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Murphy BL, Fischer JL, Tolisano AM, Navarro AI, Trinh L, Abuzeid WM, Humphreys IM, Akbar NA, Shah S, Schneider JS, Riley CA, McCoul ED. How Do Patients and Otolaryngologists Define Dizziness? Ann Otol Rhinol Laryngol 2024; 133:512-518. [PMID: 38375799 DOI: 10.1177/00034894241233949] [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: 02/21/2024]
Abstract
OBJECTIVE To assess for differences in how patients and otolaryngologists define the term dizziness. METHODS Between June 2020 and December 2022, otolaryngology clinicians and consecutive patients at 5 academic otolaryngology institutions across the United States were asked to define the term "dizziness" by completing a semantics-based questionnaire containing 20 common descriptors of the term within 5 symptom domains (imbalance-related, lightheadedness-related, motion-related, vision-related, and pain-related). The primary outcome was differences between patient and clinician perceptions of dizzy-related symptoms. Secondary outcomes included differences among patient populations by geographic location. RESULTS Responses were obtained from 271 patients and 31 otolaryngologists. Patients and otolaryngologists selected 7.7 ± 3.5 and 7.1 ± 4.3 symptoms, respectively. Most patients (266, 98.2%) selected from more than 1 domain and 17 (6.3%) patients identified symptoms from all 5 domains. Patients and clinicians were equally likely to define dizziness using terms from the imbalance (difference, -2.3%; 95% CI, -13.2%, 8.6%), lightheadedness (-14.1%; -29.2%, 1.0%), and motion-related (9.4; -0.3, 19.1) domains. Patients were more likely to include terms from the vision-related (23.6%; 10.5, 36.8) and pain-related (18.2%; 10.3%, 26.1%) domains. There were minor variations in how patients defined dizziness based on geographic location. CONCLUSIONS Patients and otolaryngologists commonly described dizziness using symptoms related to imbalance, lightheadedness, and motion. Patients were more likely to use vision or pain-related terms. Understanding of these semantic differences may enable more effective patient-clinician communication.
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Affiliation(s)
- Brianna L Murphy
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alvaro I Navarro
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
| | - Lily Trinh
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
| | - Waleed M Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Ian M Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Nadeem A Akbar
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sharan Shah
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, LA, USA
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Gaysynsky A, Senft Everson N, Heley K, Chou WYS. Perceptions of Health Misinformation on Social Media: Cross-Sectional Survey Study. JMIR Infodemiology 2024; 4:e51127. [PMID: 38687591 DOI: 10.2196/51127] [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: 07/21/2023] [Revised: 12/15/2023] [Accepted: 03/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Health misinformation on social media can negatively affect knowledge, attitudes, and behaviors, undermining clinical care and public health efforts. Therefore, it is vital to better understand the public's experience with health misinformation on social media. OBJECTIVE The goal of this analysis was to examine perceptions of the social media information environment and identify associations between health misinformation perceptions and health communication behaviors among US adults. METHODS Analyses used data from the 2022 Health Information National Trends Survey (N=6252). Weighted unadjusted proportions described respondents' perceptions of the amount of false or misleading health information on social media ("perceived misinformation amount") and how difficult it is to discern true from false information on social media ("perceived discernment difficulty"). Weighted multivariable logistic regressions examined (1) associations of sociodemographic characteristics and subjective literacy measures with misinformation perceptions and (2) relationships between misinformation perceptions and health communication behaviors (ie, sharing personal or general health information on social media and using social media information in health decisions or in discussions with health care providers). RESULTS Over one-third of social media users (35.61%) perceived high levels of health misinformation, and approximately two-thirds (66.56%) reported high perceived discernment difficulty. Odds of perceiving high amounts of misinformation were lower among non-Hispanic Black/African American (adjusted odds ratio [aOR] 0.407, 95% CI 0.282-0.587) and Hispanic (aOR 0.610, 95% CI 0.449-0.831) individuals compared to White individuals. Those with lower subjective health literacy were less likely to report high perceived misinformation amount (aOR 0.602, 95% CI 0.374-0.970), whereas those with lower subjective digital literacy were more likely to report high perceived misinformation amount (aOR 1.775, 95% CI 1.400-2.251). Compared to White individuals, Hispanic individuals had lower odds of reporting high discernment difficulty (aOR 0.620, 95% CI 0.462-0.831). Those with lower subjective digital literacy (aOR 1.873, 95% CI 1.478-2.374) or numeracy (aOR 1.465, 95% CI 1.047-2.049) were more likely to report high discernment difficulty. High perceived misinformation amount was associated with lower odds of sharing general health information on social media (aOR 0.742, 95% CI 0.568-0.968), using social media information to make health decisions (aOR 0.273, 95% CI 0.156-0.479), and using social media information in discussions with health care providers (aOR 0.460, 95% CI 0.323-0.655). High perceived discernment difficulty was associated with higher odds of using social media information in health decisions (aOR 1.724, 95% CI 1.208-2.460) and health care provider discussions (aOR 1.389, 95% CI 1.035-1.864). CONCLUSIONS Perceptions of high health misinformation prevalence and discernment difficulty are widespread among social media users, and each has unique associations with sociodemographic characteristics, literacy, and health communication behaviors. These insights can help inform future health communication interventions.
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Affiliation(s)
- Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, United States
- ICF Next, ICF, Rockville, MD, United States
| | - Nicole Senft Everson
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, United States
| | - Kathryn Heley
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, United States
| | - Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, United States
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study. JMIR Hum Factors 2024; 11:e49696. [PMID: 38551641 PMCID: PMC11015373 DOI: 10.2196/49696] [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: 06/06/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. OBJECTIVE This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). METHODS A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. RESULTS Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. CONCLUSIONS In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Digital Health & Rehabilitation, Sport Sciences - Performance & Technology, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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Upadhyay S, Jones J. Patient-provider communication quality: Socioeconomic disparities in smoking outcomes. Tob Prev Cessat 2024; 10:TPC-10-14. [PMID: 38469412 PMCID: PMC10926686 DOI: 10.18332/tpc/184050] [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] [Received: 10/18/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Patient-provider communication quality is instrumental for healthy outcomes in patients. The objective of this study is to examine the relationships between patient-provider communication quality and participant characteristics, perception of e-cigarette harmfulness, and smoking outcomes. METHODS A pooled cross-sectional design was used on secondary data obtained from the Health Information National Trends Survey (HINTS) 5 from Cycle 1 through Cycle 4, from 2017-2022. Our final sample contained 3511 observations. Our outcome variable was the perception of electronic cigarette smoking status. The independent variable was patient-provider communication quality (PPCQ), measured from a series of questions with responses on a 4-item Likert scale (always, usually, sometimes, never). Demographic variables such as marital status, health insurance status, occupation status, and health-related variables were used as participant characteristics. Ordinal logistic regression models were used to examine the above relationships. RESULTS Compared to males, females had lower odds of being in a higher category of perception of e-cigarette harmfulness compared to other categories of e-cigarette harmfulness (AOR=0.66; 95% CI: 0.57-0.76). Respondents who were non-Hispanic Black or Hispanic had lower odds of being in a higher category of perception of e-cigarettes compared to Whites (AOR=0.52; 95% CI: 0.49-0.78, and AOR=0.51; 95% CI: 0.41-0.65, respectively). Respondents who had higher education level compared to those with less than high school had lower odds (AOR=0.30; 95% CI: 0.17-0.51), and Hispanics compared to Whites had higher odds (AOR=1.59; 95% CI: 1.05-2.40), of being former smokers rather than current smokers. CONCLUSIONS Providers should invest in staff training and development to target the populations that need conversations regarding e-cigarette usage.
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Affiliation(s)
- Soumya Upadhyay
- Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, United States
| | - Jalen Jones
- Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, United States
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study. JMIR Hum Factors 2024; 11:e53391. [PMID: 38457798 PMCID: PMC10960209 DOI: 10.2196/53391] [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: 10/09/2023] [Revised: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. OBJECTIVE This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). METHODS We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. RESULTS HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. CONCLUSIONS eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies-Digital Health and Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Wust KL, Carayon P, Werner NE, Hoonakker PLT, Salwei ME, Rutkowski R, Barton HJ, Dail PVW, King B, Patterson BW, Pulia MS, Shah MN, Smith M. Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care. Hum Factors 2024; 66:701-713. [PMID: 35549738 PMCID: PMC10402098 DOI: 10.1177/00187208221092847] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits. BACKGROUND Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care. METHODS Participants included 14 older adult patients (≥ 65 years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient's ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers. RESULTS We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient's health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering. CONCLUSION Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.
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Affiliation(s)
| | | | | | | | - Megan E Salwei
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Renda S, Freeman J. You may delay, but time will not. Beta cells lost are never found again: a case for timely initiation of basal insulin in type 2 diabetes. Postgrad Med 2024; 136:150-161. [PMID: 38465574 DOI: 10.1080/00325481.2024.2328511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Since its first use just over a century ago, insulin treatment has evolved dramatically, such that the molecules are physiologic in nature, and treatment can now closely resemble the natural hormone response over 24 hours. Newer, longer-acting basal insulin analogs have provided insulin therapies with improved characteristics and, therefore, ease of use, and can readily be incorporated as part of routine treatment for type 2 diabetes (T2D), but evidence suggests that insulin remains underused in people with T2D. We review the barriers to initiation of basal insulin and the education needed to address these barriers, and we provide practical pointers, supported by evidence, for primary care physicians and advanced practice providers to facilitate timely initiation of basal insulin in the people with T2D who will benefit from such treatment.
