Communication about sexual health with breast cancer survivors: Variation among patient and provider perspectives.

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Canzona, Mollie Rose; Garcia, David; Fisher, Carla L; Raleigh, Meghan; Kalish, Virginia; Ledford, Christy J W

2016-11-01

Breast cancer survivors experience a range of sexual health (SH) issues. Communication problems between patient and provider can prevent survivors from pursuing SH goals and can negatively influence biopsychosocial outcomes. The primary aims of this study were to identify provider communication behaviors that facilitate or impede clinical interactions regarding SH (according to survivors and providers) and to highlight discrepancies that affect care. Forty breast cancer survivors and forty health care providers from a variety of specialties participated in semi-structured interviews informed by the Critical Incident Technique. Transcripts were thematically analyzed using the constant comparative method. Survivors and providers discussed the importance of honoring individual patient needs and conveying compassionate messages. However, accounts varied significantly regarding the appropriate timing and method of initiating SH discussions and the helpfulness of certain support behaviors and linguistic devices. Provider and survivor accounts of what constitutes helpful and unhelpful provider communication behaviors when discussing SH concerns are misaligned in nuanced and meaningful ways. These discrepancies reveal potential areas for educational intervention. SH discussions require providers to examine assumptions about patients' communication preferences and information needs. Patients may benefit from frank yet sensitive discussions earlier in the cancer continuum. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review.

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Voruganti, Teja; Grunfeld, Eva; Makuwaza, Tutsirai; Bender, Jacqueline L

2017-10-27

Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14

Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer.

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Nyrop, Kirsten A; Deal, Allison M; Williams, Grant R; Guerard, Emily J; Pergolotti, Mackenzi; Muss, Hyman B

2016-02-01

National guidelines recommend that patients with a cancer diagnosis engage in regular physical activity to reduce cancer-related fatigue, maintain quality of life and physical function, and improve overall prognosis and survival. This study investigates oncology provider communications about physical activity during routine clinic visits with patients with early-stage breast, colon, or prostate cancer. This study used a retrospective chart review for documentation of inquiries or recommendations pertaining to physical activity in clinician notes and after-visit patient summaries. In a 1-month period, 55 oncology providers had 361 encounters (clinic visits) with early-stage cancer patients. Thirty-five percent of these encounters included a provider communication about "physical activity," "exercise," or "activity." Encounters with a medical oncologist resulted in a physical activity communication 55% of the time, whereas encounters with other clinician specialties did so 20% of the time (P communication increased with patient age (P communications was significantly higher (46%, 37%, and 58%, respectively) than the rate when the visit was during radiation treatment or surgery (6% and 19%, respectively; P communications during routine clinic visits; however, the frequency of physical activity communications varies among providers. Interventions are needed to remind and encourage all oncology providers to encourage their patients with early-stage cancer to be physically active. . © 2015 American Cancer Society.

Effective communication with primary care providers.

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Smith, Karen

2014-08-01

Effective communication requires direct interaction between the hospitalist and the primary care provider using a standardized method of information exchange with the opportunity to ask questions and assign accountability for follow-up roles. The discharge summary is part of the process but does not provide the important aspects of handoff, such as closed loop communication and role assignments. Hospital discharge is a significant safety risk for patients, with more than half of discharged patients experiencing at least one error. Hospitalist and primary care providers need to collaborate to develop a standardized system to communicate about shared patients that meets handoff requirements. Copyright © 2014 Elsevier Inc. All rights reserved.

Disparities in perceived patient-provider communication quality in the United States: Trends and correlates.

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Spooner, Kiara K; Salemi, Jason L; Salihu, Hamisu M; Zoorob, Roger J

2016-05-01

This study aimed to describe disparities and temporal trends in the level of perceived patient-provider communication quality (PPPCQ) in the United States, and to identify sociodemographic and health-related factors associated with elements of PPPCQ. A cross-sectional analysis was conducted using nationally-representative data from the 2011-2013 iterations of the Health Information National Trends Survey (HINTS). Descriptive statistics, multivariable linear and logistic regression analyses were conducted to examine associations. PPPCQ scores, the composite measure of patients' ratings of communication quality, were positive overall (82.8; 95% CI: 82.1-83.5). However, less than half (42-46%) of respondents perceived that providers always addressed their feelings, spent enough time with them, or helped with feelings of uncertainty about their health. Older adults and those with a regular provider consistently had higher PPPCQ scores, while those with poorer perceived general health were consistently less likely to have positive perceptions of their providers' communication behaviors. Disparities in PPPCQ can be attributed to patients' age, race/ethnicity, educational attainment, employment status, income, healthcare access and general health. These findings may inform educational and policy efforts which aim to improve patient-provider communication, enhance the quality of care, and reduce health disparities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Influence of English proficiency on patient-provider communication and shared decision-making.

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Paredes, Anghela Z; Idrees, Jay J; Beal, Eliza W; Chen, Qinyu; Cerier, Emily; Okunrintemi, Victor; Olsen, Griffin; Sun, Steven; Cloyd, Jordan M; Pawlik, Timothy M

2018-06-01

The number of patients in the United States (US) who speak a language other than English is increasing. We evaluated the impact of English proficiency on self-reported patient-provider communication and shared decision-making. The 2013-2014 Medical Expenditure Panel Survey database was utilized to identify respondents who spoke a language other than English. Patient-provider communication (PPC) and shared decision-making (SDM) scores from 4-12 were categorized as "poor" (4-7), "average" (8-11), and "optimal." The relationship between PPC, SDM, and English proficiency was analyzed. Among 13,880 respondents, most were white (n = 10,281, 75%), age 18-39 (n = 6,677, 48%), male (n = 7,275, 52%), middle income (n = 4,125, 30%), and born outside of the US (n = 9,125, 65%). English proficiency was rated as "very well" (n = 7,221, 52%), "well" (n = 2,378, 17%), "not well" (n = 2,820, 20%), or "not at all" (n = 1,463, 10%). On multivariable analysis, patients who rated their English as "well" (OR 1.73, 95% CI 1.37-2.18) or "not well" (OR 1.53, 95% CI 1.10-2.14) were more likely to report "poor" PPC (both P English proficiency as "not well" (OR 1.31, 95% CI 1.04-1.65, P = .02). Decreased English proficiency was associated with worse self-reported patient-provider communication and shared decision-making. Attention to patients' language needs is critical to patient satisfaction and improved perception of care. Copyright © 2018 Elsevier Inc. All rights reserved.

Communication at an online infertility expert forum: provider responses to patients' emotional and informational cues.

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Aarts, J W M; van Oers, A M; Faber, M J; Cohlen, B J; Nelen, W L D M; Kremer, J A M; van Dulmen, A M

2015-01-01

Online patient-provider communication has become increasingly popular in fertility care. However, it is not known to what extent patients express cues or concerns and how providers respond. In this study, we investigated cues and responses that occur in online patient-provider communication at an infertility-specific expert forum. We extracted 106 threads from the multidisciplinary expert forum of two Dutch IVF clinics. We performed the following analyses: (1) thematic analysis of patients' questions; and (2) rating patients' emotional and informational cues and subsequent professionals' responses using an adaptation of the validated Medical Interview Aural Rating Scale. Frequencies of themes, frequencies of cues and responses, and sequences (what cue is followed by what response) were extracted. Sixty-five infertile patients and 19 providers participated. The most common themes included medication and lifestyle. Patients gave more informational than emotional cues (106 versus 64). Responses to informational cues were mostly adequate (61%). The most common response to emotional cues was empathic acknowledgment (72%). Results indicate that an online expert forum could have a positive effect on patient outcomes, which should guide future research. Offering infertile patients an expert forum to communicate with providers can be a promising supplement to usual care in both providing information and addressing patients' concerns.

Health literacy in the "oral exchange": an important element of patient-provider communication.

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Nouri, Sarah S; Rudd, Rima E

2015-05-01

Oral communication between health care providers and patients--the "oral exchange"--greatly impacts patient health outcomes; however, only recently have health literacy inquiries been incorporated into this field. This review examines the intersection between oral and aural literacy and the oral exchange. A systematic literature search was carried out. Papers published in English since 2003 that specifically examine oral/aural literacy and oral patient-provider communication were included. The search yielded 999 articles, 12 of which were included in this review. Three tools have been developed to measure either patient or provider oral/aural literacy. There is a discrepancy between patient and provider oral/aural literacy levels, and high literacy demand is associated with reduced patient learning. Low patient oral/aural literacy is associated with poor health outcomes. Two interventions have been developed to reduce literacy demand. This review demonstrates the critical role of oral and aural literacy in the oral exchange, the importance of reducing literacy demand, and the need for future research in this field. Recommendations include the use of plain language and teach-back by providers, as well as incorporation of awareness of oral and aural literacy into community programs and health care provider education and training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Patient-provider communication and hormonal therapy side effects in breast cancer survivors.

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Lin, Jenny J; Chao, Jennifer; Bickell, Nina A; Wisnivesky, Juan P

2017-09-01

Side effects from hormonal therapy (HT) for breast cancer treatment occur frequently and are associated with worse quality of life and HT non-adherence. Whether improved patient-physician communication is associated with patients' reporting of side effects is unknown. We undertook this study to assess factors associated with women's reports of HT side effects. Between December 2012 and April 2013, we conducted a cross-sectional survey of breast cancer patients undergoing HT in an urban medical center. Descriptive statistics, univariate analyses, and multivariate analyses were used to evaluate associations. Of the 100 participants, 67% reported having HT side effects. However, when prompted, an additional 9% reported experiencing specific HT-related symptoms. Despite very high communication scores, one-third of participants reported they had not discussed side effects with providers. Multivariate analysis showed that after controlling for age, education, race, and medication beliefs, women who had difficulty asking providers for more information were more likely to report side effects (odds ratio 8.27, 95% confidence interval 1.01-69.88). Although HT side effects often occur and are bothersome, patient-provider discussions about side effects remain suboptimal. Providers should actively ask patients about medication side effects so that they can be addressed to improve quality of life and potentially, medication adherence.

An Intervention to Enhance Goals-of-Care Communication Between Heart Failure Patients and Heart Failure Providers.

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Doorenbos, Ardith Z; Levy, Wayne C; Curtis, J Randall; Dougherty, Cynthia M

2016-09-01

Heart failure patients contend with a markedly impaired quality of life, experiencing emotional distress and severe physical discomfort that increases in frequency in the last months of life. Improving communication between patients and providers about goals of care has the potential to improve patient-provider communication and patient outcomes. To determine the effects of a goals-of-care (GoC) intervention compared to usual care on the number of GoC conversations, quality of communication between patients and providers, referrals to palliative care services and completion of advance care directives. A two-group randomized study (n = 40/group) compared a GoC intervention to usual care, conducted in an academic heart failure (HF) clinic. The GoC intervention was a previsit patient activation-education, telephone-based intervention delivered by a nurse. The primary outcome of the study was number of GoC conversations between HF patients and HF providers. Secondary outcomes were quality of communication, number of referrals to palliative care, and completion of advance directives. Patients averaged 58.15 ± 11.26 years of age, with mean left ventricular ejection fraction = 30.31 ± 9.72% and Seattle Heart Failure Model scores = 95.1 ± 1.60. There was a significant increase in goals-of-care conversations (58% vs. 2.6%, P communication (P = 0.03) in the GoC group compared to usual care after the intervention. There were no differences between groups on the other outcomes. The GoC intervention resulted in more GoC conversations and higher quality communication between HF patients and providers without increased anxiety or depression. Further studies are needed to assess impact on longer term quality of care and patient outcomes. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Perceptions of Provider Communication Among Vulnerable Patients With Diabetes: Influences of Medical Mistrust and Health Literacy.

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White, Richard O; Chakkalakal, Rosette J; Presley, Caroline A; Bian, Aihua; Schildcrout, Jonathan S; Wallston, Kenneth A; Barto, Shari; Kripalani, Sunil; Rothman, Russell

2016-01-01

Patient-provider communication is modifiable and is linked to diabetes outcomes. The association of communication quality with medical mistrust is unknown. We examined these factors within the context of a low-literacy/numeracy-focused intervention to improve diabetes care, using baseline data from diverse patients enrolled in a randomized trial of a health communication intervention. Demographics, measures of health communication (Communication Assessment Tool [CAT], Interpersonal Processes of Care survey [IPC-18]), health literacy (Short Test of Functional Health Literacy in Adults), depression, medical mistrust, and glycemic control were ascertained. Adjusted proportional odds models were used to test the association of mistrust with patient-reported communication quality. The interaction effect of health literacy on mistrust and communication quality was also assessed. A total of 410 patients were analyzed. High levels of mistrust were observed. In multivariable modeling, patients with higher mistrust had lower adjusted odds of reporting a higher CAT score (adjusted odds ratio [AOR] = 0.67, 95% confidence interval [CI] [0.52, 0.86], p = .003) and higher scores on the Communication (AOR = 0.69, 95% CI [0.55, 0.88], p = .008), Decided Together (AOR = 0.74, 95% CI [0.59, 0.93], p = .02), and Interpersonal Style (AOR = 0.69, 95% CI [0.53, 0.90], p = .015) subscales of the IPC-18. We observed evidence of an interaction effect of health literacy for the association between mistrust and the Decided Together subscale of the IPC-18 such that patients with higher mistrust and lower literacy perceived worse communication relative to mistrustful patients with higher literacy. In conclusion, medical mistrust was associated with poorer communication with providers in this public health setting. Patients' health literacy level may vary the effect of mistrust on interactional aspects of communication. Providers should consider the impact of mistrust on communication

Patient-provider communication and trust in relation to use of an online patient portal among diabetes patients: The Diabetes and Aging Study.

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Lyles, Courtney R; Sarkar, Urmimala; Ralston, James D; Adler, Nancy; Schillinger, Dean; Moffet, Howard H; Huang, Elbert S; Karter, Andrew J

2013-01-01

Patient-provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user and using secure messaging (SM). We specified regression models to evaluate main effects on portal use, and subgroup analyses by race/ethnicity and age. 52% of subjects were registered users; among those, 36% used SM. Those reporting greater trust were more likely to be registered users (relative  risk (RR)=1.14) or SM users (RR=1.29). In subgroup analyses, increased trust was associated with being a registered user among white, Latino, and older patients, as well as SM use among white patients. Better communication ratings were also related to being a registered user among older patients. Since increased trust and communication were associated with portal use within subgroups, this suggests that patient-provider relationships encourage portal engagement.

A mixed methods study of patient-provider communication about opioid analgesics.

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Hughes, Helen Kinsman; Korthuis, Philip Todd; Saha, Somnath; Eggly, Susan; Sharp, Victoria; Cohn, Jonathan; Moore, Richard; Beach, Mary Catherine

2015-04-01

To describe patient-provider communication about opioid pain medicine and explore how these discussions affect provider attitudes toward patients. We audio-recorded 45 HIV providers and 423 patients in routine outpatient encounters at four sites across the country. Providers completed post-visit questionnaires assessing their attitudes toward patients. We identified discussions about opioid pain management and analyzed them qualitatively. We used logistic regression to assess the association between opioid discussion and providers' attitudes toward patients. 48 encounters (11% of the total sample) contained substantive discussion of opioid-related pain management. Most conversations were initiated by patients (n=28, 58%) and ended by the providers (n=36, 75%). Twelve encounters (25%) contained dialog suggesting a difference of opinion or conflict. Providers more often agreed than disagreed to give the prescription (50% vs. 23%), sometimes reluctantly; in 27% (n=13) of encounters, no decision was made. Fewer than half of providers (n=20, 42%) acknowledged the patient's experience of pain. Providers had a lower odds of positive regard for the patient (adjusted OR=0.51, 95% CI: 0.27-0.95) when opioids were discussed. Pain management discussions are common in routine outpatient HIV encounters and providers may regard patients less favorably if opioids are discussed during visits. The sometimes-adversarial nature of these discussions may negatively affect provider attitudes toward patients. Empathy and pain acknowledgment are tools that clinicians can use to facilitate productive discussions of pain management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Gender differences in health care provider-patient communication: are they due to style, stereotypes, or accommodation?

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Street, Richard L

2002-12-01

This article examines gender differences in health care provider-patient communication within the framework of an ecological model of communication in the medical encounter. The ecological perspective posits that, although health care provider-patient interactions are situated within a number of contexts (e.g. organizational, political, cultural), the interpersonal domain is the primary context within which these interactions unfold. Hence, gender may influence provider-patient interaction to the extent that it can be linked to the interactants' goals, skills, perceptions, emotions, and the way the participants adapt to their partner's communication. The evidence reviewed in this essay indicates that gender differences in medical encounters may come from several sources including differences in men's and women's communicative styles, perceptions of their partners, and in the way they accommodate their partner's behavior during the interaction. However, because gender is but one of many personal and partner variables (e.g. age, ethnicity, personal experiences) that can influence these processes, gender differences are often quite modest (if apparent at all) when examined across a population of health care providers and patients. Implications for future research and communicative skill training are discussed.

Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting.

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Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A

2017-02-01

Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

Patient-Provider Communication: Experiences of Low-Wage-Earning Breast Cancer Survivors in Managing Cancer and Work.

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Nichols, Helen M; Swanberg, Jennifer E; Vanderpool, Robin C

2018-02-26

In 2017, there will be more than 250,000 new diagnoses of invasive breast cancer; most cases will occur in working-age women. The goal of this qualitative study was to explore low-wage-earning breast cancer survivors' experiences communicating with their oncology team about cancer and employment issues. Twenty-four low-wage-earning breast cancer survivors in the USA were interviewed in 2012 using a structured interview protocol. Sociodemographic data, cancer history, and patient-provider communication experiences regarding the management of cancer and work were collected. Interviews were analyzed using grounded theory strategy of constant comparative analysis. Low-wage-earning breast cancer survivors' experiences communicating with their oncology team about employment and cancer focused on three dimensions of patient-provider communication: extent, quality, and content. Over 70% of respondents reported no communication or only routine communication with their providers regarding work; three quarters of women reported poor or standard communication quality, and content of work-related communication covered scheduling issues, work absences, continuing to work during treatment, and financial concerns. Communication between oncology care teams and low-wage-earning cancer patients is critical to the successful management of treatment and work responsibilities given the vulnerable employment situation of these women. There is a need for education of oncology team members about how cancer and its treatment can impact employment for all workers, but especially for low-wage workers, thereby allowing the care team to address these issues proactively and help patients successfully manage both cancer treatment and work responsibilities.

The role of provider-patient communication and trust in online sources in Internet use for health-related activities.

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Hou, Jiran; Shim, Minsun

2010-01-01

Provider-patient communication is an important factor influencing patients' satisfaction and health outcomes. This study draws upon the uses and gratification theory to examine how individuals' perception of communication with healthcare providers is associated with their Internet use for health-related activities. Using the data from the 2007 Health Information National Trends Survey (HINTS), we found that as individuals perceived their communication with providers to be less patient-centered, they were more likely to engage in various types of online health activities, such as using websites for healthy lifestyles, searching for healthcare providers, and seeking health information. Trust in online health information was also found to be a significant predictor of online health activities. The results of this study emphasized the important role of provider-patient communication in motivating individuals to turn to the Internet for health purposes.

Patient-Provider Communication: Does Electronic Messaging Reduce Incoming Telephone Calls?

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Dexter, Eve N; Fields, Scott; Rdesinski, Rebecca E; Sachdeva, Bhavaya; Yamashita, Daisuke; Marino, Miguel

2016-01-01

Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees. A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages-a common attribute of Internet-based patient portals-and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital. All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload. © Copyright 2016 by the American Board of Family Medicine.

Measuring patient-provider communication skills in Rwanda: Selection, adaptation and assessment of psychometric properties of the Communication Assessment Tool.

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Cubaka, Vincent Kalumire; Schriver, Michael; Vedsted, Peter; Makoul, Gregory; Kallestrup, Per

2018-04-23

To identify, adapt and validate a measure for providers' communication and interpersonal skills in Rwanda. After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed. Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted. Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa = 0.81 (range: 0.69-0.89, N = 57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9-21.8%, N = 180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p = 0.02, N = 180). The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers' communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation. K-CAT is expected to be a valuable feedback tool for providers in practice and in training. Copyright © 2018 Elsevier B.V. All rights reserved.

Mobile-based patient-provider communication in cancer survivors: The roles of health literacy and patient activation.

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Jiang, Shaohai; Hong, Y Alicia

2018-03-01

Thanks to rapid penetration of mobile tools, more and more cancer survivors have adopted mobile-based patient-provider communication (MBPPC). The relationship between MBPPC and patients' health outcomes, however, remains unclear; how health literacy and patient activation interact with such relationship is unexplored. Data were drawn from National Cancer Institute's Health Information National Trends Survey 4 Cycle 3. A sample of 459 cancer survivors were included in the analysis. Based on the 3-stage model of health promotion using interactive media, this study empirically tested a moderated mediation model. MBPPC (eg, patient use of email, text message, mobile app, and social media to communicate with providers) had no direct effect on cancer survivors' emotional health. Instead, health literacy completely mediated this path. Patient activation positively moderated the effect of health literacy on emotional health and further increased the indirect effect of MBPPC on emotional health. MBPPC alone does not directly result in better emotional health outcomes; health literacy is the key to realize its health benefits; patient activation significantly strengthens the effects of MBPPC. As we embrace the mHealth movement, innovative programs are needed to promote MBPPC, and improve health literacy and activation of cancer survivors, particularly in underserved communities, to reduce health disparities. Copyright © 2017 John Wiley & Sons, Ltd.

Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes.

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Jesus, Tiago Silva; Silva, Isabel Lopes

2016-04-01

There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) 'how' rehabilitation outcomes can be improved by communication; and (b) through 'which' elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the '4 Rehab Communication Elements' deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the '4 Rehab Communication Elements'. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes. © The Author(s) 2015.

Narrative in interprofessional education and practice: implications for professional identity, provider-patient communication and teamwork.

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Clark, Phillip G

2014-01-01

Health and social care professionals increasingly use narrative approaches to focus on the patient and to communicate with each other. Both effective interprofessional education (IPE) and practice (IPP) require recognizing the various values and voices of different professions, how they relate to the patient's life story, and how they interact with each other at the level of the healthcare team. This article analyzes and integrates the literature on narrative to explore: self-narrative as an expression of one's professional identity; the co-creation of the patient's narrative by the professional and the patient; and the interprofessional multi-vocal narrative discourse as co-constructed by members of the healthcare team. Using a narrative approach to thinking about professional identity, provider-patient communication, and interprofessional teamwork expands our thinking about both IPE and IPP by providing new insights into the nature of professional practice based on relationships to oneself, the patient, and others on the team. How professionals define themselves, gather and present information from the patient, and communicate as members of a clinical team all have important dimensions that can be revealed by a narrative approach. Implications and conclusions for the further development of the narrative approach in IPE and IPP are offered.

Communication between office-based primary care providers and nurses working within patients' homes: an analysis of process data from CAPABLE.

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Smith, Patrick D; Boyd, Cynthia; Bellantoni, Julia; Roth, Jill; Becker, Kathleen L; Savage, Jessica; Nkimbeng, Manka; Szanton, Sarah L

2016-02-01

To examine themes of communication between office-based primary care providers and nurses working in private residences; to assess which methods of communication elicit fruitful responses to nurses' concerns. Lack of effective communication between home health care nurses and primary care providers contributes to clinical errors, inefficient care delivery and decreased patient safety. Few studies have described best practices related to frequency, methods and reasons for communication between community-based nurses and primary care providers. Secondary analysis of process data from 'Community Aging in Place: Advancing Better Living for Elders (CAPABLE)'. Independent reviewers analysed nurse documentation of communication (phone calls, letters and client coaching) initiated for 70 patients and analysed 45 letters to primary care providers to identify common concerns and recommendations raised by CAPABLE nurses. Primary care providers responded to 86% of phone calls, 56% of letters and 50% of client coaching efforts. Primary care providers addressed 86% of concerns communicated by phone, 34% of concerns communicated by letter and 41% of client-raised concerns. Nurses' letters addressed five key concerns: medication safety, pain, change in activities of daily living, fall safety and mental health. In letters, CAPABLE nurses recommended 58 interventions: medication change; referral to a specialist; patient education; and further diagnostic evaluation. Effective communication between home-based nurses and primary care providers enhances care coordination and improves outcomes for home-dwelling elders. Various methods of contact show promise for addressing specific communication needs. Nurses practicing within patients' homes can improve care coordination by using phone calls to address minor matters and written letters for detailed communication. Future research should explore implementation of Situation, Background, Assessment and Recommendation in home care to promote

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication.

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Lin, Sue C; McKinley, Duane; Sripipatana, Alek; Makaroff, Laura

2017-11-01

Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017

Standardizing communication from acute care providers to primary care providers on critically ill adults.

Science.gov (United States)

Ellis, Kerri A; Connolly, Ann; Hosseinnezhad, Alireza; Lilly, Craig M

2015-11-01

To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds. ©2015 American Association of Critical-Care Nurses.

Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication.

Science.gov (United States)

Nedjat-Haiem, Frances R; Carrion, Iraida V; Gonzalez, Krystana; Ell, Kathleen; Thompson, Beti; Mishra, Shiraz I

2017-05-01

Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.

Communication with patients and colleagues

DEFF Research Database (Denmark)

Nørgaard, Birgitte

2012-01-01

Although patient-centred communication has provided a focus point in health care for many years, patient surveys continuously reveal serious communication problems as experienced by patients, due to poor communication. Likewise, poor inter-collegial communication can cause problems for both health...... care staff and patients. So, knowing that patient-centred communication and good inter-collegial communication is for the benefit of both health professionals and patients, the relevance of improving health care professionals' communication skills and investigating the effect on both professionals...

Sexual health communication between cancer survivors and providers: how frequently does it occur and which providers are preferred?

Science.gov (United States)

Sporn, Nora J; Smith, Kelly B; Pirl, William F; Lennes, Inga T; Hyland, Kelly A; Park, Elyse R

2015-09-01

Sexual health concerns in cancer survivors are often unaddressed by providers. Study objectives were to assess cancer survivors' reported rates of communication with oncology providers about sexual health, preference for such communication with their oncology or primary care providers (PCPs), and factors associated with these communication rates and preferences. Sixty-six patients attending a cancer survivorship clinic were asked how often their oncologist addressed and initiated discussion about sexual functioning and whether they wanted their oncologist or PCP to ask about their sexual health. We also assessed whether various sociodemographic characteristics and levels of depression, anxiety, and sexual satisfaction were associated with survivors' sexual health communication rates and preferences. 41% of patients wanted their oncologist to ask about sexual health and 58% of patients wanted their PCP to ask about sexual health. Over 90% of patients reported that their oncologist infrequently addressed sexual health concerns and that their oncologist was unlikely to initiate such discussions. Education level influenced whether patients wanted their oncologist to ask about sexual health. Age, education level, and insurance type influenced whether patients wanted their PCP to ask about sexual health. Levels of depression, anxiety, and sexual satisfaction were not associated with communication rates or preferences. Patients attending a survivorship clinic reported infrequent communication about sexual health with their oncology providers, despite wanting their providers to ask about sexual health concerns. Copyright © 2014 John Wiley & Sons, Ltd.

Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review.

Science.gov (United States)

Luu, Ngoc-Phuong; Pitts, Samantha; Petty, Brent; Sawyer, Melinda D; Dennison-Himmelfarb, Cheryl; Boonyasai, Romsai Tony; Maruthur, Nisa M

2016-04-01

Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.

Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools.

Science.gov (United States)

Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita

2015-01-01

The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.

Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.

Science.gov (United States)

Street, Richard L; Liu, Lin; Farber, Neil J; Chen, Yunan; Calvitti, Alan; Zuest, Danielle; Gabuzda, Mark T; Bell, Kristin; Gray, Barbara; Rick, Steven; Ashfaq, Shazia; Agha, Zia

2014-09-01

The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously

Patients' perspective of the design of provider-patients electronic communication services.

Science.gov (United States)

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

2014-06-12

Information Delivery is one the most important tasks in healthcare practice. This article discusses patient's tasks and perspectives, which are then used to design a new Effective Electronic Methodology. The system design methods applicable to electronic communication in the healthcare sector are also described. The architecture and the methodology for the healthcare service portal are set out in the proposed system design.

Validation of King's transaction process for healthcare provider-patient communication in pharmaceutical context: One cross-sectional study.

Science.gov (United States)

Wang, Dan; Liu, Chenxi; Zhang, Zinan; Ye, Liping; Zhang, Xinping

2018-03-27

With the impressive advantages of patient-pharmacist communication being advocated and poor pharmacist-patient communication in different settings, it is of great significance and urgency to explore the mechanism of the pharmacist-patient communicative relationship. The King's theory of goal attainment is proposed as one of the most promising models to be applied, because it takes into consideration both improving the patient-pharmacist relationship and attaining patients' health outcomes. This study aimed to validate the King's transaction process and build the linkage between the transaction process and patient satisfaction in a pharmaceutical context. A cross-sectional study was conducted in four tertiary hospitals in two provincial cities (Wuhan and Shanghai) in central and east China in July 2017. Patients over 18 were investigated in the pharmacies of the hospitals. The instrument for the transaction process was revised and tested. Path analysis was conducted for the King's transaction process and its relationship with patient satisfaction. Five hundred eighty-nine participants were investigated for main study. Prior to the addition of covariates, the hypothesised model of the King's transaction process was validated, in which all paths of the transaction process were statistically significant (p process had direct effects on patient satisfaction (p process was established as one valid theoretical framework of healthcare provider-patient communication in a pharmaceutical context. Copyright © 2018 Elsevier Inc. All rights reserved.

Internet health information in the patient-provider dialogue.

Science.gov (United States)

Hong, Traci

2008-10-01

A patient discussing Internet health information with a health care provider (referred to as "patient-provider communication about Internet health information") can contribute positively to health outcomes. Although research has found that once Internet access is achieved, there are no ethnic differences in Internet health information seeking, it is unclear if there are ethnic differences in patient-provider communication about Internet health information. To help fill this gap in the literature, the National Cancer Institute's Health Information National Trends Survey 2005 was analyzed with Stata 9. Two sets of logistic regression analyses were conducted, one for a subsample of Internet users (n = 3,244) and one for a subsample of Internet users who are first-generation immigrants (n = 563). The dependent variable was patient-provider communication about Internet health information, which assessed whether survey participants had discussed online health information with a health care provider. The predictor variables included trust of health care provider, trust of online health information, Internet use, health care coverage, frequency of visits to health care provider, health status, and demographics. Among all Internet users, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. Similarly, among Internet users who are immigrants, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. While the digital divide is narrowing in terms of Internet access, racial differences in patient-provider communication about Internet health information may undermine the potential benefits of the information age.

