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Borsch AS, Jensen AMB, Vange SS, Jervelund SS. The video window: How video consultation technology reveals and redefines the art of medicine in Danish specialist practice. Soc Sci Med 2024; 351:116965. [PMID: 38762998 DOI: 10.1016/j.socscimed.2024.116965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
In the contemporary landscape of technologically mediated healthcare, video consultations introduce a dynamic interplay of challenges and opportunities. Taking the notion of 'the art of medicine' as an analytical frame, and drawing on interviews with medical specialists as well as participant observation of video consultations with patients (carried out between February 2022 and January 2023), this article investigates how video consultation technology changes the practices of medical specialists in the Danish healthcare system. Informed by post-phenomenology, we approach video consultations metaphorically as 'windows' between medical specialists and patients, unveiling three pivotal dimensions characterizing these changes. First, the shift from a physical to a virtual consultation room requires a reevaluation of the authoritative nature of the clinic, emphasizing the need for negotiating and staging the clinical space online. Second, while video consultations limit doctors' ability to rely on traditional non-verbal cues such as body language, they offer glimpses into patients' home environments, exposing the influence of social preconceptions on medical evaluations. Third, the adoption of video consultations introduces new conditions for doctors' use of senses, accentuating the importance of reflecting on the roles of different sensory impressions in the art of medicine. Our study illuminates how video consultation technology simultaneously expands and constrains the engagement between medical specialists and patients. Despite their inherent limitations, video consultations bring medical specialists closer to some of the intricacies of patients' lives. This proximity offers new insights and renders visible the roles of caregivers and relatives in the patient's care. The metaphor of 'the video window' encapsulates this tension between distance and closeness in video consultations, portraying the patient as both fragmented and socially situated. Our study extends beyond traditional patient and provider satisfaction evaluations, providing nuanced insights into how video consultations reconfigure the art of medicine.
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Affiliation(s)
- Anne Sofie Borsch
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark.
| | - Anja M B Jensen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Sif Sofie Vange
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Signe Smith Jervelund
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
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Hennrich P, Arnold C, Traulsen P, Peters-Klimm F, Wensing M. Opinion seeking behaviour of healthcare providers in ambulatory cardiovascular care in Germany: a cross-sectional study. BMC Health Serv Res 2022; 22:1404. [PMID: 36419070 PMCID: PMC9686109 DOI: 10.1186/s12913-022-08667-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/12/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Healthcare providers' inclination to seek or lead other providers' opinions on clinical topics may influence healthcare practices, particularly regarding their alignment across different providers in controversial domains. This study aimed to explore opinion-seeking behaviours of general practitioners and their impacts on clinical opinions in ambulatory cardiovascular care in Germany. METHODS Between 2019 and 2021, we performed a written survey in two samples of general practitioners and one sample of self-employed cardiologists in three German states. The general practitioners were asked to identify a person they deemed influential on their views on cardiovascular conditions. Their self-perceived opinion leadership and opinion seeking behaviours were then measured, using a validated 12-item-questionnaire. General practitioners and cardiologists were requested to indicate their agreement with three potentially controversial aspects of cardiovascular ambulatory care. Potential impacts on the general practitioners' views, including local cardiologists' opinions, were examined using multi-level linear regression models. RESULTS A total of 129 general practitioners and 113 cardiologists returned the questionnaire. 68.50% of general practitioners named an opinion leader, mainly cardiologists outside of their practice. General practitioners perceived themselves as opinion seeking and as opinion leading at the same time. Views on the presented controversial topics were mixed among both general practitioners and cardiologists. Self-reported opinion leadership behaviour of general practitioners was associated with their views on one of the three topics. No such associations were found for opinion seeking behaviours and the views of local cardiologists. CONCLUSION While most general practitioners named a cardiovascular opinion leader and saw themselves as opinion seeking regarding cardiovascular issues, they simultaneously perceived themselves as opinion leading, suggesting that opinion leadership and opinion seeking are not mutually exclusive concepts. The views of local cardiologists were not associated with the general practitioners' view, suggesting that local medical specialists do not necessarily influence the surrounding opinion seekers' views per se. TRIAL REGISTRATION We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de ) under ID no. DRKS00019219.