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Affiliation(s)
- Susan Renda
- Johns Hopkins Comprehensive Diabetes Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jeffrey Freeman
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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Gonzalez C, Graves JM, Ramos J, Vavilala MS, Moore M. Language access research for community health: provider perspectives on language access techniques and the role of communication technology. J Commun Healthc 2024; 17:7-14. [PMID: 37470760 DOI: 10.1080/17538068.2023.2237351] [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] [Indexed: 07/21/2023]
Abstract
BACKGROUND In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). METHODS Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. RESULTS Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. CONCLUSIONS Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Joana Ramos
- Washington State Coalition for Language Access (WASCLA), Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine and Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
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Shand R, Foster A, Baker C, O'Halloran R. Identifying communication difficulty and context-specific communication supports for patient-provider communication in a sub-acute setting: A prospective mixed methods study. Int J Speech Lang Pathol 2024:1-20. [PMID: 38425157 DOI: 10.1080/17549507.2023.2289350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE To identify the sub-acute rehabilitation inpatients who have communication difficulty and the range of communication supports that can facilitate communicative success. METHOD A prospective cohort mixed methods study was conducted on two inpatient sub-acute rehabilitation wards. Nurses screened all new admissions for communication difficulty using the Inpatient Functional Communication Interview, Screening Questionnaire (IFCI-SQ). Patients identified as having communication difficulty were interviewed by a speech-language pathologist (SLP) using the Inpatient Functional Communication Interview (IFCI). During the interview, the SLP trialled different communication supports. The number of patients who had communication difficulty on the IFCI-SQ was calculated. The number and type of communication supports that improved communication within the patient-SLP interview were calculated. Deductive-dominant qualitative content analysis was conducted on the communication supports used during the IFCI. RESULT Seventy patients were screened. Nurses reported communication difficulty in 45/70 (64%) of patients. A total of 15/45 patients were interviewed by an SLP using the IFCI. The provision of communication supports improved communication for all patients within the context of the patient-SLP interview. CONCLUSION Many sub-acute rehabilitation inpatients have communication difficulty in the hospital setting. A range of communication supports facilitated communication. These insights could inform future communication partner training (CPT) programs.
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Affiliation(s)
- Rosalind Shand
- Monash Health, Melbourne, Australia
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
| | - Abby Foster
- Monash Health, Melbourne, Australia
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Caroline Baker
- Monash Health, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, La Trobe University, Melbourne, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
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Ruby E, McDonald SD, Berger H, Melamed N, Li J, Darling EK, Geary M, Barrett J, Murray-Davis B. A Social-Ecological Model Exploring Gestational Diabetes Mellitus Screening Practices Among Antenatal Health Care Providers. Health Educ Behav 2024:10901981241232651. [PMID: 38406976 DOI: 10.1177/10901981241232651] [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: 02/27/2024]
Abstract
Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for the pregnant individual and their baby. Screening approaches for GDM have undergone several iterations, introducing variability in practice among healthcare providers. As such, our study aimed to explore the views of antenatal providers regarding their practices of, and counseling experiences on the topic of, GDM screening in Ontario. We conducted a qualitative, grounded theory study. The study population included antenatal providers (midwives, family physicians, and obstetricians) practicing in Hamilton, Ottawa, or Sudbury, Ontario. Semi-structured telephone interviews were conducted and transcribed verbatim. Transcripts were analyzed using inductive coding upon which codes, categories, and themes were developed to generate a theory grounded in the data. Twenty-two participants were interviewed. Using the social-ecological theory, we created a model outlining four contextual levels that shaped the experiences of GDM counseling and screening: Intrapersonal factors included beliefs, knowledge, and skills; interpersonal factors characterized the patient-provider interactions; organizational strengths and challenges shaped collaboration and health services infrastructure; and finally, guidelines and policies were identified as systemic barriers to health care access and delivery. A focus on patient-centered care was a guiding principle for all care providers and permeated all four levels of the model. Patient-centered care and close attention to barriers and facilitators across intrapersonal, interpersonal, organizational, and policy domains can minimize the impact of variations in GDM screening guidelines. Among care providers, there is a desire for additional skill development related to GDM counseling, and for national consensus on optimal screening guidelines.
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Affiliation(s)
- Emma Ruby
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Nir Melamed
- University of Toronto, Toronto, Ontario, Canada
| | - Jenifer Li
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Jon Barrett
- McMaster University, Hamilton, Ontario, Canada
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Anthony T, Assi S, Garcia Morales EE, Jiang K, Powell D, Martinez-Amezcua P, Oh ES, Deal JA, Reed NS. Hearing Loss, Hearing Aids, and Satisfaction With Health Care in the National Health Interview Survey. Otolaryngol Head Neck Surg 2024; 170:414-421. [PMID: 37746921 PMCID: PMC10844895 DOI: 10.1002/ohn.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Hearing loss may negatively impact satisfaction with health care via patient-provider communication barriers and may be amenable to hearing care treatment. STUDY DESIGN Cross-sectional. SETTING National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles. METHODS Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self-report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use. RESULTS Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18-1.23), a little trouble (PRR = 1.27, 95% CI, 1.23-1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24-1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18-1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78-0.88) compared to nonusers. CONCLUSION Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient-provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect.
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Affiliation(s)
- Teresa Anthony
- College of Public Health, University of South Florida,
Tampa, FL
- Department of Communication Sciences and Disorders, College
of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Kening Jiang
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Danielle Powell
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins
University Bloomberg School of Public Health, Baltimore, Maryland
| | - Pablo Martinez-Amezcua
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Esther S. Oh
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, Maryland
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public Health, Johns
Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland
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12
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Naeem K, Bhargava M, Porter RW. Medico-Legal Implications of Video Recordings of Clinic Visits in Malpractice Claims Against Medical Providers. Cureus 2024; 16:e53627. [PMID: 38449946 PMCID: PMC10917358 DOI: 10.7759/cureus.53627] [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] [Accepted: 01/23/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Although audio-video recordings of clinic visits improve patient satisfaction and recall, the associated presumed risk of increased malpractice claims limits their use. In this study, we identified whether video recording clinic visits was associated with increases in professional liability claims. METHODS From 2015 to 2017, the institution's loss run was analyzed, and the rates of medical malpractice claims per physician-year were compared between physicians who used video recordings of clinic visits (V-RoCs) and those who did not. The term "users" was applied to all physicians whose mean percentage of patient visits with video recording was greater than the mean percentage for the practice overall. RESULTS Over three years, 15,254 patients used V-RoCs. The use of video recordings for clinic visits increased at a rate of 23% per year. No association was found between video recordings and increased malpractice claims. The rate of all claims between users and nonusers did not differ significantly (P=0.66). Of seven paid claims or lawsuits from 2000 to 2017, none were against physicians who used video recordings. CONCLUSION Video recording of patient-physician encounters was not associated with an increase in malpractice lawsuits. According to federal law, a patient can legally record a clinic encounter without physician consent, which has many ethical implications. Formalizing the recording process is beneficial for both parties and allows the resource to be used to its maximum potential.
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Affiliation(s)
- Komal Naeem
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, USA
| | - Malika Bhargava
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, USA
| | - Randall W Porter
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, USA
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13
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Baglien BD, Ganesh Kumar N, Berlin NL, Hawley ST, Jagsi R, Momoh AO. Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion. Semin Plast Surg 2024; 38:39-47. [PMID: 38495060 PMCID: PMC10942833 DOI: 10.1055/s-0043-1778040] [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: 03/19/2024]
Abstract
The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p < 0.001) or a staff member (75.5% vs. 59.3%, p < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, "other") were significantly more likely to prefer a cost-of-care discussion ( p < 0.001, p = 0.02, p = 0.05, p = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.
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Affiliation(s)
- Brigit D. Baglien
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nishant Ganesh Kumar
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nicholas L. Berlin
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Adeyiza O. Momoh
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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14
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Prikhodkina M, Melnikov S. Factors that influence medication adherence in women with fibromyalgia: A path analysis. J Clin Nurs 2024. [PMID: 38284436 DOI: 10.1111/jocn.17044] [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] [Received: 09/29/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
AIMS To investigate the relationships between depression symptoms, perceived stigma, disease severity, patient-provider communication and medication adherence in fibromyalgia patients. The objectives were to explore how these factors influence treatment adherence and to develop a comprehensive model illustrating their interconnections. BACKGROUND Fibromyalgia is a chronic pain syndrome with fatigue, sleep issues and idiopathic pain. Medication adherence is limited by insufficient symptom relief, side effects and costs. Stigma further complicates fibromyalgia. Disease severity affects patient-provider communication. Associations between depression, stigma, severity, communication and adherence in fibromyalgia are unclear. DESIGN A cross-sectional, correlational study. METHODS The STROBE guidelines for cross-sectional studies were followed. Participants included Hebrew-speaking participants who were members of two Facebook groups: 'Shades of Purple' and 'Fibromyalgia- Get to Know!' Between February and April 2022. They undertook evaluations using The Patient Health Questionnaire-9 to gauge depression symptoms, assessed perceived stigma, utilised The Revised Fibromyalgia Impact Questionnaire to determine disease severity, employed The Patient Reaction Assessment questionnaire for patient-provider communication, and used the 8-item Morisky Medication Adherence Scale (MMAS-8). Associations between the variables were explored using Pearson's correlations and path analyses. RESULTS The study included 141 women with fibromyalgia, aged 22 to 76 years. Most reported having a stable partner (69.5%) and 75.2% had children. The treatment adherence levels were as follows: 53.2% (N = 75)-low, 33.3% (N = 47)-medium and 13.5% (N = 19)-high. Depression positively correlated with stigma. Stigma negatively correlated with patient-provider communication. Patient-provider communication positively correlated with treatment adherence. A significant negative indirect effect of depression on treatment adherence through stigma and patient-provider communication was found. CONCLUSIONS Perceived stigma and patient-provider communication played a mediating role in the relationships between depression and treatment adherence among women with fibromyalgia. RELEVANCE TO CLINICAL PRACTICE Addressing stigma related to fibromyalgia and effective patient-provider communication can positively influence treatment adherence. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Maria Prikhodkina
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Fischer JL, Tolisano AM, Navarro AI, Trinh L, Abuzeid WM, Humphreys IM, Akbar NA, Shah S, Schneider JS, Riley CA, McCoul ED. Are you congested? A comparison of definitions between otolaryngologists and their patients. Int Forum Allergy Rhinol 2024; 14:86-95. [PMID: 37392085 DOI: 10.1002/alr.23228] [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: 04/06/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To assess for differences of intended meaning in the description of congestion-related symptoms among otolaryngology patients and clinicians. MATERIALS AND METHODS Between June 2020 and October 2022, a questionnaire consisting of 16 common descriptors of congestion-related symptoms within four domains (obstructive-related, pressure-related, mucus-related, and other symptoms) was completed by patients and otolaryngologists at five tertiary otolaryngology practices. The primary outcome was to assess differences in patient and clinician perceptions of congestion-related symptoms. Differences based on geographic location was a secondary outcome. RESULTS A total of 349 patients and 40 otolaryngologists participated. Patients selected a median of 6.8 (standard deviation [SD] 3.0) terms compared with 4.0 (SD 1.6) terms for otolaryngologists (p < 0.001). Otolaryngologists were more likely to select obstruction-related symptoms (difference 6.3%; 95% confidence interval [CI] 3.8%, 8.9%). Patients were more likely to describe congestion using pressure-related (-43.7%; -58.9%, -28.5%), mucus-related (-43.5%; -59.3%, -27.8%), and other symptoms (-44.2; -51.3%, -37.1%) compared with otolaryngologists. There were no significant differences identified based on geographic location with regard to symptom domains on multivariate analysis. CONCLUSIONS There are differences between otolaryngologists and their patients in the interpretation of the symptoms of congestion. Clinicians tended to have a narrower interpretation of congestion that was limited to the obstruction-related symptom domain, while patients defined congestion more broadly. This has important counseling and communication implications for the clinician.
