and motivated to continuously participate in effective methods and methods of self-monitoring of diabetes. AIM To evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. MATERIALS AND METHODS A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach's reliability coefficient for each domain/subscale was ≥ 0.7. The data were analysed using an independent selective t-test and one-way ANOVA. RESULTS More than half of the doctors provided "inadequate quality" of diabetes self-management in all areas. Doctors had the highest average score in the domain of "drug intake" (4.46±0.61). Average scores in the "problem-solving domain" (3.52±0.63) and "being active domain" (3.46±0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. CONCLUSION The quality of doctors' communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behaviour associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.
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Affiliation(s)
- Oleksii Korzh
- Department of General Practice-Family Medicine, Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
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31
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Ladd MK, Peshkin BN, Isaacs C, Hooker G, Willey S, Valdimarsdottir H, DeMarco T, O'Neill S, Binion S, Schwartz MD. Predictors of genetic testing uptake in newly diagnosed breast cancer patients. J Surg Oncol 2020; 122:134-143. [PMID: 32346886 DOI: 10.1002/jso.25956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Many newly diagnosed breast cancer patients do not receive genetic counseling and testing at the time of diagnosis. We examined predictors of genetic testing (GT) in this population. METHODS Within a randomized controlled trial of proactive rapid genetic counseling and testing vs usual care, patients completed a baseline survey within 6 weeks of breast cancer diagnosis but before a definitive survey. We conducted a multinomial logistic regression to identify predictors of GT timing/uptake. RESULTS Having discussed GT with a surgeon was a dominant predictor (χ2 (2, N = 320) = 70.13; P < .0001). Among those who discussed GT with a surgeon, patients who had made a final surgery decision were less likely to receive GT before surgery compared with postsurgically (OR [odds ratio] = 0.24; 95% confidence interval [CI] = 0.12-0.49) or no testing (OR = 0.28; 95% CI = 0.14-0.56). Older patients (OR = 0.95; 95% CI = 0.91-0.99) and participants enrolled in New York/New Jersey (OR = 0.22; 95% CI = 0.07-0.72) were less likely to be tested compared with receiving results before surgery. Those with higher perceived risk (OR = 1.02; 95% CI = 1.00-1.03) were more likely to receive results before surgery than to not be tested. CONCLUSIONS This study highlights the role of patient-physician communication about GT as well as patient-level factors that predict presurgical GT.
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Affiliation(s)
- Mary K Ladd
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Beth N Peshkin
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Gillian Hooker
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Shawna Willey
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Heiddis Valdimarsdottir
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tiffani DeMarco
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Suzanne O'Neill
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Savannah Binion
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Marc D Schwartz
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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32
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Prasad A, Carey RM, Rajasekaran K. Head and neck virtual medicine in a pandemic era: Lessons from COVID-19. Head Neck 2020; 42:1308-1309. [PMID: 32298018 PMCID: PMC7262175 DOI: 10.1002/hed.26174] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/11/2022] Open
Abstract
The 2019 novel coronavirus disease (COVID‐19) has presented the world and physicians with a unique public health challenge. In light of its high transmissibility and large burden on the health care system, many hospitals and practices have opted to cancel elective surgeries in order to mobilize resources, ration personal protective equipment and guard patients from the virus. Head and neck cancer physicians are particularly affected by these changes given their scope of practice, complex patient population, and interventional focus. In this viewpoint, we discuss some of the many challenges faced by head and neck surgeons in this climate. Additionally, we outline the utility of telemedicine as a potential strategy for allowing physicians to maintain an effective continuum of care.
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Affiliation(s)
- Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Freytag J, Street RL, Barnes DE, Shi Y, Volow AM, Shim JK, Alexander SC, Sudore RL. Empowering Older Adults to Discuss Advance Care Planning During Clinical Visits: The PREPARE Randomized Trial. J Am Geriatr Soc 2020; 68:1210-1217. [PMID: 32157684 DOI: 10.1111/jgs.16405] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES A patient-directed, online program (PREPARE for Your Care [PREPARE]; prepareforyourcare.org) has been shown to increase advance care planning (ACP) documentation. However, the mechanisms underlying PREPARE are unknown. Our objectives were to compare the efficacy of PREPARE plus an easy-to-read advance directive (AD) vs an AD alone to increase active patient participation in ACP discussions during clinic visits and to examine effects of active patient participation on ACP documentation. DESIGN Audio recordings of postintervention primary care visits from two randomized trials (2013-2016). SETTING Seven primary care clinics at a veterans affair and safety-net hospital in San Francisco, CA. PARTICIPANTS English- and Spanish-speaking adults, aged 55 years and older, with two or more chronic/serious conditions. INTERVENTION PREPARE plus an easy-to-read AD or an AD alone. MEASUREMENTS The primary outcome was the number of active patient participation utterances about ACP (eg, asking questions, stating preferences) measured by the validated Active Patient Participation Coding Scheme. We examined differences in utterances by study arm using mixed effects negative binomial models and utterances as a mediator of PREPARE's effect on documentation using adjusted logistic regression. Models were adjusted for health literacy, prior care planning, and clinician. RESULTS Among 393 participants, the mean (SD) age was 66 (8.1) years, 120 (30.5%) had limited health literacy, and 99 (25.2%) were Spanish speaking. PREPARE plus the AD resulted in 41% more active patient participation in ACP discussions compared with the AD alone (mean [SD] = 10.1 [16.8] vs 6.6 [13.4] utterances; incidence rate ratio = 1.41; 95% confidence interval = 1.00-1.98). For every additional utterance, participants had 15% higher odds of ACP documentation, and active patient participation accounted for 16% of PREPARE's effect on documentation. CONCLUSIONS The PREPARE program and easy-to-read AD empowered patients to actively participate in ACP discussions during clinical visits more than the AD alone. Increased activation was associated with increased ACP documentation. Therefore, PREPARE may mitigate barriers to ACP among English- and Spanish-speaking older adults. TRIAL REGISTRATION ClinicalTrials.gov identifiers: "Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making (PREPARE)" NCT01990235 and "Preparing Spanish-Speaking Older Adults for Advance Care Planning and Medical Decision Making (PREPARE)" NCT02072941. J Am Geriatr Soc 68:1210-1217, 2020.