Race, income, and education: associations with patient and family ratings of end-of-life care and communication provided by physicians-in-training.

Science.gov (United States)

Long, Ann C; Engelberg, Ruth A; Downey, Lois; Kross, Erin K; Reinke, Lynn F; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W; Back, Anthony L; Curtis, J Randall

2014-04-01

Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families.

Patients' communication with doctors: a randomized control study of a brief patient communication intervention.

Science.gov (United States)

Talen, Mary R; Muller-Held, Christine F; Eshleman, Kate Grampp; Stephens, Lorraine

2011-09-01

In research on doctor-patient communication, the patient role in the communication process has received little attention. The dynamic interactions of shared decision making and partnership styles which involve active patient communication are becoming a growing area of focus in doctor-patient communication. However, patients rarely know what makes "good communication" with medical providers and even fewer have received coaching in this type of communication. In this study, 180 patients were randomly assigned to either an intervention group using a written communication tool to facilitate doctor-patient communication or to standard care. The goal of this intervention was to assist patients in becoming more effective communicators with their physicians. The physicians and patients both rated the quality of the communication after the office visit based on the patients' knowledge of their health concerns, organizational skills and questions, and attitudes of ownership and partnership. The results supported that patients in the intervention group had significantly better communication with their doctors than patients in the standard care condition. Physicians also rated patients who were in the intervention group as having better overall communication and organizational skills, and a more positive attitude during the office visit. This study supports that helping patients structure their communication using a written format can facilitate doctor-patient communication. Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patient communication during outpatient office visits. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment.

Science.gov (United States)

Shih, Ya-Chen Tina; Chien, Chun-Ru

2017-05-15

The American Society of Clinical Oncology released its first guidance statement on the cost of cancer care in August 2009, affirming that patient-physician cost communication is a critical component of high-quality care. This forward-thinking recommendation has grown increasingly important in oncology practice today as the high costs of cancer care impose tremendous financial burden to patients, their families, and the health care system. For the current review, a literature search was conducted using the PubMed and Web of Science databases to identify articles that covered 3 topics related to patient-physician cost communication: patient attitude, physician acceptance, and the associated outcomes; and 15 articles from 12 distinct studies were identified. Although most articles that addressed patient attitude suggested that cost communication is desired by >50% of patients in the respective study cohorts, only communication. When asked about whether cost communication actually took place in their practice, percentages reported by physicians varied widely from 60%. The data suggested that cost communication was associated with improved patient satisfaction, lower out-of-pocket expenses, and a higher likelihood of medication nonadherence; none of the studies established causality. Both patients and physicians expressed a strong need for accurate, accessible, and transparent information about the cost of cancer care. Cancer 2017;123:928-39. © 2016 American Cancer Society. © 2016 American Cancer Society.

Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors.

Science.gov (United States)

Palmer, Nynikka R A; Kent, Erin E; Forsythe, Laura P; Arora, Neeraj K; Rowland, Julia H; Aziz, Noreen M; Blanch-Hartigan, Danielle; Oakley-Girvan, Ingrid; Hamilton, Ann S; Weaver, Kathryn E

2014-12-20

We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors. In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample. We conducted linear and logistic regression analyses to identify racial and ethnic differences in PPC (overall communication and medical test communication), perceived care quality, and patient activation in clinical care (self-efficacy in medical decisions and perceived control). We further examined the potential contribution of PPC to racial and ethnic differences in perceived care quality and patient activation. Compared with white survivors (mean score, 85.16), Hispanic (mean score, 79.95) and Asian (mean score, 76.55) survivors reported poorer overall communication (P = .04 and P Asian survivors (mean score, 79.97) reported poorer medical test communication (P = .001). Asian survivors were less likely to report high care quality (odds ratio, 0.47; 95% CI, 0.30 to 0.72) and reported lower self-efficacy in medical decisions (mean score, 74.71; P Asian disparities remained significant. Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors. © 2014 by American Society of Clinical Oncology.

Race, Income, and Education: Associations with Patient and Family Ratings of End-of-Life Care and Communication Provided by Physicians-in-Training

Science.gov (United States)

Engelberg, Ruth A.; Downey, Lois; Kross, Erin K.; Reinke, Lynn F.; Cecere Feemster, Laura; Dotolo, Danae; Ford, Dee W.; Back, Anthony L.; Curtis, J. Randall

2014-01-01

Abstract Background: Minority race and lower socioeconomic status are associated with poorer patient ratings of health care quality and provider communication. Objective: To examine the association of race/ethnicity or socioeconomic status with patients' and families' ratings of end-of-life care and communication about end-of-life care provided by physicians-in-training. Methods: As a component of a randomized trial evaluating a program designed to improve clinician communication about end-of-life care, patients and patients' families completed preintervention survey data regarding care and communication provided by internal medicine residents and medical subspecialty fellows. We examined associations between patient and family race or socioeconomic status and ratings they gave trainees on two questionnaires: the Quality of End-of-Life Care (QEOLC) and Quality of Communication (QOC). Results: Patients from racial/ethnic minority groups, patients with lower income, and patients with lower educational attainment gave trainees higher ratings on the end-of-life care subscale of the QOC (QOCeol). In path models, patient educational attainment and income had a direct effect on outcomes, while race/ethnicity did not. Lower family educational attainment was also associated with higher trainee ratings on the QOCeol, while family non-white race was associated with lower trainee ratings on the QEOLC and general subscale of the QOC. Conclusions: Patient race is associated with perceptions of the quality of communication about end-of-life care provided by physicians-in-training, but the association was opposite to our hypothesis and appears to be mediated by socioeconomic status. Family member predictors of these perceptions differ from those observed for patients. Further investigation of these associations may guide interventions to improve care delivered to patients and families. PMID:24592958

Patient-centered communication in digital medical encounters.

Science.gov (United States)

Alpert, Jordan M; Dyer, Karen E; Lafata, Jennifer Elston

2017-10-01

Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

Constructions of the patient in healthcare communications: six patient figures.

Science.gov (United States)

Pors, Anja Svejgaard

2016-01-01

The purpose of this paper is to examine how strategic, patient-centred communication plays a part in the discursive management of expectations posed to patients and healthcare organizations. The paper provides an analysis of four documents collected as part of an ethnographic case study regarding "The Perspective of the Patient" - a Danish Hospital's patient-centred communication programme. Mapping methods inspired by Grounded Theory are used to qualify the analysis. The paper shows that strategic patient-centred communication addresses both a care-oriented approach to the patient and deploys market perceptions of patients. Market and care is seen as co-existing organizing modes that entail expectations to the patient. In the communication programme the patient is constructed in six information-seeking patient figures: affective patient; target group patient; citizen with rights; patient as a competent resource; user as active partner; and consumer. As a result, the patient-centred communication programme renders the patient as a flexible figure able to fit organizational demands of both care orientation and market concerns. This study contributes to qualitative research in organizational health communication by combining two subfields - patient-centredness and health communication - in an empirical study of how market and care are intertwined in a patient-centred communication programme. The argument goes beyond the prevalent prescriptive approaches to patient-centredness and healthcare communication, instead providing a critical analytical perspective on strategic communication and patient-centredness and showing how expectations are posed to both patient and organization.

PATIENT WEB PORTALS AND PATIENT-PROVIDER RELATIONSHIPS: A SUMMARY PERSPECTIVE.

Science.gov (United States)

Caldwell, Hannah D; Minkoff, Neil B; Murthy, Kalyani

2017-01-01

Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic. After a review of these topics, we present potential future directions. We conducted an exploratory PubMed search of the literature published from inception through December 2015, and focused our subsequent searches specifically to assess benefits and drawbacks of using PWPs in the management of diabetes mellitus, hypertension, and asthma. Our search revealed several potential benefits of PWP implementation in the management of chronic conditions with regards to patient-provider relationships, such as improved communication, disease management, and compliance. We also noted drawbacks such as potentially unreliable reporting, barriers to use, and increased workload. PWPs offer opportunities for patients to report symptoms and outcomes in a timely manner and allow for secure online communication with providers. Despite the drawbacks noted, the overall benefits from successful PWP implementation could improve patient-provider relationships and help in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma.

Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities.

Science.gov (United States)

Burgess, Diana J; Bokhour, Barbara G; Cunningham, Brooke A; Do, Tam; Gordon, Howard S; Jones, Dina M; Pope, Charlene; Saha, Somnath; Gollust, Sarah E

2017-10-25

We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities.

Improving nurse-patient communication with patients with communication impairments: hospital nurses' views on the feasibility of using mobile communication technologies.

Science.gov (United States)

Sharpe, Bridget; Hemsley, Bronwyn

2016-05-01

Nurses communicating with patients who are unable to speak often lack access to tools and technologies to support communication. Although mobile communication technologies are ubiquitous, it is not known whether their use to support communication is feasible on a busy hospital ward. The aim of this study was to determine the views of hospital nurses on the feasibility of using mobile communication technologies to support nurse-patient communication with individuals who have communication impairments. This study involved an online survey followed by a focus group, with findings analyzed across the two data sources. Nurses expected that mobile communication devices could benefit patient care but lacked access to these devices, encountered policies against use, and held concerns over privacy and confidentiality. The use of mobile communication technologies with patients who have communication difficulties is feasible and may lead to improvements in communication and care, provided environmental barriers are removed and facilitators enhanced. Copyright © 2015 Elsevier Inc. All rights reserved.

Development and implementation of an online program to improve how patients communicate emotional concerns to their oncology providers.

Science.gov (United States)

Porter, Laura S; Pollak, Kathryn I; Farrell, David; Cooper, Meredith; Arnold, Robert M; Jeffreys, Amy S; Tulsky, James A

2015-10-01

Patients often struggle to express their emotional concerns to their oncology providers and may therefore experience unmet needs. This paper describes the development and implementation of an online program that teaches patients how to communicate their emotions to their oncology providers. The intervention was developed by a multidisciplinary team consisting of palliative care physicians, psychologists, and an intervention software developer and included input from patients. It incorporated elements of Social Cognitive Theory and validated cognitive behavioral strategies for communication skills training. Strategies to increase intervention adherence were implemented midway through the study. The intervention consists of four interactive, online modules to teach patients strategies for expressing emotional concerns to their providers and asking for support. In addition to skill-building, the intervention was designed to raise patients' expectations that expressing emotional concerns to providers would be helpful, to enhance their self-efficacy for doing so, and to help them overcome barriers to having these conversations. After implementing strategies to improve adherence, usage rates increased from 47 to 64 %. This intervention addresses an unmet educational need for patients with advanced cancer. Strategies to increase adherence led to improvements in usage rates in this population of older patients. We are currently evaluating the intervention in a randomized clinical trial to determine its efficacy in increasing patient expression of emotional concerns and requests for support. If successful, this intervention could serve as a model for future online patient education programs.

The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review.

Science.gov (United States)

de Jong, Catharina Carolina; Ros, Wynand Jg; Schrijvers, Guus

2014-01-16

In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions. The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction. A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction. Patients' knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes. The effect of

The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes.

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Hesse, Colin; Rauscher, Emily A

2018-02-20

The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.

Does routine psychosocial screening improve referral to psychosocial care providers and patient-radiotherapist communication? A cluster randomized controlled trial.

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Braeken, Anna P B M; Lechner, Lilian; Eekers, Daniëlle B P; Houben, Ruud M A; van Gils, Francis C J M; Ambergen, Ton; Kempen, Gertrudis I J M

2013-11-01

This study tests whether using a screening instrument improves referral to psychosocial care providers (e.g. psychologist) and facilitates patient-radiotherapist communication. A cluster randomized controlled trial was used. Fourteen radiotherapists were randomly allocated to the experimental or control group and 568 of their patients received care in accordance with the group to which their radiotherapist was allocated. Patients in the experimental group were asked to complete a screening instrument before and at the end of the radiation treatment period. All patients were requested to complete questionnaires concerning patient-physician communication after the first consultation and concerning psychosocial care 3 and 12 months post-intervention. Patients who completed the screening instrument were referred to social workers at an earlier stage than patients who did not (Pcommunication. Our results suggest that a simple screening procedure can be valuable for the timely treatment of psychosocial problems in patients. Future efforts should be directed at appropriate timing of screening and enhancing physicians' awareness regarding the importance of identifying, discussing and treating psychosocial problems in cancer patients. Psychosocial screening can be enhanced by effective radiotherapist-patient communication. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Communication strategies and accommodations utilized by health care providers with hearing loss: a pilot study.

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Trotter, Alanna R; Matt, Susan B; Wojnara, Danuta

2014-03-01

Poor communication between health care providers and patients may negatively impact patient outcomes, and enhancing communication is one way to improve outcomes. Effective communication is particularly important for health care providers who have hearing loss. The authors found that a systematic survey of the communication strategies and experiences of health care providers with hearing loss had not yet been conducted. In this pilot study, 32 health care professionals with hearing loss were recruited via the Association of Medical Professionals With Hearing Losses and were asked to complete a 28-question survey. Health care providers with hearing loss already employ strategies that all health care providers are encouraged to use in order to enhance patient–provider communication, and survey participants have found the strategies to be effective. The communication techniques and assistive technologies used by individuals with hearing loss seem to be effective: All participants reported feeling able to communicate effectively with patients at least most of the time. More research is needed to determine if use of these communication techniques has similar results for health care providers without hearing loss.

Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient-Provider Communication in the START Study.

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Hirsch-Moverman, Yael; Daftary, Amrita; Yuengling, Katharine A; Saito, Suzue; Ntoane, Moeketsi; Frederix, Koen; Maama, Llang B; Howard, Andrea A

2017-01-01

mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). We describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analyzed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualized by monthly adherence data. From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilization. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.

Barriers to effective communication between veterans with chronic kidney disease and their healthcare providers.

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Lederer, Swati; Fischer, Michael J; Gordon, Howard S; Wadhwa, Anuradha; Popli, Subhash; Gordon, Elisa J

2015-12-01

Many patients with chronic kidney disease (CKD) have insufficient knowledge about CKD, which is associated with poorer health outcomes. Effective patient-provider communication can improve CKD patients' knowledge, thereby augmenting their participation in self-care practices. However, barriers to addressing CKD patients' information needs have not been previously characterized. Adults with an estimated glomerular filtration rate (eGFR) of communication dynamics. Thirty-two patients participated. The mean age of participants was 63 years; most were male (94%) and non-Hispanic white (53%). CKD severity groups represented included CKD-3 (eGFR 30-59 mL/min/1.73 m(2); 34%), CKD-4 (eGFR 15-29 mL/min/1.73 m(2); 25%), CKD-5 (eGFR barriers to patient-provider communication based on patients' reported care at both VA and non-VA facilities, including patients perceived their role as a 'listener', reported limited CKD knowledge, did not understand physicians' explanations and were dissatisfied with the patient-provider relationship. Several barriers to patient-provider communication prevent patients from meeting their information needs and perpetuate patient passivity. Future research should evaluate whether interventions that empower CKD patients to actively participate in their care increase knowledge and improve health outcomes.

Health information technology to facilitate communication involving health care providers, caregivers, and pediatric patients: a scoping review.

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Gentles, Stephen James; Lokker, Cynthia; McKibbon, K Ann

2010-06-18

Pediatric patients with health conditions requiring follow-up typically depend on a caregiver to mediate at least part of the necessary two-way communication with health care providers on their behalf. Health information technology (HIT) and its subset, information communication technology (ICT), are increasingly being applied to facilitate communication between health care provider and caregiver in these situations. Awareness of the extent and nature of published research involving HIT interventions used in this way is currently lacking. This scoping review was designed to map the health literature about HIT used to facilitate communication involving health care providers and caregivers (who are usually family members) of pediatric patients with health conditions requiring follow-up. Terms relating to care delivery, information technology, and pediatrics were combined to search MEDLINE, EMBASE, and CINAHL for the years 1996 to 2008. Eligible studies were selected after three rounds of duplicate screening in which all authors participated. Data regarding patient, caregiver, health care provider, HIT intervention, outcomes studied, and study design were extracted and maintained in a Microsoft Access database. Stage of research was categorized using the UK's Medical Research Council (MRC) framework for developing and evaluating complex interventions. Quantitative and qualitative descriptive summaries are presented. We included 104 eligible studies (112 articles) conducted in 17 different countries and representing 30 different health conditions. The most common conditions were asthma, type 1 diabetes, special needs, and psychiatric disorder. Most studies (88, 85%) included children 2 to 12 years of age, and 73 (71%) involved home care settings. Health care providers operated in hospital settings in 96 (92%) of the studies. Interventions featured 12 modes of communication (eg, Internet, intranets, telephone, video conferencing, email, short message service [SMS], and

Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences

Directory of Open Access Journals (Sweden)

Emily A. Hurley

2017-12-01

Full Text Available Effective patient-provider communication (PPC promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART, yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power, and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp. Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2% compared to a biomedical style (22.5% (p<0.001. Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2% compared to a provider-dominated style (35.8%. In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4% and/or “tough” style (40.6%, but significantly fewer preferred the “sharp” style (14.5% (p<0.001. Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately

Patient-provider communication and reproductive health among HIV-positive women in Rio de Janeiro, Brazil.

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Malta, Monica; Todd, Catherine S; Stibich, Mark A; Garcia, Thais; Pacheco, Diego; Bastos, Francisco I

2010-12-01

To qualitatively assess the influence of patient-provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access. Focus group discussions (FGD; n=3), in-depth (IDI; n=15) and freelist interviews (FLI; n=36) were conducted with HIV-positive women aged 18-40 years recruited from public health units in Rio de Janeiro/Brazil. Of 70 participants, 49 used ART and the median time since HIV diagnosis was 6 years (range: 1-18). The majority of participants (71.4%) reported some degree of dissatisfaction with their health providers (usually lack of open dialogue) and a few reported experiences of stigma/prejudice during appointments. Intra, interpersonal and social factors modulated behaviors and reproductive health decisions, and those issues were rarely addressed by providers during HIV clinical care. Despite dramatic increases in survival and life quality after universal ART implementation in Brazil, reproductive health issues are neglected by multiple cadres of HIV health providers. Communication on reproductive health issues remains fragmented and potentially contradictory, compromising care in these settings. Adequate provider training to address reproductive health-related issues in a comprehensive, culturally sensitive manner and improved integration of HIV and reproductive health care are urgently needed in this setting. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

"Are you still driving?" Metasynthesis of patient preferences for communication with health care providers.

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Betz, Marian E; Scott, Kenneth; Jones, Jacqueline; Diguiseppi, Carolyn

2016-05-18

The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers. Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers. A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed. Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers. We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving. Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers-and support their family members-through tactful communication about driving safety and mobility transitions during the life course.

Clinical social networking--a new revolution in provider communication and delivery of clinical information across providers of care?

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Kolowitz, Brian J; Lauro, Gonzalo Romero; Venturella, James; Georgiev, Veliyan; Barone, Michael; Deible, Christopher; Shrestha, Rasu

2014-04-01

The adoption of social media technologies appears to enhance clinical outcomes through improved communications as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). The ability of providers to more effectively, directly, and rapidly communicate among themselves as well as with patients should strengthen collaboration and treatment as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). This paper is a case study in one organization's development of an internally designed and developed social technology solution termed "Unite." The Unite system combines social technologies' features including push notifications, messaging, community groups, and user lists with clinical workflow and applications to construct dynamic provider networks, simplify communications, and facilitate clinical workflow optimization. Modeling Unite as a social technology may ease adoption barriers. Developing a social network that is integrated with healthcare information systems in the clinical space opens the doors to capturing and studying the way in which providers communicate. The Unite system appears to have the potential to breaking down existing communication paradigms. With Unite, a rich set of usage data tied to clinical events may unravel alternative networks that can be leveraged to advance patient care.

Anti-Smoking Communication to Preadolescents with and without a Cancer Diagnosis: Parents and Healthcare Providers as Important Communicators.

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Throckmorton-Belzer, Leslee; Tyc, Vida L; Robinson, Leslie A; Klosky, James L; Lensing, Shelly; Booth, Andrea K

2009-10-01

A cancer diagnosis does not prevent smoking among pediatric oncology patients, and anti-smoking communications among parents and health care providers have been proposed as influencing smoking outcomes in this group. Anti-smoking communications were compared among 93 preadolescents with cancer and 402 controls. After adjusting for demographics and covariates, preadolescents with cancer were less likely than control participants to report receipt of anti-smoking messages from physicians and parents, and recalled more messages >/= 4 months post-diagnosis as compared to 1-3 months. Should anti-tobacco communications prove to influence smoking outcomes, parents and physicians may be uniquely positioned to provide smoking prevention interventions to these patients.

Personal Communication Device Use by Nurses Providing In-Patient Care: Survey of Prevalence, Patterns, and Distraction Potential.

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McBride, Deborah L; LeVasseur, Sandra A

2017-04-13

Coincident with the proliferation of employer-provided mobile communication devices, personal communication devices, including basic and enhanced mobile phones (smartphones) and tablet computers that are owned by the user, have become ubiquitous among registered nurses working in hospitals. While there are numerous benefits of personal communication device use by nurses at work, little is known about the impact of these devices on in-patient care. Our aim was to examine how hospital-registered nurses use their personal communication devices while doing both work-related and non‒work-related activities and to assess the impact of these devices on in-patient care. A previously validated survey was emailed to 14,797 members of two national nursing organizations. Participants were asked about personal communication device use and their opinions about the impact of these devices on their own and their colleagues' work. Of the 1268 respondents (8.57% response rate), only 5.65% (70/1237) never used their personal communication device at work (excluding lunch and breaks). Respondents self-reported using their personal communication devices at work for work-related activities including checking or sending text messages or emails to health care team members (29.02%, 363/1251), as a calculator (25.34%, 316/1247), and to access work-related medical information (20.13%, 251/1247). Fewer nurses reported using their devices for non‒work-related activities including checking or sending text messages or emails to friends and family (18.75%, 235/1253), shopping (5.14%, 64/1244), or playing games (2.73%, 34/1249). A minority of respondents believe that their personal device use at work had a positive effect on their work including reducing stress (29.88%, 369/1235), benefiting patient care (28.74%, 357/1242), improving coordination of patient care among the health care team (25.34%, 315/1243), or increasing unit teamwork (17.70%, 220/1243). A majority (69.06%, 848/1228) of

Prehospital Providers' Perceptions on Providing Patient and Family Centered Care.

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Ayub, Emily M; Sampayo, Esther M; Shah, Manish I; Doughty, Cara B

2017-01-01

A gap exists in understanding a provider's approach to delivering care that is mutually beneficial to patients, families, and other providers in the prehospital setting. The purpose of this study was to identify attitudes, beliefs, and perceived barriers to providing patient and family centered care (PFCC) in the prehospital setting and to describe potential solutions for improving PFCC during critical pediatric events. We conducted a qualitative, cross-sectional study of a purposive sample of Emergency Medical Technicians (EMTs) and paramedics from an urban, municipal, fire-based EMS system, who participated in the Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPS) course. Two coders reviewed transcriptions of audio recordings from participants' first simulation scenario debriefings and performed constant comparison analysis to identify unifying themes. Themes were verified through member checking with two focus groups of prehospital providers. A total of 122 EMTs and paramedics participated in 16 audiotaped debriefing sessions and two focus groups. Four overarching themes emerged regarding the experience of PFCC by prehospital providers: (1) Perceived barriers included the prehospital environment, limited manpower, multi-tasking medical care, and concern for interference with patient care; (2) Providing emotional support comprised of empathetically comforting caregivers, maintaining a calm demeanor, and empowering families to feel involved; (3) Effective communication strategies consisted of designating a family point person, narration of actions, preempting the next steps, speaking in lay terms, summarizing during downtime, and conveying a positive first impression; (4) Tactics to overcome PFCC barriers were maintaining a line of sight, removing and returning a caregiver to and from the scene, and providing situational awareness. Based on debriefings from simulated scenarios, some prehospital providers identified the provision of

Communication Skills in Patient-Doctor Interactions: Learning from Patient Complaints

Directory of Open Access Journals (Sweden)

Janine W.Y. Kee

2018-06-01

Full Text Available Purpose: Despite communication skills training in medical school, junior doctors continue to demonstrate poor patient-doctor communication skills, where patient unhappiness from the encounter often manifests as patient complaints. We sought to identify crucial communication skills that should be incorporated in the communications curriculum by learning from patient complaints, to explore how the communication lapses occur. Method: 38 cases of anonymized negative patient feedback about junior doctors were analysed using qualitative content analysis. A two-step fine-coding system involving four researchers was employed. Results: Four main themes of communication errors were identified, namely: non-verbal (eye contact, facial expression and paralanguage, verbal (active listening and inappropriate choice of words, and content (poor quantity and quality of information provided; and poor attitudes (lack of respect and empathy. Discussion: Patient-doctor communication is a complex interpersonal interaction that requires an understanding of each party׳s emotional state. We identified important but overlooked communication lapses such as non-verbal paralinguistic elements that should be incorporated into communications curriculum, with an emphasis on dialectical learning. These include integrating these findings into a simulation-based communications module for training doctors at a post-graduate level as well as monitoring and analyzing patient complaints regularly to iteratively update the content of the training module. Beyond these skills training, there is also a need to highlight negative emotions of doctors in future research, as it influences their communication patterns and attitudes towards patients, ultimately shaping how patients perceive them. Keywords: Communication skills training, Patient complaints, Patient negative feedback, Patient-Doctor communication, Residency training

Email Between Patient and Provider: Assessing the Attitudes and Perspectives of 624 Primary Health Care Patients.

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Seth, Puneet; Abu-Abed, Mohamed Ismail; Kapoor, Vikram; Nicholson, Kathryn; Agarwal, Gina

2016-12-22

Email between patients and their health care providers can serve as a continuous and collaborative forum to improve access to care, enhance convenience of communication, reduce administrative costs and missed appointments, and improve satisfaction with the patient-provider relationship. The main objective of this study was to investigate the attitudes of patients aged 16 years and older toward receiving email communication for health-related purposes from an academic inner-city family health team in Southern Ontario. In addition to exploring the proportion of patients with a functioning email address and interest in email communication with their health care provider, we also examined patient-level predictors of interest in email communication. A cross-sectional study was conducted using a self-administered, 1-page survey of attitudes toward electronic communication for health purposes. Participants were recruited from attending patients at the McMaster Family Practice in Hamilton, Ontario, Canada. These patients were aged 16 years and older and were approached consecutively to complete the self-administered survey (N=624). Descriptive analyses were conducted using the Pearson chi-square test to examine correlations between variables. A logistic regression analysis was conducted to determine statistically significant predictors of interest in email communication (yes or no). The majority of respondents (73.2%, 457/624) reported that they would be willing to have their health care provider (from the McMaster Family Practice) contact them via email to communicate health-related information. Those respondents who checked their personal email more frequently were less likely to want to engage in this electronic communication. Among respondents who check their email less frequently (fewer than every 3 days), 46% (37/81) preferred to communicate with the McMaster Family Practice via email. Online applications, including email, are emerging as a viable avenue for patient

[Communication strategies used by health care professionals in providing palliative care to patients].

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Trovo de Araújo, Monica Martins; da Silva, Maria Júlia Paes

2012-06-01

The objective of this study is to verify the relevance and utilization of communication strategies in palliative care. This is a multicenter qualitative study using a questionnaire, performed from August of 2008 to July of 2009 with 303 health care professionals who worked with patients receiving palliative care. Data were subjected to descriptive statistical analysis. Most participants (57.7%) were unable to state at least one verbal communication strategy, and only 15.2% were able to describe five signs or non-verbal communication strategies. The verbal strategies most commonly mentioned were those related to answering questions about the disease/treatment. Among the non-verbal strategies used, the most common were affective touch, looking, smiling, physical proximity, and careful listening. Though professionals have assigned a high degree of importance to communication in palliative care, they showed poor knowledge regarding communication strategies. Final considerations include the necessity of training professionals to communicate effectively in palliative care.

Nurse-patient communication barriers in Iranian nursing.

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Anoosheh, M; Zarkhah, S; Faghihzadeh, S; Vaismoradi, M

2009-06-01

Providing effective communication with patients is an essential aspect of nursing care. Understanding the barriers that inhibit nurse-patient communication can provide an opportunity to eliminate them. To investigate nurse-patient and environment-related communication barriers perceived by patients and nurses in Iranian nursing. A descriptive survey was carried out in three randomly selected educational hospitals in a large urban city in Iran. Data were collected by questionnaire; the study sample consisted of 61 patients and 75 nurses. Participants were asked to rate the importance of each communication barriers item. Finally, data were analysed using descriptive statistics, and to compare the perceived importance of communication barriers between patients and nurses, item means were calculated and the t-test for independent samples was applied. Similarities and differences between the two groups were identified. According to nurses' views, 'heavy nursing workload', 'hard nursing tasks' and 'lack of welfare facilities for nurses' were the main communication barriers. From patients' views, 'unfamiliarity of nurses with dialect', 'having contagious diseases' and 'sex differences between nurses and patients' were determined as the main communication barriers. The shared communication barriers were 'age difference', 'social class difference' and 'having contagious diseases'. It can be concluded that nursing managers and healthcare system planners should focus on eliminating or modifying the barriers stated by the two groups, particularly the shared ones. It is suggested that understanding the cultural aspects of nurse-patient communication barriers in various contexts can help nurses. The study relied on self-report by a limited sample of nurses and patients. The responses should now be tested by a larger sample and then by empirical research into actual practice in order to test whether the nurses' and patients' perceived ideas of communication barriers are

Practice improvement, part II: update on patient communication technologies.

Science.gov (United States)

Roett, Michelle A; Coleman, Mary Thoesen

2013-11-01

Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Influence of Provider Communication on Women's Delivery Expectations and Birth Experience Appraisal: A Qualitative Study.

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Ledford, Christy J W; Canzona, Mollie Rose; Womack, Jasmyne J; Hodge, Joshua A

2016-07-01

Although current research suggests that patient-provider prenatal communication and expectation-setting affects women's outcomes, more needs to be understood about the kinds of communication experiences that shape women's expectations, the nature of expectations that women hold, and how those expectations influence their appraisal of labor and delivery. The goal of this study is to draw connections between provider communication, birth experience expectations, and birth experience appraisals. Recently delivered mothers (n=36) were recruited at a mid-Atlantic community hospital. Using a grounded theory approach, interviews were systematically analyzed to uncover how participants perceived provider communication during their prenatal care, how participants described their expectations of the birth experience, and how expectations affected appraisals of the experience. Mothers recognize providers' use of patient-centered communication in messages of empowerment, emotional support, explanation, decision making, and elicitation. Findings posit that it is the inflexibility or flexibility of expectations that may determine mothers' appraisals of the birth experience. Mothers continue to rely on providers as partners in health care. Through patient-centered communication, providers can help mothers develop flexible expectations of the birth experience, which in turn can result in positive appraisals of delivery.

Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication.

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Blackstone, Sarah W; Pressman, Harvey

2016-01-01

Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.

Parent-provider communication during hospitalization.

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Fisher, Mark J; Broome, Marion E

2011-02-01

Parents and health care providers interact and communicate with each other during a child's hospitalization. The purpose of this study was to compare communication experiences of parents, nurses, and physicians. A unique aspect of this study involved combining three individual data sources into a collective unit of study (triad). Triads involved in the care of three children in the inpatient setting of an urban children's hospital served as the sample for this study (n = 10). Participants were asked semistructured questions during face-to-face interviews. Findings included (a) the importance of providing information by health care providers using a caring and inclusive approach, (b) the benefits of establishing interpersonal connections and nurturing relationships, and (c) the identification of specific behaviors in all members of the triad that contribute to and sustain positively perceived communication. Future research directions examining triadic interactions, communication, and relationships among parents, nurses, and physicians are recommended. Copyright © 2011 Elsevier Inc. All rights reserved.

Perception of risk and communication among conventional and complementary health care providers involving cancer patients' use of complementary therapies: a literature review.

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Stub, Trine; Quandt, Sara A; Arcury, Thomas A; Sandberg, Joanne C; Kristoffersen, Agnete E; Musial, Frauke; Salamonsen, Anita

2016-09-08

Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with

ListeningTime; participatory development of a web-based preparatory communication tool for elderly cancer patients and their healthcare providers.

NARCIS (Netherlands)

Noordman, J.; Driesenaar, J.A.; Bruinessen, I.R. van; Dulmen, S. van

2017-01-01

Objective: This paper outlines the participatory development process of a web-based preparatory communication tool for elderly cancer patients and their oncological healthcare providers (HCPs). This tool aims to support them to (better) prepare their encounters. An overarching aim of the project is

Knowledge, Beliefs, and Communication Behavior of Oncology Health-care Providers (HCPs) regarding Lesbian, Gay, Bisexual, and Transgender (LGBT) Patient Health care.

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Banerjee, Smita C; Walters, Chasity B; Staley, Jessica M; Alexander, Koshy; Parker, Patricia A

2018-01-01

Delivery of culturally competent care toward lesbian, gay, bisexual, and transgender (LGBT) patients depends on how health-care providers (HCPs) communicate with them; however, research about knowledge, attitude, and behavior of HCPs toward LGBT patients is scant. The objectives of our study were to describe oncology HCPs' knowledge and examine if beliefs about LGB and transgender patients mediate the effects of LGBT health-care knowledge on open communication behaviors with LGB and transgender patients, respectively. A total of 1253 HCPs (187 physicians, 153 advance practice professionals (APPs), 828 nurses, and 41 others) at a Comprehensive Cancer Center completed an online survey that included the following measures: LGBT health-care knowledge, beliefs, communication behaviors, willingness to treat LGBT patients, encouraging LGBT disclosure, and perceived importance of LGBT sensitivity training. Only 50 participants (5%) correctly answered all 7 knowledge items, and about half the respondents answered 3 (out of 7) items correctly. Favorable beliefs about LGBT health care mediated the effect of higher LGBT health-care knowledge on open communication behaviors with transgender patients, controlling for effects of type of profession, religious orientation, gender identity, sexual orientation, and having LGBT friends/family. The results of this study demonstrated an overall lack of medical knowledge and the need for more education about LGBT health care among oncology HCPs.

Communication Challenges: A Qualitative Look at the Relationship Between Pediatric Hospitalists and Primary Care Providers.

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Solan, Lauren G; Sherman, Susan N; DeBlasio, Dominick; Simmons, Jeffrey M

2016-07-01

Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists. Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution. The open-ended, semistructured question guides included questions about communication experiences, patient care responsibilities, and suggestions for improvement. Using inductive thematic analysis, investigators coded the transcripts, and resolved differences through consensus. Six PCP (n = 27) and 3 hospitalist (n = 15) focus groups were held. Fifty-six percent of PCPs and 14% of hospitalists had been practicing for >10 years. Five major themes were identified: problematic aspects of communication, perceptions of provider roles, push-pull, postdischarge responsibilities/care, and proposed solutions. Aspects of communication included specific problem areas with verbal and written communication. Perceptions of provider roles highlighted the issue of PCPs feeling devalued. Push-pull described conflicting expectations about a counterpart's role and responsibilities. Postdischarge responsibilities/care addressed unclear responsibilities related to patient follow-up. Proposed solutions were suggested for ways to improve communication. Deficiencies in communication hinder successful collaboration and can cause tension between providers in inpatient and outpatient settings. Understanding specific issues that contribute to poor communication like perceptions about provider roles is critical to improving relationships and facilitating combined efforts to improve patient care

The evolving concept of "patient-centeredness" in patient-physician communication research.

Science.gov (United States)

Ishikawa, Hirono; Hashimoto, Hideki; Kiuchi, Takahiro

2013-11-01

Over the past few decades, the concept of "patient-centeredness" has been intensively studied in health communication research on patient-physician interaction. Despite its popularity, this concept has often been criticized for lacking a unified definition and operationalized measurement. This article reviews how health communication research on patient-physician interaction has conceptualized and operationalized patient-centered communication based on four major theoretical perspectives in sociology (i.e., functionalism, conflict theory, utilitarianism, and social constructionism), and discusses the agenda for future research in this field. Each theory addresses different aspects of the patient-physician relationship and communication from different theoretical viewpoints. Patient-centeredness is a multifaceted construct with no single theory that can sufficiently define the whole concept. Different theoretical perspectives of patient-centered communication can be selectively adopted according to the context and nature of problems in the patient-physician relationship that a particular study aims to explore. The present study may provide a useful framework: it offers an overview of the differing models of patient-centered communication and the expected roles and goals in each model; it does so toward identifying a communication model that fits the patient and the context and toward theoretically reconstructing existing measures of patient-centered communication. Furthermore, although patient-centered communication has been defined mainly from the viewpoint of physician's behaviors aimed at achieving patient-centered care, patient competence is also required for patient-centered communication. This needs to be examined in current medical practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

"Let Me Tell You About My…" Provider Self-Disclosure in the Emergency Department Builds Patient Rapport.

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Zink, Korie L; Perry, Marcia; London, Kory; Floto, Olivia; Bassin, Benjamin; Burkhardt, John; Santen, Sally A

2017-01-01

As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD) of personal information by primary care providers decreased patient rating of the provider communication skills. The objective of this study was to explore the incidence and impact of emergency department (ED) provider self-disclosure on patients' rating of provider communication skills. A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers' communication skills. We compared patients' ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (pself-disclosure (47.1%). Patients reported that they would like to hear about their providers' experiences with a similar chief complaint (64.4% of patients), their providers' education (49%), family (33%), personal life (21%) or an injury/ailment unlike their own (18%). Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport. Provider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction.

Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives

Science.gov (United States)

Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

2013-01-01

Purpose: Patient-centered communication is critical to quality cancer care. Effective communication can help patients and family members cope with cancer, make informed decisions, and effectively manage their care; suboptimal communication can contribute to care breakdowns and undermine clinician-patient relationships. The study purpose was to explore stakeholders' views on the feasibility and acceptability of collecting self-reported patient and family perceptions of communication experiences while receiving cancer care. The results were intended to inform the design, development, and implementation of a structured and generalizable patient-level reporting system. Methods: This was a formative, qualitative study that used semistructured interviews with cancer patients, family members, clinicians, and leaders of health care organizations. The constant comparative method was used to identify major themes in the interview transcripts. Results: A total of 106 stakeholders were interviewed. Thematic saturation was achieved. All stakeholders recognized the importance of communication and endorsed efforts to improve communication during cancer care. Patients, clinicians, and leaders expressed concerns about the potential consequences of reports of suboptimal communication experiences, such as damage to the clinician-patient relationship, and the need for effective improvement strategies. Patients and family members would report good communication experiences in order to encourage such practices. Practical and logistic issues were identified. Conclusion: Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices. This qualitative study provides a foundation for the design and pilot testing of such a patient reporting system. PMID:23943884

Patients' and family members' views on patient-centered communication during cancer care.

Science.gov (United States)

Mazor, Kathleen M; Beard, Reneé L; Alexander, Gwen L; Arora, Neeraj K; Firneno, Cassandra; Gaglio, Bridget; Greene, Sarah M; Lemay, Celeste A; Robinson, Brandi E; Roblin, Douglas W; Walsh, Kathleen; Street, Richard L; Gallagher, Thomas H

2013-11-01

To explore patients' and family members' views on communication during cancer care and to identify those aspects of clinician-patient communication which were most important to patients and family members. We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient's experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, whereas excellent listening could foster the relationship. Information exchange and relationship were also integral to decision-making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients' needs beyond the immediate medical encounter were valued. The complexity of cancer care today suggests that efforts to improve communication must be multilevel, acknowledging and addressing patient, clinician, organizational and policy barriers, and facilitators. Measurement tools are needed to assess cancer patients' and family members' experiences with communication over the course of cancer care to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.

Impact of Health Care Provider's Training on Patients ...

African Journals Online (AJOL)

Material and Methods: A situation analysis was done before training to assess existing practice of providers' communication skills and patient's satisfaction. All care providers in labour ward were trained and their practice was assessed before and after training. A ten percent sample of patients delivered in hospital before ...

Patients’ Perception of Patient–Provider Communication in Fertility Preservation Decision Making Among Young Women With Cancer

Directory of Open Access Journals (Sweden)

Aakrati Mathur

2013-09-01

Full Text Available Fertility preservation (FP for patients with cancer is an emerging field. With the advancement of technology, patients may face a complex decision-making process about whether to preserve fertility. The purpose of this article is to explore how young women with cancer perceive patient–provider communication in FP decision making. In this study, 25 women between the ages of 18 and 39 were interviewed retrospectively. They were interviewed one time to learn about their decision-making process related to FP. Results of this analysis indicate that patients seek support and involvement from providers throughout the process of decision making. They prefer providers to be directive when referring to the fertility clinic. Later in the process, they expect a supportive style of communication from providers. Patient-accessible language, supportive and reassuring styles of communication, and an existing relationship with providers may enhance well-being of the patients.

Teamwork and communication: an effective approach to patient safety.

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Mujumdar, Sandhya; Santos, Diana

2014-01-01

Teamwork and communication failures are leading causes of patient safety incidents in health care. Though health care providers must work in teams, they are not well-trained in teamwork and communication skills. Health care faces the problems of differences in communication styles, communication failures and poor teamwork. There is enough evidence in the literature to show that communication failure is detrimental to patient safety. It is estimated that 80% of serious medical errors worldwide take place because of miscommunication between medical providers. NUH recognizes that effective communication and teamwork are essential in the delivery of high quality safe patient care, especially in a complex organization. NUH is a good example, where there is a rich mix of nationalities and races, in staff and in patients, and there is a rapidly expanding care environment. NUH had to overcome these challenges by adopting a multi-pronged approach. The trials and tribulations of NUH in this journey were worthwhile as the patient safety climate survey scores improved over the years.

Variation in patient–provider communication by patient’s race and ethnicity, provider type, and continuity in and site of care: An analysis of data from the Connecticut Health Care Survey

Directory of Open Access Journals (Sweden)

Robert H Aseltine

2016-01-01

Full Text Available Objectives: The purpose of this study is to examine the quality of patient-reported communication with their health care providers using data from a large, statewide survey of patients. We examine the relationship between patient’s race and ethnicity, type of health care provider, site of and continuity in care, and the quality of patient–provider communication. Methods: We analyze data from the Connecticut Health Care Survey, a representative telephone survey of 4608 Connecticut residents conducted between June 2012 and February 2013. Eight measures of patient–provider communication were analyzed using weighted general linear and logistic regression models. Results: Patients’ assessments of the quality of communication with their health care providers were generally positive. Hispanic patients, those who received care in a clinic or hospital setting, and those who did not consistently see the same provider reported significantly poorer communication with their providers. Conclusion: Our data suggest that improving patient–provider communication for Hispanic patients may be a critical step in achieving health equity. However, increased access to health care delivered outside of physician offices where there may not be consistency in providers across encounters may pose challenges to effective health communication.

Feasibility of a patient-driven approach to recruiting older adults, caregivers, and clinicians for provider-patient communication research.

Science.gov (United States)

Lingler, Jennifer H; Martire, Lynn M; Hunsaker, Amanda E; Greene, Michele G; Dew, Mary Amanda; Schulz, Richard

2009-07-01

This report describes the implementation of a novel, patient-driven approach to recruitment for a study of interpersonal communication in a primary care setting involving persons with Alzheimer's disease (AD), their family caregivers, and their primary care providers (PCPs). Patients and caregivers were centrally recruited from a university-based memory clinic, followed by the recruitment of patient's individual PCPs. Recruitment tracking, naturalistic observation, and survey methods were used to evaluate recruitment success. About half of the patients and caregivers (n = 54; 51%) and most of the PCPs (n = 31; 76%) who we approached agreed to an audiorecording of the patient's next PCP visit. Characteristics of patient, caregiver, and PCP participants were compared to those of nonparticipants. Patient characteristics did not differ by participation status. Caregivers who volunteered for the study were more likely to be female and married than were those who declined to participate. Compared to nonparticipants, PCPs who agreed to the study were appraised slightly more favorably by patients' caregivers on a measure of satisfaction with care on the day of the visit. The vast majority of participating PCPs (95%) reported that the study had little or no impact on the flow of routine clinical operations. Findings support the feasibility of a patient-driven approach to recruitment for studies involving multiple linked participants. Our discussion highlights possible advantages of such an approach, including the potential to empower patient participants while achieving maximum variability within the pool of clinician participants.

Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

Science.gov (United States)

Wilson, I B; Kaplan, S

2000-12-15

-specific communication. In this study, female and homosexual physicians provided higher quality HIV-specific communication than male and heterosexual physicians. Better understanding the processes by which female and homosexual physicians achieve higher quality communication may help other physicians communicate more effectively. Health care providers and third-party payers should be aware that shorter visits may compromise physician-patient communication, and that this effect may be more consequential for male patients.

Oral health-related concerns, behavior, and communication with health care providers of patients with breast cancer: impact of different treatments.

Science.gov (United States)

Taichman, L Susan; Van Poznak, Catherine H; Inglehart, Marita R

2018-01-01

The objectives are to compare responses of breast cancer (BCa) treatment groups (chemotherapy, tamoxifen, and aromatase inhibitors (AIs) to each other and a control regarding (a) subjective oral health, (b) oral health-related behaviors, (c) oral health-related concerns, and (d) communication with health care providers. Survey data were collected from 140 postmenopausal BCa patients and 41 healthy postmenopausal control respondents. BCa patients reported on average more frequent mouth sores/mucositis (5-point scale with 1 = never: 1.63 vs. 1.14; p oral health than patients on tamoxifen/AI (93% vs. 55%/56%; p oral health-related effects of cancer treatment than by dentists. Oncologists/nurses were more likely to communicate about oral health-related treatment effects with patients undergoing chemotherapy than patients on tamoxifen or AIs. Few BCa patients perceived dentists as knowledgeable about cancer treatment-related oral concerns and trusted them less than oncologists. BCa treatments impact oral health. Low percentages of BCa patients had received specific information about impacts of BCa treatments on oral health from their dentists. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

Improving health outcomes for young people with long term conditions: The role of digital communication in current and future patient-clinician communication for NHS providers of specialist clinical services for young people - LYNC study protocol.

Science.gov (United States)

Griffiths, Frances E; Atherton, Helen; Barker, Jack R; Cave, Jonathan Ak; Dennick, Kathryn; Dowdall, Peter; Fraser, Joe; Huxley, Caroline; Kim, Sung-Wook; Madan, Jason J; Matharu, Harjit; Musumadi, Luhanga; Palmer, Tom M; Paul, Moli; Sankaranarayanan, Sailesh; Slowther, Anne-Marie; Sujan, Mark A; Sutcliffe, Paul A; Sturt, Jackie

2015-01-01

Young people living with long term conditions are vulnerable to health service disengagement. This endangers their long term health. Studies report requests for digital forms of communication - email, text, social media - with their health care team. Digital clinical communication is troublesome for the UK NHS. In this article we aim to present the research protocol for evaluating the impacts and outcomes of digital clinical communications for young people living with long term conditions and provide critical analysis of their use, monitoring and evaluation by NHS providers (LYNC study: Long term conditions, Young people, Networked Communications). The research involves: (a) patient and public involvement activities with 16-24 year olds with and without long term health conditions; (b) six literature reviews; (c) case studies - the main empirical part of the study - and (d) synthesis and a consensus meeting. Case studies use a mixed methods design. Interviews and non-participant observation of practitioners and patients communicating in up to 20 specialist clinical settings will be combined with data, aggregated at the case level (non-identifiable patient data) on a range of clinical outcomes meaningful within the case and across cases. We will describe the use of digital clinical communication from the perspective of patients, clinical staff, support staff and managers, interviewing up to 15 young people and 15 staff per case study. Outcome data includes emergency admissions, A&E attendance and DNA (did not attend) rates. Case studies will be analysed to understand impacts of digital clinical communication on patient health outcomes, health care costs and consumption, ethics and patient safety.

Using patients as educators for communication skills: Exploring dental students' and patients' views.

Science.gov (United States)

Coelho, C; Pooler, J; Lloyd, H

2018-05-01

A qualitative study to explore the issues for patients and students when giving feedback on the communication of dental students. The Department of Health and National Institute for Health Research are committed to involving patients in improving clinical education, research and service delivery. Yet, there is a limited body of evidence on the perceptions of patients when asked to be involved in this way, and specifically when asked to provide feedback on the communication skills of dental students. This study seeks to address this gap and heighten the understanding of the issues faced by patients when asked to be involved in clinical education. Data were collected using focus groups with dental students (n=10) and patients (n=8) being treated by these students. Both groups were asked about their thoughts, feelings and beliefs about patients being asked to provide feedback on the communication skills of dental students. Data analysis involved inductive thematic analysis of transcribed audio recordings. Four themes emerged from the data: "legitimacy," "co-educators," "maintaining the equilibrium of the patient-student relationship" and the "timing of patient feedback." Support for involving patients in giving feedback on students' communication skills was established, with patients considering they were best placed to comment on the communication skills of dental students. Patients and students do not want to provide feedback alone and want support to assist them, especially if feedback was negative. Issues of anonymity, confidentiality and ownership of the feedback process were worrisome, and the positioning of patient feedback in the programme was seen as critical. Patients and students are willing to engage in patient feedback on students' communication skills, and with support and training, the concerns around this are not insurmountable and the benefits could potentially profit both groups. These findings have resonance with other healthcare educators when

Patient-physician communication regarding electronic cigarettes.

Science.gov (United States)

Steinberg, Michael B; Giovenco, Daniel P; Delnevo, Cristine D

2015-01-01

Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician-patient communication regarding e-cigarettes. A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient-provider e-cigarette communication, and attitudes towards tobacco harm reduction. Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences.

Science.gov (United States)

Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M; Kamps, Willem A; Beishuizen, A; Bensing, Jozien M

2011-03-01

To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Preferences regarding health-care provider empathy in consultations, and children's involvement in information exchange and medical decision making were investigated by means of vignettes. Vignettes are brief descriptions of hypothetical situations, in which important factors are systematically varied following an experimental design. In total, 1440 vignettes were evaluated by 34 children with cancer (aged 8-16), 59 parents, and 51 survivors (aged 8-16 at diagnosis, currently aged 10-30). Recruitment of participants took place in three Dutch university-based pediatric oncology centers. Data were analyzed by multilevel analyses. Patients, parents, and survivors indicated the importance of health-care providers' empathy in 81% of the described situations. In most situations (70%), the three respondent groups preferred information about illness and treatment to be given to patients and parents simultaneously. Preferences regarding the amount of information provided to patients varied. The preference whether or not to shield patients from information was mainly associated with patients' age and emotionality. In most situations (71%), the three respondent groups preferred children to participate in medical decision making. This preference was mainly associated with patients' age. To be able to adapt communication to parents' and patients' preferences, health-care providers should repeatedly assess the preferences of both groups. Future studies should investigate how health-care providers balance their communication between the sometimes conflicting preferences of patients and parents. Copyright © 2010 John Wiley & Sons, Ltd.

Improving Interdisciplinary Provider Communication Through a Unified Paging System.

Science.gov (United States)

Heidemann, Lauren; Petrilli, Christopher; Gupta, Ashwin; Campbell, Ian; Thompson, Maureen; Cinti, Sandro; Stewart, David A

2016-06-01

Interdisciplinary communication at a Veterans Affairs (VA) academic teaching hospital is largely dependent on alphanumeric paging, which has limitations as a result of one-way communication and lack of reliable physician identification. Adverse patient outcomes related to difficulty contacting the correct consulting provider in a timely manner have been reported. House officers were surveyed on the level of satisfaction with the current VA communication system and the rate of perceived adverse patient outcomes caused by potential delays within this system. Respondents were then asked to identify the ideal paging system. These results were used to develop and deploy a new Web site. A postimplementation survey was repeated 1 year later. This study was conducted as a quality improvement project. House officer satisfaction with the preintervention system was 3%. The majority used more than four modalities to identify consultants, with 59% stating that word of mouth was a typical source. The preferred mode of paging was the university hospital paging system, a Web-based program that is used at the partnering academic institution. Following integration of VA consulting services within the university hospital paging system, the level of satisfaction improved to 87%. Significant decreases were seen in perceived adverse patient outcomes (from 16% to 2%), delays in patient care (from 90% to 16%), and extended hospitalizations (from 46% to 4%). Our study demonstrates significant improvement in physician satisfaction with a newly implemented paging system that was associated with a decreased perceived number of adverse patient events and delays in care.

Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm.

Science.gov (United States)

Brown-Johnson, Cati G; Burbank, Andrea; Daza, Eric J; Wassmann, Arianna; Chieng, Amy; Rutledge, Geoffrey W; Prochaska, Judith J

2016-12-01

E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches. Copyright © 2016 American Journal of Preventive Medicine. Published by

Predictors of communication preferences in patients with chronic low back pain

Directory of Open Access Journals (Sweden)

Farin E

2013-10-01

.Conclusion: Providers should take into consideration the fact that patients with back pain have a strong need for effective, open, and patient-centered communication. A flexible approach to communication needs appears to be especially important for communication about emotional and personal circumstances, because the patients differ most clearly in this respect. Personal characteristics provided only initial clues to possible preferences; for more precision, an individual assessment (by means of questionnaires or discussion is needed.Keywords: patient-physician relationship, patient-physician communication, preferences, low back pain, rehabilitation

Nurses' perception of time availability in patient communication in Hong Kong.

Science.gov (United States)

Chan, Engle A; Jones, Aled; Fung, Sylvia; Wu, Sui Chu

2012-04-01

To explore nurses' perceptions of their patient communication in practice and to identify their ways of communicating. Nurse theorists and clinicians are aware of the importance of nurse-patient communication in providing patient-centred care. However, barriers remain that prevent nurses from implementing quality/effective communication, and time is often viewed as a critical variable. Continuous emphasis on efficiency contravenes patient-centred care, warranting a re-examination of nurses' perception of time in nurse-patient communication. Focus group interviews were adopted. Thirty-nine registered nurses participated. Interviews were tape-recorded, transcribed and translated, and data were analysed using thematic analysis to identify codes, categories and themes/patterns. Three themes were identified regarding nurses' perception of communication with time: (1) Patterns of communication. (2) Routine scheduled communication vs. meeting individuals' needs. (3) Saving time through communication. Patterns of communication, based on participants' criteria such as the purpose, who initiated it, the nature of communication, expectation to perform, therapeutic value and relation with time were explicated. By integrating communication into routines as intended actions, nurses demonstrate that communication and relationship building with patients take no extra time. Good communication and good relationships help nurses save time. Nurses' communication behaviour is closely related to their perception of communication. This study suggests the need for a paradigm shift in thinking about communication as requiring time. Additionally, nurses should recognise the value of short, iterative interaction and chit-chat as quality communication for knowing their patients and providing patient-centred care. Nurses should think beyond time in the discourse of effective nurse-patient communication, as it often relates to manpower. An understanding of how nurses perceive their time

“Let Me Tell You About My…” Provider Self-Disclosure in the Emergency Department Builds Patient Rapport

Directory of Open Access Journals (Sweden)

Zink, Korie

2017-01-01

Full Text Available As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD of personal information by primary care providers decreased patient rating of the provider communication skills. The objective of this study was to explore the incidence and impact of emergency department (ED provider self-disclosure on patients’ rating of provider communication skills. A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers’ communication skills. We compared patients’ ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (p<0.05, more positive ratings of provider rapport (p<0.05 and higher satisfaction with provider communication (p<0.05. Patients who noted SD scored their providers’ communication skills as “excellent” (63.4% compared to patients without selfdisclosure (47.1%. Patients reported that they would like to hear about their providers’ experiences with a similar chief complaint (64.4% of patients, their providers’ education (49%, family (33%, personal life (21% or an injury/ailment unlike their own (18%. Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport. Provider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction. [West J Emerg Med. 2017;18(143-49.

Patients' preferences for patient-centered communication

DEFF Research Database (Denmark)

Lau, Sofie Rosenlund; Christensen, Søren Troels; Andreasen T., Jesper

2013-01-01

To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone.......To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone....

The "Hand-in" Project: Jump-starting Communication Between Inpatient and Outpatient Providers.

Science.gov (United States)

Holleck, Jürgen L; Gunderson, Craig G; Antony, Sheila M; Gupta, Shaili; Chang, John J; Merchant, Naseema; Lin, Shin; Federman, Daniel G

2017-11-01

Communication between hospitalists and primary care providers (PCPs) upon discharge has been much discussed, but the transition from outpatient to inpatient has received less attention. We questioned whether a brief, standardized e-mail from the hospitalist to the PCP upon admission could facilitate information exchange, increase communication, elucidate PCP preferences, and improve outcomes. This prospective single-center study with a preintervention-to-postintervention design involved 300 inpatient admissions from June 2015 through October 2015 in the Veterans Affairs Connecticut Healthcare System. Hospitalists e-mailed an encrypted notification of admission along with standardized questions to PCPs within 1 day of admission. Measurements included the number of communications between PCPs and hospitalists, length of stay (LOS), 30-day readmissions, 30-day emergency department (ED) utilization rates, PCP preferences with regard to communication, and follow-up. Preintervention data for 94 patients during a 6-week period revealed 0.11 communications per patient, an LOS of 4.18 days, 30-day readmissions of 28.7%, and 30-day ED visits of 32%. Postintervention data on 206 patients during the next 12 weeks showed statistically significant increased communications per patient (0.5), and a nonsignificant decrease in LOS (3.96 days), 30-day readmissions (22.3%), and 30-day ED visits (31%). P values were communication upon discharge (40%) to telephone (25%) or instant messaging (13%), and 39% wanted a follow-up appointment within 2 weeks, regardless of what transpired. A hospitalist-led transition-of-care intervention designed to improve communication and information exchange between PCPs and hospitalists at the time of admission demonstrated that encrypted e-mail could be used as a tool to obtain useful additional medical and psychosocial information and to better understand PCP attitudes and preferences. The increased level of communication did not yield statistically

Assessing patient-centred communication in teaching: a systematic review of instruments

NARCIS (Netherlands)

Brouwers, M.H.; Rasenberg, E.M.C.; Weel, C. van; Laan, R.F.; Weel-Baumgarten, E.M. van

2017-01-01

CONTEXT: Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is

"Best practice" for patient-centered communication: a narrative review.

Science.gov (United States)

King, Ann; Hoppe, Ruth B

2013-09-01

Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians. This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed. A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes "best practice" for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior. Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.

The relationship between physician humility, physician-patient communication, and patient health.

Science.gov (United States)

Ruberton, Peter M; Huynh, Ho P; Miller, Tricia A; Kruse, Elliott; Chancellor, Joseph; Lyubomirsky, Sonja

2016-07-01

Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical visit. Primary care physician-patient interactions (297 patients across 100 physicians) were rated for the physician's humility and the effectiveness of the physician-patient communication. Additionally, patients reported their overall health and physicians and patients reported their satisfaction with the interaction. Within-physician fluctuations in physician humility and self-reported patient health positively predicted one another, and mean-level differences in physician humility predicted effective physician-patient communication, even when controlling for the patient's and physician's satisfaction with the visit and the physician's frustration with the patient. The results suggest that humble, rather than paternalistic or arrogant, physicians are most effective at working with their patients. Interventions to improve physician humility may promote better communication between health care providers and patients, and, in turn, better patient outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Conduits to care: call lights and patients' perceptions of communication.

Science.gov (United States)

Montie, Mary; Shuman, Clayton; Galinato, Jose; Patak, Lance; Anderson, Christine A; Titler, Marita G

2017-01-01

Call light systems remain the primary means of hospitalized patients to initiate communication with their health care providers. Although there is vast amounts of literature discussing patient communication with their health care providers, few studies have explored patients' perceptions concerning call light use and communication. The specific aim of this study was to solicit patients' perceptions regarding their call light use and communication with nursing staff. Patients invited to this study met the following inclusion criteria: proficient in English, been hospitalized for at least 24 hours, aged ≥21 years, and able to communicate verbally (eg, not intubated). Thirty participants provided written informed consent, were enrolled in the study, and completed interviews. Using qualitative descriptive methods, five major themes emerged from patients' perceptions (namely; establishing connectivity, participant safety concerns, no separation: health care and the call light device, issues with the current call light, and participants' perceptions of "nurse work"). Multiple minor themes supported these major themes. Data analysis utilized the constant comparative methods of Glaser and Strauss. Findings from this study extend the knowledge of patients' understanding of not only why inconsistencies occur between the call light and their nurses, but also why the call light is more than merely a device to initiate communication; rather, it is a direct conduit to their health care and its delivery.

Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives.

Science.gov (United States)

Tasaki, Katsuya; Maskarinec, Gertraud; Shumay, Dianne M; Tatsumura, Yvonne; Kakai, Hisako

2002-01-01

The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease. Copyright 2002 John Wiley & Sons, Ltd.