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Affiliation(s)
- Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alvaro I Navarro
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Lily Trinh
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Waleed M Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Ian M Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Nadeem A Akbar
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sharan Shah
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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16
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Xu L, Sockler PG, Park G, Grossberg AL, Wan J. Characterization of patient portal messaging use and content among a pediatric atopic dermatitis population: A cross-sectional study. J Am Acad Dermatol 2024; 90:165-168. [PMID: 37704108 PMCID: PMC10841176 DOI: 10.1016/j.jaad.2023.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Lillian Xu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick G Sockler
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giho Park
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna L Grossberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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17
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Nembhard IM, Matta S, Shaller D, Lee YSH, Grob R, Schlesinger M. Learning from patients: The impact of using patients' narratives on patient experience scores. Health Care Manage Rev 2024; 49:2-13. [PMID: 38019459 PMCID: PMC10873528 DOI: 10.1097/hmr.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Enthusiasm has grown about using patients' narratives-stories about care experiences in patients' own words-to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published. PURPOSE We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores. APPROACH We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system. We used multilevel models to analyze survey data from patients about their experiences and from staff about exposure to useful narratives. We examined staff confidence in own knowledge as a moderator because confidence can influence use of new information sources. RESULTS Frequency of sharing useful narratives with staff was associated with patient experience scores for all measures, conditional on staff confidence in own knowledge ( p < .01). For operational measures (e.g., care coordination), increased sharing correlated with subsequently higher performance for more confident staff and lower performance or no difference for less confident staff, depending on measure. For relational measures (e.g., patient-provider communication), increased sharing correlated with higher scores for less confident staff and lower scores for more confident staff. CONCLUSION Sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge. PRACTICE IMPLICATIONS Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organizations need to address how narrative feedback interacts with their staff's confidence to realize higher experience scores across domains.
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18
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James TG, Sullivan MK, McKee MM, Rotoli J, Maruca D, Stachowiak R, Cheong J, Varnes JR. Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients. Health Expect 2023; 26:2374-2386. [PMID: 37555478 PMCID: PMC10632638 DOI: 10.1111/hex.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients. METHODS This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach. RESULTS Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes. CONCLUSIONS This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine. PATIENT OR PUBLIC CONTRIBUTION This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | | | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - JeeWon Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - Julia R. Varnes
- Department of Health Services Research, Management, and PolicyUniversity of FloridaGainesvilleFloridaUSA
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19
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Lowe C, Roter DL. Genetic counseling students' use of patient-centered communication skills predicts standardized patient satisfaction during virtual simulated sessions. J Genet Couns 2023; 32:1184-1193. [PMID: 36537339 DOI: 10.1002/jgc4.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
Communication is essential to effective genetic counseling, but few studies have systematically evaluated methods of assessing communication skills among genetic counseling trainees. The study's objective is to compare the strength of associations between standardized patient (SP) satisfaction with simulated genetic counseling sessions and student skill use during the sessions, as reported by SPs and students. We hypothesized that (1) Both SP- and student-reported skill use will be significantly associated with SP satisfaction ratings during the baseline simulation and (2): SP ratings of student skill use will show a stronger relationship to SP satisfaction than student self-rating of skill use. Sixty genetic counseling students and recent graduates (referred to as "students") from accredited U.S. and Canadian programs participated in the study and completed a baseline virtual-simulated genetic counseling session. Both students and SPs completed post-session questionnaires about communication skill use (a 22-item checklist) and SPs completed a satisfaction questionnaire based on the session (a 14-item Likert scale). Multilevel regression models assessed associations between SP satisfaction during the baseline session and SP- or student-reported skill use. SP satisfaction was significantly associated with skill use reported by both SPs and students, but the model based on SP report explained a higher proportion of the variance in SP satisfaction than student-reported skill use (SP model fixed effects R2 = 27%, adjusted R2 = 21%; vs. student model R2 = 7%, adjusted R2 = -2%). For both the SP and student models, use of more skills from the LISTEN domain (which focused on eliciting the patient's perspective) was associated with higher SP satisfaction, while other skill category domains were not. These findings support the SP satisfaction measure as sensitive to variation in student performance of key communication skills, especially those eliciting the patient's perspective. Moreover, SP assessment of session satisfaction can be a useful assessment of student communication performance and a meaningful proxy for actual patient satisfaction.
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Affiliation(s)
- Chenery Lowe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
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20
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Sacca L, Lobaina D, Burgoa S, Rao M, Jhumkhawala V, Zapata SM, Issac M, Medina S. Using Patient-Centered Dissemination and Implementation Frameworks and Strategies in Palliative Care Settings for Improved Quality of Life and Health Outcomes: A Scoping Review. Am J Hosp Palliat Care 2023:10499091231214241. [PMID: 37956239 DOI: 10.1177/10499091231214241] [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: 11/15/2023] Open
Abstract
BACKGROUND There is a need for patient-provider dissemination and implementation frameworks, strategies, and protocols in palliative care settings for a holistic approach when it comes to addressing pain and other distressing symptoms affecting the quality of life, function, and independence of patients with chronic illnesses. The purpose of this scoping review is to explore patient-centered D&I frameworks and strategies that have been adopted in PC settings to improve behavioral and environmental determinants influencing health outcomes through evidence-based programs and protocols. METHODS The five step Arksey and O'Malley's (2005) York methodology was adopted as a guiding framework: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. RESULTS Only 6 out of the 38 (16%) included studies applied a D&I theory and/or framework. The RE-AIM framework was the most prominently cited (n = 3), followed by the Diffusion of Innovation Model (n = 2), the CONNECT framework (n = 1), and the Transtheoretical Stages of Change Model (n = 1). The most frequently reported ERIC strategy was strategy #6 "Develop and organize quality monitoring systems", as it identified in all 38 of the included studies. CONCLUSION This scoping review identifies D&I efforts to translate research into practice in U.S. palliative care settings. Results may contribute to enhancing future D&I initiatives for dissemination/adaptation, implementation, and sustainability efforts aiming to improve patient health outcomes and personal satisfaction with care received.
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Affiliation(s)
- Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Diana Lobaina
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Meera Rao
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vama Jhumkhawala
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheena M Zapata
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Michelle Issac
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Suleyki Medina
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
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21
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Lowe C, Erby L, Joseph G, Biesecker B, Roter DL. Acceptability of an online communication training intervention for genetic counseling students. J Genet Couns 2023. [PMID: 37795757 DOI: 10.1002/jgc4.1790] [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: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023]
Abstract
Technology provides opportunities to enhance communication skills training for genetic counseling graduate students. We assessed the acceptability of an online communication training program. Graduate student volunteers completed five online training modules on basic communication skills with opportunities to practice the skills within three simulated/standardized patient (SP) sessions. Participants completed online questionnaires reporting on acceptability, perceived usefulness, and realism of the modules and SP sessions. They also reported on the ease of transferring skills from the modules to clinical practice. Out of the 60 students who completed the baseline session, 35 (58%) completed all five training modules. Out of these 35 students, most found the modules to be useful (94%) and agreed that they were relevant to clinical practice (97%). At least 88% of participants found the genetic counselors, patient, and case scenarios to be realistic. Twenty-eight students had participated in clinical rotations since completing the intervention. Of these, 17 (61%) reported that it was at least slightly easy to use the skills in actual clinical cases. Most students also reported being able to transfer the skills they had learned into clinical practice. While the training was well-received, the relatively low completion rate of 58% raises concern that the intervention may need formal integration into the program curriculum to succeed due to the time and effort demands on students.