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Affiliation(s)
- Patrick Hennrich
- grid.5253.10000 0001 0328 4908Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Christine Arnold
- grid.5253.10000 0001 0328 4908Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Pia Traulsen
- grid.5253.10000 0001 0328 4908Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Frank Peters-Klimm
- grid.5253.10000 0001 0328 4908Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Michel Wensing
- grid.5253.10000 0001 0328 4908Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Stabel LS, McGrath C, Björck E, Elmberger A, Laksov KB. Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners' Continued Professional Development. Vocat Learn 2022; 15:427-448. [PMID: 35818439 PMCID: PMC9261199 DOI: 10.1007/s12186-022-09295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Medical specialists' lifelong learning is essential for improving patients' health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett's theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.
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Affiliation(s)
- Linda Sturesson Stabel
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cormac McGrath
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Erik Björck
- Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Agnes Elmberger
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Klara Bolander Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Education, Stockholm University, Stockholm, Sweden
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Walraven JEW, van der Meulen R, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Hesselink G, Desar IME. Preparing tomorrow's medical specialists for participating in oncological multidisciplinary team meetings: perceived barriers, facilitators and training needs. BMC Med Educ 2022; 22:502. [PMID: 35761247 PMCID: PMC9238222 DOI: 10.1186/s12909-022-03570-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/20/2022] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The optimal treatment plan for patients with cancer is discussed in multidisciplinary team meetings (MDTMs). Effective meetings require all participants to have collaboration and communication competences. Participating residents (defined as qualified doctors in training to become a specialist) are expected to develop these competences by observing their supervisors. However, the current generation of medical specialists is not trained to work in multidisciplinary teams; currently, training mainly focuses on medical competences. This study aims to identify barriers and facilitators among residents with respect to learning how to participate competently in MDTMs, and to identify additional training needs regarding their future role in MDTMs, as perceived by residents and specialists. METHODS Semi-structured interviews were conducted with Dutch residents and medical specialists participating in oncological MDTMs. Purposive sampling was used to maximise variation in participants' demographic and professional characteristics (e.g. sex, specialty, training duration, type and location of affiliated hospital). Interview data were systematically analysed according to the principles of thematic content analysis. RESULTS Nineteen residents and 16 specialists were interviewed. Three themes emerged: 1) awareness of the educational function of MDTMs among specialists and residents; 2) characteristics of MDTMs (e.g. time constraints, MDTM regulations) and 3) team dynamics and behaviour. Learning to participate in MDTMs is facilitated by: specialists and residents acknowledging the educational function of MDTMs beyond their medical content, and supervisors fulfilling their teaching role and setting conditions that enable residents to take a participative role (e.g. being well prepared, sitting in the inner circle, having assigned responsibilities). Barriers to residents' MDTM participation were insufficient guidance by their supervisors, time constraints, regulations hindering their active participation, a hierarchical structure of relations, unfamiliarity with the team and personal characteristics of residents (e.g. lack of confidence and shyness). Interviewees indicated a need for additional training (e.g. simulations) for residents, especially to enhance behavioural and communication skills. CONCLUSION Current practice with regard to preparing residents for their future role in MDTMs is hampered by a variety of factors. Most importantly, more awareness of the educational purposes of MDTMs among both residents and medical specialists would allow residents to participate in and learn from oncological MDTMs. Future studies should focus on collaboration competences.
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Affiliation(s)
- Janneke E W Walraven
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands.
| | - Renske van der Meulen
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands
| | - Jacobus J M van der Hoeven
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands
| | - Valery E P P Lemmens
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands
| | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Goldebaldkwartier 419, Utrecht, DT, 3511, The Netherlands
- Department of Medical Oncology, Cancer Centers Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Gijs Hesselink
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Postbus 9101, huispost 707, 6500, HB, Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Postbus 9101, huispost 415, 6500, HB, Nijmegen, The Netherlands
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Sallay V, Martos T, Lucza L, Weiland A, Stegers-Jager KM, Vermeir P, Mariman ANM, Csabai M. Medical educators' experiences on medically unexplained symptoms and intercultural communication-an expert focus group study. BMC Med Educ 2022; 22:310. [PMID: 35461231 PMCID: PMC9034474 DOI: 10.1186/s12909-022-03275-0] [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] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. METHODS Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. RESULTS Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. CONCLUSIONS The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary
| | - Tamás Martos
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary.