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Affiliation(s)
- Jennifer Freytag
- Center for Innovations in Quality Effectiveness, and Safety, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas.,Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Richard L Street
- Center for Innovations in Quality Effectiveness, and Safety, Houston, Texas.,Michael E. DeBakey VA Medical Center, Houston, Texas.,Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas.,Texas A&M University, College Station, Texas
| | - Deborah E Barnes
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Innovation and Implementation Center for Aging and Palliative Care, Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Ying Shi
- San Francisco Veterans Affairs Health Care System, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Aiesha M Volow
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Janet K Shim
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California
| | | | - Rebecca L Sudore
- Innovation and Implementation Center for Aging and Palliative Care, Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
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Affiliation(s)
- Lauris C Kaldjian
- Department of Internal Medicine, and Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Poon BY, Shortell SM, Rodriguez HP. Patient Activation as a Pathway to Shared Decision-making for Adults with Diabetes or Cardiovascular Disease. J Gen Intern Med 2020; 35:732-42. [PMID: 31646455 DOI: 10.1007/s11606-019-05351-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. OBJECTIVE We examine the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship. DESIGN Patient activation, or a patients' knowledge, skills, and confidence in self-management, was assessed using the 13-item Patient Activation Measure (PAM). Patient-reported assessment of the SDM process was assessed using the 3-item CollaboRATE measure. Patients at 16 adult primary care practices were surveyed in 2015 and 2016 on PAM (α = 0.92), CollaboRATE (α = 0.90), and demographics. The relationship between PAM and CollaboRATE was estimated using a cross-lagged panel model with clustered robust standard errors and practice fixed effects, controlling for patient characteristics. PARTICIPANTS 1222 adult patients with diabetes and/or cardiovascular disease with survey responses at baseline (51% response rate) and a 1-year follow-up (73% response rate). RESULTS PAM (mean 3.27 vs 3.28 on a range of 1 to 4; p = 0.082) and CollaboRATE (mean 3.62 vs 3.63 on a range of 1 to 5; p = 0.14) did not change significantly over time. In adjusted analyses, the path from baseline PAM to follow-up CollaboRATE (β = 0.35; p < 0.0001) was stronger than the path from baseline CollaboRATE to follow-up PAM (β = 0.04; p = 0.001). CONCLUSIONS The relationship between patient activation and patients' experiences of the SDM process is bidirectional, but dominated by baseline patient activation. Rather than promoting the use of SDM for all patients, healthcare organizations should prioritize interventions to promote patient activation and engage patients with relatively high activation in SDM interventions.
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Amin S, Soliman M, McIvor A, Cave A, Cabrera C. Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies. Patient Prefer Adherence 2020; 14:541-551. [PMID: 32210541 PMCID: PMC7071882 DOI: 10.2147/ppa.s234651] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/30/2020] [Indexed: 01/11/2023] Open
Abstract
Adherence to asthma medications is generally poor and undermines clinical outcomes. Poor adherence is characterized by underuse of inhaled corticosteroids (ICS), often accompanied by over-reliance on short-acting β2-agonists for symptom relief. To identify drivers of poor medication adherence, a targeted literature search was performed in MEDLINE and EMBASE for articles presenting qualitative data evaluating medication adherence in asthma patients (≥12 years old), published from January 1, 2012 to February 26, 2018. A thematic analysis of 21 relevant articles revealed several key themes driving poor medication adherence, including asthma-specific drivers and more general drivers common to chronic diseases. Due to the episodic nature of asthma, many patients felt that their daily life was not substantially impacted; consequently, many harbored doubts about the accuracy of their diagnosis or were in denial about the impact of the disease and, in turn, the need for long-term treatment. This was further compounded by poor patient-physician communication, which contributed to suboptimal knowledge about asthma medications, including lack of understanding of the distinction between maintenance and reliever inhalers, suboptimal inhaler technique, and concerns about ICS side effects. Other drivers of poor medication adherence included the high cost of asthma medication, general forgetfulness, and embarrassment over inhaler use in public. Overall, patients' perceived lack of need for asthma medications and medication concerns, in part due to suboptimal knowledge and poor patient-physician communication, emerged as key drivers of poor medication adherence. Optimal asthma care and management should therefore target these barriers through effective patient- and physician-centered strategies.