Anti-Smoking Communication to Preadolescents with and without a Cancer Diagnosis: Parents and Healthcare Providers as Important Communicators

OpenAIRE

Throckmorton-Belzer, Leslee; Tyc, Vida L.; Robinson, Leslie A.; Klosky, James L.; Lensing, Shelly; Booth, Andrea K.

2009-01-01

A cancer diagnosis does not prevent smoking among pediatric oncology patients, and anti-smoking communications among parents and health care providers have been proposed as influencing smoking outcomes in this group. Anti-smoking communications were compared among 93 preadolescents with cancer and 402 controls. After adjusting for demographics and covariates, preadolescents with cancer were less likely than control participants to report receipt of anti-smoking messages from physicians and pa...

Improving communication between physicians and patients who speak a foreign language.

Science.gov (United States)

Bischoff, Alexander; Perneger, Thomas V; Bovier, Patrick A; Loutan, Louis; Stalder, Hans

2003-07-01

Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.

Provider-patient in-office discussions of response to hepatitis C antiviral therapy and impact on patient comprehension.

Science.gov (United States)

Hamilton, Heidi E; Nelson, Meaghan; Martin, Paul; Cotler, Scott J

2006-04-01

Providers need to communicate projected response rates effectively to enable patients with hepatitis C virus to make informed decisions about therapy. This study used interactional sociolinguistics (1) to evaluate how gastroenterologists and allied health professionals communicate information regarding response rates to antiviral therapy, (2) to determine how these discussions relate to where the patient is in the continuum of evaluation and treatment, (3) to assess whether patients were aligned with providers in their perceptions of response rates after office visits, and (4) to identify factors that improve provider-patient alignment. Gastroenterologists, allied health professionals, and patients with hepatitis C virus were videotaped and audiotaped during regularly scheduled visits. Postvisit interviews were conducted separately with patients and providers. Visits and postvisits were transcribed and analyzed using validated sociolinguistic techniques. The phase of hepatitis C virus treatment shaped the benchmarks of response talk, although across the treatment continuum providers overwhelmingly made strategic use of positive statistics, providing motivation. In postvisit interviews, 55% of providers and patients were aligned on response rates. Patients with a favorable outcome and patients who asked response-related questions in the visit were more likely to be aligned with providers. Areas identified for improvement included the tendency to discuss response rates before an individualized assessment could be made, balancing motivation and accuracy, and assessing the patient's perspective before delivering any bad news, if necessary. Sociolinguistic analysis provides a powerful tool to evaluate provider-patient interactions and to identify ways to improve in-office communication regarding antiviral therapy.

Psychiatrist-patient verbal and nonverbal communications during split-treatment appointments.

Science.gov (United States)

Cruz, Mario; Roter, Debra; Cruz, Robyn Flaum; Wieland, Melissa; Cooper, Lisa A; Larson, Susan; Pincus, Harold Alan

2011-11-01

This study characterized psychiatrist and patient communication behaviors and affective voice tones during pharmacotherapy appointments with depressed patients at four community-based mental health clinics where psychiatrists provided medication management and other mental health professionals provided therapy ("split treatment"). Audiorecordings of 84 unique pairs of psychiatrists and patients with a depressive disorder were analyzed with the Roter Interaction Analysis System, which identifies 41 discrete speech categories that can be grouped into composites representing broad conceptual communication domains. Cluster analysis identified psychiatrist communication patterns. T test and chi square analyses compared the clusters for verbal dominance, affective voice tone, and characteristics of psychiatrist and patients. On average, 53% of psychiatrist talk was devoted to partnering and relationship building, and 67% of patient talk was about biomedical subjects, such as depression symptoms, and psychosocial information giving. Psychiatrist communication patterns were characterized by two clusters, a biomedical-centered cluster that emphasized biomedical questions (η²=.22, df=82, prelationship building while maintaining a focus on symptoms or psychosocial issues. However, patient behaviors did not reflect a similar level of partnering. Future studies should identify psychiatrist communication behaviors that activate collaborative patient communications or improve treatment outcomes.

Communication practices about HPV testing among providers in Federally Qualified Health Centers

Directory of Open Access Journals (Sweden)

Lavinia Lin

2015-01-01

Conclusion: As HPV testing plays a more prominent role in cervical cancer screening, more attention should be given to communications between providers and patients about the benefits and harms of different screening options.

Communication Between Middle SES Black Women and Healthcare Providers About HIV Testing.

Science.gov (United States)

Fray, Niasha A; Caldwell, Kia Lilly

2017-01-01

This article explores the impact of patient and healthcare provider communication (PPC) on the HIV testing behaviors of middle socioeconomic status (SES) Black women in North Carolina. We explore how PPC about STIs and HIV (or the lack thereof) affects the provision of STI/HIV testing by either confirming the need for middle SES Black women to test routinely or potentially deterring women from feeling they need to be tested. After conducting 15 qualitative interviews with middle SES Black women between 25 and 45 years of age, we uncovered the role of patient self-advocacy in promoting HIV testing among middle SES Black women when they communicate with their healthcare providers. We discuss the importance of healthcare providers engaging their middle SES Black female patients in routine discussions about sexual health and sexual risk reduction, regardless of providers' perceptions of their potential STI/HIV risk. We recommend including SES as a variable in data collection and research in order to better understand how social class, race, and gender affect sexual health behavior and the provision of STI and HIV/AIDS prevention to diverse populations. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

Research and Practice Communications Between Oral Health Providers and Prenatal Health Providers: A Bibliometric Analysis.

Science.gov (United States)

Skvoretz, John; Dyer, Karen; Daley, Ellen; Debate, Rita; Vamos, Cheryl; Kline, Nolan; Thompson, Erika

2016-08-01

Objectives We aimed to examine scholarly collaboration between oral health and prenatal providers. Oral disease is a silent epidemic with significant public health implications for pregnant women. Evidence linking poor oral health during pregnancy to adverse pregnancy and birth outcomes requires oral health and prenatal providers to communicate on the prevention, treatment and co-management matters pertaining to oral health issues among their pregnant patients. The need for inter-professional collaboration is highlighted by guidelines co-endorsed by the American College of Obstetricians and Gynecologists and the American Dental Association, stressing the importance of oral health care during pregnancy. Methods To assess if interdisciplinary communication occurs between oral health and prenatal disciplines, we conducted a network analysis of research on pregnancy-related periodontal disease. Results Social Network analysis allowed us to identify communication patterns between communities of oral health and prenatal professionals via scientific journals. Analysis of networks of citations linking journals in different fields reveals a core-periphery pattern dominated by oral health journals with some participation from medicine journals. However, an analysis of dyadic ties of citation reveals statistically significant "inbreeding" tendencies in the citation patterns: both medical and oral health journals tend to cite their own kind at greater-than-chance levels. Conclusions Despite evidence suggesting that professional collaboration benefits patients' overall health, findings from this research imply that little collaboration occurs between these two professional groups. More collaboration may be useful in addressing women's oral-systemic health concerns that result in adverse pregnancy outcomes.

Interactions between patients and dental care providers: does gender matter?

Science.gov (United States)

Inglehart, Marita R

2013-04-01

Research findings concerning the role of gender in patient-physician interactions can inform considerations about the role of gender in patient-dental care provider interactions. Medical research showed that gender differences in verbal and nonverbal communication in medical settings exist and that they affect the outcomes of these interactions. The process of communication is shaped by gender identities, gender stereotypes, and attitudes. Future research needs to consider the cultural complexity and diversity in which gender issues are embedded and the degree to which ongoing value change will shape gender roles and in turn interactions between dental patients and their providers. Copyright © 2013 Elsevier Inc. All rights reserved.

Safety considerations for patients with communication disorders in rehabilitation medicine settings.

Science.gov (United States)

Cristian, Adrian; Giammarino, Claudia; Olds, Michael; Adams, Elizabeth; Moriarty, Christina; Ratner, Sabina; Mural, Shruti; Stobart, Eric C

2012-05-01

Communication barriers can pose a significant safety risk for patients. Individuals in a communication-vulnerable state are commonly seen in rehabilitation settings. These patients cannot adequately communicate their symptoms, wants, and needs to providers. Causes of communication barriers include neurologic impairments, such as stroke, cerebral palsy, and Parkinson disease, and language barriers. The ability of clinicians to adequately diagnose, treat, and monitor these patients is also hindered. This article identifies key communication barriers and strategies that clinicians can use to effectively communicate with these patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Elements of patient-health-care provider communication related to cardiovascular rehabilitation referral.

Science.gov (United States)

Pourhabib, Sanam; Chessex, Caroline; Murray, Judy; Grace, Sherry L

2016-04-01

Cardiovascular rehabilitation has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-health-care provider interactions regarding cardiovascular rehabilitation and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their health-care providers. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 health-care providers and 50 patients were recorded. Cardiovascular rehabilitation referral was related to greater health-care provider interactivity (odds ratio = 2.82, 95% confidence interval = 1.01-7.86) and less patient concern and worry (odds ratio = 0.64, 95% confidence interval = 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral. © The Author(s) 2014.

"Open your heart first of all": perspectives of holistic providers in Costa Rica about communication in the provision of health care.

Science.gov (United States)

Geist-Martin, Patricia; Bell, Keely K

2009-10-01

Research documents how the care the holistic providers offer represents the quality communication that patients often do not receive from their biomedical providers. However, research investigating the perspectives of holistic providers concerning the role they see themselves playing in the provision of health is limited. This research explores the perceptions of holistic providers in Costa Rica about their communication with their patients. The results reveal two practices of communication-authenticating and integrating as central to providers' communication with patients in the provision of holistic health care. Providers describe their communication as an exploration of an anatomy of pain/suffering, including investigating the location, timing, length, intensity, and overall rhythm of the patient's condition and sense making that leads them to seek the care of a holistic provider. Most holistic providers see their role as being careful or full of care and suggest that they have an obligation to open their heart first of all.

Large-Scale Survey Findings Inform Patients' Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment.

Science.gov (United States)

Haun, Jolie N; Patel, Nitin R; Lind, Jason D; Antinori, Nicole

2015-12-21

Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users' experiences in using secure email messaging. To quantitatively assess veteran patients' experiences in using secure email messaging in a large patient sample. A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations' Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance. The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared

Communication Skills Training for Physicians Improves Patient Satisfaction.

Science.gov (United States)

Boissy, Adrienne; Windover, Amy K; Bokar, Dan; Karafa, Matthew; Neuendorf, Katie; Frankel, Richard M; Merlino, James; Rothberg, Michael B

2016-07-01

Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted. We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience. This was an observational study. The study was conducted at a large, multispecialty academic medical center. Participants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014. An 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction. Following the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

Cancer patients' evaluation of communication

DEFF Research Database (Denmark)

Ross, Lone; Petersen, Morten Aagaard; Johnsen, Anna Thit

2013-01-01

The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication.......The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication....

Exploring the Cervical Cancer Screening Experiences of Black Lesbian, Bisexual, and Queer Women: The Role of Patient-Provider Communication.

Science.gov (United States)

Agénor, Madina; Bailey, Zinzi; Krieger, Nancy; Austin, S Bryn; Gottlieb, Barbara R

2015-01-01

Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.

Improving Patient Safety: Improving Communication.

Science.gov (United States)

Bittner-Fagan, Heather; Davis, Joshua; Savoy, Margot

2017-12-01

Communication among physicians, staff, and patients is a critical element in patient safety. Effective communication skills can be taught and improved through training and awareness. The practice of family medicine allows for long-term relationships with patients, which affords opportunities for ongoing, high-quality communication. There are many barriers to effective communication, including patient factors, clinician factors, and system factors, but tools and strategies exist to address these barriers, improve communication, and engage patients in their care. Use of universal precautions for health literacy, appropriate medical interpreters, and shared decision-making are evidence-based tools that improve communication and increase patient safety. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Examination of Routine Use of Prenatal Weight Gain Charts as a Communication Tool for Providers.

Science.gov (United States)

Aguilera, Marijo; Sidebottom, Abbey C; McCool, Brigitte R

2017-10-01

Objectives In 2009 the IOM revised prenatal weight gain guidelines. The primary purpose of this pilot study was to assess if provider education and use of prenatal weight gain charts to track weight gain and counsel patients was associated with better patient and provider knowledge and communication about the guidelines. Methods A prospective non-randomized study conducted in four OB practices (two control, two intervention). Data sources included provider surveys (n = 16 intervention, 21 control), patient surveys (n = 332), and medical records. Intervention clinics received provider education on the IOM guidelines and used patient education materials and prenatal weight gain charts to track weight gain and as a counseling tool. Comparison clinics received no education and did not use the charts or patient education information. Results More patients at intervention clinics (92.3%) reported that a provider gave them advice about weight gain, compared to patients from comparison clinics (66.4%) (p gain (83.1 vs. 64.3%, p = 0.007). Intervention clinic patients were more likely to have knowledge of the guidelines indicated by 72.3% reporting a target weight gain amount within the guidelines versus 50.4% of comparison patients (p gain charts resulted in higher patient reported communication about weight gain from their provider, higher patient satisfaction with those discussions, and better knowledge of the appropriate target weight gain goals.

Patient and provider experiences with active surveillance: A scoping review.

Directory of Open Access Journals (Sweden)

Claire Kim

Full Text Available Active surveillance (AS represents a fundamental shift in managing select cancer patients that initiates treatment only upon disease progression to avoid overtreatment. Given uncertain outcomes, patient engagement could support decision-making about AS. Little is known about how to optimize patient engagement for AS decision-making. This scoping review aimed to characterize research on patient and provider communication about AS, and associated determinants and outcomes.MEDLINE, EMBASE, CINAHL, and The Cochrane Library were searched from 2006 to October 2016. English language studies that evaluated cancer patient or provider AS views, experiences or behavioural interventions were eligible. Screening and data extraction were done in duplicate. Summary statistics were used to describe study characteristics and findings.A total of 2,078 studies were identified, 1,587 were unique, and 1,243 were excluded based on titles/abstracts. Among 344 full-text articles, 73 studies were eligible: 2 ductal carcinoma in situ (DCIS, 4 chronic lymphocytic leukemia (CLL, 6 renal cell carcinoma (RCC and 61 prostate cancer. The most influential determinant of initiating AS was physician recommendation. Others included higher socioeconomic status, smaller tumor size, comorbid disease, older age, and preference to avoid adverse treatment effects. AS patients desired more information about AS and reassurance about future treatment options, involvement in decision-making and assessment of illness uncertainty and supportive care needs during follow-up. Only three studies of prostate cancer evaluated interventions to improve AS communication or experience.This study revealed a paucity of research on AS communication for DCIS, RCC and CLL, but generated insight on how to optimize AS discussions in the context of routine care or clinical trials from research on AS for prostate cancer. Further research is needed on AS for patients with DCIS, RCC and CLL, and to evaluate

The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support.

Science.gov (United States)

Lown, Beth A; Manning, Colleen F

2010-06-01

To assess the impact of Schwartz Center Rounds, an interdisciplinary forum where attendees discuss psychosocial and emotional aspects of patient care. The authors investigated changes in attendees' self-reported behaviors and beliefs about patient care, sense of teamwork, stress, and personal support. In 2006-2007, researchers conducted retrospective surveys of attendees at six sites offering Schwartz Center Rounds ("the Rounds") for > or =3 years and prospective surveys of attendees at 10 new Rounds sites that have held > or =7 Rounds. Most of the retrospective survey respondents indicated that attending Rounds enhanced their likelihood of attending to psychosocial and emotional aspects of care and enhanced their beliefs about the importance of empathy. Respondents reported better teamwork, including heightened appreciation of the roles and contributions of colleagues. There were significant decreases in perceived stress (P teamwork (both: P communication, teamwork, and provider support. The impact on measured outcomes increased with the number of Rounds attended. The Rounds represent an effective strategy for providing support to health care professionals and for enhancing relationships among them and with their patients.

Assessing written communication during interhospital transfers of emergency general surgery patients.

Science.gov (United States)

Harl, Felicity N R; Saucke, Megan C; Greenberg, Caprice C; Ingraham, Angela M

2017-06-15

Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; among 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants' notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient's ED arrival and were not part of the original documentation provided. This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers. Copyright © 2017 Elsevier Inc. All rights reserved.

Communication Adaptations for a Diverse International Patient Population.

Science.gov (United States)

Ghosh, Aditya; Joshi, Shashank; Ghosh, Amit K

2017-11-01

We live in an age of hyper connectivity, people from around the world are looking outside their own national borders to receive medical care. As more people are learning about the quality that the elite Indian hospitals provide at a competitive, and often more affordable, price compared to other institutions around the world, they are becoming increasingly interested in receiving their medical care in Indian hospitals. It is for this exact reason that it is very important to learn the importance of communicating effectively with people from a diverse background. Over the next decade, the number of international patients that Indian hospitals will provide care for is set to dramatically increase. In this new age of medicine in India, it is imperative that doctors are adequately equipped with the communication skills to appropriately connect with patients coming from very different cultural backgrounds. The interaction with an international patient can be tremendously deepened through effective communication that adheres to the cultural beliefs of the patient. In this article, we detail how to effectively communicate with people from different backgrounds. We explore how to speak with patients and connect on a deeper level and respect the cultural differences that exist. We will also discuss how to avoid offending your patients or miscommunicating your plans to them. Overall, improved awareness of cultural differences will ensure higher patient satisfaction as well as an improved doctor patient interaction. © Journal of the Association of Physicians of India 2011.

Communication skills to ensure patient satisfaction.

Science.gov (United States)

Shendurnikar, Niranjan; Thakkar, Pareshkumar A

2013-11-01

Every pediatrician would want to satisfy their patients and their parents to sustain good practice, earn name and fame and simultaneously to avoid litigation in this era of consumer protection act. This can be achieved only by use of good communication skills. Today the patients demand time, information and want their questions to be answered. They expect politeness, empathy and human touch from doctors. Time constraints, arrogance, telephone calls, language barriers and cultural insensitivity are the important barriers to good communication. Research has shown that doctor, who undergoes training to acquire good communication skills, can better satisfy his patients. Good communication skill is an art which can be acquired or improved by putting conscious efforts in day to day practice. Such skills should also be incorporated as part of medical teaching curriculum. Asking open ended questions, effective listening, appropriate praise, providing enough information as part of advice and finally checking their understanding, are the key areas of communication during medical interview. During this process pediatrician should ensure to address the parental concerns, should empathize with parents and involve parents in decision making. This will not only ensure satisfaction of parents but also their adherence to the therapy and to the pediatrician.

Exploring challenges in the patient's discharge process from the internal medicine service: A qualitative study of patients' and providers' perceptions.

Science.gov (United States)

Pinelli, Vincent; Stuckey, Heather L; Gonzalo, Jed D

2017-09-01

In hospital-based medicine units, patients have a wide range of complex medical conditions, requiring timely and accurate communication between multiple interprofessional providers at the time of discharge. Limited work has investigated the challenges in interprofessional collaboration and communication during the patient discharge process. In this study, authors qualitatively assessed the experiences of internal medicine providers and patients about roles, challenges, and potential solutions in the discharge process, with a phenomenological focus on the process of collaboration. Authors conducted interviews with 87 providers and patients-41 providers in eight focus-groups, 39 providers in individual interviews, and seven individual patient interviews. Provider roles included physicians, nurses, therapists, pharmacists, care coordinators, and social workers. Interviews were audio-recorded and transcribed verbatim, followed by iterative review of transcripts using qualitative coding and content analysis. Participants identified several barriers related to interprofessional collaboration during the discharge process, including systems insufficiencies (e.g., medication reconciliation process, staffing challenges); lack of understanding others' roles (e.g., unclear which provider should be completing the discharge summary); information-communication breakdowns (e.g., inaccurate information communicated to the primary medical team); patient issues (e.g., patient preferences misaligned with recommendations); and poor collaboration processes (e.g., lack of structured interprofessional rounds). These results provide context for targeting improvement in interprofessional collaboration in medicine units during patient discharges. Implementing changes in care delivery processes may increase potential for accurate and timely coordination, thereby improving the quality of care transitions.

Facilitating communication about sexual health between aging women and their health care providers.

Science.gov (United States)

Hughes, Anne K; Lewinson, Terri D W

2015-04-01

Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers. © The Author(s) 2014.

Clinician-patient E-mail communication: challenges for reimbursement.

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Komives, Eugenie M

2005-01-01

Clinicians are rapidly gaining experience with online clinician-patient consultation, and more tools are becoming available to support these efforts. In addition, we now have evidence that using electronic communication is cost-effective to payers and appealing to patients and providers. At present, there appear to be few barriers to the adoption of these solutions for practices that use other online services. Security concerns can easily be overcome by using programs described in this commentary. Larger and longer studies that evaluate the benefits and cost savings in more detail may help convince other payers and providers of the utility of the Web-based programs. More studies are needed to understand the effect of dinician-patient electronic communication on the costs of caring for chronic illness. When these solutions also include support tools, such as electronic prescribing, which could improve patient safety and quality of care, they should be encouraged. In their article entitled, "Electrons in Flight-Email between Doctors and Patients," Delbanco and Sands postulate that the future of e-communication in medicine will be integrated with a patient-controlled health record and will include secure synchronous and asynchronous communication, video conferencing and messaging, instant transcription into the written record, full-patient access to the record, translation into different languages, connectivity to multiple data sources, incorporation of multi-media educational materials. It-will also allow data from home-based diagnostic technology to be sent to clinicians. "Electronic communication will move medicine inexorably toward such transparency, enabling doctors and patients to share knowledge, responsibility, and decision-making more equally. We need to explore rapidly how this change will affect the quality of care for patients and the quality of life for doctors." The widespread dependence on Internet-based electronic communication to support a variety of

The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis.

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Selman, Lucy Ellen; Brighton, Lisa J; Hawkins, Amy; McDonald, Christine; O'Brien, Suzanne; Robinson, Vicky; Khan, Shaheen A; George, Rob; Ramsenthaler, Christine; Higginson, Irene J; Koffman, Jonathan

2017-09-01

As most end-of-life care is provided by health care providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviors. Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS, and OpenGrey) plus hand searching. Randomized controlled trials of training interventions intended to enhance generalists' communication skills in end-of-life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random-effects model. PRISMA guidelines were followed. Nineteen of 11,441 articles were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n = 3144, trainees n = 791). Meta-analysis showed no effect on patient outcomes (standardized mean difference [SMD] = 0.10, 95% CI -0.05 to 0.24) and high levels of heterogeneity (chi-square = 21.32, degrees of freedom [df] = 7, P = 0.003; I 2  = 67%). The effect on trainee behaviors in simulated interactions (SMD = 0.50, 95% CI 0.19-0.81) was greater than in real patient interactions (SMD = 0.21, 95% CI -0.01 to 0.43) with moderate heterogeneity (chi-square = 8.90, df = 5, P = 0.11; I 2  = 44%; chi-square = 5.96, df = 3, P = 0.11; I 2  = 50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalized feedback on recorded interactions. The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalized feedback on recorded patient

Communication and patient participation influencing patient recall of treatment discussions.

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Richard, Claude; Glaser, Emma; Lussier, Marie-Thérèse

2017-08-01

Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. Observational study within a RCT. Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. Recall of CD, lifestyle treatment and medication information. Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Modern computer technologies facilitate communication with a young cancer patient.

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Ripamonti, Carla Ida; Piccinelli, Claudia; Pessi, Maria Adelaide; Clerici, Carlo Alfredo

2010-01-01

The aim of this paper is to show how new technologies may help the communication process in clinical practice in a department providing supportive care to patients undergoing cancer treatment. Communication via Internet chat between the psychologist and a young man who sees chatting on the Internet as a natural and familiar mode of expression was shown to be useful. The Internet link enabled us to open a communication channel with the patient and to have a conversation that would otherwise have been impossible. Although verbal communication is the most important way to communicate among people, Internet communications are certainly an opportunity worth exploring, because they may open up new channels for cancer patients whose ability to speak is restricted. We might imagine using this approach in pediatric oncology, with adolescents and preadolescents, and with young adults like the patient discussed here. The case discussed highlights the enormous difference between the mere transfer of information and genuine communication, the latter involving an encounter with the patient.

African American women and prenatal care: perceptions of patient-provider interaction.

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Dahlem, Chin Hwa Y; Villarruel, Antonia M; Ronis, David L

2015-02-01

Poor patient-provider interaction among racial/ethnic minorities is associated with disparities in health care. In this descriptive, cross-sectional study, we examine African American women's perspectives and experiences of patient-provider interaction (communication and perceived discrimination) during their initial prenatal visit and their influences on perceptions of care received and prenatal health behaviors. Pregnant African American women (n = 204) and their providers (n = 21) completed a pre- and postvisit questionnaire at the initial prenatal visit. Women were also interviewed face to face at the subsequent return visit. Women perceived high quality patient-provider communication (PPC) and perceived low discrimination in their interaction with providers. Multiple regression analyses showed that PPC had a positive effect on trust in provider (p prenatal care satisfaction (p prenatal health behaviors. Findings suggest that quality PPC improves the prenatal care experience for African American women. © The Author(s) 2014.

Oncology nurses' communication challenges with patients and families: A qualitative study.

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Banerjee, Smita C; Manna, Ruth; Coyle, Nessa; Shen, Megan Johnson; Pehrson, Cassandra; Zaider, Talia; Hammonds, Stacey; Krueger, Carol A; Parker, Patricia A; Bylund, Carma L

2016-01-01

The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions. Copyright © 2015 Elsevier Ltd. All rights reserved.

A mixed-methods examination of communication between oncologists and primary care providers among primary care physicians in underserved communities.

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Shen, Megan Johnson; Binz-Scharf, Maria; D'Agostino, Tom; Blakeney, Natasha; Weiss, Elisa; Michaels, Margo; Patel, Shilpa; McKee, M Diane; Bylund, Carma L

2015-03-15

Research has demonstrated that communication and care coordination improve cancer patient outcomes. To improve communication and care coordination, it is important to understand primary care providers' (PCPs') perceptions of communication with oncologists as well as PCPs' communication needs. A mixed-methods approach was used in the present study. In the qualitative phase of the study, 18 PCPs practicing in underserved, minority communities were interviewed about their experiences communicating with oncologists. In the quantitative phase of the study, 128 PCPs completed an online survey about their preferences, experiences, and satisfaction with communication with oncologists. Results indicated a PCP-oncologist gap in communication occurred between diagnosis and treatment. PCPs wanted more communication with oncologists, updates on their patients' prognosis throughout treatment, and to be contacted via telephone or email and saw their role as crucial in providing supportive care for their patients. Although PCPs recognize that they play a critical, proactive role in supporting patients throughout the continuum of their cancer care experience, existing norms regarding postreferral engagement and oncologist-PCP communication often hinder activation of this role among PCPs. Expected standards regarding the method, frequency, and quality of postreferral communication should be jointly articulated and made accountable between PCPs and oncologists to help improve cancer patients' quality of care, particularly in minority communities. © 2014 American Cancer Society.

Communication Barriers Perceived by Nurses and Patients.

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Norouzinia, Roohangiz; Aghabarari, Maryam; Shiri, Maryam; Karimi, Mehrdad; Samami, Elham

2015-09-28

Communication, as a key element in providing high-quality health care services, leads to patient satisfaction and health. The present Cross sectional, descriptive analytic study was conducted on 70 nurses and 50 patients in two hospitals affiliated to Alborz University of Medical Sciences, in 2012. Two separate questionnaires were used for nurses and patients, and the reliability and validity of the questionnaires were assessed. In both groups of nurses and patients, nurse-related factors (mean scores of 2.45 and 2.15, respectively) and common factors between nurses and patients (mean scores of 1.85 and 1.96, respectively) were considered the most and least significant factors, respectively. Also, a significant difference was observed between the mean scores of nurses and patients regarding patient-related (p=0.001), nurse-related (p=0.012), and environmental factors (p=0.019). Despite the attention of nurses and patients to communication, there are some barriers, which can be removed through raising the awareness of nurses and patients along with creating a desirable environment. We recommend that nurses be effectively trained in communication skills and be encouraged by constant monitoring of the obtained skills.

Patient perceptions of helpful communication in the context of advanced cancer.

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Stajduhar, Kelli I; Thorne, Sally E; McGuinness, Liza; Kim-Sing, Charmaine

2010-07-01

Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers? Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices. Secondary analysis of qualitative interview data. Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis. Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase - respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information. Communication is an important element in the provision of advanced cancer care. Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

The influence of Hispanic ethnicity on parent-provider communication about asthma.

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Carlin, Courtney; Yee, Alison B; Fagnano, Maria; Halterman, Jill S

2014-04-01

Research has shown that minority caregivers of children with asthma report poorer communication with health care providers than nonminority caregivers. Less is known about the specific influence of Hispanic ethnicity on parent-provider communication. Our objective was to evaluate the influence of Hispanic ethnicity on parent-provider communication regarding their child's asthma and on caregiver confidence in communicating with their child's provider at a primary care visit. Data were obtained from 166 caregivers of children (2-12 years) with persistent asthma. Caregiver perceptions of provider communication and confidence were evaluated. We found that Hispanic compared to non-Hispanic caregivers reported better communication with providers on several items. Hispanic caregivers also were more likely to indicate full confidence in their ability to communicate with providers. These findings suggest Hispanic caregivers may experience better parent-provider communication than non-Hispanics. Further investigation is needed to assess provider- and clinic-specific factors that may influence communication between minority caregivers and providers.

Intensity of exposure to a patient activation intervention and patient engagement in medical visit communication.

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Ibe, Chidinma; Bowie, Janice; Roter, Debra; Carson, Kathryn A; Lee, Bone; Monroe, Dwyan; Cooper, Lisa A

2017-07-01

We examined associations between intensity of exposure to a community health worker (CHW) delivered communication activation intervention targeting low-income patients with hypertension. We analyzed question-asking behaviors of patients assigned to the intervention arms (n=140) in a randomized controlled trial. Intensity of exposure to the intervention was operationalized as the duration of face-to-face coaching and number of protocol-specified topics discussed. Mixed effects models characterized the relationship between intensity of exposure and patients' communication in a subsequent medical visit. The number of topics discussed during the coaching session was positively associated with patients' asking psychosocial-related questions during their visit. The duration of the coaching session was positively associated with patients' use of communication engagement strategies to facilitate their participation in the visit dialogue. Exposure to a physician trained in patient-centered communication did not influence these relationships. A dose-response relationship was observed between exposure to a CHW- delivered communication activation intervention and patient-provider communication. This study supports the use of CHWs in activating patients toward greater communication in the therapeutic exchange. Copyright © 2017 Elsevier B.V. All rights reserved.