| | - Lilla Lucza
- Doctoral School of Education, University of Szeged, Szeged, Hungary
| | - Anne Weiland
- Department for Internal Medicine & General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Peter Vermeir
- Faculty of Medicine and Healthcare sciences, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
| | - An Noelle Margareta Mariman
- Faculty of Medicine and Healthcare sciences, Ghent University, Ghent, Belgium
- Ghent University Hospital, Center for Integrative Medicine, Ghent, Belgium
| | - Márta Csabai
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary
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Pronk SA, Gorter SL, van Luijk SJ, Barnhoorn PC, Binkhorst B, van Mook WNKA. Perception of social media behaviour among medical students, residents and medical specialists. Perspect Med Educ 2021; 10:215-221. [PMID: 33826108 PMCID: PMC8368941 DOI: 10.1007/s40037-021-00660-1] [Citation(s) in RCA: 9] [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] [Received: 04/09/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Behaviour is visible in real-life events, but also on social media. While some national medical organizations have published social media guidelines, the number of studies on professional social media use in medical education is limited. This study aims to explore social media use among medical students, residents and medical specialists. METHODS An anonymous, online survey was sent to 3844 medical students at two Dutch medical schools, 828 residents and 426 medical specialists. Quantitative, descriptive data analysis regarding demographic data, yes/no questions and Likert scale questions were performed using SPSS. Qualitative data analysis was performed iteratively, independently by two researchers applying the principles of constant comparison, open and axial coding until consensus was reached. RESULTS Overall response rate was 24.8%. Facebook was most popular among medical students and residents; LinkedIn was most popular among medical specialists. Personal pictures and/or information about themselves on social media that were perceived as unprofessional were reported by 31.3% of students, 19.7% of residents and 4.1% of medical specialists. Information and pictures related to alcohol abuse, partying, clinical work or of a sexually suggestive character were considered inappropriate. Addressing colleagues about their unprofessional posts was perceived to be mainly dependent on the nature and hierarchy of the interprofessional relation. DISCUSSION There is a widespread perception that the presence of unprofessional information on social media among the participants and their colleagues is a common occurrence. Medical educators should create awareness of the risks of unprofessional (online) behaviour among healthcare professionals, as well as the necessity and ways of addressing colleagues in case of such lapses.
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Affiliation(s)
- Sebastiaan A Pronk
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Simone L Gorter
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Scheltus J van Luijk
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Beer Binkhorst
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Blank JLT, Niaounakis TK, Valdmanis VG. Biased technical change in hospital care and the demand for physicians. Hum Resour Health 2020; 18:60. [PMID: 32819383 PMCID: PMC7441542 DOI: 10.1186/s12960-020-00500-z] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The development of labour productivity is relevant for accurately planning future staffing requirements, especially in sectors where technological developments may drive labour substitution. The present study investigates how labour productivity has developed across Dutch medical specialists (2007-2017) and discusses its implications for workforce planning, also in relation to the existing literature. METHODS A regression model is developed in which the number of full-time equivalents is related to production (admissions), hospital characteristics and a trend parameter. The trend parameter captures the average annual change in the number of full-time equivalents per production output and is a measure for labour productivity. The model is applied to a micro-data set of Dutch hospitals in the period 2007-2017 across 24 different specialties using regression methods. RESULTS The results indicate an increase in the number of full-time equivalents per admission has increased for most specialisms and that labour productivity has thus decreased. However, there is considerable heterogeneity and uncertainty across different specialisms. CONCLUSIONS The results amplify the issue of medical personnel shortages driven by the growing demand for health care. The research outcomes are linked to the existing literature regarding physicians' productivity. Changes in accountability such as using relative value units, incentive payments, use of staff and mid-level providers, and technology have been discussed, and some consensus has been reached.