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Affiliation(s)
- Suvina Amin
- US Oncology Medical Affairs, AstraZeneca, Gaithersburg, MD, USA
- Correspondence: Suvina Amin AstraZeneca, One Medimmune Way, Gaithersburg, MD20878, USATel +1 800 565 5877 Email
| | - Mena Soliman
- BioPharmaceuticals Medical (Europe and Canada), AstraZeneca, Mississauga, ON, Canada
| | - Andrew McIvor
- Department of Medicine, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare and McMaster University, Hamilton, ON, Canada
| | - Andrew Cave
- Department of Family Medicine, University of Alberta, Edmonton, AL, Canada
| | - Claudia Cabrera
- BioPharmaceuticals Medical (Evidence), AstraZeneca, Gothenburg, Sweden
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Tai D, Li E, Liu-Ambrose T, Bansback N, Sadatsafavi M, Davis JC. Patient-Reported Outcome Measures (PROMs) to Support Adherence to Falls Prevention Clinic Recommendations: A Qualitative Study. Patient Prefer Adherence 2020; 14:2105-2121. [PMID: 33154634 PMCID: PMC7608137 DOI: 10.2147/ppa.s269202] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We examined how patient-reported outcome measures (PROMs) support patients' adherence to fall prevention recommendations in a novel primary care setting - the Falls Prevention Clinic. PATIENTS AND METHODS Using a patient-oriented qualitative study design, we recruited patient partners to our study team to assist in developing focus group prompts. A trained facilitator conducted five semi-structured interviews with a total of 21 Falls Prevention Clinic participants. A trained facilitator prompted participants about: their views on the EuroQol 5 domain - 5 level (EQ-5D-5L) PROM, their preferences for PROM administration and feedback, the presentation of PROM questionnaire data, the use of comparative data and the EQ-5D-5L in improving adherence to recommendations, and other information they would need to improve adherence. Participants' responses were coded according to three stages of qualitative analysis: open, axial and selective coding using an iterative and comparative approach. RESULTS "Opportunity" and "Development" emerged as higher-level themes for the participants' perspectives on how the EQ-5D-5L may be helpful for their appointments. "Frequency" described how often the participants believed the EQ-5D-5L should be administered and feedback provided. "Challenges", "Benefits", "Patients' Understanding", "Relevance of Data", and "Usefulness of Data" provided insight on how PROMs data presentation was viewed by patients. "Performance", "Resources", "Knowledge", "Role in Behaviour Change" highlighted the participants' ideas for the role of the EQ-5D-5L and additional information in supporting their adherence to falls prevention recommendations. Participants emphasized that patients would value further support information to facilitate their adherence. CONCLUSION This patient-oriented qualitative study, among individuals at high risk of future falls, sheds light on the importance of timely, understandable feedback, integrated with other clinical feedback in supporting adherence.
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Affiliation(s)
- Daria Tai
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia – Okanagan, Kelowna, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Li
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia – Okanagan, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia – Vancouver, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia – Vancouver, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia – Okanagan, Kelowna, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence: Jennifer C Davis Faculty of Management, The University of British Columbia – Okanagan, 1137 Alumni Avenue, Kelowna, BCV1V 1V7, CanadaTel +1 250 807 9507 Email
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Solari A, Giovannetti AM, Giordano A, Tortorella C, Torri Clerici V, Brichetto G, Granella F, Lugaresi A, Patti F, Salvetti M, Pesci I, Pucci E, Centonze D, Danni MC, Bonavita S, Ferraro D, Gallo A, Gajofatto A, Nociti V, Grimaldi L, Grobberio M, Lanzillo R, Di Giovanni R, Gregori S, Manni A, Pietrolongo E, Bertagnoli S, Ronzoni M, Compagnucci L, Fantozzi R, Allegri B, Arena S, Buscarinu MC, Sabattini L, Quartuccio ME, Tsantes E, Confaloneri P, Tacchino A, Schiffmann I, Rahn AC, Kleiter I, Messmer Uccelli M, Barabasch A, Heesen C, The ManTra Project. Conversion to Secondary Progressive Multiple Sclerosis: Patient Awareness and Needs. Results From an Online Survey in Italy and Germany. Front Neurol 2019; 10:916. [PMID: 31507519 PMCID: PMC6713887 DOI: 10.3389/fneur.2019.00916] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 02/11/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders. Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified. Methods: Participants were consenting adults with SPMS since ≤5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs. Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28-35% obtained second opinions, and 48-56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001). Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13-0.78 for Central Italy; OR 0.21, 95% CI 0.08-0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47-41.37 for dependent vs. autonomous patients). All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: "physiotherapy" and "active patient care involvement." The other two differed across countries: "an individualized health care plan" and "information on social rights and policies" in Italy, and "psychological support" and "cognitive rehabilitation" in Germany. Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Giampaolo Brichetto
- Rehabilitation Centre, Italian Multiple Sclerosis Society, Genoa, Italy.,Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Francesco Patti
- Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli, Italy.,Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Ilaria Pesci
- Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy
| | - Eugenio Pucci
- UOC Neurologia, Ospedale "A. Murri", ASUR Marche-AV4, Fermo, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Simona Bonavita
- II Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Gallo
- I Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Viviana Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Grimaldi
- UOC Neurologia e Centro Regionale SM, Fondazione Istituto "G. Giglio", Cefalù, Italy
| | - Monica Grobberio
- Laboratory of Clinical Neuropsychology, Department of Neurology and Psychology, ASST Lariana, Como, Italy
