1
|
Liu SK, Bourgeois F, Dong J, Harcourt K, Lowe E, Salmi L, Thomas EJ, Riblet N, Bell SK. What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process. Diagnosis (Berl) 2024; 11:63-72. [PMID: 38114888 PMCID: PMC10875277 DOI: 10.1515/dx-2023-0075] [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: 06/21/2023] [Accepted: 10/18/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what constitutes a "good" diagnostic process (DxP). METHODS We evaluated patient/family feedback on "what's going well" as part of an online pre-visit survey designed to engage patients/families in the DxP. Patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) were invited to complete the survey between December 2020 and March 2022. We adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. RESULTS In total, 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Of all participants, 1,578 volunteered positive feedback, ranging from 1-79 words. Qualitative analysis of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). Compared to primary care, subspecialty comments showed the same overall rankings. Within Relationships, patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). Within Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %). CONCLUSIONS Patients/families valued relationships with clinicians above all else in the DxP, emphasizing the importance of supporting clinicians to nurture effective relationships and relationship-centered care in the DxP.
Collapse
Affiliation(s)
- Stephen K. Liu
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Joe Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kendall Harcourt
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth Lowe
- Patient and Family Advisory Council, Department of Social Work, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric J. Thomas
- Department of Medicine, University of Texas McGovern Medical School, Houston, TX, USA
- Center for Healthcare Quality and Safety, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Natalie Riblet
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sigall K. Bell
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| |
Collapse
|
2
|
Fuehrer S, Weil A, Osterberg LG, Zulman DM, Meunier MR, Schwartz R. Building Authentic Connection in the Patient-Physician Relationship. J Prim Care Community Health 2024; 15:21501319231225996. [PMID: 38281122 PMCID: PMC10823846 DOI: 10.1177/21501319231225996] [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: 11/29/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Delivering optimal patient care is impacted by a physician's ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients. METHODS Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic. RESULTS AND CONCLUSIONS The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one's internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one's interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients.
Collapse
Affiliation(s)
| | - Amy Weil
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lars G. Osterberg
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Donna M. Zulman
- Stanford University School of Medicine, Palo Alto, CA, USA
- VA Palo Alto Health Care System, Menlo Park, CA, USA
| | | | | |
Collapse
|
3
|
Abstract
BACKGROUND Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. MATERIALS AND METHODS We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children's Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. RESULTS Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. CONCLUSION Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions.Key MessageWe used a mixed-methods approach to assess the effects of a longitudinal narrative medicine intervention on well-being in pediatric residents.Open-ended responses indicated that residents found utility in and appreciated the intervention and experienced sustained improvements in their mental and emotional health, though the sample size was likely too small to show quantitative changes in well-being measures.Narrative medicine is not a panacea, but it can be a useful tool to provide to pediatric residents to promote sustained improvements in their well-being through the framework of relationship-centered care.
Collapse
Affiliation(s)
- Nimisha Bajaj
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - James Phelan
- Department of English, The Ohio State University, Columbus, OH, USA
| | - Erin E McConnell
- Internal Medicine/Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Suzanne M Reed
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
4
|
Englar RE. Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care. J Feline Med Surg 2023; 25:1098612X231209855. [PMID: 38131211 DOI: 10.1177/1098612x231209855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
AIM This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed. RELEVANCE Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery. SERIES OUTLINE This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.
Collapse
Affiliation(s)
- Ryane E Englar
- University of Arizona College of Veterinary Medicine, Oro Valley, AZ, USA
| |
Collapse
|
5
|
Abstract
SERIES OUTLINE This is the second part of a two-part series on spectrum of care that encourages practitioners to tailor case management to the patient along a continuum of acceptable options. Part I defined the spectrum of care and broadened its approach beyond initial cost-of-care considerations. This second article introduces strategies for initiating conversations with clients about their needs, wants and expectations specific to healthcare options and case management decisions. It will explore how open inquiry, reflective listening, transparency and unconditional positive regard facilitate dialogue between providers and their clients as they collaborate on decision-making along a spectrum of care. RELEVANCE Contextual case management prioritizes interventions that are appropriate for both the patient and the client. To identify and explore which healthcare options represent the best fit for those impacted most by medical decisions, veterinarians need to make space for clients to feel comfortable sharing their perspectives. Clients are more likely to be engaged in decision-making when their insight is actively solicited. They have much to share with us as experts about their cat's overall health and wellness needs. Inviting clients to contribute to the consultation and being receptive to hearing what motivates their choices helps us to structure conversations around healthcare options. The ability to communicate healthcare options is as vital as the provision of healthcare, if not more so.
Collapse
Affiliation(s)
- Ryane E Englar
- University of Arizona College of Veterinary Medicine, Oro Valley, AZ, USA
| |
Collapse
|
6
|
Lim SA, Khorrami A, Wassersug RJ, Agapoff JA. Gender Differences among Healthcare Providers in the Promotion of Patient-, Person- and Family-Centered Care-And Its Implications for Providing Quality Healthcare. Healthcare (Basel) 2023; 11. [PMID: 36833099 DOI: 10.3390/healthcare11040565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
The concept of "patient-centered care" (PCC) emphasizes patients' autonomy and is commonly promoted as a good healthcare practice that all of medicine should strive for. Here, we assessed how six medical specialties-pediatrics, OBGYN, orthopedics, radiology, dermatology, and neurosurgery-have engaged with PCC and its derivative concepts of "person-centered care" (PeCC) and "family-centered care" (FCC) as a function of the number of female physicians in each field. To achieve this, we conducted a scoping review of three databases-PubMed, CINAHL, and PsycInfo-to assess the extent that PCC, PeCC, FCC, and RCC were referenced by different specialties in the medical literature. Reference to PCC and PeCC in the literature correlates significantly with the number of female physicians in each field (all p < 0.00001) except for neurosurgery (p > 0.5). Pediatrics shows the most extensive reference to PCC, followed by OBGYN, with a significant difference between all disciplines (p < 0.001). FCC remains exclusively embraced by pediatrics. Our results align with documented cognitive differences between men and women that recognize gender differences in empathizing (E) versus systemizing (S) with females demonstrating E > S, which supports PCC/PeCC/FCC approaches to healthcare.
