Patient perspectives on how to demonstrate respect: Implications for clinicians and healthcare organizations

OBJECTIVE

Clinicians and healthcare organizations are ethically obligated to treat patients with respect, yet it is not clear what actions best demonstrate respect to patients. This exploratory qualitative study aimed to understand what actions on both an individual and organizational level effectively demonstrate respect for primary care patients.

METHODS

We conducted semi-structured telephone interviews with primary care patients in an integrated healthcare delivery system in Oregon and an integrated safety net health system in Colorado who were participating in a genomics implementation research study of a hereditary cancer screening program. We systematically coded interview transcripts using a coding framework developed based on iterative review of the interview guide and transcripts. We further analyzed the data coded with sub-codes relating to patients' experiences with respect in healthcare using a descriptive content analysis approach.

RESULTS

We interviewed 40 English-speaking (n = 30, 75%) and Spanish-speaking (n = 10, 25%) patients. Most interviewees identified as female (n = 35, 88%) and either Hispanic/Latino(a) (n = 17, 43%) or White or European American (n = 15, 38%). Interviewees identified two categories of efforts by individual clinicians that demonstrate respect: engaging with patients and being transparent. They identified five efforts by healthcare organizations: promoting safety and inclusivity, protecting patient privacy, communicating about scheduling, navigating financial barriers to care, and ensuring continuity of care.

CONCLUSIONS

Our findings suggest that patients' experiences of respect depend on efforts by individual clinicians as well as healthcare organizations. Our findings offer insight into how clinicians can build stronger partnerships with patients and how organizations can seek to promote access to care and patient safety and comfort. They also illustrate areas for future research and quality improvement to more effectively respect patients.

Ethnic and Sex Differences in Adiponectin: From Childhood to Adulthood

CONTEXT

Insulin resistance (IR) and type 2 diabetes are increasing, particularly in Hispanic (H) vs non-Hispanic White (NHW) populations. Adiponectin has a known role in IR, and therefore, understanding ethnic and sex-specific behavior of adiponectin across the lifespan is of clinical significance.

OBJECTIVE

To compare ethnic and sex differences in adiponectin, independent of body mass index, across the lifespan and relationship to IR.

DESIGN

Cross-sectional.

SETTING

Primary care, referral center.

PATIENTS

A total of 187 NHW and 117 H participants (8-57 y) without diabetes. Life stage: pre-/early puberty (Tanner 1/2), midpubertal (Tanner 3/4), late pubertal (Tanner 5, <21 years), and adult (Tanner 5, ≥21).

INTERVENTIONS

None.

MAIN OUTCOME MEASURE(S)

Fasting adiponectin, insulin, glucose, and revised homeostatic model assessment of insulin resistance.

RESULTS

Adiponectin was significantly inversely correlated with revised homeostatic model assessment of insulin resistance. Regarding puberty, adiponectin trended downward in late puberty, but only males were significantly lower in adulthood. By sex, adiponectin was lower in adult males vs females of both ethnicities. Regarding ethnicity, H adults of both sexes had lower adiponectin than NHW adults. Of note, in NHW females, adiponectin trended highest in adulthood, whereas in H females, adiponectin fell in late puberty and remained lower in adulthood.

CONCLUSIONS

Adiponectin inversely correlated with IR, trended down in late puberty, and was lowest in adult males. H adults of both sexes had lower adiponectin than NHW adults, and H females followed a more "male pattern," lacking the rebound in adiponectin seen in NHW females after puberty. These data suggest that adiponectin, independent of body mass index, may relate to the greater cardiometabolic risk seen in H populations and in particular H females.

Social mobility and reproduction among nineteenth-century Colorado silver prospectors

Popular cultural convention holds that, for those with enough gumption, the American frontier was a land of unparalleled opportunity. However, careful research throws doubt on the universality of this convention. Thus, the authors explore factors that increase or decrease opportunities for upward mobility in frontier towns. The authors' longitudinal study of late nineteenth century silver prospectors in Gothic, Colorado, demonstrates that while enthusiastic prospecting in Gothic did not lead to upward social mobility, it did provide enhanced reproductive opportunities.

Dark teens and born-again martyrs: captivity narratives after Columbine

In Columbine and its legacy, two streams of American discourse about threatening young people and captivity by evil forces converged: Protestant evangelical captivity narratives dating from the colonial period and discourse about troubled youth that has its origins in the mid-nineteenth century. Tales about threatening youth convey the extent to which young people do important work for their cultures, especially when they are used to shore up the bounds of normality against the threat of deviance. Captivity narratives provided powerful impetus for change after Columbine, just as they did for Protestants in seventeenth-century New England and for nineteenth-century nativist movements. After Columbine, tales of adolescents captured by darkness contributed to a growing evangelical youth movement, effected legislation concerning the separation of church and state, impacted public school dress codes and behavior policies, and in general shaped Americans' thinking about teenage deviance and normality.