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Affiliation(s)
- Jos L. T. Blank
- Institute of Public Sector Efficiency Studies, Delft University of Technology, P.O. Box 5015, 2600 GA Delft, the Netherlands
| | - Thomas K. Niaounakis
- Institute of Public Sector Efficiency Studies, Delft University of Technology, P.O. Box 5015, 2600 GA Delft, the Netherlands
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Schröder AK, Fassmer AM, Allers K, Hoffmann F. Needs and availability of medical specialists' and allied health professionals' visits in German nursing homes: a cross-sectional study of nursing home staff. BMC Health Serv Res 2020; 20:332. [PMID: 32317028 PMCID: PMC7171863 DOI: 10.1186/s12913-020-05169-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The medical care for nursing home residents is estimated to be partly inadequate in Germany. The aim of this study is to investigate the needs and utilization of general practitioners (GPs), medical specialists and allied health professionals. METHODS A survey was sent to a nationwide random sample of 1069 nursing homes in Germany in January 2019. Nursing staff managers were asked about medical care. Regular nursing home visits by medical specialists and allied health professionals were defined as at least one contact per year to at least one nursing home resident. RESULTS A total of 486 persons responded (45.5%). On average, nursing homes have contact to 8.6 (interquartile range: 4-10) different GPs. Almost 70% of respondents agreed that residents' medical care should be coordinated by GPs. However, only 46.0% stated that specialist treatment should require GP referral. A high need was seen for care from physiotherapists (91.0%), neurologists or psychiatrists (89.3%), dentists (73.7%), and urologists (71.3%). Regarding the actual utilization of medical specialists and health professionals, most nursing homes have regular contact to physiotherapists (97.1%), psychiatrists or neurologists (90.4%), speech therapists (85.0%), and dentists (84.8%). Remarkable discrepancies between need and utilization were found for urologists and ophthalmologists. CONCLUSION There is large variance in the number of GPs per nursing home, and needs for medical specialists, especially urologists and ophthalmologists, seem unmet. Interprofessional collaboration between GPs, medical specialists and allied health professionals should be improved, and GPs should play a more coordinating role.
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Affiliation(s)
- Ann-Kristin Schröder
- Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | - Alexander Maximilian Fassmer
- Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Kersemaekers WM, Vreeling K, Verweij H, van der Drift M, Cillessen L, van Dierendonck D, Speckens AEM. Effectiveness and feasibility of a mindful leadership course for medical specialists: a pilot study. BMC Med Educ 2020; 20:34. [PMID: 32019524 PMCID: PMC7001198 DOI: 10.1186/s12909-020-1948-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Medical specialists experience high levels of stress. This has an impact on their well-being, but also on quality of their leadership. In the current mixed method study, the feasibility and effectiveness of a course Mindful Leadership on burnout, well-being and leadership skills of medical specialists were evaluated. METHODS This is a non-randomized controlled pre-post evaluation using self-report questionnaires administered at 3 months before (control period), start and end of the training (intervention period). Burn-out symptoms, well-being and leadership skills were assessed with self-report questionnaires. Semi-structured interviews were used to qualitatively evaluate barriers and facilitators for completion of the course. RESULTS From September 2014 to June 2016, 52 medical specialists participated in the study. Of these, 48 (92%) completed the course. Compared to the control period, the intervention period resulted in greater reductions of depersonalization (mean difference = - 1.2, p = 0.06), worry (mean difference = - 4.3, p = 0.04) and negative work-home interference (mean difference = - 0.2, p = 0.03), and greater improvements of mindfulness (mean difference = 0.5, p = 0.04), life satisfaction (mean difference = 0.4, p = 0.01) and self-reported ethical leadership (mean difference = 0.1, p = 0.02). Effect sizes were generally small to medium (0.3 to 0.6) and large for life satisfaction (0.8). Appreciation of course elements was a major facilitator and the difficulty of finding time a major barrier for participating. CONCLUSIONS A 'Mindful Leadership' course was feasible and not only effective in reducing burnout symptoms and improving well-being, but also appeared to have potential for improving leadership skills. Mindful leadership courses could be a valuable part of ongoing professional development programs for medical specialists.