Collapse
|
7
|
Abstract
In health care, well-being is considered to be composed of multiple interacting dimensions and to regard the subjective (affective and cognitive) evaluation of these dimensions. These dimensions are often referred to as physical, psychological, and social domains of life. Although there are various disease-specific and group-specific conceptual approaches, starting from a universal perspective provides a more inclusive approach to well-being. Indeed, universal approaches to well-being have striking overlaps with dementia-specific approaches. Although many initiatives have been launched to promote person-centered care and attention for well-being in recent decades, the current COVID pandemic showed that the primary focus in (Dutch) long-term care was still on physical health. However, a well-being perspective can be a central base of care: it is a means to include positive aspects, and it can be applied when addressing problems such as challenging behavior in the sense that both are about needs. Furthermore, providing care from this perspective is not only about the well-being of frail people and their loved ones but also about the well-being and needs of the involved professionals. Increasingly, research shows the importance of the quality of the resident-carer relationship, the carer's behavior, and their well-being for improving the well-being of residents. Applying the care approaches 'attentiveness in care' and relationship-centered care can contribute to the well-being of all involved stakeholders as these uphold the reciprocity of care relationships and take the values and attitudes, but also the vulnerability of those involved, into account.
Collapse
Affiliation(s)
- Debby L Gerritsen
- Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Department of Primary and Community care, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Englar RE, Graham Brett T. Integrating Communication Skills, Awareness of Self and Others, and Reflective Feedback into One Inclusive Anatomical Representation of Relationship-Centered Health Care. J Vet Med Educ 2022; 50:e20220060. [PMID: 36538494 DOI: 10.3138/jvme-2022-0060] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The American Veterinary Medical Association Council on Education mandates in standard 11 that all accredited colleges of veterinary medicine must develop and deliver formal processes by which students are observed and assessed in nine competencies. The eighth competency combines clinical communication and sensitivity toward soliciting and understanding individual narratives across a diverse clientele to facilitate health care delivery. Several frameworks have been designed to structure health care consultations for teaching and coaching purposes. The Calgary-Cambridge guide (CCG) provides an evidence-based approach to outlining the flow of consultations, incorporating foundational communication skills and elements of relationship-centered care into a series of sequential tasks. Although the CCG was intended for use as a flexible tool kit, it lacks visible connections between concrete experiences (e.g., the consultation) and reflective observation (e.g., the feedback). This teaching tip describes the development of a novel anatomical representation of the consultation that integrates process elements of the CCG with other core curricular concepts. By combining knowledge, technical skills, critical thinking, reflection, cultural humility, and self-awareness into a skeletal consultation model, linkages are established between communication and intergroup dialogue skills, diversity and inclusion (D&I). This model has been further adapted as feline, caprine, porcine, equine, avian, and reptilian versions for in-class use as strategic visual aids that highlight key areas of focus for Professional Skills class sessions. Future developments by the authors will explore how to link species-specific consultation models to assessment rubrics to reinforce the connection between content (what) and process (how).
Collapse
Affiliation(s)
- Ryane E Englar
- Veterinary Skills Development, and Associate Professor of Practice, University of Arizona College of Veterinary Medicine, 1580 E Hanley Blvd./Oro Valley, AZ 85737 USA
| | - Teresa Graham Brett
- University of Arizona College of Veterinary Medicine, 1580 E Hanley Blvd./Oro Valley, AZ 85737 USA
| |
Collapse
|
9
|
Abstract
BACKGROUND Advance care planning gives patients and their family members the possibility to consider and make decisions regarding future care and medical procedures. AIM To explore the view of people in the early stage of dementia on planning for future care. RESEARCH DESIGN The study is a qualitative interview study with a semistructured interview guide. The data were analyzed according to the Qualitative Analysis Guide of Leuven. PARTICIPANTS AND RESEARCH CONTEXT Dementia nurses assisted in the recruiting of people with dementia for participation in the study. Study information was mailed to 95 people with early stage dementia. Ten people with dementia and eight caregiver spouses participated in the study. ETHICAL CONSIDERATIONS People with dementia belong to a vulnerable patient group, and care was taken in the areas of informed consent and accessible information. FINDINGS The views of people with dementia are characterized by a complex storyline involving tensions and movement within the themes of wants, beliefs, and levels of insight. Participants wanted to think about the future but also wanted to live in the here and now. DISCUSSION High demands are placed on the advance care planning process for people with dementia and their family caregivers. A dignity-enhancing approach in dementia care emphasizes the dignity of and respect for this vulnerable and care-dependent patient group. CONCLUSION The process of advance care planning in dementia care needs to go beyond person-centered care to a relationship-centered process. The illness trajectory and the impact on autonomy need to be taken into consideration.