| | - Roberta Lanzillo
- Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy
| | | | - Silvia Gregori
- UOC Neurologia, Ospedale San Camillo de Lellis, Rieti, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy
| | - Erika Pietrolongo
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Marco Ronzoni
- Centro Sclerosi Multipla, Ospedale "G. Salvini"-ASST Rhodense, Garbagnate Milanese, Italy
| | - Laura Compagnucci
- Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Beatrice Allegri
- Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy
| | - Sebastiano Arena
- Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Loredana Sabattini
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Elena Tsantes
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Confaloneri
- Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Kleiter
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | | | - Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - The ManTra Project
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy.,Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.,Rehabilitation Centre, Italian Multiple Sclerosis Society, Genoa, Italy.,Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.,UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy.,IRCCS Neuromed, Pozzilli, Italy.,Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.,Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy.,UOC Neurologia, Ospedale "A. Murri", ASUR Marche-AV4, Fermo, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.,Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy.,II Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,I Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy.,Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,UOC Neurologia e Centro Regionale SM, Fondazione Istituto "G. Giglio", Cefalù, Italy.,Laboratory of Clinical Neuropsychology, Department of Neurology and Psychology, ASST Lariana, Como, Italy.,Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy.,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Italy.,UOC Neurologia, Ospedale San Camillo de Lellis, Rieti, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,Italian Multiple Sclerosis Society, Mantua, Italy.,Centro Sclerosi Multipla, Ospedale "G. Salvini"-ASST Rhodense, Garbagnate Milanese, Italy.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany.,Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy
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Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education. Health Equity 2019; 3:312-318. [PMID: 31294243 PMCID: PMC6615346 DOI: 10.1089/heq.2019.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/29/2022] Open
Abstract
In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S. Spanish-speaking population growth, importance of language in diagnosis, and benefits of patient–physician language concordance, addressing LCME standards equitably should involve linguistic preparedness education. The authors present strategies for implementation of linguistic preparedness education in medical schools by discussing (1) examples of institutional approaches to dedicated medical Spanish courses that meet best practice guidelines and (2) a partnership model with medical interpreters to implement integrated global linguistic competencies in undergraduate medical curricula.
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Affiliation(s)
- Pilar Ortega
- Department of Emergency Medicine, College of Medicine, University of Illinois, Chicago, Illinois.,Department of Medical Education, College of Medicine, University of Illinois, Chicago, Illinois
| | - Norma Pérez
- Special Programs, School of Medicine, Hispanic Center of Excellence, University of Texas Medical Branch, Galveston, Texas
| | - Brenda Robles
- Language Interpreters Program, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Yumirle Turmelle
- Washington University St. Louis School of Medicine, St. Louis, Missouri
| | - David Acosta
- Association of American Medical Colleges, Washington, District of Columbia
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40
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Duberstein PR, Maciejewski PK, Epstein RM, Fenton JJ, Chapman B, Norton SA, Hoerger M, Wittink MN, Tancredi DJ, Xing G, Mohile S, Kravitz RL, Prigerson HG. Effects of the Values and Options in Cancer Care Communication Intervention on Personal Caregiver Experiences of Cancer Care and Bereavement Outcomes. J Palliat Med 2019; 22:1394-1400. [PMID: 31237459 DOI: 10.1089/jpm.2019.0078] [Citation(s) in RCA: 11] [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: 12/27/2022] Open
Abstract
Background: Care teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members). Improving communication among oncologists, patients with advanced cancer, and their personal caregivers might enhance caregivers' experiences of end-of-life (EoL) cancer care and bereavement outcomes. Objective: To explore the effects of the Values and Options in Cancer Care intervention on caregivers' experiences of EoL care and bereavement outcomes. Design: We developed a brief behavioral intervention to improve communication among oncologists, patients with advanced cancer, and their personal caregivers. The intervention was designed to help patients/caregivers ask questions, express concerns, and help oncologists respond effectively. We randomly assigned oncologists (and their patients/caregivers) to the intervention or usual care. Setting/Subjects: Medical oncologists in NY and CA; patients/personal caregivers with advanced cancer. Measurements: Two months after the patient's death, caregivers completed three instruments assessing their experiences of EoL care. Seven months after the patient's death, caregivers completed the Prolonged Grief Disorder-13 (PG-13; primary prespecified outcome), the Purpose-in-Life scale, and scales assessing mental health function, depression, and anxiety. Results: The intervention did not significantly improve caregivers' scores on the PG-13 (p = 0.21), mental health function, depression, or anxiety, but it did improve purpose-in-life scores (p = 0.018). Cohen's d (95% confidence interval) for all three experiences of EoL care outcomes were promising, ranging from 0.22 (-0.19 to 0.63) to 0.39 (-0.07 to 0.86) although none was statistically significant. Conclusion: Preliminary findings show promise that scalable interventions in cancer care settings may improve caregiver experiences with cancer care and some bereavement outcomes.