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Affiliation(s)
- Chenery Lowe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lori Erby
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, California, USA
| | - Barbara Biesecker
- RTI International, Analytics, Research Triangle Park, North Carolina, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, Maryland, USA
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22
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Hillen MA, Smets EMA, M Stouthard J, de Vos FYF, Lehmann V. Cancer patients' trust as a motivator to seek a second opinion and its effects on trust. Psychol Health 2023; 38:1109-1127. [PMID: 34894900 DOI: 10.1080/08870446.2021.2011282] [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] [Received: 07/25/2021] [Revised: 10/31/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cancer patients may seek a second opinion (SO) driven by reduced trust in their own providers. Their trust may be diminished or reinforced through the SO. This study aimed to assess (1) what proportion of patients seek SOs motivated by lacking trust and how trust changes over time; (2) whether patients' trust differs by the outcome of the SO (i.e. similar/different opinion); and (3) how communication during the SO affects trust. DESIGN A longitudinal mixed methods study including self-report assessments before (T0), immediately following (T1), and two months after the SO (T2). SO consultations (N = 62) were audio recorded, and patient-oncologist communication about the referring oncologist was coded. MAIN OUTCOME MEASURES Patient-reported motives and their trust in referring oncologists. RESULTS Reduced trust motivated 21% of patients to seek a SO. Most patients criticised their referring oncologist. Consulting oncologists generally defended their colleagues, but such affirmation was unrelated to patients' subsequent trust. Over time, trust did not change substantially. Yet, it was restored in patients motivated by impaired trust, and remained low for patients receiving a different medical outcome. CONCLUSION Patients need support to more constructively discuss their treatment relationship. Oncologists need support in providing independent SOs without harming trust relations.
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Affiliation(s)
- Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Filip Y F de Vos
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Lesnewich LM, Hyde JK, McFarlin ML, Bolton RE, Bayley PJ, Chandler HK, Helmer DA, Phillips LA, Reinhard MJ, Santos SL, Stewart RS, McAndrew LM. 'She thought the same way I that I thought:' a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness. Psychol Health 2023:1-19. [PMID: 37654203 DOI: 10.1080/08870446.2023.2248481] [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] [Received: 08/16/2022] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance-shared understanding between patient and provider about illness causes, course, and treatment-is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients' experiences, communicating knowledge about MUS, and establishing trust.
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Affiliation(s)
- Laura M Lesnewich
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Justeen K Hyde
- Department of Medicine, Section General Internal Medicine, Boston University, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
| | | | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Helena K Chandler
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L Alison Phillips
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- Department of Psychology, Iowa State University, IA, USA
| | - Matthew J Reinhard
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Susan L Santos
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Rachel S Stewart
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- University at Albany, State University of New York (SUNY), Albany, NY, USA
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Derksen C, Dietl JE, Haeussler FE, Steinherr Zazo M, Schmiedhofer M, Lippke S. Behavior change training for pregnant women's communication during birth: A randomized controlled trial. Appl Psychol Health Well Being 2023; 15:865-883. [PMID: 36380576 DOI: 10.1111/aphw.12413] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/20/2022] [Indexed: 08/09/2023]
Abstract
Applying health psychological theories can improve communication interventions to empower pregnant women and ensure safe births. The aim was to test a short digital communication intervention based on the health action process approach. A randomized-controlled trial was conducted with pregnant women at two German university hospitals. The intervention group (NT1 = 225; NT2 = 142) received a 2.5 h online training focusing on communication planning, self-efficacy and communicating personal needs and preferences under difficult circumstances. This group was compared with a passive control group (NT1 = 199; NT2 = 144). Data from the N = 286 women with complete datasets were used for multilevel analyses. Data from all recruited N = 424 women were used for intention-to-treat analyses with multiple imputation. Both groups improved regarding communication behavior, quality of birth, action planning, coping planning and coping self-efficacy after birth, which was more pronounced in the intervention group. The intention-to-treat analyses confirmed the higher improvement for communication behavior, perceived quality of birth and coping planning. The intervention was related to improvements in pregnant women's communication behavior and quality of birth. Hence, future research and practice should apply and evaluate health psychological theories when targeting communication and empowerment.
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Affiliation(s)
- Christina Derksen
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Jacobs University Bremen gGmbH, Bremen, Germany
| | - Johanna Elisa Dietl
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Jacobs University Bremen gGmbH, Bremen, Germany
- German Coalition for Patient Safety (Aktionsbuendnis Patientensicherheit e.V.), Berlin, Germany
| | - Freya Elise Haeussler
- German Coalition for Patient Safety (Aktionsbuendnis Patientensicherheit e.V.), Berlin, Germany
| | - Miriam Steinherr Zazo
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Jacobs University Bremen gGmbH, Bremen, Germany
| | - Martina Schmiedhofer
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Jacobs University Bremen gGmbH, Bremen, Germany
- German Coalition for Patient Safety (Aktionsbuendnis Patientensicherheit e.V.), Berlin, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Jacobs University Bremen gGmbH, Bremen, Germany
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25
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Perez A, Fetters MD, Creswell JW, Scerbo M, Kron FW, Gonzalez R, An L, Jimbo M, Klasnja P, Guetterman TC. Enhancing Nonverbal Communication Through Virtual Human Technology: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46601. [PMID: 37279041 PMCID: PMC10282909 DOI: 10.2196/46601] [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: 02/19/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Communication is a critical component of the patient-provider relationship; however, limited research exists on the role of nonverbal communication. Virtual human training is an informatics-based educational strategy that offers various benefits in communication skill training directed at providers. Recent informatics-based interventions aimed at improving communication have mainly focused on verbal communication, yet research is needed to better understand how virtual humans can improve verbal and nonverbal communication and further elucidate the patient-provider dyad. OBJECTIVE The purpose of this study is to enhance a conceptual model that incorporates technology to examine verbal and nonverbal components of communication and develop a nonverbal assessment that will be included in the virtual simulation for further testing. METHODS This study will consist of a multistage mixed methods design, including convergent and exploratory sequential components. A convergent mixed methods study will be conducted to examine the mediating effects of nonverbal communication. Quantitative (eg, MPathic game scores, Kinect nonverbal data, objective structured clinical examination communication score, and Roter Interaction Analysis System and Facial Action Coding System coding of video) and qualitative data (eg, video recordings of MPathic-virtual reality [VR] interventions and student reflections) will be collected simultaneously. Data will be merged to determine the most crucial components of nonverbal behavior in human-computer interaction. An exploratory sequential design will proceed, consisting of a grounded theory qualitative phase. Using theoretical, purposeful sampling, interviews will be conducted with oncology providers probing intentional nonverbal behaviors. The qualitative findings will aid the development of a nonverbal communication model that will be included in a virtual human. The subsequent quantitative strand will incorporate and validate a new automated nonverbal communication behavior assessment into the virtual human simulation, MPathic-VR, by assessing interrater reliability, code interactions, and dyadic data analysis by comparing Kinect responses (system recorded) to manually scored records for specific nonverbal behaviors. Data will be integrated using building integration to develop the automated nonverbal communication behavior assessment and conduct a quality check of these nonverbal features. RESULTS Secondary data from the MPathic-VR randomized controlled trial data set (210 medical students and 840 video recordings of interactions) were analyzed in the first part of this study. Results showed differential experiences by performance in the intervention group. Following the analysis of the convergent design, participants consisting of medical providers (n=30) will be recruited for the qualitative phase of the subsequent exploratory sequential design. We plan to complete data collection by July 2023 to analyze and integrate these findings. CONCLUSIONS The results from this study contribute to the improvement of patient-provider communication, both verbal and nonverbal, including the dissemination of health information and health outcomes for patients. Further, this research aims to transfer to various topical areas, including medication safety, informed consent processes, patient instructions, and treatment adherence between patients and providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46601.
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Affiliation(s)
- Analay Perez
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - John W Creswell
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mark Scerbo
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Frederick W Kron
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Richard Gonzalez
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Lawrence An
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Masahito Jimbo
- Department of Family and Community Medicine, University of Illinois College of Medicine, Chicago, IL, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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Frydman JL, Dow LA, Smith CB, Kelley AS, Lindenberger EC, Gelfman LP. Virtual Geritalk: Does Intensive Virtual Communication Skills Training Improve Use of Serious Illness Communication Skills? Am J Hosp Palliat Care 2023; 40:620-623. [PMID: 35857414 PMCID: PMC9979275 DOI: 10.1177/10499091221116078] [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: 01/27/2023] Open
Abstract
Background: The COVID-19 pandemic presented a unique opportunity to adapt in-person communication skills training to a virtual format. Objective: Examine use of serious illness communication skills by learners after participating in an intensive virtual communication skills training. Design: Prospective cohort study. Setting/Subjects: Icahn School of Medicine at Mount Sinai, Clinical Fellows. Measurements: Family Meeting Communication Assessment Tool (FAMCAT) assessed fundamental and advanced communication skills. Results: As compared to a historical benchmark obtained after a prior in-person course, the virtual course showed equivalent or better use of communication skills across fundamental skills and advanced skills. Conclusions: Our findings suggest that a virtual communication skills training is associated with the use of serious illness communication skills in the clinical setting by learners.
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Affiliation(s)
- Julia L. Frydman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lindsay A. Dow
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Cardinale B. Smith
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy S. Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth C. Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, NY
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education & Clinical Center, James J. Peters Veterans’ Affairs Medical Center, Bronx, NY
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27
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Mitchell KAR, Boyle JR, Juricekova L, Brown RF. Adjuvant chemotherapy non-adherence, patient-centered communication, and patient-level factors in elderly breast and colon cancer patients. Cancer Med 2023. [PMID: 37148551 DOI: 10.1002/cam4.5884] [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: 08/29/2022] [Revised: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND We examined patient-level factors (patient characteristics, disease and treatment factors, and patient experience), patient-centered communication (PCCM), and non-adherence to adjuvant chemotherapy (AC) guidelines among breast and colon cancer patients to inform AC adherence promotion and improve clinical outcomes. METHODS Descriptive statistics for patient-level factors, PCCM, and AC non-adherence (primary non-adherence, non-persistence at 3 and 6 months) were obtained. Multiple logistic regression models were used to estimate AC non-adherence after accounting for the identified patient-level factors. RESULTS The majority of the sample (n = 577) were White (87%), breast cancer patients (87%), and reported PCCM (provider communication score ≥ 90%, 73%, provider communication score = 100%, 58%). All three levels of AC nonadherence were significantly higher in breast cancer patients (69%, 81%, and 89% for primary non-adherence, and non-persistence at 3 and 6 months, respectively) than colon cancer patients (43%, 46%, and 62%, respectively). Male sex, survey assistance, and low/average ratings of a personal doctor, specialist, and healthcare were associated with lower PCCM. Older age, breast cancer diagnosis, and diagnosis group following 2007-2009 increased the likelihood of all three levels of AC non-adherence. Comorbidities and PCCM-90 were exclusively associated with non-persistence at 3 months. CONCLUSIONS Adjuvant chemotherapy non-adherence varied by cancer diagnosis and treatment factors. The relationship between PCCM and AC non-adherence differed by level of PCCM, time period, and the presence of comorbidities. AC guideline adherence, communication, and value-concordant treatment should be assessed and compared simultaneously to improve our understanding of their interrelationships.