Collapse
Affiliation(s)
| | | | | | - Lisbeth Fagerström
- Åbo Akademi University, Finland; University of South-Eastern Norway, Norway
| |
Collapse
|
10
|
Griffin JM, Riffin C, Bangerter LR, Schaepe K, Havyer RD. Provider Perspectives on Integrating Family Caregivers into Patient Care Encounters. Health Serv Res 2021; 57:892-904. [PMID: 34957543 PMCID: PMC9264458 DOI: 10.1111/1475-6773.13932] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine and compare healthcare provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. DATA SOURCES/SETTING Data were from nineteen interviews conducted in 2018, ten with primary care or palliative care providers and nine with proceduralists or interventionists in practices located in Minnesota, Florida, and Arizona. STUDY DESIGN This was a qualitative study using data collected from one-on-one, semi-structured interviews with physicians. DATA COLLECTION Using purposeful 'maximum variation' sampling to capture differences between primary and palliative care providers and proceduralists/interventionists, data were collected, reviewed, coded, and then analyzed using inductive content analysis with a constant comparison approach. PRIMARY FINDINGS Primary care providers described a lack of organizational and institutional resources to support caregivers. Accordingly, they were compelled to curb caregiver engagement in order to meet patients' clinical care needs within the time and workflow demands in encounters. Proceduralists and interventionists described the need to assess caregivers for suitability to provide care during intense periods of treatment. They reported having access to more formal organizational resources for supporting caregivers. Overall, providers described a paradox, where caregivers are seen as contributing value to patient encounters until they need training, education, or support to provide care, at which point they become burdensome and require more time and resources than are typically available. CONCLUSIONS Results highlight how organizational constraints inhibit caregiver engagement in patient encounters and influence provider attitudes about engaging caregivers and assessing their unmet needs. Findings also provide insights into challenges across practice types for implementing state and federal laws that promote caregiver engagement. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Joan M Griffin
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Catherine Riffin
- Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH-317), New York, New York, United States
| | | | - Karen Schaepe
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Rachel D Havyer
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| |
Collapse
|
11
|
Merle R, Küper AM. Attitude of Veterinarians Toward Self-Informed Animal Owners Affects Shared Decision Making. Front Vet Sci 2021; 8:692452. [PMID: 34746272 PMCID: PMC8564114 DOI: 10.3389/fvets.2021.692452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The aims of this study were to investigate the role of the veterinarian characteristics (e.g., age, gender, self-estimation, use of the internet), and their attitudes concerning animal owners seeking self-information. A particular focus was laid on any association between shared decision making (SDM), age and gender. In an online survey, 527 German veterinarians were asked about their attitude regarding SDM principles and their experiences with self-informed animal owners. The factors associated with veterinarians' perception of SDM were investigated in a multivariable linear regression model. A recently published structural equation model consolidated the application of SDM, empathic behavior, and veterinarians' evaluation of self-education as latent factors. Interconnected questionnaire items were processed using an exploratory factor analysis to 11 interpretable factors. Veterinarians who assumed therapy failure was associated with themselves had significantly higher rates of SDM (p = 0.002). In contrast, SDM was significantly lower (p = 0.002) if they assumed that therapy failure was due to the animal's owners. SDM was negatively associated with the perceived quality of the pet owners' self-information (p < 0.001) and if skepticism was perceived as the reason for seeking the self-information (p = 0.001). Veterinarians who advised against self-information (p = 0.006) and those who assumed that self-information of animal owners goes along with uncertainty (p = 0.001) had low SDM values (p = 0.006). Asking the animal owner for self-information (p = 0.001), and recommendations of good information sources (p = 0.022) were positively associated with SDM. Looking at the influence of age and gender on the application of SDM, older people and males rated higher. However, the evaluation of the latent factor SDM was based on the self-estimation of the participants. Assuming that younger women were less self-confident, we cannot exclude that young female participants self-evaluated their SDM skills lower than older male participants, although both groups would objectively have the same SDM level. Practitioners who have a positive attitude toward animal owners, who enjoy contact with animal owners and welcome their interest in further (self-)information, show empathic behavior, and have a positive attitude toward SDM are more likely to have better veterinarian-animal owner-relationships.
Collapse
Affiliation(s)
- Roswitha Merle
- Department of Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Alina M Küper
- Department of Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
12
|
Küeper AM, Merle R. Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model. Front Vet Sci 2021; 7:605631. [PMID: 33585596 PMCID: PMC7873293 DOI: 10.3389/fvets.2020.605631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.
Collapse
Affiliation(s)
- Alina M Küeper
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
13
|
Keller HH, Wu SA, Iraniparast M, Trinca V, Morrison-Koechl J, Awwad S. Relationship-Centered Mealtime Training Program Demonstrates Efficacy to Improve the Dining Environment in Long-Term Care. J Am Med Dir Assoc 2020; 22:1933-1938.e2. [PMID: 33306996 DOI: 10.1016/j.jamda.2020.11.008] [Citation(s) in RCA: 2] [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: 08/17/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Mealtimes in residential care tend to be task-focused rather than relationship-centered, impacting resident quality of life. CHOICE+ uses participatory approaches to make mealtimes more relationship-centered. The aim of this study was to demonstrate the efficacy of the 12-month external-facilitated implementation of CHOICE+ to improve the mealtime environment. DESIGN Modified stepped-wedge time series design. SETTING AND PARTICIPANTS Dining rooms in 3 homes were entered into the intervention every 4 months; total study length was 20 months. Pre- and postintervention evaluations were attained from residents (n = 27, n = 19) and staff (n = 39, n = 29) respectively. METHODS Five meals in each home were observed by a blinded trained assessor every 4 months using the Mealtime Scan+ to assess physical, social, and relationship-centered practices and overall quality of the dining environment. Repeated measures analysis determined change in mealtime environment scores. The Team member Mealtime Experience Questionnaire and 5 questions from the InterRAI Quality of Life Questionnaire for residents and family were administered at pre- and postintervention. RESULTS There were significant increases in physical and social environments, relationship-centered care practices, and overall quality of the mealtime environment during the intervention period at all sites (all P < .001) and significant site by intervention interactions for physical (P = .01) and relationship-centered care (P = .03). Statistically significant site differences were noted for relationship-centered care practices (P < .001) and overall quality of the dining environment (P < .002). There was no significant difference in staff and resident/family pre-/postintervention questionnaire results. CONCLUSIONS AND IMPLICATIONS The external facilitated model of CHOICE+ resulted in significant improvements in the mealtime environment. Although site context impacted implementation, this study demonstrates that mealtimes can be improved even in homes that have challenges. Future work should determine impact of these improvements on other outcomes such as resident quality of life, using more specific measures.