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Affiliation(s)
- Paul R Duberstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, Piscataway, New Jersey
| | - Paul K Maciejewski
- Department of Radiology, Department of Medicine, Weill Cornell Medical College, New York, New York.,Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ronald M Epstein
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, California.,UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California.,Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California
| | - Benjamin Chapman
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sally A Norton
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,School of Nursing, University of Rochester, Rochester, New York
| | - Michael Hoerger
- Tulane Cancer Center, Tulane University, New Orleans, Louisiana.,Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana
| | - Marsha N Wittink
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Daniel J Tancredi
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.,Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California
| | - Supriya Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard L Kravitz
- UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, California.,Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.,Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medical College, New York, New York.,Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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Aslakson RA, Isenberg SR, Crossnohere NL, Conca-Cheng AM, Moore M, Bhamidipati A, Mora S, Miller J, Singh S, Swoboda SM, Pawlik TM, Weiss M, Volandes A, Smith TJ, Bridges JFP, Roter DL. Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial. J Palliat Med 2019; 22:764-772. [PMID: 30964385 DOI: 10.1089/jpm.2018.0209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/11/2023] Open
Abstract
Background: Preoperative advance care planning (ACP) may benefit patients undergoing major surgery. Objective: To evaluate feasibility, safety, and early effectiveness of video-based ACP in a surgical population. Design: Randomized controlled trial with two study arms. Setting: Single, academic, inner-city tertiary care hospital. Subjects: Patients undergoing major cancer surgery were recruited from nine surgical clinics. Of 106 consecutive potential participants, 103 were eligible and 92 enrolled. Interventions: In the intervention arm, patients viewed an ACP video developed by patients, surgeons, palliative care clinicians, and other stakeholders. In the control arm, patients viewed an informational video about the hospital's surgical program. Measurements: Primary Outcomes-ACP content and patient-centeredness in patient-surgeon preoperative conversation. Secondary outcomes-patient Hospital Anxiety and Depression Scale (HADS) score; patient goals of care; patient and surgeon satisfaction; video helpfulness; and medical decision maker designation. Results: Ninety-two patients (target enrollment: 90) were enrolled. The ACP video was successfully integrated with no harm noted. Patient-centeredness was unchanged (incidence rate ratio [IRR] = 1.06, confidence interval [0.87-1.3], p = 0.545), although there were more ACP discussions in the intervention arm (23% intervention vs. 10% control, p = 0.18). While slightly underpowered, study results did not signal that further enrollment would have yielded statistical significance. There were no differences in secondary outcomes other than the intervention video was more helpful (p = 0.007). Conclusions: The ACP video was successfully integrated into surgical care without harm and was thought to be helpful, although video content did not significantly change the ACP content or patient-surgeon communication. Future studies could increase the ACP dose through modifying video content and/or who presents ACP. Trial Registration: clinicaltrials.gov Identifier NCT02489799.
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Affiliation(s)
- Rebecca A Aslakson
- 1 Palliative Care Section, Department of Medicine, Stanford University School of Medicine, Stanford, California.,2 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,3 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarina R Isenberg
- 3 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,4 Temmy Latner Centre for Palliative Care and Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Norah L Crossnohere
- 3 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison M Conca-Cheng
- 5 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Madeleine Moore
- 5 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Akshay Bhamidipati
- 5 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Silvia Mora
- 5 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Judith Miller
- 6 Patient/Family Member Co-Investigator, Ellicott City, Maryland
| | - Sarabdeep Singh
- 5 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sandra M Swoboda
- 7 Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Timothy M Pawlik
- 8 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew Weiss
- 7 Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Angelo Volandes
- 9 Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas J Smith
- 10 Department of Oncology and Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - John F P Bridges
- 8 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Debra L Roter