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Affiliation(s)
| | - Joseph R Boyle
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Lenka Juricekova
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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28
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Hintz EA. Improving communication between women with vulvodynia and their romantic partners: insights and recommendations for practitioners. J Sex Med 2023; 20:918-920. [PMID: 37076134 DOI: 10.1093/jsxmed/qdad050] [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] [Received: 12/09/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Interactions among female patients with vulvodynia, their romantic partners, and clinicians are key to promoting positive health outcomes. Previous studies have investigated how the content of romantic partners' responses to expressions of pain are related to these outcomes. Yet, the content of patients' conversations and the appraisals of their difficulty remain unknown. AIM This study offers guidance to clinicians counseling patients with vulvodynia by explicating the frequency and difficulty of various salient conversational topics. METHODS Thirty-four women with vulvodynia completed a screener survey indicating the frequency and difficulty of conversational topics. Follow-up in-depth interviews were conducted with 26 women. A dominant partner response type was identified for each participant. RESULTS Topics most often discussed, such as sex, were rated as among the least difficult to discuss. Most participants reported experiencing the facilitative partner response type, which promotes adaptive coping. CONCLUSION Determining patients' perceived conversational difficulty and frequency is necessary to provide quality and efficient counseling to women with vulvodynia and their partners. Patients also experience partner response types. Therefore, clinicians must solicit subjective assessments of conversational difficulty when advising patients and their romantic partners.
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Affiliation(s)
- Elizabeth A Hintz
- Department of Communication, University of Connecticut, Storrs, CT 06269, United States
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Robinson SA, Zocchi M, Purington C, Am L, DeLaughter K, Vimalananda VG, Netherton D, Ash AS, Hogan TP, Shimada SL. Secure Messaging for Diabetes Management: Content Analysis. JMIR Diabetes 2023; 8:e40272. [PMID: 36951903 PMCID: PMC10131591 DOI: 10.2196/40272] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management. OBJECTIVE We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control. METHODS We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control. RESULTS Explicit diabetes-related content was the most frequent topic (72.1% of participants), followed by blood pressure (31.7% of participants). Among diabetes-related conversations, 90.7% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5% vs 27.2%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7% vs 12.4%, P=.009). CONCLUSIONS There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes.
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Affiliation(s)
- Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Mark Zocchi
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Carolyn Purington
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Linda Am
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Kathryn DeLaughter
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Dane Netherton
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
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Söderhielm K, Eriksson K, Möller M. Communicative participation in goal-setting meetings for patients with aphasia after stroke. A study using patients' and healthcare professionals' self-ratings. Int J Lang Commun Disord 2023; 58:342-356. [PMID: 36218168 DOI: 10.1111/1460-6984.12791] [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: 12/22/2021] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Communicative participation poses a challenge in meetings between healthcare professionals (HCPs) and people with aphasia (PwA). How communication is affected by aphasia in group meetings, where several healthcare professionals participate together with the patient, is largely unexplored. The aim of this study was to investigate self-rated communicative participation during goal-setting meetings among PwA compared to patients without aphasia and to investigate whether communicative participation among PwA was associated with self-rated knowledge about aphasia among HCPs. A further aim was to investigate if there was a difference in the use of communication strategies among HCPs in the respective situations. METHODS Nine PwA and nine control patients without aphasia rated their experience of communication during a goal-setting meeting. Thirty-eight HCPs rated their knowledge about aphasia and communication, and their use of communication strategies during goal-setting meetings. RESULTS The PwA reported being listened to by the HCPs as well as being able to comprehend the meeting. PwA with more severe language impairment did not report a lower level of communicative participation compared to PwA with milder impairment. Half of the patients from both groups indicated some difficulty asking questions during the meeting. Patients' ratings of communication were not correlated to HCPs' knowledge of communication strategies. There was a significant difference in self-rated use of communication strategies among HCPs for the two conditions, although the individual variation was large. CONCLUSION Results from both PwA and controls imply that patients may need more support to be able to ask questions in meetings with HCPs. Although self-ratings increase the ecological validity of the study of participation, further studies could benefit from using video observations in combination with self-reported experience, since awareness might influence results. WHAT THIS PAPER ADS What is already known on this subject Aphasia is an acquired language disorder that affects patient-provider communication. In stroke rehabilitation, person-centred goal setting is a key component. If healthcare professionals (HCPs) are not able to use adequate communication strategies, a lack of accessible communication can become a barrier to person-centredness. There are evidence-based communication strategies which can be used to overcome this barrier. What this paper adds to existing knowledge This study aimed to investigate communicative participation during goal-setting meetings from the perspective of patients with aphasia and HCPs. To our knowledge, this is the first study where persons with aphasia are asked to rate communicative participation in goal-setting meetings. To broaden the perspective on communication and goal setting, ratings of patients with aphasia are compared to ratings by patients with stroke but no aphasia. The results of this study indicate that there is room for improvement regarding communication during goal-setting meetings. However, asking direct questions on communicative participation to persons with severe aphasia may not be feasible. What are the potential or actual clinical implications of this work? The results of this study imply that both patients with and without aphasia may need more support to be able to express themselves during goal-setting meetings. There also seems to be a need for further education on aphasia and communication strategies among rehabilitation professionals.
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Affiliation(s)
- Kajsa Söderhielm
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eriksson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Geriatrics, Pulmonary Disease and Allergology, Gothenburg, Sweden
| | - Marika Möller
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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Canzona MR, Fisher CL, Garcia DS, Dong T, Ledford CJW. Partner presence in clinical conversations about sexual health: Breast cancer survivors', partners', and providers' perspectives of triadic interactions. J Psychosoc Oncol 2023; 41:166-181. [PMID: 35587166 DOI: 10.1080/07347332.2022.2068397] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Breast cancer survivors' (BCSs') sexual health (SH) clinical conversations are rarely studied from a dyadic perspective let alone from a triadic perspective. Using a triadic approach, we evaluated BCSs' comfort discussing SH with partners present and identified factors that can contribute to their comfort level. DESIGN Qualitative approach using in-depth interviews. PARTICIPANTS 93 BCSs, partners, and providers involved in BCS care. METHODS In-depth interviews with BCSs, partners, and providers explored triadic perspectives to understand factors informing BCSs' comfort level. Thematic analysis was used to analyze data. FINDINGS Four themes characterize potential benefits of partner presence: 1) partner facilitates information exchange, 2) partner realizes BCS's SH concerns are "a real thing," 3) partner better understands SH challenges, and 4) partner presence encourages relational communication about SH. Five themes illustrate potential complications of partner presence: 1) partner feels/becomes embarrassed, 2) partner is/becomes defensive, 3) partner presence constrains BCS's agency in clinical conversations, 4) partner presence threatens partner's view of BCS as a sexual being, and 5) partner presence increases partner burden. IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY Providers should (1) initiate conversations about BCS comfort with partner presence, (2) be aware of the interaction between BCS primary and secondary goals, (3) consider how BCS/partner goal conflicts obstruct BCS agency and sexual/relational health, and (4) offer opportunities to clarify goals and expectations, and coordinate therapeutic options.
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Affiliation(s)
- Mollie Rose Canzona
- Department of Communication, Wake Forest University, Department Social Sciences & Health Policy, Wake Forest School of Medicine, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Carla L Fisher
- College of Journalism and Communications, University of Florida, UF Health Cancer Center, Gainesville, Florida, USA
| | - David S Garcia
- Eglin Family Medicine Residency, Eglin Air Force Base, Okaloosa, Florida, USA
| | - Thrandia Dong
- Department of Communication, Wake Forest University, Winston-Salem, NC, USA
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Hansen MA, Chen R, Hirth J, Langabeer J, Zoorob R. Impact of COVID-19 lockdown on patient-provider electronic communications. J Telemed Telecare 2023:1357633X221146810. [PMID: 36659875 PMCID: PMC9892807 DOI: 10.1177/1357633x221146810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/20/2022] [Accepted: 11/30/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature. METHODS All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period. RESULTS Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, p-value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels. CONCLUSION Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.
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Affiliation(s)
- Michael A. Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Rebecca Chen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James Langabeer
- Department of Health Management and Policy, University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Carlson MM, Bear B, Alderfer MA, Schultz CL, Monroe DP, Crosby LE, Hildenbrand AK. Family-centered communication in pediatric sickle cell disease. Pediatr Blood Cancer 2022; 69:e30016. [PMID: 36152000 DOI: 10.1002/pbc.30016] [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: 03/09/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Individuals with sickle cell disease (SCD) experience systemic barriers in accessing high-quality care. Research suggests that patient/family-provider relationships are an important indicator of healthcare quality and can influence disease self-management and outcomes. The Patient Centered Communication (PCC) framework holds that patient/family-centered communication (e.g., eliciting, understanding, and validating patients' perspectives within their unique psychosocial contexts) contributes to improved family-provider relationships, as well as self-efficacy for disease management, adherence, and health outcomes. While the PCC framework has been useful in guiding the evaluation of patient/family-provider communication in other pediatric populations, it has not yet been applied in the context of pediatric SCD. This study aimed to use this framework to examine patient and family perceptions of communication with pediatric SCD healthcare providers. PROCEDURE Total 17 caregivers (82% mothers, 94% Black/African American) and eight patients (62% female, aged 13-19 years, M = 16.50) completed semi-structured interviews. The PCC framework informed the development of a preliminary codebook. Thematic content analysis summarized family perspectives regarding communication with providers. RESULTS For youth with SCD and their caregivers, specific themes related to family-centered communication included: reducing patient/family distress, supporting disease self-management efforts, facilitating information exchange and decision-making, and fostering positive and trusting relationships with providers. CONCLUSIONS This study helps to address gaps in the literature related to patient/family-provider communication within pediatric SCD. Results underscore the importance of patient- and family-centered communication across pediatric SCD care. These findings can inform future research and clinical care initiatives to improve patient/family-provider interactions and health outcomes for this underserved population.