Collapse
Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Sarah A Wu
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Maryam Iraniparast
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Vanessa Trinca
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Sarah Awwad
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
14
|
Kelly MA, Gormley GJ. In, But Out of Touch: Connecting With Patients During the Virtual Visit. Ann Fam Med 2020; 18:461-462. [PMID: 32928765 PMCID: PMC7489979 DOI: 10.1370/afm.2568] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/07/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 11/09/2022] Open
Abstract
Covid-19 has rapidly changed physician-patient interaction, from hands-on to hands-off medicine. In this essay, 2 family physicians on different continents reflect on the meaning of touch in clinical practice and how virtual care is transforming this tacit aspect of patient care. Although technology enables physicians to stay in touch with patients verbally, we have lost the ability to physically touch. Traditionally, touch is central to medical practice, physical examination guides diagnosis and informs management. But the silent language of touch fulfills a deeper symbolic function, enabling physicians to acknowledge patient concerns in a tangible way. Touch expresses healing, extending beyond skin-to-skin contact to express humanity, caring, and connection. As we adapt to novel technologies, we wonder how, as family physicians, we will adapt our clinical acumen to extend our ability to connect with patients.
Collapse
Affiliation(s)
- Martina Ann Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Gerard J Gormley
- Centre for Medical Education, Queens University Belfast, Belfast, Northern Ireland, UK
| |
Collapse
|
15
|
Sion K, Verbeek H, de Vries E, Zwakhalen S, Odekerken-Schröder G, Schols J, Hamers J. The Feasibility of Connecting Conversations: A Narrative Method to Assess Experienced Quality of Care in Nursing Homes from the Resident's Perspective. Int J Environ Res Public Health 2020; 17:E5118. [PMID: 32679869 DOI: 10.3390/ijerph17145118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/29/2022]
Abstract
Currently, residents living in nursing homes and their caring relationships are being placed more centrally in the care experience. Experienced quality of care is influenced by the interactions between residents, family and caregivers, who each have their own experiences and needs. Connecting Conversations is a narrative method aimed at assessing experienced quality of care in nursing homes from the resident's perspective by having separate conversations with residents, family and caregivers (triads), adopting an appreciative inquiry approach. This study presents how to use Connecting Conversations and its feasibility. Feasibility was assessed as performance completeness, protocol adherence and interviewers' experiences. Conversations were conducted by trained nursing home staff (n = 35) who performed 275 Connecting Conversations in another nursing home than where they were employed (learning network). Findings show it is feasible to perform separate appreciative conversations with resident-family-caregiver triads by an interviewer employed in another nursing home; however, protocol adherence was sometimes challenging in conversations with residents. Interviewers valued the appreciative approach, the learning network and the depth of the separate conversations. Challenges were experienced with scheduling conversations and receiving time and support to perform the conversations. Stakeholders should continue collaboration to embed Connecting Conversations into daily practice in nursing homes.
Collapse
|
16
|
Sion K, Verbeek H, Aarts S, Zwakhalen S, Odekerken-Schröder G, Schols J, Hamers J. The Validity of Connecting Conversations: A Narrative Method to Assess Experienced Quality of Care in Nursing Homes from the Resident's Perspective. Int J Environ Res Public Health 2020; 17:E5100. [PMID: 32679736 DOI: 10.3390/ijerph17145100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/29/2022]
Abstract
It is important to assess experienced quality of care in nursing homes, as this portrays what is important to residents and helps identify what quality improvements should focus on. Connecting Conversations is a narrative method that assesses experienced quality of care from the resident’s perspective in nursing homes by having separate conversations with residents, family, and professional caregivers (triads) within a learning network. This study assessed the validity of performing the narrative method, Connecting Conversations. Trained nursing home staff (interviewers) performed the conversations in another nursing home than where they were employed. In total, 149 conversations were performed in 10 nursing homes. Findings show that experts deemed the narrative assessment method appropriate and complete to assess experienced quality of care (face validity). The questions asked appeared to capture the full construct of experienced quality of care (content validity). Additionally, there was a range in how positive conversations were and first results indicated that a nursing home scoring higher on satisfaction had more positive conversations (construct validity). More data are needed to perform additional construct validity analyses. In conclusion, Connecting Conversations shows promising results for its use as a valid narrative method to assess experienced quality of care.
Collapse
|
17
|
England JA, Howell M, White BAA. Creating a culture of communication in undergraduate medical education. Proc AMIA Symp 2020; 33:485-491. [PMID: 32676001 PMCID: PMC7340425 DOI: 10.1080/08998280.2020.1746156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
Quality communication improves outcomes across a wide variety of health care metrics. However, communication training in undergraduate medical education remains heterogeneous, with real-life clinical settings notably underutilized. In this perspective, the authors review the current landscape in communication training and propose the development of communication-intensive rotations (CIRs) as a method of integrating communication training into the everyday clinical environment. Despite its importance, communication training is often relegated to a "parallel curriculum." Through integration, CIRs can provide opportunities for real-life skills training, decrease parallel curriculum burden, and provide specialty-specific training in preparation for residency. Clear, efficient communication and human connection remain central in a physician's practice. CIRs reinforce these crucial principles. Potential benefits of a CIR model include role modeling of expert communication techniques; real-time, specific feedback on communication behaviors; development of relationship-centered communication skills and human connection, thereby decreasing burnout; and the opportunity for quality communication practices to become habits in a medical student's daily routine.
Collapse
Affiliation(s)
- Julie A. England
- College of Medicine, Texas A&M Health Sciences CenterTempleTexas
| | - Martha Howell
- Office of Patient Experience, Baylor Scott & White HealthTempleTexas
| | - Bobbie Ann Adair White
- Department of Humanities in Medicine, Texas A&M College of MedicineTempleTexas
- MGH Health Professions InstituteBostonMassachusetts
| |
Collapse
|
18
|
Bergman D, Bethell C, Gombojav N, Hassink S, Stange KC. Physical Distancing With Social Connectedness. Ann Fam Med 2020; 18:272-277. [PMID: 32393566 PMCID: PMC7213990 DOI: 10.1370/afm.2538] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 11/22/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/09/2022] Open
Abstract
In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. These ways of investing in relationships can exhibit different manifestations and emphases during different kinds of visits, but most are available during all kinds of encounters.Recognizing and supporting the many ways of investing in relationships has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care clinicians.The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships. What we need in a pandemic is not social distancing, but physical distancing with social connectedness.