- 3 Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, Castaneda-Guarderas A, Gionfriddo MR, Branda ME, Montori VM. Eliciting the Patient's Agenda- Secondary Analysis of Recorded Clinical Encounters. J Gen Intern Med 2019; 34:36-40. [PMID: 29968051 PMCID: PMC6318197 DOI: 10.1007/s11606-018-4540-5] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/18/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Eliciting patient concerns and listening carefully to them contributes to patient-centered care. Yet, clinicians often fail to elicit the patient's agenda and, when they do, they interrupt the patient's discourse. OBJECTIVE We aimed to describe the extent to which patients' concerns are elicited across different clinical settings and how shared decision-making tools impact agenda elicitation. DESIGN AND PARTICIPANTS We performed a secondary analysis of a random sample of 112 clinical encounters recorded during trials testing the efficacy of shared decision-making tools. MAIN MEASURES Two reviewers, working independently, characterized the elicitation of the patient agenda and the time to interruption or to complete statement; we analyzed the distribution of agenda elicitation according to setting and use of shared decision-making tools. KEY RESULTS Clinicians elicited the patient's agenda in 40 of 112 (36%) encounters. Agendas were elicited more often in primary care (30/61 encounters, 49%) than in specialty care (10/51 encounters, 20%); p = .058. Shared decision-making tools did not affect the likelihood of eliciting the patient's agenda (34 vs. 37% in encounters with and without these tools; p = .09). In 27 of the 40 (67%) encounters in which clinicians elicited patient concerns, the clinician interrupted the patient after a median of 11 seconds (interquartile range 7-22; range 3 to 234 s). Uninterrupted patients took a median of 6 s (interquartile range 3-19; range 2 to 108 s) to state their concern. CONCLUSIONS Clinicians seldom elicit the patient's agenda; when they do, they interrupt patients sooner than previously reported. Physicians in specialty care elicited the patient's agenda less often compared to physicians in primary care. Failure to elicit the patient's agenda reduces the chance that clinicians will orient the priorities of a clinical encounter toward specific aspects that matter to each patient.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Rochester, MN, USA
| | | | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Rochester, MN, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez", Universidad Autónoma de Nuevo Leon, Monterrey, Mexico
- Laboratorio Nacional para el Estudio y Aplicación de la Medicina Basada en Evidencia, Análisis Crítico de la Información Científica y Farmacoeconomía, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - Megan E Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Rochester, MN, USA.
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Hagiwara N, Mezuk B, Elston Lafata J, Vrana SR, Fetters MD. Study protocol for investigating physician communication behaviours that link physician implicit racial bias and patient outcomes in Black patients with type 2 diabetes using an exploratory sequential mixed methods design. BMJ Open 2018; 8:e022623. [PMID: 30341127 PMCID: PMC6196822 DOI: 10.1136/bmjopen-2018-022623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 02/27/2018] [Revised: 06/12/2018] [Accepted: 08/17/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions. The overall goal of this research is to identify physician communication behaviours that link physician implicit racial bias and Black patient immediate (patient-reported satisfaction and trust) and long-term outcomes (eg, medication adherence, self-management and healthcare utilisation) as well as clinical indicators of diabetes control (eg, blood pressure, HbA1c and history of diabetes complication). METHODS AND ANALYSIS Using an exploratory sequential mixed methods research design, we will collect data from approximately 30 family medicine physicians and 300 Black patients with type 2 diabetes mellitus. The data sources will include one physician survey, three patient surveys, medical interaction videos, video elicitation interviews and medical chart reviews. Physician implicit racial bias will be assessed with the physician survey, and patient outcomes will be assessed with the patient surveys and medical chart reviews. In video elicitation interviews, a subset of patients (approximately 20-40) will watch their own interactions while being monitored physiologically to identify evocative physician behaviours. Information from the interview will determine which physician communication behaviours will be coded from medical interactions videos. Coding will be done independently by two trained coders. A series of statistical analyses (zero-order correlations, partial correlations, regressions) will be conducted to identify physician behaviours that are associated significantly with both physician implicit racial bias and patient outcomes. ETHICS AND DISSEMINATION Ethics approval was obtained from the Virginia Commonwealth University IRB. Study results will be disseminated through publications in peer-reviewed journals and presentations at conferences. A novel Medical Interaction involving Black Patients Coding System from this project will be made publicly available.
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Affiliation(s)
- Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Briana Mezuk
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Elston Lafata
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott R Vrana
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
Ideal communication between a physician and a patient, where there are higher efficiency and the conveying of quality information, is the cornerstone of achieving meaningful health outcomes for the patient. Today, increasing constraints in the form of mandatory documentation, guideline-based requirements, and other bureaucratic necessities have limited the time that the physician can truly spend on communicating with the patient. As such, counseling often takes lower priority during a patient visit. To correct this deficiency, the modern physician must adapt to the new constraints to create a more-efficient communication model that incorporates greater literature and infographic-based technological usage with advanced preparation. It is a challenge that must be met in order to maintain a critical element of patient visits.