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Affiliation(s)
- Megan M Carlson
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Benjamin Bear
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinna L Schultz
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Cancer and Blood Disorders, Nemours Children's Health, Wilmington, Delaware, USA
| | | | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, Delaware, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital, Wilmington, Delaware, USA
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Macauda MM, Arent MA, Sakhuja M, Yelton B, Noblet S, Fedrick D, Zona D, New C, Isenhower WD, Wandersman A, Friedman DB. Elements for successful implementation of a clinic-based health literacy intervention. Front Public Health 2022; 10:977765. [PMID: 36388330 PMCID: PMC9650509 DOI: 10.3389/fpubh.2022.977765] [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] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.
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Affiliation(s)
- Mark M. Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,*Correspondence: Mark M. Macauda
| | - Michelle A. Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States,Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Diana Zona
- South Carolina Hospital Association, Columbia, SC, United States
| | - Cyndi New
- South Carolina Hospital Association, Columbia, SC, United States
| | | | | | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Sood E, Kenowitz J, Goldberg SW, Butler SC. Normalize-Ask-Pause-Connect: A Clinical Approach to Address the Emotional Health of Pediatric Patients with Chronic Conditions and Their Families. J Pediatr 2022:S0022-3476(22)00906-4. [PMID: 36270392 DOI: 10.1016/j.jpeds.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
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36
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Nassar AK, Sasnal M, Miller-Kuhlmann RK, Jensen RM, Blankenburg RL, Rassbach CE, Smith-Bentley M, Vyas A, Korndorffer JR, Gold CA. Developing a multi-departmental residency communication coaching program. Educ Health (Abingdon) 2022; 35:98-104. [PMID: 37313890 DOI: 10.4103/efh.efh_357_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Local needs assessments in our institution's surgery and neurology residency programs identified barriers to effective communication, such as no shared communication framework and limited feedback on nontechnical clinical skills. Residents identified faculty-led coaching as a desired educational intervention to improve communication skills. Three university departments (Surgery, Neurology, and Pediatrics) and health-care system leaders collaborated closely to develop an innovative communication coaching initiative generalizable to other residency programs. Innovation Coaching program development involved several layers of collaboration between health-care system leaders, faculty educators, and departmental communication champions. The efforts included: (1) creating and delivering communication skills training to faculty and residents; (2) hosting frequent meetings among various stakeholders to develop program strategy, discuss opportunities and learnings, and engage other medical educators interested in coaching; (3) obtaining funding to implement the coaching initiative; (4) selecting coaches and providing salary and training support. Evaluation A multi-phased mixed-methods study utilized online surveys and virtual semi-structured interviews to assess the program's quality and impact on the communication culture and the satisfaction and communication skills of residents. Quantitative and qualitative data have been integrated during data collection and analysis using embedding, building, and merging strategies. Discussion and Implications Establishing a multi-departmental coaching program may be feasible and can be adapted by other programs if similar resources and focus are present. We found that stakeholders' buy-in, financial support, protected faculty time, flexible approach, and rigorous evaluation are crucial factors in successfully implementing and sustaining such an initiative.
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Affiliation(s)
- Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Marzena Sasnal
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca K Miller-Kuhlmann
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel M Jensen
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Rebecca L Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Alpa Vyas
- Stanford Health Care, Stanford, California, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Carl A Gold
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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Walker AQ, Blake CE, Moore JB, Wilcox S, DuBois K, W Watkins K. Experiences of midlife and older African American men living with type 2 diabetes. Ethn Health 2022; 27:1256-1270. [PMID: 33830823 DOI: 10.1080/13557858.2021.1910206] [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: 08/14/2020] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Type 2 Diabetes Mellitus (T2DM) is a complicated disease that disproportionately affects African American men. Understanding the experiences of African American men living with T2DM is important for developing effective, culturally sensitive interventions. The purpose of this study was to describe how African American men view their T2DM and describe their perspectives on living with and self-managing T2DM. DESIGN In-depth semi-structured qualitative interviews were conducted with 22 African American men aged 40-85 years diagnosed with T2DM. Interviews were transcribed and analyzed using NVivo 10 with thematic analysis. RESULTS Disbelief, shock, and denial were commonly experienced reactions at initial diagnosis. Many participants defined diabetes using words such as 'sugar' or 'glucose' and reported an awareness of health complications caused by diabetes, such as amputations and diabetic comas. Participants expressed various perspectives and attitudes towards having diabetes, including avoidance/apathy, fatalism, guilt and shame, fear and concern, and self-mastery. The majority of men described efforts to self-manage diabetes via glucose monitoring, changing dietary habits, and exercise. Many participants expressed concern over the financial burden associated with managing diabetes and reported that high costs can hinder a patient's ability to maintain active self-monitoring and deter patients from attending needed doctor's visits. Many participants expressed confidence in their healthcare providers, although a few expressed feelings of distrust and being uninformed. Participants tended to most appreciate physicians who spent time discussing their condition and who made an effort to engage in open patient-provider communication. CONCLUSION Living with diabetes can be emotionally, physically, and mentally challenging. Efforts to improve adoption and maintenance of self-management behaviors may benefit from sensitivity to the patient's attitude and perspectives towards diabetes self-management, assistance overcoming the financial burden of managing diabetes, and open patient-provider communication.
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Affiliation(s)
- Anthony Q Walker
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Christine E Blake
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kelli DuBois
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ken W Watkins
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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38
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Thorpe S, Iyiewuare P, Ware S, Malone N, Jester JK, Dogan JN, Hargons CN. "Why Would I Talk To Them About Sex?": Exploring Patient-Provider Communication Among Black Women Experiencing Sexual Pain. Qual Health Res 2022; 32:1527-1543. [PMID: 35758050 DOI: 10.1177/10497323221110091] [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] [Indexed: 06/15/2023]
Abstract
Ineffective patient-provider communication poses a potential health risk to Black women if medical providers are not addressing their needs or concerns. Additionally, less than half of OBGYNs report asking their patients about sexual difficulties, which limits women's opportunities to disclose their experiences of sexual pain. The purpose of this qualitative study is to explore Black women's experiences of patient-provider communication about sexual pain (reoccurring unwanted genital pain). Specifically, we aimed to describe the pathway from sexual pain disclosure to treatment among N = 25 premenopausal Black women living in the southern United States who were experiencing sexual pain. Using constructivist grounded theory, open-ended responses to six interview questions related to healthcare experiences, treatment, and patient-provider communication were qualitatively analyzed and categorized to form a conceptual framework of patient-provider communication about sexual pain. Five key categories emerged related to Black women's experiences with their medical providers regarding sexual pain: (1) provider preferences, (2) healthcare experiences, (3) reasons for non-disclosure, (4) provider responses to sexual pain, and (5) treatment for sexual pain. Useful strategies to improve patient-provider communication are presented for both patients and providers.
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Affiliation(s)
- Shemeka Thorpe
- Department of Educational, School, and Counseling Psychology, 4530University of Kentucky, Lexington, KY, USA
| | - Praise Iyiewuare
- Department of Psychological Science, 2092The University of Vermont, Burlington, VT, USA
| | | | - Natalie Malone
- Department of Educational, School, and Counseling Psychology, 4530University of Kentucky, Lexington, KY, USA
| | - Jasmine K Jester
- Department of Educational, School, and Counseling Psychology, 4530University of Kentucky, Lexington, KY, USA
| | - Jardin N Dogan
- Department of Educational, School, and Counseling Psychology, 4530University of Kentucky, Lexington, KY, USA
| | - Candice N Hargons
- Department of Educational, School, and Counseling Psychology, 4530University of Kentucky, Lexington, KY, USA
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Koskan AM, Stecher C, Helitzer DL. Influences on male college students' patient-provider communications and uptake behaviors related to the human papillomavirus vaccine. J Am Coll Health 2022:1-7. [PMID: 35728081 DOI: 10.1080/07448481.2022.2086004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/12/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We assessed the psychosocial influences on college males' human papillomavirus (HPV) vaccine patient-provider communication and their uptake of one or more HPV vaccine doses. METHODS We conducted a cross-sectional survey with college males attending one large southwestern university. We used logistic regressions to explore the relationships between psychosocial and demographic variables on patient-provider communication and HPV vaccine uptake. RESULTS Patient-provider communication had the most significant influence on HPV vaccine uptake. However, most college males reported never discussing the HPV vaccine with their healthcare providers. HPV vaccine awareness, perceived subjective norms to vaccinate, and behavioral control to talk to healthcare providers about the vaccine significantly influenced college males' patient-provider communication and vaccine uptake. CONCLUSION HPV vaccine awareness, perceived behavioral control to communicate about the vaccine, and subjective norms to vaccinate are all addressable factors that influence HPV vaccine communication and uptake. Future intervention work should specifically target these factors for college men.