Collapse
|
19
|
Benoot C, Enzlin P, Peremans L, Bilsen J. A Qualitative Study About How Nurses in Belgium Offer Relationship Support to Couples in Palliative Care. J Fam Nurs 2020; 26:38-51. [PMID: 31452429 DOI: 10.1177/1074840719866838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although palliative care nurses are identified as key players in supporting couples during advanced illness, there is a lack of evidence about their knowledge and experiences with this particular role. The aim of the study was to explore palliative care nurses' attitudes, roles, and experiences in addressing relationship functioning of couples in daily practice. A qualitative study was conducted using in-depth interviews, observational research, and peer debriefing groups with palliative care nurses in Flanders, Belgium. Nurses support relationship functioning by creating a couple-positive care environment, by being present/acknowledging feelings, and by rectifying imbalances between couples. They do so in a proactive way, backed up by team support. Nurses hesitate toward explicitly unraveling and intervening in relationship problems, in favor of providing comfort or offering a strengths-based approach. The findings offer an urgent call to enhance the educational programs for palliative care nurses by integrating the theories and practice frameworks that guide relational assessment and intervention, which are being used in family nursing.
Collapse
Affiliation(s)
| | | | - Lieve Peremans
- Vrije Universiteit Brussel, Belgium
- University of Antwerp, Belgium
| | | |
Collapse
|
20
|
Griffin JM, Riffin C, Havyer RD, Biggar VS, Comer M, Frangiosa TL, Bangerter LR. Integrating Family Caregivers of People With Alzheimer's Disease and Dementias into Clinical Appointments: Identifying Potential Best Practices. J Appl Gerontol 2019; 39:1184-1194. [PMID: 31603041 PMCID: PMC7454004 DOI: 10.1177/0733464819880449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family caregiver engagement in clinical encounters can promote relationship-centered care and optimize outcomes for people with Alzheimer's disease and related dementias (ADRD). Little is known, however, about effective ways for health care providers to engage family caregivers in clinical appointments to provide the highest quality care. We describe what caregivers of people with ADRD and people with mild cognitive impairment (MCI) consider potential best practices for engaging caregivers as partners in clinical appointments. Seven online focus groups were convened. Three groups included spousal caregivers (n = 42), three included non-spousal caregivers (n = 36), and one included people with MCI (n = 15). Seven potential best practices were identified, including the following: "acknowledge caregivers' role and assess unmet needs and capacity to care" and "communicate directly with person with ADRD yet provide opportunities for caregivers to have separate interactions with providers." Participants outlined concrete steps for providers and health care systems to improve care delivery quality for people with ADRD.
Collapse
|
21
|
Kelly MA, Freeman LK, Dornan T. Family Physicians' Experiences of Physical Examination. Ann Fam Med 2019; 17:304-310. [PMID: 31285207 PMCID: PMC6827637 DOI: 10.1370/afm.2420] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To reappraise its utility, we explored family physicians' experiences. METHODS Guided by principles of phenomenology, we conducted in-depth qualitative interviews exploring 16 family physicians' experiences of conducting physical examination: 7 (44%) men and 9 women (56%) whose clinical experience varied widely, from 11 (69%) urban and 5 (31%) rural locations. We recorded the interviews, transcribed them verbatim, and identified initial themes using template analysis. We worked reflexively, critiquing our own and other team members' interpretations, in order to synthesize and write a final interpretation. RESULTS Participants described 2 facets of physical examination: making diagnoses and estimating prognoses rationally and objectively; and responding subjectively and intuitively to patients' illnesses, which formed relationships between doctor and patient that enacted medical care in the moment. Physical examination allowed physicians to use their own bodies to experience patients' illnesses. Performing physical examination was integral to being a family doctor because it promoted rapport and developed trust. CONCLUSIONS Physical examination is part of the identity of family physicians. It not only contributes diagnostic information but is a therapeutic intervention in and of itself. Physical examination contributes to relationship-centered care in family practice.
Collapse
Affiliation(s)
- Martina Ann Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lisa Kathryn Freeman
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| |
Collapse
|
22
|
Abstract
Background: Integrative health is an expanding field that is increasingly called upon by conventional medicine to provide care for patients with chronic pain and disease. Although evidence has mounted for delivering integrative therapies individually, there is little consensus on how best to deliver these therapies in tandem as part of whole person care. While many models exist, few are financially sustainable. Methods and results: This article describes a conceptual and logistical model for providing integrative outpatient health care within an academic medical center or hospital system to patients with chronic pain and disease. In hopes that the model will be replicated, administrative details are provided to explain how the model operates and has been maintained over nine years. The details include the intentional building of a particular work culture. Conclusion: This whole person care model that addresses chronic pain and disease in an outpatient integrative clinic has been successful, sustainable and can be replicated in other academic medical centers or hospital clinics.
Collapse
Affiliation(s)
- Kathryn A Hansen
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.,3 Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Lindsey C McKernan
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.,4 Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan D Carter
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cynthia Allen
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruth Q Wolever
- 1 Osher Center for Integrative Medicine at Vanderbilt, Nashville, Tennessee.,2 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee.,3 Vanderbilt University School of Nursing, Nashville, Tennessee.,4 Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
23
|
Küper AM, Merle R. Being Nice Is Not Enough-Exploring Relationship-Centered Veterinary Care With Structural Equation Modeling. A Quantitative Study on German Pet Owners' Perception. Front Vet Sci 2019; 6:56. [PMID: 30873422 PMCID: PMC6403131 DOI: 10.3389/fvets.2019.00056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
Abstract
During the last years, the philosophy of relationship-centered care gained increasing attention in veterinary medicine. Relationship-centered care is based on a joint venture between pet owner and veterinarians and therefore offers the opportunity to satisfy the pet owners' need for participation in medical decision-making and to provide the best care for the patient. Although research on relationship-centered care in the veterinary consultation is still limited, the available findings suggest that the characteristics of relationship-centered care reflect the pet owners' expectations on satisfactory veterinary care. In this study a quantitative survey was conducted among German pet owners that collected information regarding their perception of the veterinarians' communication during the last appointments. Questionnaires were available online and paper-based. Data were analyzed using exploratory factor analysis and structural equation modeling using SAS. First aim of the study was to explore structural equation modeling (SEM) as an opportunity to evaluate quantitative data in the field of research on relationship-centered care. Further, SEM was used to evaluate associations between the implementation of different characteristics of relationship-centered care in the veterinary practice (empathic communication, partnership-building) and latent outcome variables regarding the pet owners (pet owners' need for further information, consultation of competing health care providers). N = 1,270 valid questionnaires were completed. Participants owned small companion animals (55.6%), horses (7.6%), or both (36.9%) within the last 2 years. Results of SEM suggest that partnership-centered and empathic communication decreased the pet owners' needs for further information (e.g., from online sources) and their need to consult alternative health providers (e.g., homeopaths). Especially addressing the pet owners' worries and fears, discussing pros and cons of diagnostic and therapeutic options as well as providing the required amount of information were shown to be large influence factors within the model. Therefore, veterinarians are recommended to implement the concept of partnership-centered care in their daily practice, for it may increase pet owners' loyalty and satisfaction. Results may motivate future research in this field. Further development of the proposed model assumptions may enable valuable progress in the field of quantitative research on relationship-centered care.