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Affiliation(s)
- Abhishek Gupta
- Geriatrics, Center for Addiction and Mental Health/University of Toronto, Toronto, CAN
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45
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Lanham HJ, Leykum LK, Pugh JA. Examining the Complexity of Patient-Outpatient Care Team Secure Message Communication: Qualitative Analysis. J Med Internet Res 2018; 20:e218. [PMID: 29997107 PMCID: PMC6060302 DOI: 10.2196/jmir.9269] [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] [Received: 10/25/2017] [Revised: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communicating both routine and nonroutine issues, and the implications of these differences in use are less well understood. OBJECTIVE The purpose of this study was to examine secure messaging use to extend current knowledge of how this tool is being used in outpatient care settings and generate new research questions to improve our understanding of the role of secure messaging in the patient-provider communication toolbox. METHODS We conducted an in-depth qualitative analysis of secure message threads in 12 US Department of Veterans Affairs outpatient clinics in south Texas. We analyzed 70 secure message threads with a total of 179 unique communications between patients and their outpatient teams for patterns in communication and secure message content. We used theories from information systems and complexity science in organizations to explain our observations. RESULTS Analysis identified content relating to 3 main themes: (1) information management, (2) uncertainty management, and (3) patient safety and engagement risks and opportunities. Within these themes, we identified 2 subcategories of information management (information exchange and problem solving), 2 subcategories of uncertainty management (relationship building and sensemaking), and 3 subcategories of patient safety and engagement risks and opportunities (unresolved issues, tone mismatch, and urgent medical issues). Secure messages were most often used to communicate routine issues (eg, information exchange and problem solving). However, the presence of subcategories pertaining to nonroutine issues (eg, relationship building, sensemaking, tone mismatch, urgent issues, and unresolved issues) requires attention, particularly for improving opportunities in outpatient care settings using secure messaging. CONCLUSIONS Patients use secure messaging for both routine and nonroutine purposes. Our analysis sheds light on potentially new patient safety concerns, particularly when using secure messaging to address some of the more complex issues patients are communicating with providers. Secure messaging is an asynchronous communication information system operated by patients and providers who are often characterized as having significant differences in knowledge, experience and expectations. As such, justification for its use beyond routine purposes is limited-yet this occurs, presenting a multifaceted dilemma for health care organizations. Secure messaging use in outpatient care settings may be more nuanced, and thus more challenging to understand and manage than previously recognized. New information system designs that acknowledge the use of secure messaging for nonroutine and complex health topics are needed.
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Affiliation(s)
- Holly Jordan Lanham
- Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, TX, United States.,Veterans Evidence Based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Luci K Leykum
- Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, Austin, TX, United States.,Veterans Evidence Based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, United States
| | - Jacqueline A Pugh
- Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States.,Veterans Evidence Based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, TX, United States
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Daniel F, Jabak S, Sasso R, Chamoun Y, Tamim H. Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians' Perceptions and Attitudes. JMIR Med Inform 2018; 6:e18. [PMID: 29625955 PMCID: PMC5910531 DOI: 10.2196/medinform.8895] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. OBJECTIVE The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. METHODS This was a cross-sectional observational study using an online survey that addressed physicians' perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. RESULTS A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. CONCLUSIONS The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality.
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Affiliation(s)
- Fady Daniel
- Department of Internal Medicine, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Suha Jabak
- Department of Internal Medicine, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Roula Sasso
- Department of Emergency Medicine, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Yara Chamoun
- Hotel-Dieu de France Medical Center, Department of Psychiatry, Université Saint Joseph, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
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Peacock S, Reddy A, Leveille SG, Walker J, Payne TH, Oster NV, Elmore JG. Patient portals and personal health information online: perception, access, and use by US adults. J Am Med Inform Assoc 2018; 24:e173-e177. [PMID: 27413120 DOI: 10.1093/jamia/ocw095] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Access to online patient portals is key to improving care, but we have limited understanding of patient perceptions of online portals and the characteristics of people who use them. Methods Using a national survey of 3677 respondents, we describe perceptions and utilization of online personal health information (PHI) portals. Results Most respondents (92%) considered online PHI access important, yet only 34% were offered access to online PHI by a health care provider, and just 28% accessed online PHI in the past year. While there were no differences across race or ethnicity in importance of access, black and Hispanic respondents were significantly less likely to be offered access ( P = .006 and <.001, respectively) and less likely to access their online PHI ( P = .041 and <.001, respectively) compared to white and non-Hispanic respondents. Conclusion Health care providers are crucial to the adoption and use of online patient portals and should be encouraged to offer consistent access regardless of patient race and ethnicity.
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Affiliation(s)
- Sue Peacock
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Ashok Reddy
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Suzanne G Leveille
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center; Department of Medicine, Harvard Medical School, Boston, Massachusetts.,College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Jan Walker
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Thomas H Payne
- Medicine Information Technology Services, Department of Medicine, University of Washington, Seattle, Washington
| | - Natalia V Oster
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joann G Elmore
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
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Abstract
OBJECTIVE To identify and classify all clinical decisions that emerged in a sample of patient-physician encounters and compare different categories of decisions across clinical settings and personal characteristics. DESIGN Cross-sectional descriptive evaluation of hospital encounters videotaped in 2007-2008 using a novel taxonomy to identify and classify clinically relevant decisions (both actions and judgements). PARTICIPANTS AND SETTING 372 patients and 58 physicians from 17 clinical specialties in ward round (WR), emergency room (ER) and outpatient (OP) encounters in a Norwegian university hospital. RESULTS The 372 encounters contained 4976 clinically relevant decisions. The average number of decisions per encounter was 13.4 (min-max 2-40, SD 6.8). The overall distribution of the 10 topical categories in all encounters was: defining problem: 30%, evaluating test result: 17%, drug related: 13%, gathering additional information: 10%, contact related: 10%, advice and precaution: 8%, therapeutic procedure related: 5%, deferment: 4%, legal and insurance related: 2% and treatment goal: 1%. Across three temporal categories, the distribution of decisions was 71% here-and-now, 16% preformed and 13% conditional. On average, there were 15.7 decisions per encounter in internal medicine specialties, 7.1 in ear-nose-throat encounters and 11.0-13.6 in the remaining specialties. WR encounters contained significantly more drug-related decisions than OP encounters (P=0.031) and preformed decisions than ER and OP encounters (P<0.001). ER encounters contained significantly more gathering additional information decisions than OP and WR encounters (P<0.001) and fewer problem defining decisions than WR encounters (P=0.028). There was no significant difference in the average number of decisions related to the physician's and patient's age or gender. CONCLUSIONS Patient-physician encounters contain a larger number of clinically relevant decisions than described in previous studies. Comprehensive descriptions of how decisions, both as judgements and actions, are communicated in medical encounters may serve as a first step in assessing clinical practice with respect to efficiency and quality on a provider or system level.