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Affiliation(s)
- Alexis M Koskan
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Deborah L Helitzer
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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40
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Thayer Z, Gildner T. Reported information sharing and satisfaction with maternity care providers during the COVID-19 pandemic: Associations with socioeconomic status and shifts to telehealth. Birth 2022; 50:396-406. [PMID: 35698760 PMCID: PMC9349980 DOI: 10.1111/birt.12660] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic has dramatically affected pregnant people's prenatal care, labor, and delivery experiences. Given these rapid changes, providers have needed to be proactive in sharing information about COVID-19-related care impacts. The purpose of this study was to investigate: (a) Whether patient demographics or disrupted care (eg, canceled appointments and rapid shift to telehealth) is associated with patient-reported information sharing from the providers; and (b) Whether patient-reported provider information sharing or disruptions to care are associated with patient satisfaction with provider. METHODS Data come from a convenience sample of 1999 pregnant people living in the United States who completed an online survey between April 16 and May 7 2020. RESULTS Thirty-eight percent of participants said that their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. Participants with lower education, less income, or whose appointments had been canceled or rescheduled because of the pandemic were significantly less likely to report information sharing. Provider satisfaction was significantly lower among participants who did not report information sharing, those who had appointments by way of telehealth, and those who reported that all their appointments had been rescheduled/canceled. DISCUSSION At the beginning of the pandemic, there were significant socioeconomic inequities in reported information sharing by the providers, which in turn was negatively associated with provider satisfaction. Providers need to be aware of the role implicit bias may play in information sharing-both generally and during public health crises-and consider ways to reduce the impacts of disrupted care delivery on patient satisfaction. If left unaddressed, perceived poor provider communication and associated low satisfaction with providers could contribute to adverse perinatal outcomes.
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Affiliation(s)
- Zaneta Thayer
- Department of AnthropologyDartmouth CollegeHanoverNew HampshireUSA
| | - Theresa Gildner
- Department of AnthropologyWashington University at St. LouisSt. LouisMissouriUSA
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Paudel R, Lane GI. Delivering patient-centered care through shared decision making in overactive bladder. Neurourol Urodyn 2022; 41:884-893. [PMID: 35332575 PMCID: PMC9169772 DOI: 10.1002/nau.24915] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 12/31/2022]
Abstract
Introduction Men and women living with overactive bladder (OAB) face many treatment decisions as they progress through the treatment pathway. Decisions to pursue specific therapies are highly preference sensitive and ideal for shared decision making (SDM). The aim of this narrative review is to provide urologists with a practical summary of methods to elicit preferences and facilitate SDM to promote patient‐centered care for OAB. Methods We explore OAB as a preference sensitive condition through a review of treatment outcomes and present available data on prediction tools, patient preferences, and decision aids. We propose a paradigm for applying Everyday SDM to OAB care. Results Clinical outcome data points to equipoise (balanced outcomes) between options for first‐, second‐, and third‐line OAB therapies, making OAB preference sensitive and appropriate for SDM. Methods to personalize care through individualized outcome prediction calculators and tools to elicit patient preferences are emerging. While patient information about OAB is readily available, we identified few OAB decision aids that facilitate patient preference elicitation and SDM. Conclusions OAB is a preference sensitive condition, where treatment is largely based on the patient's preferences and values. SDM is an ideal approach to supporting patients through these treatment decisions. We propose the application of Everyday SDM, a personalized, clinically efficient methodology as a method to support patient‐centered OAB care.
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Affiliation(s)
- Roshan Paudel
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Giulia I Lane
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Hu H, Gong H, Wu X, Wu X. Effect of patient-provider communication on patient risk awareness: The moderating role of trust based on scenario experiment. Psych J 2022; 11:359-369. [PMID: 35289096 DOI: 10.1002/pchj.530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/03/2020] [Revised: 11/11/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022]
Abstract
Good patient-provider communication and high level of trust can decrease patients' risk perception and promote their acceptability of medical risks.The extent to which communication can be effective may be distinguished by different levels of trust. The present study examined the effect of patient-provider communication and treatment outcome on patients' risk awareness, and explored the moderating effect of trust. This research adopted a paper-based scenario experiment with a 2 (communication: good vs. poor) × 2 (treatment outcome: good vs. poor) between-subjects design. Three hundred sixteen college students were enrolled. They were randomly assigned to four groups and instructed to read more information about the two independent variables. Finally, all participants finished the manipulation check (eight items), affect- and cognition-based trust scales (10 items), and risk awareness scales (eight items) by questionnaire. The results showed the positive interaction effects between communication and treatment outcome on patients' acceptance of uncertainties. Affect- and cognition-based trust had similar moderating mechanisms on the interaction effect of communication and treatment outcome on uncertainty acceptability, and different moderating mechanisms on patient risk perception. In clinical work, we should develop the strategy to improve patien-provider communication and trust to improve patients' acceptability of uncertainty.
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Affiliation(s)
- Huiling Hu
- School of Nursing, Peking University, Beijing, China
| | - Haiyan Gong
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Xuanna Wu
- Department of Psychology, Capital Normal University, Beijing, China
| | - Xue Wu
- School of Nursing, Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Peking University, Beijing, China
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Lee LE, Greene K, Venetis MK, Bontempo AC, Catona D, Buckley de Meritens A, Devine KA. Aligned and Divergent Perceptions of Support Persons' Role in Triadic Gynecologic Cancer Communication. Qual Health Res 2022; 32:710-724. [PMID: 35000506 DOI: 10.1177/10497323211066868] [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] [Indexed: 06/14/2023]
Abstract
Health care providers routinely advise cancer patients to involve support persons in oncology care to fulfill critical support roles. This qualitative descriptive study explored alignment of triadic perceptions of support person involvement in oncology treatment visits and cancer-related care from the perspectives of patients with gynecologic cancer (n = 18), regular visit-attending support people (n = 16), and health care providers (n = 10), including oncologists, nurses, and medical assistants. Semi-structured interviews (N = 44) captured perceptions of facilitation and interference of support persons' roles within and outside appointments with oncology providers. Thematic analyses revealed alignment and divergence regarding support persons' instrumental, informational, and emotional support behaviors. Perspectives aligned regarding what support functions companions provide. However, patients and support persons emphasized the significance of instrumental followed by informational and emotional support, whereas oncology providers highlighted informational, followed by emotional and instrumental support. Discussion provides insight into each role's perspective in the triad.
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Affiliation(s)
- Lauren E Lee
- Department of Communication, 242612Rutgers University, New Brunswick, NJ, USA
| | - Kathryn Greene
- Department of Communication, 242612Rutgers University, New Brunswick, NJ, USA
| | - Maria K Venetis
- Department of Communication, 242612Rutgers University, New Brunswick, NJ, USA
| | - Allyson C Bontempo
- Department of Communication, 242612Rutgers University, New Brunswick, NJ, USA
| | - Danielle Catona
- Department of Global and Community Health, 3298George Mason University, Fairfax, VA, USA
| | - Alexandre Buckley de Meritens
- 145249Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- 43982Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Katie A Devine
- 145249Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Cederberg M, Fors A, Ali L, Goulding A, Mäkitalo Å. The interactive work of narrative elicitation in person-centred care: Analysis of phone conversations between health care professionals and patients with common mental disorders. Health Expect 2022; 25:971-983. [PMID: 35148442 PMCID: PMC9122427 DOI: 10.1111/hex.13440] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/29/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Narratives play a central part in person-centred care (PCC) as a communicative means of attending to patients' experiences. The present study sets out to explore what activities are performed and what challenges participants face in the interactive process of narrative elicitation, carried through in patient-professional communication in a remote intervention based on PCC. METHODS Data were gathered from a randomized controlled trial (RCT) in a Swedish city where health care professionals (HCPs) conducted remote PCC for patients on sick leave due to common mental disorders. A sample of eleven audio-recorded phone conversations between HCPs and patients enroled in the RCT were collected and subjected to conversation analysis. RESULTS Three interactive patterns in narrative elicitation were identified: Completed narrative sequences driven by the patient, question-driven narrative sequences guided by the HCP, and narrative sequences driven as a collaborative project between the patient and the HCP. In the question-driven narrative sequences, communication was problematic for both participants and they did not accomplish a narrative. In the other two patterns, narratives were accomplished but through various collaborative processes. CONCLUSION This study provides insight into what challenges narrative elicitation may bring in the context of a remote PCC intervention and what interactive work patients and HCP need to engage in. Importantly, it also highlights tensions in the ethics of PCC and its operationalization, if the pursuit of a narrative is not properly balanced against the respect for patients' integrity and personal preferences. Our findings also show that narrative elicitation may represent an interactive process in PCC in which illness narratives are jointly produced, negotiated and transformed. PATIENT OR PUBLIC CONTRIBUTION Stakeholders, including patient representatives, were involved in the design of the main study (the RCT). They have been involved in discussions on research questions and dissemination throughout the study period. They have not been involved in conducting the present study.
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Affiliation(s)
- Matilda Cederberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Goulding
- Region Västra Götaland, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Mäkitalo
- Department of Education, University of Oslo, Oslo, Norway.,Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
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Wallander Karlsen MM, Finset A, Heggdal K, Günterberg Heyn L. Caught between ideals and reality: Phenomenological-hermeneutic study of healthcare providers' experiences while interacting with mechanically ventilated patients. J Interprof Care 2022; 36:492-499. [PMID: 35129397 DOI: 10.1080/13561820.2021.1967303] [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: 10/19/2022]
Abstract
This study aimed to explore healthcare providers' experiences of their communication and interaction with conscious patients on mechanical ventilation in intensive care. Nurses, physicians, and physiotherapists were interviewed after they had been video recorded in naturally occurring interactions with patients. The interviews were analyzed using a phenomenological-hermeneutical approach. Three themes were identified: The willingness to engage and understand the mechanically ventilated patient, the potential risk of neglecting the patient in the encounters, and provider interdependence as the core of intensive care. The themes elicited how providers handled the dissonance between their own personal ideals of care and their real-world encounters with patients and other professionals. The healthcare providers were aware of how easily patients could be neglected while being non-vocal, and therefore invested time and effort communicating with the patients. Based on their personal ideals of patient participation and autonomy, it was difficult to perform procedures, such as weaning off the ventilator or mobilization, to which the patient was opposed. Interprofessional collaboration was valued by the providers in such situations. The study revealed that providers need to consider the communication barriers that exist on the individual and team levels when interacting with patients on mechanical ventilation.