Development and Psychometric Testing of the Caregiver Communication Competence Scale in Patients With Dementia.

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Chao, Hui-Chen; Yang, Ya-Ping; Huang, Mei-Chih; Wang, Jing-Jy

2016-01-01

Appropriate communication skills are essential for understanding patient needs, particularly those of patients with dementia. Assessing health care providers' competence in communicating with patients with dementia is critical for planning a communication education program. However, no formally established scale can be used. The purpose of the current study was to develop a valid and reliable instrument for determining the communication competence of health care providers with patients with dementia. Through use of a literature review and previous clinical experience, an initial 28-item scale was developed to assess the frequency of use of each item by health care providers. Fourteen items were extracted and three factors were distinguished. Results indicated that the internal consistency reliability of the 14-item scale was 0.84. Favorable convergent and discriminant validities were reached. The communication competence scale provides administrators or educators with a useful tool for assessing communication competence of health care providers when interacting with patients with dementia so a suitable education program can be planned and implemented. Copyright 2016, SLACK Incorporated.

Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions.

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Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen

2017-06-01

The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

Science.gov (United States)

2012-01-01

Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

Directory of Open Access Journals (Sweden)

McGilton Katherine S

2012-10-01

Full Text Available Abstract Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1 examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2 examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1 development of an individualized patient communication care plan; (2 a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3 a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to

Patient-provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study

Directory of Open Access Journals (Sweden)

Östenson Claes-Göran

2007-10-01

Full Text Available Abstract Background Patients' expectations and perceptions of the medical encounter and interactions are important tools in diabetes management. Some problems regarding the interaction during encounters may be related to a lack of communication skills on the part of either the physician or the patient. This study aimed at exploring the perceptions of type 2 diabetes patients regarding the medical encounters and quality of interactions with their primary health-care providers. Methods Four focus group discussions (two women and two men groups were conducted among 27 purposively selected patients (13 men and 14 women from six primary health-care centres in Muscat, Oman. Qualitative content analysis was applied. Results The patients identified some weaknesses regarding the patient-provider communication like: unfriendly welcoming; interrupted consultation privacy; poor attention and eye contact; lack of encouraging the patients to ask questions on the providers' side; and inability to participate in medical dialogue or express concerns on the patients' side. Other barriers and difficulties related to issues of patient-centeredness, organization of diabetes clinics, health education and professional competency regarding diabetes care were also identified. Conclusion The diabetes patients' experiences with the primary health-care providers showed dissatisfaction with the services. We suggest appropriate training for health-care providers with regard to diabetes care and developing of communication skills with emphasis on a patient-centred approach. An efficient use of available resources in diabetes clinics and distributing responsibilities between team members in close collaboration with patients and their families seems necessary. Further exploration of the providers' work situation and barriers to good interaction is needed. Our findings can help the policy makers in Oman, and countries with similar health systems, to improve the quality and

Impacts of mobile tablet computing on provider productivity, communications, and the process of care.

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Schooley, Benjamin; Walczak, Steven; Hikmet, Neset; Patel, Nitin

2016-04-01

Health information technology investments continue to increase while the value derived from their implementation and use is mixed. Mobile device adoption into practice is a recent trend that has increased dramatically and formal studies are needed to investigate consequent benefits and challenges. The objective of this study is to evaluate practitioner perceptions of improvements in productivity, provider-patient communications, care provision, technology usability and other outcomes following the adoption and use of a tablet computer connected to electronic health information resources. A pilot program was initiated in June 2013 to evaluate the effect of mobile tablet computers at one health provider organization in the southeast United States. Providers were asked to volunteer for the evaluation and were each given a mobile tablet computer. A total of 42 inpatient and outpatient providers were interviewed in 2015 using a survey style questionnaire that utilized yes/no, Likert-style, and open ended questions. Each had previously used an electronic health record (EHR) system a minimum of one year outside of residency, and were regular users of personal mobile devices. Each used a mobile tablet computer in the context of their practice connected to the health system EHR. The survey results indicate that more than half of providers perceive the use of the tablet device as having a positive effect on patient communications, patient education, patient's perception of the provider, time spent interacting with patients, provider productivity, process of care, satisfaction with EHR when used together with the device, and care provision. Providers also reported feeling comfortable using the device (82.9%), would recommend the device to colleagues (69.2%), did not experience increased information security and privacy concerns (95%), and noted significant reductions in EHR login times (64.1%). Less than 25% of participants reported negative impacts on any of these areas as

It takes two to tango: A dyadic approach to understanding the medication dialogue in patient-provider relationships.

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Schoenthaler, Antoinette; Basile, Melissa; West, Tessa V; Kalet, Adina

2018-08-01

To describe typologies of dyadic communication exchanges between primary care providers and their hypertensive patients about prescribed antihypertensive medications. Qualitative analysis of 94 audiotaped patient-provider encounters, using grounded theory methodology. Four types of dyadic exchanges were identified: Interactive (53% of interactions), divergent-traditional (24% of interactions), convergent-traditional (17% of interactions) and disconnected (6% of interactions). In the interactive and convergent-traditional types, providers adopted a patient-centered approach and used communication behaviors to engage patients in the relationship. Patients in these interactions adopted either an active role in the visit (interactive), or a passive role (convergent-traditional). The divergent-traditional type was characterized by provider verbal dominance, which inhibited patients' ability to ask questions, seek information, or check understanding of information. In the disconnected types, providers used mainly closed-ended questions and terse directives to gather and convey information, which was often disregarded by patients who instead diverted the conversation to psychosocial issues. This study identified interdependent patient-provider communication styles that can either facilitate or hinder discussions about prescribed medications. Examining the processes that underlie dyadic communication in patient-provider interactions is an essential first step to developing interventions that can improve the patient-provider relationship and patient health behaviors. Copyright © 2018 Elsevier B.V. All rights reserved.

Evaluating Surgical Residents' Patient-Centered Communication Skills: Practical Alternatives to the "Apprenticeship Model".

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Newcomb, Anna; Trickey, Amber W; Lita, Elena; Dort, Jonathan

2017-10-06

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments. Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs). We measured perception of resident communication using the 14-item Communication Assessment Tool (CAT), collecting data from patients at the surgery clinic and surgical wards in the hospital, and from SP encounters during simulated training scenarios. We developed a handout of CAT example behaviors to guide patients completing the communication assessment. Independent academic medical center. General surgery residents. The primary outcome is the percentage of total items patients rated "excellent;" we collected data on 24 of 25 residents. Outpatient evaluations resulted in significantly higher scores (mean 84.5% vs. 68.6%, p communication assessments in their concurrent patient population (p = 0.017), and (2) receiving CAT example instructions was associated with a lower percentage of excellent ratings by 9.3% (p = 0.047). Our data collection process provides a model for obtaining meaningful information about resident communication proficiency. CAT evaluations of surgical residents by the inpatient population had not previously been described in the literature; our results provide important insight into relationships between the evaluations provided by inpatients, clinic patients, and SPs in simulation. Our example behaviors guide shows promise for addressing a common concern, minimizing ceiling effects when measuring physician-patient communication. Copyright © 2017 Association of Program Directors in Surgery. Published by

The Effects of Hospital-Level Factors on Patients' Ratings of Physician Communication.

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Al-Amin, Mona; Makarem, Suzanne C

2016-01-01

The quality of physician-patient communication influences patient health outcomes and satisfaction with healthcare delivery. Yet, little is known about contextual factors that influence physicians' communication with their patients. The main purpose of this article is to examine organizational-level factors that influence patient perceptions of physician communication in inpatient settings. We used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and American Hospital Association data to determine patients' ratings of physician communication at the hospital level, and to collect information about hospital-level factors that can potentially influence physician communication. Our sample consisted of 2,756 hospitals. We ran a regression analysis to determine the predictors of poor physician communication, measured as the percentage of patients in a hospital who reported that physicians sometimes or never communicated well. In our sample of hospitals, this percentage ranged between 0% and 21%, with 25% of hospitals receiving poor ratings from more than 6% of patients. Three organizational factors had statistically significant negative associations with physician communication: for-profit ownership, hospital size, and hospitalists providing care in the hospital, On the other hand, the number of full-time-equivalent physicians and dentists per 10,000 inpatient days, physician ownership of the hospital, Medicare share of inpatient days, and public ownership were positively associated with patients' ratings of physician communication. Physician staffing levels are an understudied area in healthcare research. Our findings indicate that physician staffing levels affect the quality of physician communication with patients. Moreover, for-profit and larger hospitals should invest more in physician communication given the role that HCAHPS plays in value-based purchasing.

Communication elements supporting patient safety in psychiatric inpatient care.

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Kanerva, A; Kivinen, T; Lammintakanen, J

2015-06-01

Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view. Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly. Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care. In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries. The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi-structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication

Differences in perceived communication barriers among nurses and elderly patients in China.

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Ruan, Jing; Lambert, Vickie A

2008-06-01

In China, limited information exists about nurses' and elderly patients' perceptions of barriers to the communication process. Therefore, the purposes of this study were to identify the major communication barriers (nurse-related, patient-related, and environment-related) perceived both by nurses and elderly patients and to determine the perceived differences in the level of importance of the communication barriers between nurses and elderly patients. The sample consisted of 84 nurses and 75 elderly patients who completed a demographic questionnaire and a communication barriers questionnaire. The findings suggested that the nurses and elderly patients often selected similar barriers related to the communication process. The nurses tended to assign higher values to the communication barriers that were found to be significantly different from those of the elderly patients. The study findings provide information about which type of barriers nurses need to address so as to facilitate effective communication with elderly patients.

Iranian Nursing Student-patient Health Communication in Medical Surgical Wards.

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Abdolrahimi, Mahbobeh; Ghiyasvandian, Shahrzad; Zakerimoghadam, Masoumeh; Ebadi, Abbas

2018-01-01

Health communication (HC) is considered an important task of nurses to provide high quality and holistic care as well as to improve patient health. The nursing student-patient HC is an abstract concept and needs to be clarified. Therefore, this study was conducted to increase the knowledge about nursing students' HC with patients by considering various participants' viewpoints. In this conventional qualitative content analysis, 18 semi-structured interviews were conducted with six nursing students, six nursing instructors, and six patients in educational hospitals affiliated to the University of Medical Sciences. Credibility, confirmability, dependability, and transferability were established to validate the trustworthiness of the data. The process of data collection and analysis lasted 9 months. After data analysis, two categories were generated: (A) "junior nursing student-patient communication," with two subcategories of "performing social communication with patients" and "failure to build therapeutic relationships with patients," and (B) "senior nursing student-patient communication" with two subcategories of "establishing effective communication with patients" and "performing one-way communication with patients." More attention should be paid to improve HC through shifting towards student-centered approaches in nursing curriculum. Further, role model nurses and clinical educators should guide nursing students for institutionalizing HC in future nurses.

QUOTEchemo: a patient-centred instrument to measure quality of communication preceding chemotherapy treatment through the patient's eyes.

Science.gov (United States)

van Weert, Julia C M; Jansen, Jesse; de Bruijn, Gert-Jan; Noordman, Janneke; van Dulmen, Sandra; Bensing, Jozien M

2009-11-01

Knowing patients' needs is a prerequisite to ensure high quality cancer care. This study describes the development and psychometric properties of a patient-centred instrument to measure needs and actual experiences with communication preceding chemotherapy treatment: QUOTE(chemo). QUOTE-questionnaires (Quality Of care Through the patients' Eyes) are widely used to gain insight into unmet needs, but no validated, standardised questionnaire combining patients' needs and experiences surrounding chemotherapy treatment is available yet. To evaluate the psychometric properties of the QUOTE(chemo), content validity, internal structure and convergent validity were investigated amongst 345 cancer patients, new to chemotherapy, from 10 different hospitals. Literature study, focus group discussions and a categorisation procedure of 67 relevant topics revealed seven main themes: Treatment-related information, Prognosis information, Rehabilitation information, Coping information, Interpersonal communication, Tailored communication and Affective communication. Confirmatory factor analysis using structural equation modelling indicated that the measurement model provided good fit to the data with factor loadings ranging from .43 to .77. The seven QUOTE(chemo) dimensions captured relevant issues of concern with good internal consistency (alpha .72-.92), satisfactory item-total correlations (.35-.79) and satisfactory convergent validity. Affective communication, Treatment-related information and Rehabilitation information were perceived most important by patients. The instrument also appeared to be able to determine which aspects need improvement to ensure high quality care. The highest need for improvement was found for communicating Prognosis information and Rehabilitation information and for Interpersonal communication. These findings provide preliminary evidence of the reliability and validity of the QUOTE(chemo) for use in cancer care surrounding chemotherapy treatment

Are Low Patient Satisfaction Scores Always Due to the Provider?: Determinants of Patient Satisfaction Scores During Spine Clinic Visits.

Science.gov (United States)

Bible, Jesse E; Shau, David N; Kay, Harrison F; Cheng, Joseph S; Aaronson, Oran S; Devin, Clinton J

2018-01-01

A prospective study. The aim of this study was to investigate the impact of various components on patient satisfaction scores SUMMARY OF BACKGROUND DATA.: Patient satisfaction has become an important component of quality assessments. However, with many of these sources collecting satisfaction data reluctant to disclose detailed information, little remains known about the potential determinants of patient satisfaction. Two hundred patients were contacted via phone within 3 weeks of new patient encounter with 11 spine providers. Standardized patient satisfaction phone survey consisting of 25 questions (1-10 rating scale) was administered. Questions inquired about scheduling, parking, office staff, teamwork, wait-time, radiology, provider interactions/behavior, treatment, and follow-up communication. Potential associations between these factors and three main outcome measures were investigated: (1) provider satisfaction, (2) overall clinic visit satisfaction, and (3) quality of care. Significant associations (P  0.05).In multivariate regression analysis, explanation of medical condition/treatment (P = 0.002) and provider empathy (P = 0.04) were significantly associated with provider satisfaction scores, while the amount of time spent with the provider was not. Conversely, teamwork of staff/provider and follow-up communication were significantly associated with both overall clinic visit satisfaction and quality of care (P ≤ 0.03), while provider behaviors or satisfaction were not. Satisfaction with the provider was associated with better explanations of the spine condition/treatment plan and provider empathy, but was not a significant factor in either overall clinic visit satisfaction or perceived quality of care. Patients' perception of teamwork between staff and providers along with reliable follow-up communication were found to be significant determinants of overall patient satisfaction and perceived quality of care. 3.

Assessing patient-centred communication in teaching: a systematic review of instruments.

Science.gov (United States)

Brouwers, Marianne; Rasenberg, Ellemieke; van Weel, Chris; Laan, Roland; van Weel-Baumgarten, Evelyn

2017-11-01

Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments. The aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor-patient communication and can be used to provide direct feedback. A systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor-patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist. Thirteen articles describing 14 instruments measuring patient centredness in doctor-patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity. This review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor-patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient-centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and

The human factor: the critical importance of effective teamwork and communication in providing safe care.

Science.gov (United States)

Leonard, M; Graham, S; Bonacum, D

2004-10-01

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety?

Science.gov (United States)

Schwappach, David L B; Meyer Massetti, Carla; Gehring, Katrin

2012-10-01

Foreign-language (FL) patients are at increased risk for adverse drug events. Evidence regarding communication barriers and the safety of pharmaceutical care of FL patients in European countries is scarce despite large migrant populations. To investigate Swiss public pharmacists' experiences and current practices in counselling FL patients with a focus on patient safety. In a cross-sectional study heads of public pharmacies in Switzerland were surveyed using an electronic questionnaire. The survey assessed the frequency of communication barriers encountered in medication counselling of FL patients, perceptions of risks for adverse drug events, satisfaction with the quality of counselling provided to FL patients, current strategies to reduce risks, and preferences towards tools to improve safety for FL patients. 498 pharmacists completed the survey (43 % response rate). More than every second pharmacist reported at least weekly encounters at which they cannot provide good medication counselling to FL patients in the regional Swiss language. Ad-hoc interpreting by minors is also common at a considerable number of pharmacies (26.5 % reported at least one weekly occurrence). Approximately 10 % of pharmacies reported that they fail at least weekly to explain the essentials of drug therapy (e.g. dosing of children's medications) to FL patients. 79.8 % perceived the risk of FL patients for adverse drug events to be somewhat or much higher compared to other patients. 22.5 % of pharmacists reported being concerned at least monthly about medication safety when FL patients leave their pharmacy. However, the majority of pharmacists were satisfied with the quality of care provided to FL patients in their pharmacy [78.6 % (very) satisfied]. The main strategy used to improve counselling for FL patients was the employment of multilingual staff. Participants would use software for printing foreign-language labels (41.2 %) and multilingual package inserts (42.0 %) if these were

Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT).

Science.gov (United States)

Stausmire, Julie M; Cashen, Constance P; Myerholtz, Linda; Buderer, Nancy

2015-01-01

The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive

Doctor-patient communication in the e-health era.

Science.gov (United States)

Weiner, Jonathan P

2012-08-28

The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices.In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs), biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications.In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward.The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt, and embrace these rapidly

Doctor-patient communication in the e-health era

Directory of Open Access Journals (Sweden)

Weiner Jonathan P

2012-08-01

Full Text Available Abstract The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices. In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs, biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications. In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT and health information technology (HIT will have on clinician/patient communication moving forward. The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt

Communication in conversation in stroke patients.

Science.gov (United States)

Rousseaux, Marc; Daveluy, Walter; Kozlowski, Odile

2010-07-01

In stroke patients, it has been suggested that communication disorders could result from lexical and syntactic disorders in left hemisphere lesions and from pragmatics problems in right lesions. However, we have little information on patient behaviour in dyadic communication, especially in conversation. Here, we analyzed the various processes participating in communication difficulties at the rehabilitation phase (1-6 months) post-stroke, in order to define the main mechanisms of verbal and non-verbal communication (VC, NVC) disorders and their relationship with aphasic disorders. Sixty-three patients were recruited, who belonged to six groups, with left or right cortico-sub-cortical (L-CSC, R-CSC) or sub-cortical (L-SC, R-SC), frontal (Fro) or posterior fossa (PF) lesions. They were compared with an equivalent control group (gender, age, education level). We used the Lille Communication Test, which comprises three parts: participation to communication (greeting, attention, engagement), verbal communication (verbal comprehension, speech outflow, intelligibility, word production, syntax, verbal pragmatics and verbal feedback) and non-verbal communication (understanding gestures, affective expressivity, producing gestures, pragmatics and feedback). We also used the Functional Communication Profile and the Boston Diagnostic Aphasia Examination (BDAE). Decrease in participation was found in L-CSC, R-CSC and Fro patients. Verbal communication was essentially disrupted in L-SCS and L-SC groups, including by verbal pragmatic disorders, and to a lesser degree in frontal patients. Nonverbal communication was mainly affected in R-CSC patients, especially by pragmatic difficulties. L-CSC patients showed an increase in gesture production, compensating for aphasia. In conclusion, communication disorders were relatively complex and could not be summarised by syntactical and lexical difficulties in left stroke and pragmatic problems in right stroke. The former also showed severe

[Communication Test for Foreign Physicians in Germany: The Patient Communication Test].

Science.gov (United States)

Farhan, N; Leonhart, R; Puffe, L; Boeker, M; Wirsching, M

2016-04-01

The number of foreign doctors in Germany has increased steadily in recent years. To obtain the German medical license, sufficient language competence is mandatory. Nevertheless, in practice, foreign doctors have considerable difficulties in their communication with patients, medical colleagues and other health professionals. This can lead to misunderstandings and thus impair patient safety. To overcome this problem, the "patient communication test" was developed and piloted as an additional requirement to be granted license to practice medicine in Germany. The aim of this study is to present our results in the development and piloting of this test. 3 OSCE stations (Objective Structured Clinical Examination) were designed, which evaluate communication skills in 3 medical competences: history taking, case presentation and explaining to patients before obtaining informed consent. After extensive instruction of actors as patients and raters on the basis of the evaluation criteria, the communication test was subjected to pilot studies in 6 different cities (Freiburg, Jena, Mainz, Mannheim, Tübingen, and Ulm). In 2013, 639 foreign doctors participated in the test; 461 (72.14%) of these doctors passed the test on their first try, 51 (7.98%) on their second attempt and 6 (0.93%) on their third try. The patient communication test evaluates the communication skills of foreign doctors in OSCE-setting using standardized actor-patients. This improves the communication skills and enhances patient safety in the German health care system by smooth inter-professional and patient-centered communication. © Georg Thieme Verlag KG Stuttgart · New York.

Physician-patient communication in managed care.

OpenAIRE

Gordon, G H; Baker, L; Levinson, W

1995-01-01

The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...

Patient-provider communication about medication use at the community pharmacy counter.

Science.gov (United States)

van Dijk, Marloes; Blom, Lyda; Koopman, Laura; Philbert, Daphne; Koster, Ellen; Bouvy, Marcel; van Dijk, Liset

2016-02-01

The objectives of this study were to, first, describe the information exchanged between pharmacy staff and patients about prescribed medication at the community pharmacy counter, and second, to investigate to what extent this met professional medication counselling guidelines. Pharmaceutical encounters were videotaped in four community pharmacies in the Netherlands. Patients were included if they collected a prescription for their own use. An observation protocol, including the MEDICODE checklist, was used to analyse the video recordings. A distinction was made between first and repeat prescriptions. One hundred fifty-three encounters were videotaped. When dispensing first prescriptions, pharmacy staff provided most information on instructions how to use the medication (83.3%), form of the medication (71.4%) and treatment duration (42.9%). Topics for repeat prescriptions (such as the effects of the medication and the incidence of observed adverse effects) were rarely discussed. Pharmacy staff rarely encouraged patients to ask questions. Pharmacy staff members provided little medication-related information at the counter, especially for repeat prescriptions, did not encourage active patient participation, and thereby did not adhere to the guidelines of their professional organisation. Further research is needed to understand the reasons for this. © 2015 Royal Pharmaceutical Society.

Evaluation of communication between physicians and patients in Astana City Hospital №1

Directory of Open Access Journals (Sweden)

Anara Zhumadilova

2014-01-01

Full Text Available Introduction: Communication between patients and health care providers is important for the effective functioning of health care systems. Miscommunication often stems from discrepancies in expectations of both healthcare professionals and patients due to cultural and historical influences. We investigated the degree to which health care providers (doctors and nurses and patients in Kazakhstan believe that interaction between doctors and patients should be doctor- or patient-oriented. Material and methods: We conducted a cross-sectional study of 163 patients and 176 health care providers (71 doctors and 105 nurses in a general hospital in Astana, Kazakhstan. The subjects completed a structured questionnaire containing the Patient-Practitioner Orientation Scale (PPOS, and scales assessing life and job satisfaction, effort-reward balance of healthcare professionals, and the patients’ perceptions of communication practices. Results: An overwhelming majority of doctors (81.7%, nurses (88.1%, and patients (92.3% were doctor-oriented. Among health care providers, PPOS was not associated with age, sex, life and job satisfaction, or effort-reward imbalance. Among patients, PPOS was not associated with age, sex, or specialty of health care provider. However, higher PPOS among patients (indicating preference for patient-oriented interaction was associated with higher satisfaction with communication with health care providers and, less strongly, with their life satisfaction. Conclusion: The main finding of this study is the very small proportion of doctors, nurses and patients who believe that interaction should be patient-oriented. These results highlight the necessity of improvement of communication among health care providers towards patient-oriented approach in order to decrease miscommunication with patients. The fact that most patients prefer doctor-oriented interaction may reflect historical stereotypes; educational/information interventions among

Effects of Patient Care Unit Design and Technology on Nurse and Patient Care Technician Communication.

Science.gov (United States)

Beck, Mary S; Doscher, Mindy

2018-04-01

The current study described RN and patient care technician (PCT) communication in centralized and hybrid decentralized workstation designs using hands-free communication technology and infrared locator badge technology to facilitate communication. New construction of an oncology unit provided the opportunity to compare staff communication in two different workstation designs. Observations and questionnaires compared nurse and PCT communication in the two-unit designs. Descriptive statistics were used to analyze the differences. The hybrid decentralized unit had increased use of hands-free communication technology and hallway communication by nurses and PCTs, and increased patient room communication by nurses. Perceptions of communication between nurses and PCTs and congruency of priorities for care were similar for both units. The locator badge technology had limited adoption. Replacement of nurse workstations with new construction or remodeling impact staff communication patterns, necessitating that nurse leaders understand the impact of design and technology on communication. [Journal of Gerontological Nursing, 44(4), 17-22.]. Copyright 2018, SLACK Incorporated.

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences.

NARCIS (Netherlands)

Zwaanswijk, M.; Tates, K.; Dulmen, S. van; Hoogerbrugge, P.M.; Kamps, W.A.; Beishuizen, A.; Bensing, J.M.

2011-01-01

Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Methods: Preferences regarding health-care provider empathy in consultations, and

Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences

NARCIS (Netherlands)

Zwaanswijk, M.; Tates, K.; Dulmen, A.M. van; Hoogerbrugge, P.M.; Kamps, W.A.; Beishuizen, A.; Bensing, J.M.

2011-01-01

OBJECTIVE: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. METHODS: Preferences regarding health-care provider empathy in consultations, and

Communicating with child patients in pediatric oncology consultations : a vignette study on child patients', parents', and survivors' communication preferences

NARCIS (Netherlands)

Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M.; Kamps, Willem A.; Beishuizen, A.; Bensing, Jozien M.

Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Methods: Preferences regarding health-care provider empathy in consultations, and

A model to teach concomitant patient communication during psychomotor skill development.

Science.gov (United States)

Nicholls, Delwyn; Sweet, Linda; Muller, Amanda; Hyett, Jon

2018-01-01

Many health professionals use psychomotor or task-based skills in clinical practice that require concomitant communication with a conscious patient. Verbally engaging with the patient requires highly developed verbal communication skills, enabling the delivery of patient-centred care. Historically, priority has been given to learning the psychomotor skills essential to clinical practice. However, there has been a shift towards also ensuring competent communication with the patient during skill performance. While there is literature outlining the steps to teach and learn verbal communication skills, little is known about the most appropriate instructional approach to teach how to verbally engage with the patient when also learning to perform a task. A literature review was performed and it identified that there was no model or proven approach which could be used to integrate the learning of both psychomotor and communication skills. This paper reviews the steps to teach a communication skill and provides a suggested model to guide the acquisition and development of the concomitant -communication skills required with a patient at the time a psychomotor skill is performed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tools for Communication: Novel infrastructure to address patient-perceived gaps in oncology care
.

Science.gov (United States)

McMullen, Suzanne; Szabo, Shelagh; Halbert, Ronald J; Lai, Catherine; Parikh, Aparna; Bunce, Mikele; Khoury, Raya; Small, Art; Masaquel, Anthony

2017-04-01

Healthcare providers (HCPs) and patient communication are integral to high-quality oncology care. The patient and HCP perspectives are needed to identify gaps in care and develop communication tools.
. This study aimed to understand patient- and HCP-perceived elements of and gaps in high-quality care to develop novel communication tools to improve care. 
. Qualitative interviews were conducted among 16 patients with cancer and 10 HCPs in the United States. Trained interviewers elicited patients' and HCPs' concerns, views, and perceived needs for communication tools. A thematic analysis was used to identify four quality of care domains, depicted in a conceptual model, and two draft communication tools were developed to address identified gaps.
. No patients reported previously using a communication tool, and gaps in communication regarding treatment aims and education were evident. Two tools were developed to assess patients' life and treatment goals and the importance of ongoing education.

Patients’ and Family Members’ Views on Patient-Centered Communication During Cancer Care

Science.gov (United States)

Mazor, Kathleen M.; Beard, Renee L.; Alexander, Gwen L.; Arora, Neeraj K.; Firneno, Cassandra; Gaglio, Bridget; Greene, Sarah M.; Lemay, Celeste A.; Robinson, Brandi E.; Roblin, Douglas W.; Walsh, Kathleen; Street, Richard L.; Gallagher, Thomas H.

2013-01-01

Objectives To explore patients’ and family members’ views on communication during cancer care, and to identify those aspects of clinician-patient communication which were most important to patients and family members. Methods We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Results Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient’s experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, while excellent listening could foster the relationship. Information exchange and relationship were also integral to decision making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients’ needs beyond the immediate medical encounter were valued. Conclusions The complexity of cancer care today suggest that efforts to improve communication must be multi-level, acknowledging and addressing patient, clinician, organizational and policy barriers and facilitators. Measurement tools are needed to assess cancer patients’ and family members’ experiences with communication over the course of cancer care in order to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. PMID:23780672

Patient Use of the Electronic Communication Portal in Management of Type 2 Diabetes.

Science.gov (United States)

Peremislov, Diana

2017-09-01

High incidence and prevalence of type 2 diabetes require urgent attention to the management of this chronic disease. The purpose of this study was to explore electronic communication (e-communication) between patients with type 2 diabetes and their providers within the patient portal. Qualitative design with conventional content analysis techniques was used. A purposive random sample of 90 electronic medical record charts of patient-portal users with type 2 diabetes was subjected to a retrospective review. The sample mainly consisted of patients between the ages of 50 and 70 years, who were white, non-Hispanic, and English-speaking. The three major themes that emerged in e-communication via patient portal were inform theme, which was the most frequently identified theme; instruct/request theme, which was mainly used in initiation of e-communication; and the question theme. The patient portal was used primarily for requests by patients and instruction by providers, showing relatively short e-message encounters with a high number of partially completed encounters, frequent lack of resolution, and a low level of involvement of diabetes specialists in e-communication. There is a need to revise healthcare system guidelines on initiation and use of e-communication via patient portal and develop standardized templates to promote diabetes education in type 2 diabetes.

American Sign Language Interpreters Perceptions of Barriers to Healthcare Communication in Deaf and Hard of Hearing Patients.

Science.gov (United States)

Hommes, Rachel E; Borash, Amy I; Hartwig, Kari; DeGracia, Donna

2018-04-25

Communication barriers between healthcare providers and patients contribute to health disparities and the effectiveness of health promotion messages. This is especially true regarding communication between providers and deaf and hard of hearing (HOH) patients due to lack of understanding of cultural and linguistic differences, ineffectiveness of various means of communication and level of health literacy within that population. This research aimed to identify American Sign Language (ASL) interpreters' perceptions of barriers to effective communication between deaf and HOH patients and healthcare providers. We conducted a survey of ASL interpreters attending the 2015 National Symposium on Healthcare Interpreting with an overall response rate of 25%. Results indicated a significant difference (p communication between providers and deaf/HOH patients as perceived by interpreters. ASL interpreters observed that patients did not understand provider instructions in nearly half of appointments. Eighty-one percent of interpreters said that providers "hardly ever" use "teach-back" methods with patients to ensure understanding. A focus on improving health care and health promotion efforts in the deaf/HOH community depends on improving communication, health literacy, and patient empowerment and involves holding health care organizations accountable for assuring adequate staffing of ASL interpreters and communication resources in order to reduce health disparities in this population.