"A different kind of beauty": scientific and architectural style in I.M. Pei's Mesa Laboratory and Louis Kahn's Salk Institute

I.M. Pei's Mesa Laboratory for the National Center for Atmospheric Research in Boulder, Colorado, and Louis Kahn's Salk Institute in La Jolla, California, are rare examples of laboratories as celebrated for their architecture as for their scientific contributions. Completed in the mid-1960s, these signature buildings still express the scientific style of their founding directors, Walter Roberts and Jonas Salk. yet in commissioning their laboratories, Roberts and Salk had to work with architects as strong-willed as themselves. A close reading of the two laboratories reveals the ongoing negotiations and tensions in collaborations between visionary scientist and visionary architect. Moreover, Roberts and Salk also had to become architects of atmospheric and biomedical sciences. For laboratory architecture, however flexible in theory, necessarily stabilizes scientific practice, since a philosophy of research is embedded in the very structure of the building and persists far longer than the initial vision and mission that gave it life. Roberts and Salk's experiences suggest that even the most carefully designed laboratories must successfully adapt to new disciplinary configurations, funding opportunities, and research priorities, or risk becoming mere architectural icons.

A Columbine study: giving voice, hearing meaning

On a quiet spring morning, the 20th of April 1999, Columbine High School emerged from relative anonymity as a typical suburban high school and became internationally recognized as a symbol of school violence and tragic loss. As a parent whose child was in the school at the time of the attack, I struggled to make sense of the tragedy. I decided to conduct research into the experience as a way to learn lessons that might help others exposed to community-wide trauma in the future. Through modified oral history interviews of other Columbine parents in combination with other qualitative research strategies, I collected and studied stories of the events of that day and the years following. An unexpected by-product emerged from the study, for it seemed that I was not only learning about crisis response and trauma care but also offering a means for parents to gain comfort in reflecting on their own experience. This paper describes the distinct approach that I employed to create a gateway to understanding this experience. It does not explicate the findings of the Columbine study but instead explores the potential for positive outcomes for those who, by giving voice to their stories, can connect to a deeper appreciation for their own experience.

Quiet pride: the experience of chronic illness by rural older adults

PURPOSES

To explore how chronic illness is experienced and managed by rural Hispanic and non-Hispanic older adults and their families, and to identify how the health care system and community facilitate or inhibit the ability to manage chronic illness in a changing health care environment.

DESIGN

Descriptive ethnography with purposive sampling.

METHODS

Data-generation methods included audiotaped interviews from 42 Hispanic and White, non-Hispanic participants, participant observations, examination of documents and artifacts, and photography in rural Colorado. Interpretive ethnographic methods were used to identify an overarching cultural theme.

FINDINGS

Living with chronic illness was a proactive, reciprocal learning process shaped by interrelationships in the context of multiple, diverse communities. Participants expressed living with chronic illness as a quiet pride on the journey toward living a meaningful life.

CONCLUSIONS

Findings provide an understanding of the webs of relationships that constitute the experience of elders living with chronic illness in rural communities. Viewing life as meaningful in the context of a broader understanding of health and well-being is important for nursing practice and future models of care.

On the role of vitamin D binding globulin in glucose homeostasis: results from the San Luis Valley Diabetes Study

Several studies have reported association between noninsulin-dependent diabetes mellitus and GC, the vitamin D binding protein of human plasma, with the GC 1 allele in significant excess among diabetics. Additionally, there is a considerable body of animal data suggesting that vitamin D has a significant impact on insulin secretion. Examination of the insulin levels in Dogrib Indians showed that the lowest levels of fasting insulin were associated with the GC IF-IF genotype. The present study examined levels of glucose, C-peptide, and insulin at fasting and 1 hr and 2 hr following a 75 g oral glucose challenge, in a population of Hispanic-Americans and Anglos in the San Luis Valley of southern Colorado. The sample comprised a total of 468 individuals with normal glucose tolerance. Of these, 289 were Anglos and 179 were Hispanic-Americans. An analysis of covariance was performed to determine the effect of the GC genotypes on mean levels of the primary variables--glucose, C-peptide, and insulin--and a secondary variable--insulinogenic index adjusting for the covariates age, body mass index (BMI), gender, and ethnicity. The analyses revealed that there is a significant difference in mean levels of glucose at fasting (F value = 2.46; P = 0.033) among the GC genotypes in the sample. Additionally, the differences in mean levels of 1 hr postprandial glucose among the GC genotypes although not significant at a 5% level, were significant at the 10% level. No other significant phenotypic effects were observed. These analyses are not in concordance with the results of an earlier study, where lower fasting insulin was associated with the GC 1F-1F genotype.