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Affiliation(s)
- Wendy M. Kersemaekers
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Kiki Vreeling
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hanne Verweij
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Miep van der Drift
- Department of Respiratory Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Linda Cillessen
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dirk van Dierendonck
- Department of Organisation and Personnel Management, Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands
| | - Anne E. M. Speckens
- Radboudumc Center for Mindfulness, Department of Psychiatry, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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van der Burgt SME, Kusurkar RA, Wilschut JA, Tjin A Tsoi SLNM, Croiset G, Peerdeman SM. Medical specialists' basic psychological needs, and motivation for work and lifelong learning: a two-step factor score path analysis. BMC Med Educ 2019; 19:339. [PMID: 31488116 PMCID: PMC6728936 DOI: 10.1186/s12909-019-1754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/14/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Continuing professional development and lifelong learning are crucial to secure safe and good quality healthcare. Lack of motivation has been found to be among the most important barriers for participation in lifelong learning. This study was conducted to investigate the relationships between medical specialists' work motivation, lifelong learning motivation, autonomy, competence and relatedness satisfaction. METHODS Self-Determination Theory was used as a theoretical framework for this study. Data were collected through an online survey, that was sent to all (N = 1591) medical specialists in four Dutch hospitals. The survey measured background characteristics, autonomy, competence, and relatedness satisfaction, autonomous and controlled work motivation, and lifelong learning motivation. Two step factor path analysis with the method of Croon was used to analyze the data from 193 cases. RESULTS Autonomy need satisfaction was positively associated with autonomous work motivation which in turn was positively associated with lifelong learning motivation. Competence need satisfaction and age were negatively associated with controlled work motivation. Competence need satisfaction was also positively related with lifelong learning motivation. No significant nor any hypothesized associations were found for relatedness. CONCLUSIONS Our findings, in line with Self-determination Theory literature, show that autonomy and competence need satisfaction are the important factors as they were positively associated with medical specialists' motivation for work and for lifelong learning.
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Affiliation(s)
- Stéphanie M. E. van der Burgt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Research in Education, VUmc School of Medical Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Rashmi A. Kusurkar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Research in Education, VUmc School of Medical Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Janneke A. Wilschut
- Department of Epidemiology & Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sharon L. N. M. Tjin A Tsoi
- PAOFarmacie, The Netherlands Centre for Post-Academic Education in Pharmacy, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerda Croiset
- Amsterdam UMC, Vrije Universiteit Amsterdam, Research in Education, VUmc School of Medical Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Saskia M. Peerdeman
- Department of Neurosurgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Alders I, Henselmans I, Smits C, Visscher T, Heijmans M, Rademakers J, Brand PLP, van Dulmen S. Patient coaching in specialist consultations. Which patients are interested in a coach and what communication barriers do they perceive? Patient Educ Couns 2019; 102:1520-1527. [PMID: 30910403 DOI: 10.1016/j.pec.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/06/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To characterize patients interested in support by a patient coach to guide them in medical specialist consultations. METHODS We compared 76 patients interested in a patient coach with 381 patients without such an interest, using a representative panel of patients with a chronic disease in the Netherlands. Independent variables were demographic factors, socio-economic status, perceived efficacy in patient-provider interaction, communication barriers, health literacy, (duration and type of) disease(s) and activation level. RESULTS In univariate analyses, patients who are interested in a coach were significantly older, had lower health literacy skills and less self-efficacy and, overall, experienced more communication barriers (>4), than patients without such interest (1-2 barriers). Multivariate analyses indicated three communications barriers as determinants of patient interest in a coach: feeling tense, uncertainty about own understanding, and believing that a certain topic is not part of a healthcare providers' task. CONCLUSION Patients interested in a coach perceive specific barriers in communicating with their medical specialist. In addition, patients who are > = 65 years, have lower health literacy and low self-efficacy may have interest in a coach. PRACTICE IMPLICATIONS Characterizing patients interested in a patient coach facilitates identification of those who could benefit from such a coach in clinical practice.
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Affiliation(s)
- Irèn Alders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Windesheim University of Applied Sciences, Zwolle, the Netherlands.