Knowledge, information and communication among cancer patients

International Nuclear Information System (INIS)

Parvez, T.; Saeed, N.; Pervaiz, K.

2001-01-01

Objective: Knowledge, information and communication, within oncology, are a core clinical strength for the out-come of the disease and inadequate communication, can cause distress for the patient and their families. Design: A senior doctor conducted this study by filling in the performa after interviewing the subject of the study. Place and duration of study: This study was done in Oncology Department of Service Hospital, Lahore and was completed in four months. Subjects and Method: One hundred cancer patients were interviewed regarding their knowledge about their disease, its causes, prognosis, and information supplied by the health-care providers. They were also asked about their satisfaction regarding this information, deficiencies and pitfalls in this information, need for more information, which should supply the information from among the hospital team or their relative, attitude of the family and their communication regarding the disease. Results: Study revealed that the knowledge about the disease and its causes was present in 53% and 7% respectively. The patients (59%) wanted more information. Majority perceived that the information was not adequate and needed more information and 68% thought that more information would reduce their anxiety. The attitude of family was found encouraging in 87% of patients and 42% were communicating with other family members regarding their diseases. Conclusion: Knowledge about the disease and its cause should be increasingly supplied by the doctors, as it will reduce the anxiety and have a good effect on health. Communication among the family members needs to be improved. (author)

Role of Self-Efficacy in the Relationship Between Patient-Provider Relationships and Psychological Insulin Resistance Among Patients with Type 2 Diabetes

OpenAIRE

Nam, Soohyun; Nam, Soohyun; Song, Youngshin

2014-01-01

Psychological insulin resistance (PIR) affects patients’ self-care behaviors and quality of life due to the delay of insulin treatment for optimal glycemic control. Although effective patient-provider communication and relationships have been shown to improve patients’ overall treatment adherence and attitude toward treatment, little is known about the potential mechanisms by which effective patient-provider communication and relationships decrease PIR and whether these relationships are medi...

Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.

Science.gov (United States)

Paternotte, Emma; Scheele, Fedde; Seeleman, Conny M; Bank, Lindsay; Scherpbier, Albert J J A; van Dulmen, Sandra

2016-10-01

Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature. In total, 39 videotaped consultations were analyzed. The doctors proved to be capable of practising many communication skills, such as listening and empathic communication behaviour. Other skills were not practised, such as being culturally aware and checking the patient's language ability. We showed that doctors did practice some but not all the relevant ICC skills and that the ICC style of the doctors was mainly biomedically centred. Furthermore, we discussed the possible overlap between intercultural and patient-centred communication. Implications for practice could be to implement the relevant ICC skills in the existing communication training or develop a communication training with a patient-centred approach including ICC skills.

Surgeon-patient communication during awake procedures.

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Smith, Claire S; Guyton, Kristina; Pariser, Joseph J; Siegler, Mark; Schindler, Nancy; Langerman, Alexander

2017-06-01

Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature. Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures. Three researchers used the constant comparative method to transcribe, code, and review interviews until saturation was reached. Twenty-three surgeons described the advantages and disadvantages of awake procedures, their communication with the awake patient, their interactions with staff and with trainees, the environment of awake procedures, and how communication in this context is taught and learned. Surgeons recognized communication during awake procedures as important and reported varied strategies for ensuring patient comfort in this context. However, they also acknowledged challenges with multiparty communication during awake procedures, especially in balancing commitments to teaching with their duty to comfort the patient. Copyright © 2016 Elsevier Inc. All rights reserved.

Use and acceptance of electronic communication by patients with multiple sclerosis: a multicenter questionnaire study.

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Haase, Rocco; Schultheiss, Thorsten; Kempcke, Raimar; Thomas, Katja; Ziemssen, Tjalf

2012-10-15

The number of multiple sclerosis (MS) information websites, online communities, and Web-based health education programs has been increasing. However, MS patients' willingness to use new ways of communication, such as websites, mobile phone application, short message service, or email with their physician, remains unknown. We designed a questionnaire to evaluate the a priori use of electronic communication methods by MS patients and to assess their acceptance of such tools for communication with their health care providers. We received complete data from 586 MS patients aged between 17 and 73 years. Respondents were surveyed in outpatient clinics across Germany using a novel paper-and-pencil questionnaire. In addition to demographics, the survey items queried frequency of use of, familiarity with, and comfort with using computers, websites, email, and mobile phones. About 90% of all MS patients used a personal computer (534/586) and the Internet (527/586) at least once a week, 87.0% (510/586) communicated by email, and 85.6% (488/570) communicated by mobile phone. When asked about their comfort with using electronic communication methods for communication with health care providers, 20.5% (120/586) accepted communication by mobile Internet application or short message service via mobile phone, 41.0% (240/586) by websites, 54.3% (318/586) by email service, and 67.8% (397/586) by at least one type of electronic communication. The level of a priori use was the best predictor for the acceptance of electronic communication with health care providers. Patients who reported already searching online for health information (odds ratio 2.4, P higher acceptance for Web-based communication. Patients who already scheduled appointments with their mobile phones (odds ratio 2.1, P = .002) were more likely to accept the use of mobile phone applications or short message service for communicating with their physician. The majority of MS patients seen at specialist centers already use

Oncology nurse communication barriers to patient-centered care.

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Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty

2013-04-01

Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article.

Augmentative And Alternative Communication Systems For Post-Stroke Patients With Severe Communication And Motor Impairment

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Talieh Zarifian

2017-02-01

Full Text Available Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ... develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses.      Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language.  Specifically designed Human Computer Interfaces (HCI, as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments.       In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally; AAC availability

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

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Luger, Tana M; Volkman, Julie E; Rocheleau, Mary; Mueller, Nora; Barker, Anna M; Nazi, Kim M; Houston, Thomas K; Bokhour, Barbara G

2018-01-01

Background As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70

Email communication in a developing country: different family physician and patient perspectives.

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Makarem, Nisrine N; Antoun, Jumana

2016-01-01

Email communication between physicians and patients could improve access to and delivery of health care. Most of the literature studies about email communication between physicians and patients have been conducted in developing countries. Therefore, this study aims to analyze the practices, attitudes, and barriers of both physicians' and patients' use of email within the same health care setting of a developing country. A cross-sectional paper-based survey was conducted among 39 physicians and 500 patients at the Family Medicine clinics of the American University of Beirut, a tertiary academic medical center. Most of the surveyed patients and physicians reported that they would like to communicate through email and agreed that it is useful. However, only 19% of the patients have ever communicated with their physicians via email, and only 5.1% of physicians have often communicated with their patients via email. Almost half of the patients surveyed were unaware of the possibility of this form of communication, and only 17% reported that their physician offered them his or her email address. In addition, physicians and patients did not agree on the services to be provided by email communication. For instance, almost half of the patients indicated consultation for an urgent medical matter as suitable for email communication. The use of email communication in health care is still scarce. Patients and physicians have different perspectives of its use and importance. Further rigorous research is needed to clarify the advantages and disadvantages of this form of communication, especially in the developing world. Interested physicians are encouraged to establish appropriate personal policies for email communication with adequate announcement and patient education plans.

A comparison of the scorings of real and standardized patients on physician communication skills.

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Rezaei, Rita; Mehrabani, G

2014-05-01

To compare the scorings of real and standardized patients on physician communication skills. Patient scoring (n=183) on physicians' communication skills was determined by 93 real and 90 standardized patients. Eighty physicians (42 specialists and 38 general physicians) in private practice were enrolled. Data were analyzed using self administered questionnaires and checklists including 16 close ended questions. Twelve percent of patients were not satisfied with the physician communication skills. Poor communication skills were more reported by male patients and those with a higher educational level. The physician communication skill received a higher score with increase of age of patients. A good physician's communication skill was reported more by married patients. A good physician's communication skill was significantly more in female doctors, in general physicians and in doctors wearing a White Coat. Real patients scored physician's communication skills higher than standardized patients. It is important that physicians try to learn the principles of a good physician-patient communication skill. Therefore, providing medical educational programs on the role of a good doctor and patient relationship at all levels for the doctors and applying them in their clinical practice seem necessary to improve the physician communication skills.

Patterns of Physician-Patient Communication Associated with Patient Satisfaction.

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Williams, M. Lee; Clampitt, Phillip G.

Using data drawn from ten initial physician/patient interviews, an original category system was employed to analyze patterns of physician/patient communication. Static analysis, interaction analysis, and Markov chain analysis were used to discover the underlying communication patterns associated with patient satisfaction. Results revealed that…

Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model.

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Griffiths, Jane; Wilson, Charlotte; Ewing, Gail; Connolly, Michael; Grande, Gunn

2015-10-01

To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication.

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Ko, Eunjeong; Zúñiga, María Luisa; Peacher, Diana; Palomino, Helen; Watson, Mercedes

2018-02-01

Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.

Medical student use of communication elements and association with patient satisfaction: a prospective observational pilot study.

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Turner, Joseph S; Pettit, Katie E; Buente, Bryce B; Humbert, Aloysius J; Perkins, Anthony J; Kline, Jeffrey A

2016-05-21

Effective communication with patients impacts clinical outcome and patient satisfaction. We measure the rate at which medical students use six targeted communication elements with patients and association of element use with patient satisfaction. Participants included fourth year medical students enrolled in an emergency medicine clerkship. A trained observer measured use of six communication elements: acknowledging the patient by name, introducing themselves by name, identifying their role, explaining the care plan, explaining that multiple providers would see the patient, and providing an estimated duration of time in the emergency department. The observer then conducted a survey of patient satisfaction with the medical student encounter. A total of 246 encounters were documented among forty medical student participants. For the six communication elements evaluated, in 61% of encounters medical students acknowledged the patient, in 91% they introduced themselves, in 58 % they identified their role as a student, in 64% they explained the care plan, in 80% they explained that another provider would see the patient, and in only 6% they provided an estimated duration of care. Only 1 encounter (0.4%) contained all six elements. Patients' likelihood to refer a loved one to that ED was increased when students acknowledged the patient and described that other providers would be involved in patient care (P = 0.016 and 0.015 respectively, Chi Square). Likewise, patients' likelihood to return to the ED was increased when students described their role in patient care (P = 0.035, Chi Square). This pilot study demonstrates that medical students infrequently use all targeted communication elements. When they did use certain elements, patient satisfaction increased. These data imply potential benefit to additional training for students in patient communication.

Shared presence in physician-patient communication: A graphic representation.

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Ventres, William B; Frankel, Richard M

2015-09-01

Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care--all deceptive in their simplicity but, in fact, highly complex--or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physician-patient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients. (c) 2015 APA, all rights reserved).

Patient-provider connectivity and the role of e-health.

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Holmes, Suzanne C; Kearns, Ellen Hope

2003-01-01

Patient-provider connectivity (PPC) offers innovative approaches to control costs, improve quality, and sustain a healthy workforce. The application of e-commerce to health care is one facet of PPC and provides solutions to educating, informing, and more efficiently using scarce resources to sustain the nation's health. Technology is available to provide real-time access to clinical results, medical records, health-care providers, and other time-sensitive patient information. This is the first article in a series on PPC that explores the application of e-commerce to the health-care industry from the consumers' and providers' points of view and examines and assesses trends and data from various interdisciplinary sources and studies. Two models exemplifying PPC are explored including the Science Business & Education, Inc., proof-of-concept patient demonstration project, and the emerging application of peer-to-peer (P2P) technology. PPC promises to improve efficiency, facilitate communication between physician and patient, monitor compliance with medical regimens, and positively affect the quality of health care provided and the overall health of the patient. Future articles will address the growth of telemedicine, issues of confidentiality and e-risk, and other PPC applications.

Iranian Nursing Student–patient Health Communication in Medical Surgical Wards

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Abdolrahimi, Mahbobeh; Ghiyasvandian, Shahrzad; Zakerimoghadam, Masoumeh; Ebadi, Abbas

2018-01-01

Background: Health communication (HC) is considered an important task of nurses to provide high quality and holistic care as well as to improve patient health. The nursing student–patient HC is an abstract concept and needs to be clarified. Therefore, this study was conducted to increase the knowledge about nursing students' HC with patients by considering various participants' viewpoints. Materials and Methods: In this conventional qualitative content analysis, 18 semi-structured interviews were conducted with six nursing students, six nursing instructors, and six patients in educational hospitals affiliated to the University of Medical Sciences. Credibility, confirmability, dependability, and transferability were established to validate the trustworthiness of the data. The process of data collection and analysis lasted 9 months. Results: After data analysis, two categories were generated: (A) “junior nursing student–patient communication,” with two subcategories of “performing social communication with patients” and “failure to build therapeutic relationships with patients,” and (B) “senior nursing student–patient communication” with two subcategories of “establishing effective communication with patients” and “performing one-way communication with patients.” Conclusions: More attention should be paid to improve HC through shifting towards student-centered approaches in nursing curriculum. Further, role model nurses and clinical educators should guide nursing students for institutionalizing HC in future nurses. PMID:29628962

Iranian nursing student–patient health communication in medical surgical wards

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Mahbobeh Abdolrahimi

2018-01-01

Full Text Available Background: Health communication (HC is considered an important task of nurses to provide high quality and holistic care as well as to improve patient health. The nursing student–patient HC is an abstract concept and needs to be clarified. Therefore, this study was conducted to increase the knowledge about nursing students' HC with patients by considering various participants' viewpoints. Materials and Methods: In this conventional qualitative content analysis, 18 semi-structured interviews were conducted with six nursing students, six nursing instructors, and six patients in educational hospitals affiliated to the University of Medical Sciences. Credibility, confirmability, dependability, and transferability were established to validate the trustworthiness of the data. The process of data collection and analysis lasted 9 months. Results: After data analysis, two categories were generated: (A “junior nursing student–patient communication,” with two subcategories of “performing social communication with patients” and “failure to build therapeutic relationships with patients,” and (B “senior nursing student–patient communication” with two subcategories of “establishing effective communication with patients” and “performing one-way communication with patients.” Conclusions: More attention should be paid to improve HC through shifting towards student-centered approaches in nursing curriculum. Further, role model nurses and clinical educators should guide nursing students for institutionalizing HC in future nurses.

The social gradient in doctor-patient communication

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Verlinde Evelyn

2012-03-01

Full Text Available Abstract Objective In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. Methods A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. Results Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. Conclusion This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication. Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. Practice implications By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.

Disruption or innovation? A qualitative descriptive study on the use of electronic patient-physician communication in patients with advanced cancer.

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Voruganti, Teja; Husain, Amna; Grunfeld, Eva; Webster, Fiona

2018-03-04

In the advanced cancer context, care coordination is often inadequate, leading to suboptimal continuity of care. We evaluated an electronic web-based tool which assembles the patient, their caregivers, and their healthcare providers in a virtual space for team-based communication. We sought to understand participant perceptions on electronic communication in general and the added value of the new tool in particular. We conducted a qualitative descriptive study with participants (patients, caregivers, cancer physicians) who participated in a 3-month pilot trial evaluating the tool. Interviews were thematically analyzed and the perspectives from patients, caregivers, and cancer physicians were triangulated. Interviews from six patients, five of their caregivers, and seven cancer physicians conducted alongside monthly outcome assessments were analyzed. We identified five themes relating participants' perspectives on electronic communication to their experience of care: (1) apparent gaps in care, (2) uncertainty in defining the circle of care, (3) relational aspects of communication, (4) incongruence between technology and social norms of patient-physician communication, and (5) appreciation but apprehension about the team-based communication tool for improving the experience of care. The potential of tools for electronic communication to bring together a team of healthcare providers with the patient and caregivers is significant but may pose new challenges to existing team structure and interpersonal dynamics. Patients and physicians were worried about the impact that electronic communication may have on the patient-physician relationship. Implementation approaches, which build on the relationship and integrate the team as a whole, could positively position electronic communication to enhance the team-based care.

[Doctor patient communication: which skills are effective?].

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Moore, Philippa; Gómez, Gricelda; Kurtz, Suzanne; Vargas, Alex

2010-08-01

Effective Communication Skills form part of what is being a good doctor. There is a solid evidence base that defines the components of effective communication. This article offers a practical conceptual framework to improve physician patient communication to a professional level of competence. There are six goals that physicians and patients work to achieve through their communication with each other. These are to construct a relationship, structure an interview, start the interview, gather information, explain, plan and close the interview. The outcomes that can be improved with an effective communication and the "first principles" of communication are described. A brief look at the historical context that has influenced our thinking about communication in health care is carried out. Finally, the Calgary Cambridge Guide, an approach for delineating and organizing the specific skills required of an effective communication with patients is described. It is clear from the literature that better communication skills improve patient satisfaction and clinical outcomes.

The impact of patient centered communication in managing Gardner′s syndrome

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Gayathri Subramanian

2015-01-01

Full Text Available Effective patient communication and comprehension are fundamental toward empowering the patient to make optimal health decisions. Barriers in patient health literacy extend beyond cultural and language differences and can significantly impede this process. This case report illustrates a major communication gap that resulted in contradictory perceptions between a treating oncologist and a patient. The patient′s dentist was able to resolve this miscommunication and facilitate the patient′s acceptance of the recommended intravenous chemotherapy for management of malignant desmoid tumors occurring secondary to Gardner′s syndrome (GS. This report also documents classic craniofacial manifestations of GS including multiple unerupted supernumerary teeth, compound odontomas associated with a dentigerous cyst, as well as multiple osteomas in both arches and in the ethmoid and irregularly shaped radioopacities in both arches. In summary, effective patient-centered communication is a prerequisite for the optimal delivery of healthcare. Both interdisciplinary care and one-on-one patient-provider relationship center on coherent bidirectional communication.

Perception of risk and benefit in patient-centered communication and care

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Hakim A

2011-05-01

Full Text Available Amin HakimHealthcare Consulting, Staten Island, NY, USAAbstract: There has been an increase in the adoption of patient-centered communication and accountable care that has generated greater interest in understanding patient perception of risk and benefit (PPRB. Patients find complex medical information hard to understand, resulting in inaccurate conclusions. Health behavior models describe the processes that individuals use to arrive at decisions concerning their own care. Studies have shown that their perception and decision making are associated with many factors such as age, gender, race, past experience, cost, and familiarity. Communication plays an important role in health literacy, and many adults are not proficient in the latter, regardless of their education. Clinicians have long provided educational materials but as our understanding of practitioner–patient communication and PPRB increased, so has the need for better ways to present medical advice and potential outcomes to the patient. Educational materials should be accessible, understandable, and actionable. They should have a reading level of grade 5 or 6, and where possible include graphical representations. New print and multimedia tools incorporate easier to understand summaries of risks and benefits, but they often need additional improvements. Patients frequently have a great desire to share in decision making regarding their health, and may prefer to do so in a collaborative fashion with their health care providers. A shared decision will have the patient’s input and promises better clinical outcomes as suggested by the literature; however, evidence from randomized controlled trials is scant. Additional studies should examine these and other types of outcomes. Patients tend to delegate decision making to clinicians in emergent or serious conditions. Practitioners need to have a positive communication style that engages patients in a shared decision making process and

An integrative review of patient safety in studies on the care and safety of patients with communication disabilities in hospital.

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Hemsley, Bronwyn; Georgiou, Andrew; Hill, Sophie; Rollo, Megan; Steel, Joanne; Balandin, Susan

2016-04-01

To review the research literature on the experiences of patients with communication disabilities in hospital according to the Generic Model of patient safety. In 2014 and 2015, we searched four scientific databases for studies with an aim or result relevant to safety of hospital patients with communication disabilities. The review included 27 studies. A range of adverse event types were outlined in qualitative research. Little detail was provided about contributing or protective factors for safety incidents in hospital for these patients or the impact of the incidents on the patient or organisations involved. Further research addressing the safety of patients with communication disabilities is needed. Sufficient detail is required to identify the nature, timing, and detection of incidents; factors that contribute to or prevent adverse events; and detail the impact of the adverse events. In order to provide safe and effective care to people with communication disabilities in hospital, a priority for health and disability services must be the design and evaluation of ecologically appropriate and evidence-based interventions to improve patient care, communication, and reduce the risk of costly and harmful patient safety incidents. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Communication Skills of Physicians and Patients' Satisfaction.

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Biglu, Mohammad-Hossein; Nateq, Farnaz; Ghojazadeh, Morteza; Asgharzadeh, Ali

2017-09-01

The communication skills of physicians is an effective step of making effective relationship between doctor and patient. It plays essential role through diagnosis and treatment processes. This current study was performed to investigate the impact of communication skillfulness of physicians on patients' satisfaction. A cross-sectional descriptive study was done to determine the impact of communication capability of practitioners on patients' satisfaction. The DiMatto's Patient Satisfaction Scale was administered among patients referring to the all 8 specialized clinics of Tabriz University of Medical Sciences. The validity and reliability of Persian translation of questionnaire of DiMatto's Patient Satisfaction was verified by 10 specialists. The validity of the questionnaire was measured by content and structural analysis, and Cronbach's alpha coefficients. The data were analyzed by software package of SPSS version 16 using Pearson's correlation coefficient, U Mann-Whitney, Kruskal-wallis Test, Regression. The study showed that there was a significant correlation between patients' satisfaction and the communication skills of physicians (devoting the appropriate time for visiting the patients, explaining diagnosis and treatment procedures). In addition, the therapeutic skills of physicians, their friendly manners, respecting the patients' feelings, and careful examination of patients by physician, revealed a significant correlation with patient satisfaction (P Communication skills of physician play an important role on patients' satisfaction; therefore, we propose strongly to improve the communication skills of physicians by improving the communication skills through related training courses.

Provider Factors and Patient-Reported Healthcare Discrimination in the Diabetes Study of California (DISTANCE)

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Lyles, Courtney R.; Karter, Andrew J.; Young, Bessie A.; Spigner, Clarence; Grembowski, David; Schillinger, Dean; Adler, Nancy

2011-01-01

Objective We examined provider-level factors and reported discrimination in the healthcare setting. Methods With data from the Diabetes Study of Northern California (DISTANCE)—a race-stratified survey of diabetes patients in Kaiser Permanente Northern California—we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables including racial concordance. Results Subjects (n=12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2% to 8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR=0.09; 95% CI: 0.01–0.67), those rating their provider higher on communication (OR=0.70; 95% CI: 0.66–0.74) were less likely to report discrimination, while those with more visits (OR=1.10; 95% CI: 1.03–1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity. Conclusions Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination. Practice Implications Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment. PMID:21605956

The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

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Newell, Stephanie; Jordan, Zoe

2015-01-01

The objective of this systematic review is to synthesize the eligible evidence of patients' experience of engaging and interacting with nurses, in the medical-surgical ward setting.This review will consider the following questions: Communication is a way in which humans make sense of the world around them. Communication takes place as an interactive two-way process or interaction, involving two or more people and can occur by nonverbal, verbal, face-to-face or non-face-to-face methods. Effective communication is described to occur when the sender of a message sends their message in a way that conveys the intent of their message and then is understood by the receiver of the message. As a result of the communication from both the sender and the receiver of the message a shared meaning is created between both parties.Communication can therefore be viewed as a reciprocal process. In the health care literature the terms communication and interaction are used interchangeably.Communication failures between clinicians are the most common primary cause of errors and adverse events in health care. Communication is a significant factor in patient satisfaction and complaints about care. Communication plays an integral role in service quality in all service professions including health care professions.Within healthcare, quality care has been defined by the Institute of Medicine as 'care that is safe, effective, timely, efficient, equitable and patient-centred'. Patient-centered care is defined as 'care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient's values guide all clinical decisions. Patient centered-care encompasses the 'individual experiences of a patient, the clinical service, the organizational and the regulatory levels of health care'. At the individual patient level, patient-centered care is care that is 'provided in a respectful manner, assures open and ongoing sharing of useful information in an

Factors influencing intercultural doctor-patient communication: a realist review.

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Paternotte, Emma; van Dulmen, Sandra; van der Lee, Nadine; Scherpbier, Albert J J A; Scheele, Fedde

2015-04-01

Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. Training for improving ICC can be developed as an extension of the existing training for patient-centered communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Access, interest, and attitudes toward electronic communication for health care among patients in the medical safety net.

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Schickedanz, Adam; Huang, David; Lopez, Andrea; Cheung, Edna; Lyles, C R; Bodenheimer, Tom; Sarkar, Urmimala

2013-07-01

Electronic and internet-based tools for patient-provider communication are becoming the standard of care, but disparities exist in their adoption among patients. The reasons for these disparities are unclear, and few studies have looked at the potential communication technologies have to benefit vulnerable patient populations. To characterize access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network. Observational, cross-sectional study Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH) MAIN MEASURES: Current email use, interest in communicating electronically with health care professionals, barriers to and facilitators of electronic health-related communication, and demographic data-all self-reported via survey. Sixty percent of patients used email, 71 % were interested in using electronic communication with health care providers, and 19 % reported currently using email informally with these providers for health care. Those already using any email were more likely to express interest in using it for health matters. Most patients agreed electronic communication would improve clinic efficiency and overall communication with clinicians. A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers. This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging. Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings, but this will require tailoring these tools to patients' language, literacy level, and experience with communication technology.

"I couldn't even talk to the patient": Barriers to communicating with cancer patients as perceived by nursing students.

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Lin, M-F; Hsu, W-S; Huang, M-C; Su, Y-H; Crawford, P; Tang, C-C

2017-07-01

Communication is closely related to safe practice and patient outcomes. Given that most clinicians fall into routines when communicating with patients, it is important to address communication issues early. This study explores Taiwanese nursing students' experiences of communication with patients with cancer and their families. Senior nursing students who had cared for cancer patients were recruited to participate in focus group interviews. These semi-structured interviews were recorded and transcribed for content analysis. Among the 45 participants, about 36% of them never received any communication training. Up to 76% of the participants stated that their communication with cancer patients was difficult and caused them emotional stress. Subsequent data analysis revealed four themes: disengagement, reluctance, regression and transition. Students' negative communication experiences were related to the patients' terminally ill situation; the students' lack of training, low self-efficacy and power status, poor emotional regulation, and cultural considerations. The findings of this study provide a deeper understanding of nursing students' communication experiences in oncology settings within the cultural context. Early and appropriate communication training is necessary to help students regulate their emotions and establish effective communication skills. Further studies are needed to examine the relationship among students' emotional labour, communication skills and outcomes. © 2017 John Wiley & Sons Ltd.

Hospital pharmacists' and patients' views about what constitutes effective communication between pharmacists and patients.

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Chevalier, Bernadette A M; Watson, Bernadette M; Barras, Michael A; Cottrell, William N

2017-12-06

The study's objective was to explore hospital pharmacists' and patients' views about what constitutes effective communication exchanges between pharmacists and patients. This was a novel theory-based qualitative study using semi-structured interviews to elicit patients' and pharmacists' perspectives. Pharmacists providing clinical pharmacy services in either inpatient or outpatient settings were recruited first. Eligible patients had been admitted to a study pharmacist's practice area and were prescribed three or more medications to manage a chronic disease(s). Following each pharmacist-patient medication counselling session, semi-structured interviews were held separately with patients and pharmacists. Participants were asked questions intended to explore their views about what constitutes an effective pharmacist-patient conversation. Audio recordings were transcribed verbatim, analysed using a process of inductive thematic analysis and then mapped to Communication Accommodation Theory strategies. Observational notes and reflexive note taking were conducted throughout. Twelve pharmacists each engaged four individual patients for a total of 48 pharmacist-patient conversations (resulting in 48 separate interviews with pharmacists and patients). An overall shared goal was the assurance of patients' confidence in managing their medications at home. Themes included shared colloquialisms/slang, well-explained information, engagement, established rapport and empowerment. Participants provided rich exemplars for each of the themes. Pharmacists and patients provided valuable insights about what makes pharmacist-patient interactions effective. Patient-identified preferences for pharmacist-patient exchanges may help guide pharmacy students and practitioners to engage patients in effective conversations. © 2017 Royal Pharmaceutical Society.

Communication Preferences of Pediatric Cancer Patients: Talking about Prognosis and Their Future Life

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Brand, Sarah R; Fasciano, Karen; Mack, Jennifer W

2017-01-01

Purpose The American Academy of Pediatrics recommends that healthcare providers communicate information to patients in a truthful and developmentally appropriate manner. However there is limited guidance about how to translate these recommendations into clinical practice. The aim of this study was to explore how young cancer patients experienced communication around their illness, especially communication about possible outcomes from disease or treatment. Methods Participants included young people ages 8 to under 18 years with cancer (N=16). Semi-structured interviews focused on their expectations about the future, the process of information exchange, and their preferences for communication within the pediatric oncology setting. Results Overall, participants wanted medical information to be provided to them by their healthcare providers and wanted to be direct participants in medical conversations. However, many participants displayed some ambivalence or conveyed conflicting wishes for prognostic information. For example, some participants reported that they were satisfied with what they knew, but later raised lingering questions. While not the focus of the study, almost every participant discussed social concerns as a key concern for their present and future life. Conclusions While most pediatric cancer patients want to be involved in conversations about their cancer care, including conversations about prognosis, this is an individual and sometimes fluctuating decision, and healthcare providers should be encouraged to discuss preferences for involvement with patients and families. This study highlights the importance of understanding the developmental factors that make pediatric patients unique, especially with regards to their patterns of communication. PMID:27747479

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging.

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Hogan, Timothy P; Luger, Tana M; Volkman, Julie E; Rocheleau, Mary; Mueller, Nora; Barker, Anna M; Nazi, Kim M; Houston, Thomas K; Bokhour, Barbara G

2018-03-08

As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and

The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction.

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Roter, Debra L; Wexler, Randy; Naragon, Phyllis; Forrest, Brian; Dees, Jason; Almodovar, Astrid; Wood, Julie

2012-09-01

The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants' report of skill use and patient satisfaction. Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction. Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all ppost intervention, physicians reported using more skills in the same 5 areas (all pCommunication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction. Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The many "Disguises" of patient-centered communication: Problems of conceptualization and measurement.