Collapse
Affiliation(s)
| | - Roswitha Merle
- Department of Veterinary Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
24
|
Sheats MK, Hammond S, Kedrowicz AA. Analysis of Final Year Veterinary Students' Telephone Communication Skills at a Veterinary Teaching Hospital. Vet Sci 2018; 5:E99. [PMID: 30513906 DOI: 10.3390/vetsci5040099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 12/30/2022] Open
Abstract
Client communication is a core clinical skill that is taught as part of the required curriculum at many veterinary colleges. Although much client communication occurs face-to-face, telephone communication is used to provide patient updates, relay results of diagnostic tests, and check on discharged patients. This research explored fourth year veterinary medical students' telephone communication skills. We recorded and analyzed the transcripts of 25 calls students made to clients of three different services in the Veterinary Teaching Hospital. Additionally, we explored the perspectives of veterinary educators by distributing a survey to university faculty and house officers (n = 57). Results indicate that students excelled at identifying the patient and purpose of the call and incorporating professional language and clear explanations. They require development in providing structure and incorporating core communication skills. Compared with our survey results, the student findings are at odds with clinicians' expectations of students' communication abilities. We conclude that additional training is required to familiarize students with expectations regarding telephone communication, including reviewing the case thoroughly, preparing to answer questions and provide explanations, following organizational protocol, and incorporating open ended questions, reflective listening, and empathy. This data will inform design, and help to measure the impact, of telephone communication education and training that will be incorporated into the existing veterinary communication curriculum.
Collapse
|
25
|
Leffel GM, Oakes Mueller RA, Ham SA, Karches KE, Curlin FA, Yoon JD. Project on the Good Physician: Further Evidence for the Validity of a Moral Intuitionist Model of Virtuous Caring. Teach Learn Med 2018; 30:303-316. [PMID: 29351403 DOI: 10.1080/10401334.2017.1414608] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
THEORY In the Project on the Good Physician, the authors propose a moral intuitionist model of virtuous caring that places the virtues of Mindfulness, Empathic Compassion, and Generosity at the heart of medical character education. HYPOTHESES Hypothesis 1a: The virtues of Mindfulness, Empathic Compassion, and Generosity will be positively associated with one another (convergent validity). Hypothesis 1b: The virtues of Mindfulness and Empathic Compassion will explain variance in the action-related virtue of Generosity beyond that predicted by Big Five personality traits alone (discriminant validity). Hypothesis 1c: Virtuous students will experience greater well-being ("flourishing"), as measured by four indices of well-being: life meaning, life satisfaction, vocational identity, and vocational calling (predictive validity). Hypothesis 1d: Students who self-report higher levels of the virtues will be nominated by their peers for the Gold Humanism Award (predictive validity). Hypothesis 2a-2c: Neuroticism and Burnout will be positively associated with each other and inversely associated with measures of virtue and well-being. METHOD The authors used data from a 2011 nationally representative sample of U.S. medical students (n = 499) in which medical virtues (Mindfulness, Empathic Compassion, and Generosity) were measured using scales adapted from existing instruments with validity evidence. RESULTS Supporting the predictive validity of the model, virtuous students were recognized by their peers to be exemplary doctors, and they were more likely to have higher ratings on measures of student well-being. Supporting the discriminant validity of the model, virtues predicted prosocial behavior (Generosity) more than personality traits alone, and students higher in the virtue of Mindfulness were less likely to be high in Neuroticism and Burnout. CONCLUSIONS Data from this descriptive-correlational study offered additional support for the validity of the moral intuitionist model of virtuous caring. Applied to medical character education, medical school programs should consider designing educational experiences that intentionally emphasize the cultivation of virtue.
Collapse
Affiliation(s)
- G Michael Leffel
- a Department of Psychology , Point Loma Nazarene University , San Diego , California , USA
| | - Ross A Oakes Mueller
- a Department of Psychology , Point Loma Nazarene University , San Diego , California , USA
| | - Sandra A Ham
- b The Center for Health and Social Sciences, The University of Chicago , Chicago , Illinois , USA
| | - Kyle E Karches
- c Department of Internal Medicine , St. Louis University , St. Louis , Missouri , USA
| | - Farr A Curlin
- d Trent Center for Bioethics, Humanities and History of Medicine, Duke University , Durham , North Carolina , USA
| | - John D Yoon
- e Department of Medicine , The University of Chicago , Chicago , Illinois , USA
| |
Collapse
|
26
|
Van Winkle LJ, Schwartz BD, Michels N. A Model to Promote Public Health by Adding Evidence-Based, Empathy-Enhancing Programs to All Undergraduate Health-care Curricula. Front Public Health 2017; 5:339. [PMID: 29322041 PMCID: PMC5732135 DOI: 10.3389/fpubh.2017.00339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/28/2017] [Indexed: 12/30/2022] Open
Abstract
Fostering empathy in future health-care providers through service-learning is emerging as central to public health promotion. Patients fare better when their caregivers have higher relationship-centered characteristics such as the ones measured by the Jefferson Scale of Empathy. Unfortunately, these characteristics often deteriorate during health-care professional training. Nevertheless, growing literature documents how we can promote empathy, and other patient-centered characteristics, throughout health-care professional students’ undergraduate education. As for proven treatment plans, we believe we should also use evidence-based guidelines to foster relationship-centered characteristics in our students when training them to practice as part of an interdisciplinary health-care team.