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Affiliation(s)
| | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Edvin Schei
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Richard M Frankel
- Indiana University School of Medicine, VA HSR and Development Center for Health Information and Communication, Indianapolis, Indiana, USA
| | | | - Pål Gulbrandsen
- The Research Centre, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Lorenskog, Norway
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Sims T, Koopmann-Holm B, Young H, Jiang D, Fung H, Tsai JL. Asian Americans respond less favorably to excitement (vs. calm)-focused physicians compared to European Americans. Cultur Divers Ethnic Minor Psychol 2018; 24:1-14. [PMID: 28714709 PMCID: PMC5771974 DOI: 10.1037/cdp0000171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Despite being considered a "model minority," Asian Americans report worse health care encounters than do European Americans. This may be due to affective mismatches between Asian American patients and their European American physicians. We predicted that because Asian Americans value excitement (vs. calm) less than European Americans, they will respond less favorably to excitement-focused (vs. calm) physicians. METHOD In Study 1, 198 European American, Chinese American, and Hong Kong Chinese community adults read a medical scenario and indicated their preference for an excitement-focused versus calm-focused physician. In Study 2, 81 European American and Asian American community college students listened to recommendations made by an excitement-focused or calm-focused physician in a video, and later attempted to recall the recommendations. In Study 3, 101 European American and Asian American middle-aged and older adults had multiple online encounters with an excitement-focused or calm-focused physician and then evaluated their physicians' trustworthiness, competence, and knowledge. RESULTS As predicted, Hong Kong Chinese preferred excitement-focused physicians less than European Americans, with Chinese Americans falling in the middle (Study 1). Similarly, Asian Americans remembered health information delivered by an excitement-focused physician less well than did European Americans (Study 2). Finally, Asian Americans evaluated an excitement-focused physician less positively than did European Americans (Study 3). CONCLUSIONS These findings suggest that while physicians who promote and emphasize excitement states may be effective with European Americans, they may be less so with Asian Americans and other ethnic minorities who value different affective states. (PsycINFO Database Record
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Affiliation(s)
- Tamara Sims
- Stanford University, Department of Psychology
| | | | - Henry Young
- Stanford University, Department of Psychology
| | - Da Jiang
- Chinese University of Hong Kong, Department of Psychology
- Australian National University, Centre for Research on Ageing, Health, and Wellbeing
| | - Helene Fung
- Chinese University of Hong Kong, Department of Psychology
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Jacobs B, Ryan AM, Henrichs KS, Weiss BD. Medical Interpreters in Outpatient Practice. Ann Fam Med 2018; 16:70-76. [PMID: 29311179 PMCID: PMC5758324 DOI: 10.1370/afm.2154] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 05/14/2017] [Revised: 06/30/2017] [Accepted: 07/24/2017] [Indexed: 11/09/2022] Open
Abstract
This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs. The only exception is providers whose only federal assistance is through Medicare Part B, an exception that applies to a very small percentage of practicing physicians. All required language assistance services must be free and provided by qualified translators and interpreters. Interpreters must meet specified qualifications and ideally be certified. Although the cost of interpreter services can be considerable, ranging from $45-$150/hour for in-person interpreters, to $1.25-$3.00/minute for telephone interpreters, and $1.95-$3.49/minute for video remote interpreting, it may be reimbursed or covered by a patient's Medicaid or other federally funded medical insurance. Failure to use qualified interpreters can have serious negative consequences for both practitioners and patients. In one study, 1 of every 40 malpractice claims were related, all or in part, to failure to provide appropriate interpreter services. Most importantly, however, the use of qualified interpreters results in better and more efficient patient care.
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Affiliation(s)
- Barb Jacobs
- Language Interpreter Center, Alaska Institute for Justice, Anchorage, Alaska
| | - Anne M Ryan
- Tucson Family Advocacy Program, Medical Legal Partnership for Health, Tucson, Arizona.,Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Katherine S Henrichs
- Tucson Family Advocacy Program, Medical Legal Partnership for Health, Tucson, Arizona.,University of Arizona James E. Rogers College of Law, Tucson, Arizona
| | - Barry D Weiss
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, Arizona .,Department of Health Sciences, University of Alaska, Anchorage, Alaska
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