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Street, Richard L

2017-11-01

To critically examine different approaches to the measurement of patient-centered communication. Provides a critique of 7 different measures of patient-centered communication with respect to differences in their assumptions about what constitutes patient-centeredness and in their approaches to measurement. The measures differed significantly with regard to whether the measure captured behavior (what the interactants did) or judgment (how well the behavior was performed), focused on the individual clinician or on the interaction as a whole, and on who makes the assessment (participant or observer). A multidimensional framework for developing patient-centered communication measures is presented that encompasses the patient's perspective and participation, the biopsychosocial context of the patient's health, the clinician-patient relationship, quality of information-exchange, shared understanding, and shared, evidence-based decision-making. The state of measurement of the patient-centered communication construct lacks coherence, in part because current measures were developed either void of a conceptual framework or from very different theoretical perspectives. Assessment of patients' experiences with quality of communication in medical encounters should drill down into specific domains of patient-centeredness. Copyright © 2017. Published by Elsevier B.V.

Interprovider Communication Using a Scheduled Provider Alert-Response Communication System in 3 Inpatient Neurology Units.

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Siegler, James E; Finegan, Dan; Kasner, Scott E; Price, Raymond S

2017-10-01

Nonemergent communications between nursing staff and residents often occur randomly throughout the workday at teaching institutions, resulting in inefficiency and interruptions of scheduled resident educational conferences or periods of overnight rest. The aim of this study was to determine whether a quality improvement communication strategy can reduce interruptive notifications during scheduled resident didactic sessions. We conducted a prospective, mixed-methods trial of a communication strategy between nurses and residents in 3 neurology units of an academic institution. We measured content and volume of notifications from nurses to residents during scheduled conferences and overnight and categorized these notifications according to levels of urgency. We implemented an intervention requiring multidisciplinary evening work rounds between the on-call resident and charge nurse and batching of nonemergent communications. Survey data were collected. The total census during the 6-month study period was 728 patients. Of the 704 resident-reported nursing notifications, 50% could be safely deferred until change of shift. After the intervention, there was a 52% decrement of notifications (0.52 vs 0.25 notifications per patient, P communication system reduced interruptive calls during educational conferences and overnight by half. This intervention was perceived as safe and effective and resulted in higher satisfaction among participants.

Right-to-try laws and individual patient "compassionate use" of experimental oncology medications: A call for improved provider-patient communication.

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Hoerger, Michael

2016-01-01

The U.S. Food and Drug Administration's Expanded Access program allows patients with life-threatening diagnoses, such as advanced cancer, to use experimental medications without participating in clinical research (colloquially, "Compassionate Use"). Sixteen U.S. states recently passed "right-to-try" legislation aimed at promoting Expanded Access. Acknowledging popular support, Expanded Access could undermine clinical trials that benefit public health. Moreover, existing norms in oncologic care, for example, often lead patients to pursue intense treatments near the end of life, at the expense of palliation, and improved communication about the risks and benefits of Expanded Access would more often discourage its use.

Communication and cultural issues in providing reproductive health care to immigrant women: health care providers' experiences in meeting the needs of [corrected] Somali women living in Finland.

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Degni, Filio; Suominen, Sakari; Essén, Birgitta; El Ansari, Walid; Vehviläinen-Julkunen, Katri

2012-04-01

Communication problems due to language and cultural differences between health care professionals and patients are widely recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as more open in their communication. The aim of the study was to explore physicians-nurses/midwives' communication when providing reproductive and maternity health care to Somali women in Finland. Four individual and three focus group interviews were carried out with 10 gynecologists/obstetricians and 15 nurses/midwives from five selected clinics. The health care providers considered communication (including linguistic difficulties), cultural traditions, and religious beliefs to be problems when working with Somali women. Male and female physicians were generally more similar in communication style, interpersonal contacts, and cultural awareness than the nurses/midwives who were engaged in more partnership-building with the Somali women in the clinics. Despite the communication and cultural problems, there was a tentative mutual understanding between the Finnish reproductive health care professionals and the Somali women in the clinics.

Effect of the patient-to-patient communication model on dysphagia caused by total laryngectomy.

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Tian, L; An, R; Zhang, J; Sun, Y; Zhao, R; Liu, M

2017-03-01

The study aimed to evaluate the effect of a patient-to-patient communication model on dysphagia in laryngeal cancer patients after total laryngectomy. Sixty-five patients who had undergone total laryngectomy were randomly divided into three groups: a routine communication group, a patient communication group (that received the patient-to-patient communication model) and a physician communication group. Questionnaires were used to compare quality of life and swallowing problems among all patient groups. The main factors causing dysphagia in total laryngectomy patients were related to fear and mental health. The patient communication group had improved visual analogue scale scores at one week after starting to eat. Quality of life in swallowing disorders questionnaire scores were significantly higher in the patient communication and physician communication groups than in the routine communication group. In addition, swallowing problems were much more severe in patients educated to high school level and above than in others. The patient-to-patient communication model can be used to resolve swallowing problems caused by psychological factors in total laryngectomy patients.

Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients.

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Dithole, K S; Thupayagale-Tshweneagae, Gloria; Akpor, Oluwaseyi A; Moleki, Mary M

2017-01-01

Patients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses' experience of a communication skills training intervention. A convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis. Six themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses. The findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training.

[Supervised administration of Alzheimer's patients using information communication technology].

Science.gov (United States)

Noda, Yasuha; Sakata, Yoshifumi; Kubota, Masakazu; Uemura, Kengo; Kihara, Takeshi; Kimura, Toru; Ino, Masashi; Tsuji, Teruyuki; Hayashi, Michiyuki; Kinoshita, Ayae

2014-12-01

Drug adherence is central to the treatment of dementia, which might reduce compliance due to memory loss, particularly among home-based patients with dementia. In order to improve drug adherence, we suggest the efficient and effective supervised administration by use of information communication technology(ICT). ICT makes face-to-face real-time communication possible, and it also enables picture sharing. Therefore, it might be useful to apply ICT to controlling and supervising medication for patients with dementia to improve drug adherence. Accordingly, we enrolled patients who were supposed to take a newly prescribed anti-dementia patch containing the choline esterase inhibitor rivastigmine(Rivastach®)and investigated the effect of ICT-based intervention for drug adherence, emotional change, and cognitive change, utilizing Skype, a free communication software program. Scheduled Skype interventions increased drug adherence ratio, levels of subjective satisfaction, and instrumental activities of daily living(IADL). Furthermore, we can provide patients and their caregivers with a feeling of safety through regular bidirectional communication, as patients can easily consult medical staff regarding the adverse effects of newly prescribed drugs. Instead of frequent visits to their primary physicians, ICT-based communications can be used as a substitute for supervision of medication, given the availability of the telecommunication system. By directly connecting the medical institution to the home, we expect that this ICT-based system will expand into the geriatric care field, including the care of elderly individuals living alone.

Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.

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van Bruinessen, Inge Renske; van Weel-Baumgarten, Evelyn M; Gouw, Hans; Zijlstra, Josée M; Albada, Akke; van Dulmen, Sandra

2013-12-01

This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. A qualitative approach was applied, derived from the context mapping framework. A total of 28 patients completed a set of assignments about their experiences with provider-patient communication during medical consultations. Subsequently, these patients and nine companions shared their experiences during a semistructured (group) interview, which was recorded on audiotape. The audiotapes and assignments were analysed with MAXQDA software. From the patients' viewpoint, communicating effectively appears to depend on their own attributes (e.g. emotions), the health care professionals' attributes (e.g. attitude) and external factors (e.g. time pressure). Three patient communication states were identified: (i) overwhelmed, passive; (ii) pro-active, self-motivated; and (iii) proficient, empowered. Patients seem to behave differently in the three communication states. This study lists patient-perceived communication barriers and facilitators and identifies three different communication states, which indicate when certain barriers and facilitators are encountered. These findings may support health care professionals to tailor the provision of support and information and remove communication barriers accordingly. Additionally, they provide input for interventions to support patients in effective communication. Copyright © 2013 John Wiley & Sons, Ltd.

A 3-stage model of patient-centered communication for addressing cancer patients' emotional distress.

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Dean, Marleah; Street, Richard L

2014-02-01

To describe pathways through which clinicians can more effectively respond to patients' emotions in ways that contribute to betterment of the patient's health and well-being. A representative review of literature on managing emotions in clinical consultations was conducted. A three-stage, conceptual model for assisting clinicians to more effectively address the challenges of recognizing, exploring, and managing cancer patients' emotional distress in the clinical encounter was developed. To enhance and enact recognition of patients' emotions, clinicians can engage in mindfulness, self-situational awareness, active listening, and facilitative communication. To enact exploration, clinicians can acknowledge and validate emotions and provide empathy. Finally, clinicians can provide information empathetically, identify therapeutic resources, and give referrals and interventions as needed to help lessen patients' emotional distress. This model serves as a framework for future research examining pathways that link clinicians' emotional cue recognition to patient-centered responses exploring a patient's emotional distress to therapeutic actions that contribute to improved psychological and emotional health. Specific communicative and cognitive strategies are presented that can help clinicians better recognize a patient's emotional distress and respond in ways that have therapeutic value. Published by Elsevier Ireland Ltd.

Doctor-patient communication: a review of the literature

NARCIS (Netherlands)

Ong, L. M.; de Haes, J. C.; Hoos, A. M.; Lammes, F. B.

1995-01-01

Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of

A systematic review of surgeon-patient communication: strengths and opportunities for improvement.

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Levinson, Wendy; Hudak, Pamela; Tricco, Andrea C

2013-10-01

Effective communication is critical to patient satisfaction, outcomes of care and malpractice prevention. Surgeons need particularly effective communication skills to discuss complicated procedures and help patients make informed choices. We conducted a systematic review of the literature on surgeon-patient communication. Searches were conducted in MEDLINE, PsycINFO, and Sociological Abstract. Two reviewers screened citations and full-text articles. Quality was appraised using the Critical Appraisal Skills Program tool. Studies were categorized into content of communication, patient satisfaction, relationship of communication to malpractice, and duration of visits. 2794 citations and 74 full-text articles, 21 studies and 13 companion reports were included. Surgeons spent the majority of their time educating patients and helping them to make choices. Surgeons were generally thorough in providing details about surgical conditions and treatments. Surgeons often did not explore the emotions or concerns of patients. Potential areas of improvement included discussing some elements of informed decision making, and expressing empathy. Surgeons can enhance their communication skills, particularly in areas of relative deficiency. Studies in primary care demonstrate communication programs are effective in teaching these skills. These can be adapted to surgical training and ultimately lead to improved outcomes and satisfaction with care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The challenge of effectively communicating patient safety information.

Science.gov (United States)

Hugman, Bruce; Edwards, I Ralph

2006-07-01

Rational use of drugs and patient safety are seriously compromised by a lack of good information, education and effective communication at all stages of drug development and use. From animal trials through to dispensing, there are misconceptions and opportunities for error which current methods of drug information communication do not adequately address: they do not provide those responsible for prescribing and dispensing drugs with the data and information they need to pass on complex and often changing messages to patients and the public. The incidence of adverse reactions due to the way drugs are used; the variable impact of regulatory guidelines and warnings on prescribing behaviour; drug scares and crises suggest a great gap between the ideals of the safe use of medicines and the reality in homes, clinics and hospitals around the world. To address these challenges, the authors review the several levels at which safety information is generated and communicated, and examine how, at each stage, the content and its significance, and the method of communication can be improved.

[Patients, clients, doctors and providers: is it just a question of terminology?].

Science.gov (United States)

Ayuzo Del Valle, Cipatli

2016-01-01

With the modernization of healthcare and management of a Hospital as a bussiness, There is the risk of changing the words "patient" and "doctor" into "client" and "provider", risking the humanitarian care, thrustworthiness, and doctor-patient relationship. Using first and last names could be an option for communication.

Improving Pharmacy Student Communication Outcomes Using Standardized Patients.

Science.gov (United States)

Gillette, Chris; Rudolph, Michael; Rockich-Winston, Nicole; Stanton, Robert; Anderson, H Glenn

2017-08-01

Objective. To examine whether standardized patient encounters led to an improvement in a student pharmacist-patient communication assessment compared to traditional active-learning activities within a classroom setting. Methods. A quasi-experimental study was conducted with second-year pharmacy students in a drug information and communication skills course. Student patient communication skills were assessed using high-stakes communication assessment. Results. Two hundred and twenty students' data were included. Students were significantly more likely to have higher scores on the communication assessment when they had higher undergraduate GPAs, were female, and taught using standardized patients. Similarly, students were significantly more likely to pass the assessment on the first attempt when they were female and when they were taught using standardized patients. Conclusion. Incorporating standardized patients within a communication course resulted in improved scores as well as first-time pass rates on a communication assessment than when using different methods of active learning.

Patient-Provider Teamwork via Cooperative Note Taking on Tele-Board MED.

Science.gov (United States)

Perlich, Anja; Meinel, Christoph

2016-01-01

There is significant, unexploited potential to improve the patients' engagement in psychotherapy treatment through technology use. We develop Tele-Board MED (TBM), a digital tool to support documentation and patient-provider collaboration in medical encounters. Our objective is the evaluation of TBM's practical effects on patient-provider relationships and patient empowerment in the domain of talk-based mental health interventions. We tested TBM in individual therapy sessions at a psychiatric ward using action research methods. The qualitative results in form of therapist observations and patient stories show an increased acceptance of diagnoses and patient-therapist bonding. We compare the observed effects to patient-provider relationship and patient empowerment models. We can conclude that the functions of TBM - namely that notes are shared and cooperatively taken with the patient, that diagnostics and treatment procedures are depicted via visuals and in plain language, and that patients get a copy of their file - lead to increased patient engagement and an improved collaboration, communication and integration in consultations.

ACOG Committee Opinion No. 587: Effective patient-physician communication.

Science.gov (United States)

2014-02-01

Physicians' ability to effectively and compassionately communicate information is key to a successful patient-physician relationship. The current health care environment demands increasing clinical productivity and affords less time with each patient, which can impede effective patient-physician communication. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient-physician communication. Involving advanced practice nurses or physician assistants may improve the patient's experience and understanding of her visit. Electronic communication with established patients also can enhance the patient experience in select situations.

Improving Resident Communication in the Intensive Care Unit. The Proceduralization of Physician Communication with Patients and Their Surrogates.

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Miller, David C; McSparron, Jakob I; Clardy, Peter F; Sullivan, Amy M; Hayes, Margaret M

2016-09-01

Effective communication between providers and patients and their surrogates in the intensive care unit (ICU) is crucial for delivery of high-quality care. Despite the identification of communication as a key education focus by the American Board of Internal Medicine, little emphasis is placed on teaching trainees how to effectively communicate in the ICU. Data are conflicting on the best way to teach residents, and institutions vary on their emphasis of communication as a key skill. There needs to be a cultural shift surrounding the education of medical residents in the ICU: communication must be treated with the same emphasis, precision, and importance as placing a central venous catheter in the ICU. We propose that high-stakes communications between physicians and patients or their surrogates must be viewed as a medical procedure that can be taught, assessed, and quality controlled. Medical residents require training, observation, and feedback in specific communication skill sets with the goal of achieving mastery. It is only through supervised training, practice in real time, observation, and feedback that medical residents can become skillful practitioners of communication in the ICU.

Effective doctor-patient communication: an updated examination.

Science.gov (United States)

Matusitz, Jonathan; Spear, Jennifer

2014-01-01

This article examines, in detail, the quality of doctor-patient interaction. Doctor-patient communication is such a powerful indicator of health care quality that it can determine patients' self-management behavior and health outcomes. The medical visit (i.e., the medical encounter) plays a pivotal role in the health care process. In fact, doctor-patient communication is one of the most essential dynamics in health care, affecting the course of patient care and patient compliance with recommendations for care. Unlike many other analyses (that often look at only one or two specific aspects of doctor-patient relationships), this analysis is more encompassing; it looks at doctor-patient communication from multiple perspectives.

Development and Validation of Quality Criteria for Providing Patient- and Family-centered Injury Care.

Science.gov (United States)

Boyd, Jamie M; Burton, Rachael; Butler, Barb L; Dyer, Dianne; Evans, David C; Felteau, Melissa; Gruen, Russell L; Jaffe, Kenneth M; Kortbeek, John; Lang, Eddy; Lougheed, Val; Moore, Lynne; Narciso, Michelle; Oxland, Peter; Rivara, Frederick P; Roberts, Derek; Sarakbi, Diana; Vine, Karen; Stelfox, Henry T

2017-08-01

The aim of this study was to develop and evaluate the content validity of quality criteria for providing patient- and family-centered injury care. Quality criteria have been developed for clinical injury care, but not patient- and family-centered injury care. Using a modified Research AND Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Methodology, a panel of 16 patients, family members, injury and quality of care experts serially rated and revised criteria for patient- and family-centered injury care identified from patient and family focus groups. The criteria were then sent to 384 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation. A total of 46 criteria were rated and revised by the panel over 4 rounds of review producing 14 criteria related to clinical care (n = 4; transitions of care, pain management, patient safety, provider competence), communication (n = 3; information for patients/families; communication of discharge plans to patients/families, communication between hospital and community providers), holistic care (n = 4; patient hygiene, kindness and respect, family access to patient, social and spiritual support) and end-of-life care (n = 3; decision making, end-of-life care, family follow-up). Medical directors, managers, or coordinators representing 254 trauma centers (66% response rate) rated 12 criteria to be important (95% of responses) for patient- and family-centered injury care. Fewer centers rated family access to the patient (80%) and family follow-up after patient death (65%) to be important criteria. Fourteen-candidate quality criteria for patient- and family-centered injury care were developed and shown to have content validity. These may be used to guide quality improvement practices.

Understanding Family Caregiver Communication to Provide Family-Centered Cancer Care.

Science.gov (United States)

Wittenberg, Elaine; Buller, Haley; Ferrell, Betty; Koczywas, Marianna; Borneman, Tami

2017-12-01

To describe a family caregiver communication typology and demonstrate identifiable communication challenges among four caregiver types: Manager, Carrier, Partner, and Lone. Case studies based on interviews with oncology family caregivers. Each caregiver type demonstrates unique communication challenges that can be identified. Recognition of a specific caregiver type will help nurses to adapt their own communication to provide tailored support. Family-centered cancer care requires attention to the communication challenges faced by family caregivers. Understanding the challenges among four family caregiver communication types will enable nurses to better address caregiver burden and family conflict. Copyright © 2017 Elsevier Inc. All rights reserved.

Enhancing Student Communication Skills Through Arabic Language Competency and Simulated Patient Assessments.

Science.gov (United States)

Hasan, Sanah; Tarazi, Hamadeh M Khier; Halim Hilal, Dana Abdel

2017-05-01

Objective. To assess student communication and patient management skill with introduction of Arabic and use of simulated patient assessments to a communication and counseling course. Design. Five, 3-hour tutorials (clinical skill laboratory) were added to the course covering: listening and empathic responding, non-verbal communications, interviewing skills, assertiveness, counseling in special situations: conflict, anger, worry or rushed situations, and professional decision making. Arabic content was introduced to the course to enhance Arabic communications and competence among students. Simulated patient assessment was used to evaluate student skills. Students' feedback about course changes was evaluated. Assessment. The course now covers a wider content and Arabic language. Students' scores were similar in the assessment and other assessments within the course and between Arabic and English groups. Students favorably rated the changes in the course and provided constructive feedback on content usefulness and adequacy. Conclusion. Expanding the course to include Arabic language and content and simulated patient assessments enhanced student communication skills.

ICT and the future of health care: aspects of doctor-patient communication.

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Haluza, Daniela; Jungwirth, David

2014-07-01

The current digital revolution is particularly relevant for interactions of healthcare providers with patients and the community as a whole. The growing public acceptance and distribution of new communication tools such as smart mobile phones provide the prerequisite for information and communication technology (ICT) -assisted healthcare applications. The present study aimed at identifying specifications and perceptions of different interest groups regarding future demands of ICT-supported doctor-patient communication in Austria. German-speaking Austrian healthcare experts (n = 73; 74 percent males; mean age, 43.9 years; SD 9.4) representing medical professionals, patient advocates, and administrative personnel participated in a 2-round online Delphi process. Participants evaluated scenario-based benefits and obstacles for possible prospect introduction as well as degree of innovation, desirability, and estimated implementation dates of two medical care-related future set ups. Panelists expected the future ICT-supported doctor-patient dialogue to especially improve the three factors doctors-patient relationship, patients' knowledge, and quality of social health care. However, lack of acceptance by doctors, data security, and monetary aspects were considered as the three most relevant barriers for ICT implementation. Furthermore, inter-group comparison regarding desirability of future scenarios showed that medical professionals tended to be more skeptical about health-related technological innovations (p ICT-supported collaboration and communication between doctors and patients.

Dental students' self-perceived communication skills for patient motivation.

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Rindlisbacher, F; Davis, J M; Ramseier, C A

2017-08-01

The aim of this study was to evaluate dental students' self-perceived communication skills for patient motivation over the course of their training. Pre-clinical and clinical dental students at the University of Bern School of Dental Medicine were surveyed annually from 2008 to 2011 utilising a written questionnaire. Self-reported data were pooled from all classes per time-point in the curriculum. A total of 157 students were surveyed from five classes with an overall response rate of 94.8%. A total of 393 questionnaires were available for analysis. The self-perceived skill-sets for general patient care and patient communication were rated at the end of the first clinical year with mean Visual Analog Scale values of 75.0 ± 1.6 and 75.1 ± 1.5, respectively. During the second clinical year, the self-perceived skills increased in both patient care (82.5 ± 1.2, P = 0.0004) and patient communication (81.4 ± 1.4, P = 0.0034). The students rated their competence higher when providing oral hygiene instructions as opposed to motivating patients to quit tobacco use, modify their diet or employ stress-reduction strategies (P motivating patients to utilise oral hygiene instructions, they also expressed the desire for more motivational training early in their curriculum. Therefore, these results may indicate the need to enhance communications training in patient motivation on all behavioural aspects early in the dental curriculum. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Face-to-face communication between patients and family physicians in Canada: A scoping review.

Science.gov (United States)

Armas, Alana; Meyer, Samantha B; Corbett, Kitty K; Pearce, Alex R

2018-05-01

Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Nurse-Patient Communication Interactions in the Intensive Care Unit

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Happ, Mary Beth; Garrett, Kathryn; Thomas, Dana DiVirgilio; Tate, Judith; George, Elisabeth; Houze, Martin; Radtke, Jill; Sereika, Susan

2011-01-01

Background The inability to speak during critical illness is a source of distress for patients, yet nurse-patient communication in the intensive care unit has not been systematically studied or measured. Objectives To describe communication interactions, methods, and assistive techniques between nurses and nonspeaking critically ill patients in the intensive care unit. Methods Descriptive observational study of the nonintervention/usual care cohort from a larger clinical trial of nurse-patient communication in a medical and a cardiothoracic surgical intensive care unit. Videorecorded interactions between 10 randomly selected nurses (5 per unit) and a convenience sample of 30 critically ill adults (15 per unit) who were awake, responsive, and unable to speak because of respiratory tract intubation were rated for frequency, success, quality, communication methods, and assistive communication techniques. Patients self-rated ease of communication. Results Nurses initiated most (86.2%) of the communication exchanges. Mean rate of completed communication exchange was 2.62 exchanges per minute. The most common positive nurse act was making eye contact with the patient. Although communication exchanges were generally (>70%) successful, more than one-third (37.7%) of communications about pain were unsuccessful. Patients rated 40% of the communication sessions with nurses as somewhat difficult to extremely difficult. Assistive communication strategies were uncommon, with little to no use of assistive communication materials (eg, writing supplies, alphabet or word boards). Conclusions Study results highlight specific areas for improvement in communication between nurses and nonspeaking patients in the intensive care unit, particularly in communication about pain and in the use of assistive communication strategies and communication materials. PMID:21362711

Patient-centered communication strategies for patients with aphasia: discrepancies between what patients want and what physicians do.

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Morris, Megan A; Clayman, Marla L; Peters, Kaitlin J; Leppin, Aaron L; LeBlanc, Annie

2015-04-01

Communication during clinical encounters can be challenging with patients with communication disabilities. Physicians have the potential to positively affect the encounter by using communication strategies that engage the patient in patient-centered communication. We engaged patients and their physicians in defining their preferences for patient-centered communication strategies, then evaluated the use of the identified strategies during observed clinical encounters. We video-recorded 25 clinical encounters with persons with aphasia. All encounters were previously scheduled with community physicians and a companion was present. Following each encounter, physicians completed a brief questionnaire and the person with aphasia and his or her companion participated in a video elicitation interview. While many of the communication strategies identified and described by physicians, patients and companions were similar, patients and companions identified three additional key communication strategies. These strategies included (1) using visual aids, (2) writing down key words while speaking, and (3) using gestures. In the video recorded clinical encounters, no physicians wrote down key words while speaking and only one used a visual aid during the clinical encounter. The frequency with which physicians used gestures varied greatly, even within the same patient, suggesting the use of gestures was independent of patient or companion characteristics. To maximize patient-centered communication with patients with communication disabilities, physicians should use "disability-specific" communication strategies. Our study suggests that physicians should routinely ask patients and companions about communication preferences and then incorporate identified communication strategies into their communication style. Copyright © 2015 Elsevier Inc. All rights reserved.

Survey mode matters: adults' self-reported statistical confidence, ability to obtain health information, and perceptions of patient-health-care provider communication.

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Wallace, Lorraine S; Chisolm, Deena J; Abdel-Rasoul, Mahmoud; DeVoe, Jennifer E

2013-08-01

This study examined adults' self-reported understanding and formatting preferences of medical statistics, confidence in self-care and ability to obtain health advice or information, and perceptions of patient-health-care provider communication measured through dual survey modes (random digital dial and mail). Even while controlling for sociodemographic characteristics, significant differences in regard to adults' responses to survey variables emerged as a function of survey mode. While the analyses do not allow us to pinpoint the underlying causes of the differences observed, they do suggest that mode of administration should be carefully adjusted for and considered.

Assessing the Nursing and Midwifery Students Competencies in Communication With Patients With Severe Communication Problems

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Adib Hajbaghery, Mohsen; Rezaei Shahsavarloo, Zahra

2014-01-01

Background: Clients with communication impairment are at risk for health disparity. Hence, health care workers should be knowledgeable and skillful in communication. However, no studies are available on Iranian nursing and midwifery students’ communication skills with patients with severe communication problems. Objectives: The present study was conducted to investigate Iranian nursing and midwifery students' competencies in communication with patients with severe communication problems. Materials and Methods: This study was performed on all senior nursing and midwifery students of Kashan University of Medical Sciences in spring 2013. Data were collected through a knowledge questionnaire and two checklists for evaluation of skills needed for communication with patients with severe communication problems. Data analysis was performed through independent samples t test, and Fisher’s exact test. Results: In total, 68.8% of the participants were female, 37.6% had a history of part-time job as a nurse or midwife. The mean score of knowledge were 4.41 ± 1.42 and 4.77 ± 1.77 for nursing and midwifery students, respectively and the difference was not significant (P = 0.312). In addition, the mean score of communication skills with deaf patients was 13.23 ± 4.68 and 11.86 ± 5.55 for nursing and midwifery students, respectively and the difference was not significant (P = 0.258). Also, the mean score of communication skills with stutter patients was 23.91 ± 4.17 and 21.25 ± 3.91 for nursing and midwifery students, respectively but the difference was not significant (P = 0.269). Conclusions: Nursing and midwifery students did not significantly differ in terms of communication with patients with severe communication problems. Most of the students had low or very low knowledge and skills in communication with patients with hearing impairment. However, they had better skills in communication with patient with speech problem. Special workshops or training programs are

Confidence in communicating with patients with cancer mediates the relationship between rehabilitation therapists' autistic-like traits and perceived difficulty in communication.

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Hayashibara, Chinatsu; Inagaki, Masatoshi; Fujimori, Maiko; Higuchi, Yuji; Fujiwara, Masaki; Terada, Seishi; Okamura, Hitoshi; Uchitomi, Yosuke; Yamada, Norihito

2018-01-21

Recently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists' communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT. Rehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties. Participants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p Communication difficulty was linked to rehabilitation therapists' ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.

Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor-patient communication.

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Kenny, David A; Veldhuijzen, Wemke; Weijden, Trudy van der; Leblanc, Annie; Lockyer, Jocelyn; Légaré, France; Campbell, Craig

2010-03-01

Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters. 2009 Elsevier Ltd. All rights reserved.

Communication skills training for radiation therapists: preparing patients for radiation therapy.

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Halkett, Georgia; O'Connor, Moira; Aranda, Sanchia; Jefford, Michael; Merchant, Susan; York, Debra; Miller, Lisa; Schofield, Penelope

2016-12-01

Patients sometimes present for radiation therapy with high levels of anxiety. Communication skills training may assist radiation therapists to conduct more effective consultations with patients prior to treatment planning and treatment commencement. The overall aim of our research is to examine the effectiveness of a preparatory programme 'RT Prepare' delivered by radiation therapists to reduce patient psychological distress. The purpose of this manuscript was to describe the communication skills workshops developed for radiation therapists and evaluate participants' feedback. Radiation therapists were invited to participate in two communication skills workshops run on the same day: (1) Consultation skills in radiation therapy and (2) Eliciting and responding to patients' emotional cues. Evaluation forms were completed. Radiation therapists' consultations with patients were then audio-recorded and evaluated prior to providing a follow-up workshop with participants. Nine full day workshops were held. Sixty radiation therapists participated. Positive feedback was received for both workshops with 88% or more participants agreeing or strongly agreeing with all the statements about the different components of the two workshops. Radiation therapists highlighted participating in role play with an actor, discussing issues; receiving feedback; acquiring new skills and knowledge; watching others role play and practicing with checklist were their favourite aspects of the initial workshop. The follow-up workshops provided radiation therapists with feedback on how they identified and addressed patients' psychological concerns; time spent with patients during consultations and the importance of finding private space for consultations. Communication skills training consisting of preparing patients for radiation therapy and eliciting and responding to emotional cues with follow-up workshops has the potential to improve radiation therapists' interactions with patients undergoing

How electricity providers communicate price increases – A qualitative analysis of notification letters

International Nuclear Information System (INIS)

Pick, Doreén; Zielke, Stephan

2015-01-01

In several markets firms are required to explicitly announce price increases by sending customers notification letters. The purpose of this article is to analyze how electricity providers deal with such obligatory price increase communication and to provide a comprehensive overview of communicative arguments used by firms. Data is gathered through a content analysis of 97 price increase mailings. Findings show that electricity providers apply several price communication strategies while other promising strategies for customer retention are mostly ignored (i.e., those related to competitors, offerings and relationship benefits). Further, price increase communication differs between national and local firms. Local firms are more transparent in their price increase communication and refer even less often to offer and relationship benefits. Electricity firms have many options to improve the potential effects of price increase letters, such as referring to the future relationship. This is the first study which examines the content of price increase communication by firms. It structures price communication practices used by electricity providers, analyzes their empirical relevance, summarizes findings in five global propositions, and provides a detailed agenda for future research. Moreover, the study indicates several means for public policy organizations to offer regulations on the content of price increase notifications. - Highlights: • We examine 97 price increase letters from electricity providers in Germany. • We investigate the means how firms deal with price increase communications. • Electricity providers aim to hide price increases towards their customers. • Electricity providers only scarcely use benefit and relationship communication. • Price increase communication differs between types of providers as national firms are more professional.