Collapse
|
27
|
Stevens BJ, Kedrowicz AA. Evaluation of Fourth-Year Veterinary Students' Client Communication Skills: Recommendations for Scaffolded Instruction and Practice. J Vet Med Educ 2017; 45:85-90. [PMID: 28795904 DOI: 10.3138/jvme.0816-129r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Effective client communication is important for success in veterinary practice. The purpose of this project was to describe one approach to communication training and explore fourth-year veterinary students' communication skills through an evaluation of their interactions with clients during a general practice rotation. Two raters coded 20 random videotaped interactions simultaneously to assess students' communication, including their ability to initiate the session, incorporate open-ended questions, listen reflectively, express empathy, incorporate appropriate nonverbal communication, and attend to organization and sequencing. We provide baseline data that will guide future instruction in client communication. Results showed that students' communication skills require development. Half of the students sampled excelled at open-ended inquiry (n=10), and 40% (n=8) excelled at nonverbal communication. Students needed improvement on greeting clients by name and introducing themselves and their role (n=15), reflective listening (n=18), empathy (n=17), and organization and sequencing (n=18). These findings suggest that more focused instruction and practice is necessary in maintaining an organized structure, reflective listening, and empathy to create a relationship-centered approach to care.
Collapse
|
28
|
Haidet P, Jarecke J, Yang C, Teal CR, Street RL, Stuckey H. Using Jazz as a Metaphor to Teach Improvisational Communication Skills. Healthcare (Basel) 2017; 5:E41. [PMID: 28777345 DOI: 10.3390/healthcare5030041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 12/02/2022] Open
Abstract
Metaphor helps humans understand complex concepts by “mapping” them onto accessible concepts. The purpose of this study was to investigate the effects of using jazz as a metaphor to teach senior medical students improvisational communication skills, and to understand student learning experiences. The authors designed a month-long course that used jazz to teach improvisational communication. A sample of fourth-year medical students (N = 30) completed the course between 2011 and 2014. Evaluation consisted of quantitative and qualitative data collected pre- and post-course, with comparison to a concurrent control group on some measures. Measures included: (a) Student self-reports of knowledge and ability performing communicative tasks; (b) blinded standardized patient assessment of students’ adaptability and quality of listening; and (c) qualitative course evaluation data and open-ended interviews with course students. Compared to control students, course students demonstrated statistically significant and educationally meaningful gains in adaptability and listening behaviors. Students’ course experiences suggested that the jazz components led to high engagement and creativity, and provided a model to guide application of improvisational concepts to their own communication behaviors. Metaphor proved to be a powerful tool in this study, partly through enabling increased reflection and decreased resistance to behaviors that, on the surface, tended to run counter to generally accepted norms. The use of jazz as a metaphor to teach improvisational communication warrants further refinement and investigation.
Collapse
|
29
|
Green J, Wright H. From Bench to Bedside: Converting Placebo Research into Belief Activation. J Altern Complement Med 2017; 23:575-580. [PMID: 28719223 DOI: 10.1089/acm.2016.0375] [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: 11/13/2022] Open
Abstract
Research on the placebo effect contains important elements that can be harnessed to improve clinical care. This paper proposes a new term, "Belief Activation," to describe the deliberate use of placebo effect tools by both patients and clinicians to catalyze healing. Belief Activation includes, but is not limited to, maximizing patient and practitioner expectations, classical and social conditioning, spirituality and prayer/intention, therapeutic relationship, healing environments, and minimizing the nocebo effect. This paper demonstrates ways in which Belief Activation is a form of evidence-based medicine and seeks to translate knowledge from placebo research into medical practice.
Collapse
Affiliation(s)
- Jen Green
- 1 Emcura Integrative Clinic , Bloomfield Township, MI
| | | |
Collapse
|
30
|
Abstract
Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work's PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood's concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.
Collapse
Affiliation(s)
- Allyson M Washburn
- a Department of Psychology , National University , San Diego , California , USA
| | - Melanie Grossman
- a Department of Psychology , National University , San Diego , California , USA
| |
Collapse
|
31
|
Michael Leffel G, Oakes Mueller RA, Ham SA, Curlin FA, Yoon JD. Project on the Good Physician: A Proposal for a Moral Intuitionist Model of Virtuous Caring. Teach Learn Med 2017; 29:75-84. [PMID: 27466977 DOI: 10.1080/10401334.2016.1205497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
THEORY In the Project on the Good Physician, the authors endeavor to advance medical character education by proposing and testing a moral intuitionist model of virtuous caring that may be applicable to physician training. This model proposes that the moral intuition to care/harm motivates students to extend care to those in need. HYPOTHESES Hypothesis 1: Medical students will report stronger preferences for the intuition to Care/harm over other moral intuitions in clinical decision making. Hypothesis 2: Care/harm will have the strongest correlation with Generosity than the other moral intuitions. Hypothesis 3: There will be positive associations between Care/harm and the caring virtues (Mindfulness, Empathic Compassion, and Generosity). Hypotheses 4-5: The virtue of Empathic Compassion (or Mindfulness) will moderate the relationship between Care/harm and Generosity. Hypotheses 6-7: Neuroticism (or Burnout) will negatively moderate the association between Care/harm and Generosity (or between Empathic Compassion and Generosity). METHOD The authors used data from a 2011 nationally representative sample of U.S. medical students (N = 500) to test the relationship between the moral intuition to Care/harm and physician caring virtues. Moral intuitions were assessed using the Moral Foundations Questionnaire, whereas physician virtues were measured using scales adapted from validated constructs. RESULTS The authors found that students reported stronger preferences for the intuition to Care/harm over the four other moral intuitions. Each moral foundation was weakly but significantly correlated with Generosity, yet Care/harm had the strongest correlation among them. Neuroticism and Burnout did not weaken the link between Care/harm and the virtues. CONCLUSIONS Data from the descriptive-correlational study reported here offer preliminary support for the construct validity of an educational model that targets the moral intuitions. The article concludes with a discussion of the implications of a moral intuitionist approach for medical character education and offers three hypotheses for future empirical research.