| | - Inge Henselmans
- Dept. of Medical Psychology Academic Medical Centre University of Amsterdam, the Netherlands
| | - Carolien Smits
- Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Tommy Visscher
- Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Monique Heijmans
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Dept. of General Practice, CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Paul L P Brand
- Isala, Zwolle, the Netherlands; UMCG, Groningen, the Netherlands
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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12
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Bayat M, Salehi Zalani G, Harirchi I, Shokri A, Mirbahaeddin E, Khalilnezhad R, Khodadost M, Yaseri M, Jaafaripooyan E, Akbari-Sari A. Extent and nature of dual practice engagement among Iran medical specialists. Hum Resour Health 2018; 16:61. [PMID: 30453977 PMCID: PMC6245857 DOI: 10.1186/s12960-018-0326-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dual practice (DP) by medical specialists is a widespread issue across health systems. This study aims to determine the level of DP engagement among Iran's specialists. METHODS A pre-structured form was developed to collect the data about medical specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes, and eventually a combination of the first name, surname, and father's name. RESULTS A total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals. Sixteen thousand eight hundred forty-nine (69% of) specialists were non-faculty members and 6317 (26% of) specialists were employed on a contract basis. Eleven thousand six hundred and thirty-eight (47.7% of) specialists were engaged in DP on total. Female specialists had 0.78 times less DP chance; faculties compared to non-faculties had 0.65 times more DP chance and full-time geographic specialists compared to non-full-time specialists had 0.15 times more DP chance. DP was more frequent in specialists with higher age and more job experience and in provinces with more population, deprivation, and higher number of specialists per facility (P < 0.05). CONCLUSIONS The level of DP is relatively high among Iran medical specialists, especially in geographic full-time specialists. However, they are totally banned and they receive extra payment for being full-time; restrictive regulations and financial incentives without considering other factors might not eliminate DP in specialists and it should be addressed based on conditions of each country and regions inside the country.
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Affiliation(s)
- Mahboubeh Bayat
- Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran
| | - Gholamhossein Salehi Zalani
- Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran
| | - Iraj Harirchi
- Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Azad Shokri
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Islamic Republic of Iran
| | | | - Roghayeh Khalilnezhad
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mehdi Yaseri
- Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina St, 16 Azar St, Bolvar Keshavarz, Tehran, Islamic Republic of Iran
| | - Ali Akbari-Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina St, 16 Azar St, Bolvar Keshavarz, Tehran, Islamic Republic of Iran
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Alders I, Smits C, Brand P, van Dulmen S. Does patient coaching make a difference in patient-physician communication during specialist consultations? A systematic review. Patient Educ Couns 2017; 100:882-896. [PMID: 28089309 DOI: 10.1016/j.pec.2016.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/24/2016] [Accepted: 12/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To systematically review the literature on the effectiveness of a patient coach intervention on patient - physician communication in specialists consultations. METHODS PubMed, Cochrane, PsycInfo, Cinahl and Embase were searched until November 2015. Included were papers describing interventions directed at adult outpatients in secondary care with a variety of somatic diseases. Outcomes had to be measured in communication effectivity from a patient's perspective. RESULTS Seventeen publications met the inclusion criteria (involving 3787 patients), describing 13 unique interventions. Most interventions were single one-on-one sessions taking between 20 and 40min before consultation. Research quality in ten studies was high. These studies showed significant improvement on immediate, intermediate and long term patient - physician communication. CONCLUSION We found limited evidence suggesting an improvement of patient - physician communication by having multiple patient coaching encounters during which questions are prepared and rehearsed and consultations are evaluated and reflected upon, sometimes supported by audio recording the consultation. PRACTICE IMPLICATIONS The results of this review contribute to the (re-)design of an effective model for patient coaching, a profile and training approach of patient coaches. Future research should aim at determining which patients will benefit most from coaching interventions.
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Affiliation(s)
- Irèn Alders
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; Research Group Innovation with Older Adults, Windesheim, University of Applied Sciences, Zwolle, the Netherlands.
| | - Carolien Smits
- Research Group Innovation with Older Adults, Windesheim, University of Applied Sciences, Zwolle, the Netherlands
| | - Paul Brand
- Amalia Children's Centre Isala, Zwolle, the Netherlands; University Medical Centre Groningen, the Netherlands
| | - Sandra van Dulmen
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Dinkel A, Schneider A, Schmutzer G, Brähler E, Häuser W. Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study. Patient Educ Couns 2016; 99:1213-1219. [PMID: 26924610 DOI: 10.1016/j.pec.2016.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 02/09/2016] [Accepted: 02/12/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care. METHODS Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. RESULTS Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. CONCLUSIONS The quality of the family physician-patient relationship is not independently associated with frequent attendance. PRACTICE IMPLICATIONS Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Antonius Schneider
- Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Gabriele Schmutzer
- Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany.