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Affiliation(s)
| | - Arnstein Finset
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Lena Günterberg Heyn
- Lovisenberg Diaconal University College, Oslo, Norway.,University of South-Eastern Norway, Oslo, Norway
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Gorbenko KO, Riggs AR, Koeppel B, Phlegar S, Dubinsky MC, Ungaro R, Keefer L. Photovoice as a tool to improve patient-Provider communication in inflammatory bowel disease clinic: A feasibility study. J Eval Clin Pract 2022; 28:159-168. [PMID: 34382292 DOI: 10.1111/jep.13609] [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: 03/16/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The emotional health of patients with inflammatory bowel disease (IBD) is critical to self-management, but has been difficult to elucidate in routine care. Patients are often unsure how to communicate their preferences and concerns to their providers in ways that could directly inform shared decision making. Photovoice is an established research methodology used to give vulnerable patients a voice through photographic expression, but has not been previously used in gastroenterology or in IBD. OBJECTIVE To determine the acceptability and feasibility of using Photovoice in an IBD clinic. PATIENT INVOLVEMENT Patients with IBD took photos in response to open-ended prompts, participated in a focus group, and brainstormed ways to share their experience with clinicians. METHODS Enrolled IBD patients received a digital camera, training on basic usage and 10 open-ended prompts related to management of their IBD. Participants completed one-hour in-depth interviews about their photos, which were audio-recorded and professionally transcribed. Three analysts coded transcripts for themes using qualitative analysis software QSR NVivo 11. A subset of patients participated in a focus group about their Photovoice experience. Gastroenterologists were interviewed, using patient photos as prompts, to evaluate feasibility of using Photovoice in the clinic. RESULTS Eleven patients completed the interviews, with five participating in the focus group. Patients shared and discussed a total of 118 photographs. We identified two major themes: disease burden and patient - provider communication. Five IBD physicians reviewed select patient photos and suggested ways to incorporate Photovoice into clinical practice. DISCUSSION Photovoice may be a feasible methodology for patients with IBD and acceptable for providers to use in a clinical setting. PRACTICAL VALUE Photovoice may help providers identify patient concerns and make their communication more patient-centred.
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Affiliation(s)
- Ksenia O Gorbenko
- Mount Sinai Health System, Institute for Health Care Delivery Science, New York, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexa Rae Riggs
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brooke Koeppel
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sydney Phlegar
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marla C Dubinsky
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Ungaro
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- Department of Medicine, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Nouri S, Street RL, Barnes DE, Shi Y, Volow AM, Li B, Alexander SC, Sudore RL. Empowering patients with the PREPARE advance care planning program results in reciprocal clinician communication. J Am Geriatr Soc 2022; 70:585-591. [PMID: 34758115 PMCID: PMC8821241 DOI: 10.1111/jgs.17540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/23/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The patient-directed PREPAREforYourCare.org program empowers patients to participate in advance care planning (ACP) discussions with clinicians. Our goal was to determine whether PREPARE could reciprocally increase clinician ACP communication. METHODS In a secondary analysis of two trials evaluating the efficacy of PREPARE plus an easy-to-read advance directive (AD) versus an AD alone, patients were included if they were ≥55 years old, English- or Spanish-speaking, and had ≥2 chronic conditions. We audio-recorded postintervention primary care visits and used the validated clinician-patient participation coding scheme to calculate the number of clinician ACP utterances concerning information-giving, recommendations, or supportive talk. We examined differences by study arm using mixed effects negative binomial models, stratifying by language. To assess possible mediation, we adjusted for active patient participation (e.g., asking questions or stating preferences). RESULTS Three hundred ninety-three visits were audio-recorded (177 in PREPARE arm and 216 in AD-only arm). Recordings included 179 clinicians (mean 2.2 [SD 1.9] patients each). Patients' mean age was 66 ± 8 years, 31% had limited health literacy, and 25% were Spanish-speaking. Exactly 67% of recordings included information-giving, 85% recommendations, and 62% supportive talk. PREPARE resulted in 51% more clinician supportive talk versus the AD alone (mean 4.5 [8.9] vs. 2.9 [6.0] utterances; incidence rate ratio 1.51 [95% CI 1.02-2.24]). Effects were most pronounced among Spanish speakers. There were no differences in information-giving or recommendations. After adjusting for active patient participation, no differences in supportive talk remained. CONCLUSIONS The patient-directed PREPARE program was associated with greater clinician supportive ACP communication with older adults compared with an AD alone; the effect was most pronounced among Spanish speakers and was mediated by active patient participation. Thus, PREPARE helps patients be more engaged communicators, which in turn encourages clinicians to be more supportive of patients. Enhanced patient-clinician communication represents an important mechanism by which PREPARE may decrease disparities in ACP.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Richard L. Street
- 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 and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Ying Shi
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Aiesha M. Volow
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Brookelle Li
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Rebecca L. Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Melnik T, Thompson JA, Vasilakes J, Annis T, Zhou S, Schutte D, Melton GB, Pleasants S, Zhang R. Semi-automated Clinical Content Curation of COVID-19 Chatbot Remote Patient Monitoring Solution. AMIA Annu Symp Proc 2022; 2022:756-765. [PMID: 37128405 PMCID: PMC10148278] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Remote patient monitoring (RPM) programs are being increasingly utilized in the care of patients to manage acute and chronic disease including with acute COVID-19. The goal of this study is to explore the topics and patterns of patients' messages to the care team in an RPM program in patients with presumed COVID-19. We conducted a topic analysis to 6,262 comments from 3,248 patients enrolled in the COVID-19 RMP at M Health Fairview. Evaluation of comments was performed using LDA and CorEx topic modeling. Subject matter experts evaluated topic models, including identification of and defining topics and categories. Topics plotted over time to identify trends in topic weights over the enrollment period. The overall accuracy of comments assignment to topics by LDA and CorEx models were 72.8% and 88.2%. Most identified topics focused on signs and symptoms of COVID-19. Topics related to COVID-19 diagnosis demonstrated a correlation with announcements of availability of viral and antibody testing in national and local media.
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Affiliation(s)
- Tanya Melnik
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joshua A Thompson
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jake Vasilakes
- Institute for Health Informatics,, University of Minnesota, Minneapolis, MN, USA
| | - Tucker Annis
- Fairview Health Services, University of Minnesota, Minneapolis, MN, USA
| | - Sicheng Zhou
- Institute for Health Informatics,, University of Minnesota, Minneapolis, MN, USA
| | - Dalton Schutte
- Institute for Health Informatics,, University of Minnesota, Minneapolis, MN, USA
| | - Genevieve B Melton
- Department of Medicine and Surgery, University of Minnesota, Minneapolis, MN, USA
- Institute for Health Informatics,, University of Minnesota, Minneapolis, MN, USA
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Susan Pleasants
- Fairview Health Services, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Institute for Health Informatics,, University of Minnesota, Minneapolis, MN, USA
- College of Pharmacy and Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, USA
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James TG, Coady KA, Stacciarini JMR, McKee MM, Phillips DG, Maruca D, Cheong J. "They're Not Willing To Accommodate Deaf patients": Communication Experiences of Deaf American Sign Language Users in the Emergency Department. Qual Health Res 2022; 32:48-63. [PMID: 34823402 DOI: 10.1177/10497323211046238] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Deaf people who use American Sign Language (ASL) are more likely to use the emergency department (ED) than their hearing English-speaking counterparts and are also at higher risk of receiving inaccessible communication. The purpose of this study is to explore the ED communication experience of Deaf patients. A descriptive qualitative study was performed by interviewing 11 Deaf people who had used the ED in the past 2 years. Applying a descriptive thematic analysis, we developed five themes: (1) requesting communication access can be stressful, frustrating, and time-consuming; (2) perspectives and experiences with Video Remote Interpreting (VRI); (3) expectations, benefits, and drawbacks of using on-site ASL interpreters; (4) written and oral communication provides insufficient information to Deaf patients; and (5) ED staff and providers lack cultural sensitivity and awareness towards Deaf patients. Findings are discussed with respect to medical and interpreting ethics to improve ED communication for Deaf patients.
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Affiliation(s)
- Tyler G James
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
| | - Kyle A Coady
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
| | - Jeanne-Marie R Stacciarini
- Department of Family, Community and Health System Science, College of Nursing, 3463University of Florida, Gainesville, FL, USA
| | - Michael M McKee
- Department of Family Medicine, 12266University of Michigan, Ann Arbor, MI, USA
| | | | | | - JeeWon Cheong
- Department of Health Education and Behavior, 3463University of Florida, Gainesville, FL, USA
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Eggly S, Manning M, Senft N, Moore TF, Albrecht TL, Penner LA, Heath E, Carducci MA, Lansey DG, Hamel LM. Development and pilot test of a physician-focused cancer clinical trials communication training intervention. PEC Innov 2021; 1:100012. [PMCID: PMC10194245 DOI: 10.1016/j.pecinn.2021.100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 05/30/2023]
Abstract
Objective We describe the development and pilot test of a physician-focused, web-based training module designed to improve physician communication related to clinical trials in a diverse cancer patient population. Methods Researchers and stakeholders developed the training module, which included a video explaining patient-centered communication strategies for discussing trials, and re-enactments of actual clinical interactions. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two major urban cancer centers. Questionnaires assessed change in beliefs, behavioral attitudes, knowledge and comfort; and perceptions of the module. Results Nineteen physicians participated in the pilot test. Most were experienced in discussing trials. Assessments of change were mixed regarding beliefs; they showed marginal improvement in attitudes, and significant improvement in knowledge, but no change in comfort. Feedback on the module was favorable. Conclusions This stakeholder-developed physician communication training module was acceptable and effective, albeit in this small and highly-experienced physician sample. Future research should determine its effectiveness on communication in clinical settings. Innovation This is the first physician training module to focus on communicating about clinical trials in a diverse patient population. It offers a web-based format and re-enactments of naturally-occurring clinical interactions. Trial Registration Number: NCT02906241
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Mark Manning
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Nicole Senft
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Tanina Foster Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Terrance L. Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Louis A. Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Elisabeth Heath
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Michael A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Dina G. Lansey
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States of America
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, United States of America
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