Collapse
Affiliation(s)
- G Michael Leffel
- a Department of Psychology , Point Loma Nazarene University , San Diego , California , USA
| | - Ross A Oakes Mueller
- a Department of Psychology , Point Loma Nazarene University , San Diego , California , USA
| | - Sandra A Ham
- b Center for Health and Social Sciences, University of Chicago , Chicago , Illinois , USA
| | - Farr A Curlin
- c Trent Center for Bioethics, Humanities, & History of Medicine, Duke University , Durham , North Carolina , USA
| | - John D Yoon
- d MacLean Center for Clinical Medical Ethics, Department of Medicine, University of Chicago , Chicago , Illinois , USA
| |
Collapse
|
32
|
Steckler NA, Rawlins DB, Williamson PR, Suchman AL. Preparing to lead change: An innovative curriculum integrating theory, group skills and authentic presence. Healthc (Amst) 2016; 4:247-251. [PMID: 28007221 DOI: 10.1016/j.hjdsi.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Nicole A Steckler
- Division of Management, School of Medicine, Oregon Health & Science University, Mail Code L473, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA.
| | | | - Penelope R Williamson
- Independent Consultant, Baltimore, MD, USA; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony L Suchman
- Relationship Centered Health Care, Rochester, NY, USA; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| |
Collapse
|
33
|
Abstract
Despite the current focus on patient centeredness, healthcare professionals face numerous challenges that impede their ability to provide compassionate care that ameliorates concerns, distress, or suffering. These include fragmentation and discontinuity of care, technologies that both help and hinder communication and relationship-building, burgeoning operational and administrative requirements, inadequate communication skills training, alarming rates of burnout, and increased cost and market pressures. A compassionate healthcare system begins with compassionate people, but the organizations in which they train and work must reliably enable them to express and act on their compassion rather than impede it. We present a set of guiding commitments and recommendations to foster a more compassionate healthcare system. We urge healthcare organizations to adopt these commitments and take action to embed compassionate care in all aspects of training, research, patient care and organizational life.
Collapse
|
34
|
Abstract
Much has been written about patient-centered care (PCC) in medical literature. PCC has been praised as the ultimate objective of medicine by some. However, critics have pointed out the obvious: The antonym of PCC is doctor-centered medical care. Is doctor-centered care wrong? And what do we practice if we do not follow PCC? Can physicians transfer all responsibility for decision making to patients, in the name of PCC? Do patients have a right to choose outcomes, and make clinical decisions to achieve those outcomes? Most of the work on PCC has been done in the fields of family medicine and primary care. Minimal publications are available to highlight the role of PCC in endocrinology and diabetology. This brief communication discusses some concepts of PCC, and expands upon this term, to assess its relevance to diabetology.
Collapse
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | | | - Fatema Jawad
- Department of Diabetology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
35
|
Abstract
All illness, care, and healing processes occur in relationship--relationships of an individual with self and with others. Relationship-centered care (RCC) is an important framework for conceptualizing health care, recognizing that the nature and the quality of relationships are central to health care and the broader health care delivery system. RCC can be defined as care in which all participants appreciate the importance of their relationships with one another. RCC is founded upon 4 principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable. In RCC, relationships between patients and clinicians remain central, although the relationships of clinicians with themselves, with each other and with community are also emphasized.
Collapse
Affiliation(s)
- Mary Catherine Beach
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | |
Collapse
|
36
|
Abstract
Relationship-centered care reflects both knowing and feeling: the knowledge that physician and patient bring from their respective domains of expertise, and the physician's and patient's experience, expression, and perception of emotions during the medical encounter. These processes are conveyed and reciprocated in the care process through verbal and nonverbal communication. We suggest that the emotional context of care is especially related to nonverbal communication and that emotion-related communication skills, including sending and receiving nonverbal messages and emotional self-awareness, are critical elements of high-quality care. Although nonverbal behavior has received far less study than other care processes, the current review argues that it holds significance for the therapeutic relationship and influences important outcomes including satisfaction, adherence, and clinical outcomes of care.
Collapse
Affiliation(s)
- Debra L Roter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|
37
|
Abstract
Relationship-Centered Care acknowledges the central importance of relationships in medical care. In a similar fashion, relationships hold a central position in medical education, and are critical for achieving favorable learning outcomes. However, there is little empirical work in the medical literature that explores the development and meaning of relationships in medical education. In this essay, we explore the growing body of work on the culture of medical school, often termed the "hidden curriculum." We suggest that relationships are a critical mediating factor in the hidden curriculum. We explore evidence from the educational literature with respect to the student-teacher relationship, and the relevance that these studies hold for medical education. We conclude with suggestions for future research on student-teacher relationships in medical education settings.
Collapse
Affiliation(s)
- Paul Haidet
- Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | | |
Collapse
|
38
|
Suchman AL, Williamson PR, Litzelman DK, Frankel RM, Mossbarger DL, Inui TS. Toward an informal curriculum that teaches professionalism. Transforming the social environment of a medical school. J Gen Intern Med 2004; 19:501-4. [PMID: 15109312 PMCID: PMC1492320 DOI: 10.1111/j.1525-1497.2004.30157.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The social environment or "informal" curriculum of a medical school profoundly influences students' values and professional identities. The Indiana University School of Medicine is seeking to foster a social environment that consistently embodies and reinforces the values of its formal competency-based curriculum. Using an appreciative narrative-based approach, we have been encouraging students, residents, and faculty to be more mindful of relationship dynamics throughout the school. As participants discover how much relational capacity already exists and how widespread is the desire for a more collaborative environment, their perceptions of the school seem to shift, evoking behavior change and hopeful expectations for the future.
Collapse
|