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg Universität Mainz, Mainz, Germany.
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.
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Westra D, Angeli F, Jatautaitė E, Carree M, Ruwaard D. Understanding specialist sharing: A mixed-method exploration in an increasingly price-competitive hospital market. Soc Sci Med 2016; 162:133-42. [PMID: 27348610 DOI: 10.1016/j.socscimed.2016.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/18/2015] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Medical specialists seem to increasingly work in- and be affiliated to- multiple organizations. We define this phenomenon as specialist sharing. This form of inter-organizational cooperation has received scant scholarly attention. We investigate the extent of- and motives behind- specialist sharing, in the price-competitive hospital market of the Netherlands. METHODS A mixed-method was adopted. Social network analysis was used to quantitatively examine the extent of the phenomenon. The affiliations of more than 15,000 medical specialists to any Dutch hospital were transformed into 27 inter-hospital networks, one for each medical specialty, in 2013 and in 2015. Between February 2014 and February 2016, 24 semi-structured interviews with 20 specialists from 13 medical specialties and four hospital executives were conducted to provide in-depth qualitative insights regarding the personal and organizational motives behind the phenomenon. RESULTS Roughly, 20% of all medical specialists are affiliated to multiple hospitals. The phenomenon occurs in all medical specialties and all Dutch hospitals share medical specialists. Rates of specialist sharing have increased significantly between 2013 and 2015 in 14 of the 27 specialties. Personal motives predominantly include learning, efficiency, and financial benefits. Increased workload and discontinuity of care are perceived as potential drawbacks. Hospitals possess the final authority to decide whether and which specialists are shared. Adhering to volume norms and strategic considerations are seen as their main drivers to share specialists. DISCUSSION We conclude that specialist sharing should be interpreted as a form of inter-organizational cooperation between healthcare organizations, facilitating knowledge flow between them. Although quality improvement is an important perceived factor underpinning specialist sharing, evidence of enhanced quality of care is anecdotal. Additionally, the widespread occurrence of the phenomenon and the underlying strategic considerations could pose an antitrust infringement.
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Affiliation(s)
- Daan Westra
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Federica Angeli
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Evelina Jatautaitė
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - Martin Carree
- Department of Organization and Strategy, School of Business and Economics, Maastricht University, Tongersestraat 53, 6211 LM, Maastricht, the Netherlands.
| | - Dirk Ruwaard
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
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De Snoo-Trimp JC, Brom L, Pasman HRW, Onwuteaka-Philipsen BD, Widdershoven GAM. Perspectives of Medical Specialists on Sharing Decisions in Cancer Care: A Qualitative Study Concerning Chemotherapy Decisions With Patients With Recurrent Glioblastoma. Oncologist 2015; 20:1182-8. [PMID: 26245676 DOI: 10.1634/theoncologist.2015-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/09/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In cancer care, difficult decisions concerning advanced treatment need to be made, weighing possible life prolongation against harmful side effects. Treatment is frequently started, showing the need to explore how decisions are made. Little is known about the perspectives of physicians on sharing decision making with patients. This qualitative study aimed to describe the perspectives of medical specialists on the decision-making process with patients with glioblastoma concerning starting new treatment. METHODS Qualitative interviews were held with medical specialists. One focus group was organized with medical professionals. Their opinions about elements of shared decision making and the applicability in the context of patients with glioblastoma were assessed. The topic list for the focus group was based on the analysis of the interviews. Qualitative analysis of the transcripts was performed by three researchers independently. RESULTS Medical specialists considered shared decision making to be important; however, they did not adhere to its elements. Stopping treatment was not considered equal to continuing treatment. Exploration of the patients' wishes was done implicitly, and shared responsibility for the decision was not highly recognized. The main barriers to shared decision making were preferences of both patients and specialists for starting or continuing treatment and assumptions of physicians about knowing what patients want. CONCLUSION Medical specialists recognized the importance of patient involvement but experienced difficulty in sharing decision making in practice. Elements of shared decision making are partly followed but do not guide decision making. To improve cancer care, education of medical specialists and adjustment to the elements are needed to involve patients.
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Affiliation(s)
- Janine C De Snoo-Trimp
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Linda Brom
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - H Roeline W Pasman
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Guy A M Widdershoven
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
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Weiland A, Blankenstein AH, Willems MHA, Van Saase JLCM, Van der Molen HT, Van Dulmen AM, Arends LR. Post-graduate education for medical specialists focused on patients with medically unexplained physical symptoms; development of a communication skills training programme. Patient Educ Couns 2013; 92:355-360. [PMID: 23906652 DOI: 10.1016/j.pec.2013.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 06/23/2013] [Accepted: 06/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Stepwise description of the development of a post-graduate communication skills training programme for medical specialists focused on patients with medically unexplained physical symptoms (MUPS) to improve specialist interaction with MUPS patients. METHODS Using the 'intervention mapping approach' we accomplished a needs assessment (literature study and pilot) to formulate intervention objectives and identify methods and techniques for a MUPS-focused communication skills training programme for medical specialists. RESULTS A 14-h training programme which consists of experiential learning, role-play and feedback. Using skills from Cognitive Behavioural Therapy, medical specialists are stimulated to explore interrelating factors that reinforce symptoms, to reassure patients effectively and to provide plausible and understandable explanations for MUPS. Dealing with complex referrals and informing GPs properly are also practiced. CONCLUSION By applying the 'intervention mapping approach' we were able to create a feasible and promising intervention to improve specialist interaction with MUPS patients. Intervention effects are currently being assessed in a randomized controlled trial. PRACTICE IMPLICATIONS If the RCT demonstrates sufficient effectiveness and efficiency of the MUPS focused communication skills training programme for medical specialists the intervention could be embedded in post-graduate education of medical specialists and residents.
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Affiliation(s)
- Anne Weiland
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Weiland A, Van de Kraats RE, Blankenstein AH, Van Saase JLCM, Van der Molen HT, Bramer WM, Van Dulmen AM, Arends LR. Encounters between medical specialists and patients with medically unexplained physical symptoms; influences of communication on patient outcomes and use of health care: a literature overview. Perspect Med Educ 2012; 1:192-206. [PMID: 23205344 PMCID: PMC3508274 DOI: 10.1007/s40037-012-0025-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Medically unexplained physical symptoms (MUPS) burden patients and health services due to large quantities of consultations and medical interventions. The aim of this study is to determine which elements of communication in non-psychiatric specialist MUPS care influence health outcomes. Systematic search in PubMed, PsycINFO and Embase. Data extraction comprising study design, patient characteristics, number of patients, communication strategies, outcome measures and results. Elements of doctor-patient communication were framed according to symptoms, health anxiety, satisfaction, daily functioning and use of health care. Eight included studies. Two studies described the effect of communication on patient outcome in physical symptoms, three studies on health anxiety and patient satisfaction and one study on daily functioning. Two studies contained research on use of health care. Qualitative synthesis of findings was conducted. Communication matters in non-psychiatric MUPS specialist care. Perceiving patients' expectations correctly enables specialists to influence patients' cognitions, to reduce patients' anxiety and improve patients' satisfaction. Patients report less symptoms and health anxiety when symptoms are properly explained. Positive interaction and feedback reduces use of health care and improves coping. Development of communication skills focused on MUPS patients should be part of postgraduate education for medical specialists.
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Affiliation(s)
- Anne Weiland
- Department of Internal Medicine, Erasmus MC, University Medical Center, 2040, 3000 CA, Rotterdam, the Netherlands.
- Faculty of Social Sciences, Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | | | - Annette H Blankenstein
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Jan L C M Van Saase
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Henk T Van der Molen
- Faculty of Social Sciences, Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alexandra M Van Dulmen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Department of Health Science, Buskerud University College, Drammen, Norway
| | - Lidia R Arends
- Faculty of Social Sciences, Institute of Psychology and Institute of Pedagogy, Erasmus University, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Abstract
Karlijn Overeem, general practitioner and researcher, defended her thesis on 15 November 2011. The thesis concerns the development and implementation of a performance assessment system for medical specialists (consultants) in Dutch hospitals. Besides the use of multisource feedback, the assessments consist of a portfolio and an assessment interview with a trained colleague. The thesis comprises: a review, two qualitative studies and three quantitative studies.
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Affiliation(s)
- Karlijn Overeem
- IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Present Address: Department of Educational Research and Development, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 Maastricht, the Netherlands
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