Email for communicating results of diagnostic medical investigations to patients.

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Meyer, Barbara; Atherton, Helen; Sawmynaden, Prescilla; Car, Josip

2012-08-15

As medical care becomes more complex and the ability to test for conditions grows, pressure on healthcare providers to convey increasing volumes of test results to patients is driving investigation of alternative technological solutions for their delivery. This review addresses the use of email for communicating results of diagnostic medical investigations to patients. To assess the effects of using email for communicating results of diagnostic medical investigations to patients, compared to SMS/ text messaging, telephone communication or usual care, on outcomes, including harms, for health professionals, patients and caregivers, and health services. We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists and contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies of interventions using email for communicating results of any diagnostic medical investigations to patients, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Two review authors independently assessed the titles and abstracts of retrieved citations. No studies were identified for inclusion. Consequently, no data collection or analysis was possible. No studies met the inclusion criteria, therefore there are no results to report on the use of email for communicating results of diagnostic medical

Digital mobile technology facilitates HIPAA-sensitive perioperative messaging, improves physician-patient communication, and streamlines patient care.

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Gordon, Chad R; Rezzadeh, Kameron S; Li, Andrew; Vardanian, Andrew; Zelken, Jonathan; Shores, Jamie T; Sacks, Justin M; Segovia, Andres L; Jarrahy, Reza

2015-01-01

Mobile device technology has revolutionized interpersonal communication, but the application of this technology to the physician-patient relationship remains limited due to concerns over patient confidentiality and the security of digital information. Nevertheless, there is a continued focus on improving communication between doctors and patients in all fields of medicine as a means of improving patient care. In this study, we implement a novel communications platform to demonstrate that instantaneously sharing perioperative information with surgical patients and members of their support networks can improve patient care and strengthen the physician-patient relationship. 423 consecutive patients scheduled to undergo elective surgical procedures were offered complimentary registration to a secure, web-based service designed to distribute perioperative updates to a group of recipients designated by each patient via Short Message Service (SMS) and/or email. Messages were created by attending surgeons and delivered instantaneously through the web-based platform. In the postoperative period, patients and their designated message recipients, as well as participating healthcare providers, were asked to complete a survey designed to assess their experience with the messaging system. Survey results were statistically analyzed to determine satisfaction rates. Of the qualifying 423 patients, 313 opted to enroll in the study. On average, patients selected a total of 3.5 recipients to receive perioperative updates. A total of 1,195 electronic messages were generated for distribution to designated recipients during the study period and delivered to recipients located around the world. There were no documented errors or failures in message delivery. Satisfaction surveys were completed by 190 users of the service (73 %). Respondents identified themselves as either patients (n = 48, 25.5 %), family/friends (n = 120, 63.8 %), or healthcare providers (n = 15, 12

Emergency department team communication with the patient: the patient's perspective.

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McCarthy, Danielle M; Ellison, Emily P; Venkatesh, Arjun K; Engel, Kirsten G; Cameron, Kenzie A; Makoul, Gregory; Adams, James G

2013-08-01

Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication. The objective of this study was to determine patients' perceptions of their ED team's communication skills. This was a cross-sectional study in an urban, academic ED. Patients completed the Communication Assessment Tool for Teams (CAT-T) survey upon ED exit. The CAT-T was adapted from the psychometrically validated Communication Assessment Tool (CAT) to measure patient perceptions of communication with a medical team. The 14 core CAT-T items are associated with a 5-point scale (5 = excellent); results are reported as the percent of participants who responded "excellent." Responses were analyzed for differences based on age, sex, race, and operational metrics (wait time, ED daily census). There were 346 patients identified; the final sample for analysis was 226 patients (53.5% female, 48.2% Caucasian), representing a response rate of 65.3%. The scores on CAT-T items (reported as % "excellent") ranged from 50.0% to 76.1%. The highest-scoring items were "let me talk without interruptions" (76.1%), "talked in terms I could understand" (75.2%), and "treated me with respect" (74.3%). The lowest-scoring item was "encouraged me to ask questions" (50.0%). No differences were noted based on patient sex, race, age, wait time, or daily census of the ED. The patients in this study perceived that the ED teams were respectful and allowed them to talk without interruptions; however, lower ratings were given for items related to actively engaging the patient in decision-making and asking questions. Copyright © 2013 Elsevier Inc. All rights reserved.

Communication Challenges of Oncologists and Intensivists Caring for Pediatric Oncology Patients: A Qualitative Study.

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Odeniyi, Folasade; Nathanson, Pamela G; Schall, Theodore E; Walter, Jennifer K

2017-12-01

The families of oncology patients requiring intensive care often face increasing complexity in communication with their providers, particularly when patients are cared for by providers from different disciplines. The objective of this study was to describe experiences and challenges faced by pediatric oncologists and intensivists and how the oncologist-intensivist relationship impacts communication and initiation of goals of care discussions (GCDs). We conducted semi-structured interviews with a convenience sample of 10 physicians, including pediatric oncology and intensive care attendings and fellows. We identified key themes (three barriers and four facilitators) to having GCDs with families of oncology patients who have received intensive care. Barriers included challenges to communication within teams because of hierarchy and between teams due to incomplete sharing of information and confusion about who should initiate GCDs; provider experiences of internal conflict about how to engage parents in decision-making and about the "right thing to do" for patients; and lack of education and training in communication. Facilitators included team preparation for family meetings; skills for partnering with families; the presence of palliative care specialists; and informal education in communication and willingness for further training in communication. Notably, the education theme was identified as both a barrier and resource. We identified barriers to communication with families both within and between teams and for individual physicians. Formal communication training and processes that standardize communication to ensure completeness and role delineation between clinical teams may improve oncologists' and intensivists' ability to initiate GCDs, thereby fulfilling their ethical obligations of decision support. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Spanish-speaking patients' satisfaction with clinical pharmacists' communication skills and demonstration of cultural sensitivity.

Science.gov (United States)

Kim-Romo, Dawn N; Barner, Jamie C; Brown, Carolyn M; Rivera, José O; Garza, Aida A; Klein-Bradham, Kristina; Jokerst, Jason R; Janiga, Xan; Brown, Bob

2014-01-01

OBJECTIVE To assess Spanish-speaking patients' satisfaction with their clinical pharmacists' communication skills and demonstration of cultural sensitivity, while controlling for patients' sociodemographic, clinical, and communication factors, as well as pharmacist factors, and to identify clinical pharmacists' cultural factors that are important to Spanish-speaking patients. DESIGN Cross-sectional study. SETTING Central Texas during August 2011 to May 2012. PARTICIPANTS Spanish-speaking patients of federally qualified health centers (FQHCs). MAIN OUTCOME MEASURE(S) A Spanish-translated survey assessed Spanish-speaking patients' satisfaction with their clinical pharmacists' communication skills and demonstration of cultural sensitivity. RESULTS Spanish-speaking patients (N = 101) reported overall satisfaction with their clinical pharmacists' communication skills and cultural sensitivity. Patients also indicated that pharmacists' cultural rapport (e.g., ability to speak Spanish, respectfulness) was generally important to Spanish speakers. Multiple linear regression analyses showed that cultural rapport was significantly related to satisfaction with pharmacists' communication skills and demonstration of cultural sensitivity. CONCLUSION Overall, patients were satisfied with pharmacists' communication skills and cultural sensitivity. Patient satisfaction initiatives that include cultural rapport should be developed for pharmacists who provide care to Spanish-speaking patients with limited English proficiency.

Physician communication behaviors from the perspective of adult HIV patients in Kenya.

Science.gov (United States)

Wachira, Juddy; Middlestadt, Susan; Reece, Michael; Peng, Chao-Ying Joanne; Braitstein, Paula

2014-04-01

We describe perceived physician communication behaviors and its association with adherence to care, among HIV patients in Kenya. This cross-sectional study was conducted between July and August 2011. The study was conducted in three adult HIV clinics within the Academic Model Providing Healthcare program in western Kenya. HIV adult patients. Patient's predisposition to attend clinic, missed appointment and missed combined antiretroviral therapy (cART) medication. A total of 400 patients were enrolled and participated in the study; the median age was 38 years (IQR = 33-44) and 56.5% were female. Patients perceived physicians engaged in a high number of communication behaviors (mean = 3.80, range 1-5). A higher perceived general health status (P = 0.01), shorter distance to the health facility (P = 0.03) and lesser time spent at the health facility (P = 0.02) were associated with a higher number of perceived physician communication behaviors. Physician-patient relationship factors were not associated with physician communication behaviors. In addition, a higher number of perceived physician communication behaviors was associated with a very high likelihood of patients' attending the next HIV clinic [adjusted odds ratio (AOR): 1.89, 95% confidence interval (CI): 1.49-2.40], a lower likelihood of patients' missing an appointment (AOR: 0.75, 95% CI: 0.61-0.92) and missing cART medication (AOR: 0.68, 95% CI: 0.52-0.87). Patients' perception of physician communication behaviors was found to be associated with their adherence to HIV care.

Large-Scale Survey Findings Inform Patients’ Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment

Science.gov (United States)

Patel, Nitin R; Lind, Jason D; Antinori, Nicole

2015-01-01

Background Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users’ experiences in using secure email messaging. Objective To quantitatively assess veteran patients’ experiences in using secure email messaging in a large patient sample. Methods A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations’ Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance. Results The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy

Associations between parents' satisfaction with provider communication and HPV vaccination behaviors.

Science.gov (United States)

Kornides, Melanie L; Fontenot, Holly B; McRee, Annie-Laurie; Panozzo, Catherine A; Gilkey, Melissa B

2018-05-03

Despite increasing awareness of the importance of a provider recommendation for HPV vaccine, the U.S. has yet to achieve the Healthy people 2020 goal of 80% series completion among adolescents. This failure indicates a need for further examination of the modifiable influences on parents' decision-making. Healthcare providers can influence parents' HPV vaccination decision-making, but little is known about parents' perspectives on the counseling they receive. We sought to assess U.S. parents' satisfaction with provider communication about HPV vaccine and associations with vaccination behaviors. Parents of 11-to-17-year-old adolescents who discussed HPV vaccination with a healthcare provider at least once (n = 795) completed our online survey in Fall 2016. We assessed their satisfaction with the discussion using the HPV Vaccine Communication Satisfaction Scale (α = 0.94). We examined associations between satisfaction (categorized as low, moderate, or high), and three vaccination behaviors: refusal/delay, series initiation (≥1 dose), and continuation (≥2 doses among initiators) using multivariable logistic regression. Most parents reported high (36%) or moderate (38%) satisfaction with provider communication about HPV vaccination; fewer reported low (26%) satisfaction. Moderately satisfied parents (vs. low) had lower odds of refusal/delay (aOR = 0.59, 95% CI: 0.38-0.89), and higher odds of initiation (aOR = 1.71, 95% CI:1.15-2.55) and continuation (aOR = 2.05, 95% CI: 1.24-3.40). The associations were stronger for highly satisfied parents (refusal/delay aOR = 0.45, 95% CI: 0.29-0.70, initiation aOR = 3.59, 95% CI: 2.23-5.78, and continuation aOR = 4.08, 95% CI: 2.38-7.01). Our study suggests that parent satisfaction with provider communication may play an important role in HPV vaccination decision-making. Yet, communication satisfaction has been largely unexamined in the HPV-vaccine literature to date. We introduce a brief, 7-item

Communication activity in stroke patients with aphasia.

Science.gov (United States)

Mazaux, Jean-Michel; Lagadec, Tiphaine; de Sèze, Mathieu Panchoa; Zongo, Drissa; Asselineau, Julien; Douce, Emmanuelle; Trias, Joel; Delair, Marie-France; Darrigrand, Bénédicte

2013-04-01

To study communication disability in stroke patients with aphasia. Prospective, multicentric cohort study of patients with aphasia, consecutively included after a first stroke, and examined 1 year later at home. Assessment included a stroke severity scale, the Barthel Index, the boston diagnostic aphasia examination, a communication questionnaire, and the aphasia depression rating scale. A total of 164 patients were included. Among the 100 survivors assessed at follow-up, 24% had severe aphasia, 12% moderate aphasia and 64% mild aphasia according to the Boston diagnostic aphasia examination severity score. Patients mainly reported difficulties in conversation with strangers and/or on abstract topics, using a phone, reading and writing administrative documents, dealing with money and outdoor communication activities. Communication was strongly related to aphasia severity. Age, gender, education level, residence status and type of stroke had no influence on communication activity. On multivariate analysis, severity of stroke and severity of aphasia on inclusion were found to account for 58% of variance and were independent predictors of the communication questionnaire score at follow-up. Documenting the most impaired communication skills may help to set priority goals for speech and language therapy in aphasia.

High pregnancy intentions and missed opportunities for patient-provider communication about fertility in a South African cohort of HIV-positive women on antiretroviral therapy.

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Schwartz, Sheree R; Mehta, Shruti H; Taha, Taha E; Rees, Helen V; Venter, Francois; Black, Vivian

2012-01-01

High fertility intentions amongst HIV-positive women have been reported elsewhere. Less is known about how clinical and HIV treatment characteristics correlate with fertility intentions. We use cross-sectional baseline data from a prospective cohort study to assess pregnancy intentions and patient-provider communication around fertility. Non-pregnant, HIV-positive women aged 18-35 on ART were recruited through convenience sampling at Johannesburg antiretroviral (ART) treatment facilities. Among the 850 women in this analysis, those on efavirenz had similar fertility intentions over the next year as women on nevirapine-based regimens (33% vs. 38%). In multivariate analysis, recent ART initiation was associated with higher current fertility intentions; there was no association with CD4 cell count. Forty-one percent of women had communicated with providers about future pregnancy options. Women on ART may choose to conceive at times that are sub-optimal for maternal, child and partner health outcomes and should be routinely counseled around safer pregnancy options.

Young patients', parents', and survivors' communication preferences in paediatric oncology: Results of online focus groups

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Kamps Willem A

2007-11-01

Full Text Available Abstract Background Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer. Methods Communication preferences were examined by means of online focus groups. Seven patients (aged 8–17, 11 parents, and 18 survivors (aged 8–17 at diagnosis participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making. Results Participants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication. Conclusion Young patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancer patients and their parents.

Routine failures in the process for blood testing and the communication of results to patients in primary care in the UK: a qualitative exploration of patient and provider perspectives.

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Litchfield, Ian; Bentham, Louise; Hill, Ann; McManus, Richard J; Lilford, Richard; Greenfield, Sheila

2015-11-01

The testing and result communication process in primary care is complex. Its successful completion relies on the coordinated efforts of a range of staff in primary care and external settings working together with patients. Despite the importance of diagnostic testing in provision of care, this complexity renders the process vulnerable in the face of increasing demand, stretched resources and a lack of supporting guidance. We conducted a series of focus groups with patients and staff across four primary care practices using process-improvement strategies to identify and understand areas where either unnecessary delay is introduced, or the process may fail entirely. We then worked with both patients and staff to arrive at practical strategies to improve the current system. A total of six areas across the process were identified where improvements could be introduced. These were: (1) delay in phlebotomy, (2) lack of a fail-safe to ensure blood tests are returned to practices and patients, (3) difficulties in accessing results by telephone, (4) role of non-clinical staff in communicating results, (5) routine communication of normal results and (6) lack of a protocol for result communication. A number of potential failures in testing and communicating results to patients were identified, and some specific ideas for improving existing systems emerged. These included same-day phlebotomy sessions, use of modern technology methods to proactively communicate routine results and targeted training for receptionists handling sensitive data. There remains an urgent need for further work to test these and other potential solutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Providing cell phone numbers and email addresses to Patients: the physician's perspective

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2011-01-01

Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%). Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007). They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001). More physicians (79.7%) would have preferred allotted time for email communication than allotted time for cell phone communication (50%). However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001). There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039). Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number. PMID:21426591

Providing cell phone numbers and email addresses to Patients: the physician's perspective

Directory of Open Access Journals (Sweden)

Freud Tamar

2011-03-01

Full Text Available Abstract Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%. Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007. They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001. More physicians (79.7% would have preferred allotted time for email communication than allotted time for cell phone communication (50%. However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001. There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039. Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number.

Considering culture in physician-- patient communication during colorectal cancer screening.

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Ge Gao; Burke, Nancy; Somkin, Carol P; Pasick, Rena

2009-06-01

Racial and ethnic disparities exist in both incidence and stage detection of colorectal cancer (CRC). We hypothesized that cultural practices (i.e., communication norms and expectations) influence patients' and their physicians' understanding and talk about CRC screening. We examined 44 videotaped observations of clinic visits that included a CRC screening recommendation and transcripts from semistructured interviews that doctors and patients separately completed following the visit. We found that interpersonal relationship themes such as power distance, trust, directness/ indirectness, and an ability to listen, as well as personal health beliefs, emerged as affecting patients' definitions of provider-patient effective communication. In addition, we found that in discordant physician-patient interactions (when each is from a different ethnic group), physicians did not solicit or address cultural barriers to CRC screening and patients did not volunteer culture-related concerns regarding CRC screening.

Methods for teaching effective patient communication techniques to radiography students.

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Makely, S

1990-07-01

Teaching students to communicate effectively with patients has always been part of the radiography curriculum in the USA. However, developing these skills has become even more important in recent times due to several factors. Patients who have been well versed in what to expect from the examination being conducted are in a better position to co-operate with the radiographer. This increases the chances of producing optimal results from an examination at the first attempt, thus reducing radiation exposure, patient discomfort and the overall cost of conducting the procedure. Also, increased competition among health care providers has resulted in more emphasis being placed on patient, or customer, satisfaction. Radiographers are in the 'front line' of patient care. Patients often have more interaction with radiographers than with physicians or other medical specialists. Radiographers who practise effective communication techniques with their patients can alleviate anxiety and make an important contribution to the overall satisfaction of the patient with respect to the quality of service and care they receive. This article describes instructional methods being used in the USA to help develop effective patient communication techniques, and reports the findings of a study among radiography educators as to which of these methods are thought to be most successful.

Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study.

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Rai, Minnie; Vigod, Simone N; Hensel, Jennifer M

2016-08-01

With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns

Role of the speech-language pathologist: augmentative and alternative communication for acute care patients with severe communication impairments.

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Vento-Wilson, Margaret T; McGuire, Anthony; Ostergren, Jennifer A

2015-01-01

Severe communication deficits occur frequently in acute care. Augmentative and alternative communication (AAC) may improve patient-nurse communication, yet it remains underutilized. The objective of this study was to assess the impact of training student nurses (SNs) in acute and critical care on the use of AAC with regard to confidence levels and likelihood of implementation of AAC by SNs in acute care. Training in AAC techniques was provided to SNs. A pretraining and posttraining assessment was completed along with follow-up surveys conducted after the SNs had an opportunity to use AAC. A 6-fold increase in confidence (P the SNs after AAC training, as was an approximately 3-fold increase in likelihood of use (P The reliable yes/no was the most reported AAC technique (34.7% of the students). Providing SNs with AAC tools accompanied by brief training increases their confidence in the use of AAC and the likelihood that they will use them. Inclusion of AAC education in nursing curricula and nursing orientations could be an important step in risk reduction among patients with severe communication disorders. Further study is needed of the relationship between training student nurses in the use of AAC as a way to change practice and improve communication outcomes.

Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

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Epstein, Ronald M.; Duberstein, Paul R.; Fenton, Joshua J.; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J.; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S.; Street, Richard L.; Shields, Cleveland G.; Back, Anthony L.; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L.

2018-01-01

IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized

Learning patient-centred communication: The journey and the territory.

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Cushing, Annie M

2015-10-01

The student entering medical school is about to undergo a socialisation process that profoundly shapes their development as a professional. A central feature is the formal and informal curriculum on the doctor-patient relationship and patient-centred communication. In this paper I will chart some of the features of the student journey which might impact on learning and practice. The medical undergraduate's role is largely that of observer and learner, rather than a provider of care, so much of the formal teaching on patient-centred communication is within simulated practice. Clinical practice environments are the most powerful influences on learning about professional behaviour. Challenges for educational practitioners include how to support authenticity in learners, respond to their agendas, and foster insight to enable flexibility about communication in different contexts. Parallels between the doctor-patient relationship and the student-tutor relationship are explored for their relevance. A number of educational theories can inform curriculum design and educational practice, notably Vygotsky's Zone of Proximal Development. Application of this and other social learning theories, together with students' reflections can enrich our planning of educational interventions and understanding of their impact. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Patient communication in hormone therapy.

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Schnare, S M

2001-01-01

Common regimens of HRT therapy are reviewed, including common routes of hormone administration. Inconsistent patterns of HRT use are discussed, including the reasons women most often give for discontinuing hormone therapies. Specific issues related to misperceptions and fears regarding HRT are clarified, and specific, focused patient education formats are discussed to address women's common concerns about HRT. Obstacles to HRT use are elucidated, with suggestions for clinicians about how to communicate more effectively with women: clinicians must focus on emotional and physical aspects of HRT choices and tailor therapies to the individual patient. Discussing frankly the very serious concerns of women regarding the association between lobular breast cancer and endometrial cancer is important; discussing and preparing women for possible side effects helps patients cope better if and when side effects occur. Finally, offering a wide variety of HRT therapies provides women with a broader choice if an initial regimen is unsuccessful.

From transitions to transformation - A study of pharmacists developing patient-centered communication skills.

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Luetsch, Karen; Burrows, Judith

2017-08-12

Pharmacists' communication with patients often focuses on technical aspects of advice giving, while limiting socio-emotional content. To develop pharmacists' patient-centered communication a learning and practice module integrating motivational interviewing (MI) was designed for an online postgraduate program, and its impact on their self-described practice evaluated. To investigate whether training in patient-centered communication changes pharmacists' perceptions of communicating with patients, and how any changes in their communication style influenced interactions and relationships with patients. A descriptive, qualitative study analyzing reflective journal entries detailing pharmacists' experiences of implementing patient-centered communication in practice was designed, evaluating reflections on initial patient interactions after training and 9-12 weeks later. Using the framework method of content and thematic analysis, an evaluation framework was devised that integrated communication, change and learning theories. Reflections were categorized within the framework as transitional (e.g. using good communication skills), transactional (e.g. using MI techniques, achieving reciprocity) or transformational (e.g. describing transformative learning, changing frames of reference in understanding of patient-centeredness). Differences between the first and last journal entries were evaluated and analyzed using descriptive statistics. Eighty-nine pharmacists provided two reflective journal entries for evaluation. Over 9-12 weeks, pharmacists described a change in their perspective of patient-centeredness, how they expanded the socio-emotional aspects of communication and succeeded in difficult conversations. When applying the thematic evaluation framework to initial journal entries, 38 (42%) of reflections fell within the transitional category, 51 (58%) were deemed transactional and none transformational. This changed to 10 (11%) transitional, 45 (51%) transactional and

Using Patient Case Video Vignettes to Improve Students’ Understanding of Cross-cultural Communication

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Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

2017-01-01

Objective. To develop, implement, and assess whether simulated patient case videos improve students’ understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students’ understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum. PMID:28496276

Using Patient Case Video Vignettes to Improve Students' Understanding of Cross-cultural Communication.

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Arif, Sally; Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

2017-04-01

Objective. To develop, implement, and assess whether simulated patient case videos improve students' understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students' understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum.

Depression and doctor-patient communication in the emergency department.

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Haerizadeh, Mytra; Moise, Nathalie; Chang, Bernard P; Edmondson, Donald; Kronish, Ian M

2016-01-01

Depression may adversely affect health outcomes by influencing doctor-patient communication. We aimed to determine the association between depressive symptoms and doctor-patient communication among patients presenting to the emergency department (ED) with a suspected acute coronary syndrome (ACS). We enrolled a consecutive sample of 500 patients evaluated for ACS symptoms from the ED of an urban medical center. Depressive symptoms (8-item Patient Health Questionnaire, PHQ-8) and doctor-patient communication in the ED (Interpersonal Processes of Care) were assessed during hospitalization. Logistic regression was used to determine the association between depressive symptoms and doctor-patient communication, adjusting for age, sex, race, ethnicity, education, language, health insurance status and comorbidities. Compared to nondepressed patients, depressed patients (PHQ-8≥10) were more likely (Pcommunication on five of seven communication domains: clarity, elicitation of concerns, explanations, patient-centered decision making and discrimination. A greater proportion of depressed versus nondepressed patients reported suboptimal overall communication (39.8% versus 22.9%, Pcommunication (adjusted odds ratio 2.42, 95% confidence interval 1.52-3.87; Pcommunication in the ED than nondepressed patients. Research is needed to determine whether subjectively rated differences in communication are accompanied by observable differences. Copyright © 2016 Elsevier Inc. All rights reserved.

Examining the effects of enhanced provider-patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care.

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van Vliet, Liesbeth M; van Dulmen, Sandra; Thiel, Bram; van Deelen, Gerard W; Immerzeel, Stephanie; Godfried, Marc B; Bensing, Jozien M

2017-11-03

Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider's communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients' outcomes. Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse-patient interactions. Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication. NTR5994; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Audiologist-patient communication profiles in hearing rehabilitation appointments.

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Meyer, Carly; Barr, Caitlin; Khan, Asaduzzaman; Hickson, Louise

2017-08-01

To profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients' decisions to pursue hearing aids. Sixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted. Two distinct audiologist-patient communication profiles were identified during both the history taking phase (46=biopsychosocial profile, 15=psychosocial profile) and diagnosis and management planning phase (45=expanded biomedical profile, 11=narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients' decisions to pursue hearing aids. Initial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction. Findings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Provider Communication Regarding Psychosocial Factors Predicts Pain Beliefs in Parent and Child

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Sood, Erica; Pinder, Wendy; Pendley, Jennifer S.; Fisher, Alicia O.; Wali, Prateek D.; del Rosario, Fernando

2017-01-01

Objective To examine the role of provider communication about psychosocial causes of abdominal pain and recommendations for psychosocial intervention during a gastroenterology clinic visit in predicting families’ causal beliefs and perceptions of treatment acceptability. Method Participants were 57 children with a diagnosed or suspected abdominal pain-related functional gastrointestinal disorder (FGID) presenting for an outpatient gastroenterology follow-up visit and their accompanying parent. Children and parents completed questionnaires assessing child anxiety and abdominal pain severity, recall of provider communication about causes of abdominal pain and recommendations for intervention, their own causal beliefs about pain, and perceived acceptability of cognitive behavioral therapy (CBT) and standard medical treatment (SMT) after reading descriptions of each treatment. Providers completed a questionnaire assessing their perceptions and communication about the causes of the child’s abdominal pain and perceived acceptability of CBT. Results Provider communication about psychosocial causes and interventions was reported infrequently by parents, children, and providers. Parents rated psychosocial causes for abdominal pain as less likely than physical causes, and children and parents rated CBT as less acceptable than SMT. Parents’ recall of provider communication about psychosocial causes was associated with their own causal beliefs about pain and their perceived acceptability of CBT. Children’s and parents’ recall of provider recommendations for psychosocial intervention was associated with their perceived acceptability of CBT. Conclusion Results highlight the importance of provider communication about psychosocial contributors to abdominal pain and psychosocial interventions for children with FGIDs. Medical and mental health providers can partner to deliver care to children with FGIDs using a biopsychosocial approach. PMID:27035693

Overcoming communication challenges in integrative supportive cancer care: The integrative physician, the psycho-oncologist, and the patient.

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Ben-Arye, Eran; Shavit, Efrat; Wiental, Haya; Schiff, Elad; Agour, Olga; Samuels, Noah

2016-12-01

Complementary/integrative medicine (CIM) services are increasingly being integrated into conventional supportive cancer care, presenting a number of challenges to communication between healthcare professionals (HCPs). The purpose of the present study was to explore the impact of the communication between integrative physicians (IPs) trained in CIM and social workers (SWs) working as psycho-oncologists in the same oncology setting. We examine whether IP-SW communication correlates with the number of patient-SW sessions, as provided within the oncology department. SW-IP communication, defined as a summary of the IP consultation sent to the patient's SW, was compared to SW-patient communication, defined as the number of psycho-oncology treatment sessions. Of 344 patients referred by their oncology HCP for IP consultation, 91 were referred by an SW and 253 by an oncologist or nurse. IP-to-SW summaries were provided for 150 patients referred by a non-SW HCP (43.6%), and for 91 of SW-referred patients (26.5%). In all, 32 patients referred to the IP had no psycho-oncology interaction with an SW; 58 only one meeting; and 254 with ≥2 interactions, with 119 having >6 sessions. SW-patient interactions were greater with higher rates of IP-SW communication, for both patients referred by an SW (79.1%) and those referred by a non-SW HCP (77.3%) when compared to patients for whom no summary was provided (64.1%; p= 0.02). A greater level of IP-SW communication, measured by the provision of an IP summary to the patient's SW, was found to correlate with a higher rate of SW-patient interactions. The use of a structured two-way referral-summary between IPs and SWs has the potential to advance the SW-patient psycho-oncology interaction, within an integrative supportive cancer care setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Patient-reported Communication Quality and Perceived Discrimination in Maternity Care.

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Attanasio, Laura; Kozhimannil, Katy B

2015-10-01

High-quality communication and a positive patient-provider relationship are aspects of patient-centered care, a crucial component of quality. We assessed racial/ethnic disparities in patient-reported communication problems and perceived discrimination in maternity care among women nationally and measured racial/ethnic variation in the correlates of these outcomes. Data for this analysis came from the Listening to Mothers III survey, a national sample of women who gave birth to a singleton baby in a US hospital in 2011-2012. Outcomes were reluctance to ask questions and barriers to open discussion in prenatal care, and perceived discrimination during the birth hospitalization, assessed using multinomial and logistic regression. We also estimated models stratified by race/ethnicity. Over 40% of women reported communication problems in prenatal care, and 24% perceived discrimination during their hospitalization for birth. Having hypertension or diabetes was associated with higher levels of reluctance to ask questions and higher odds of reporting each type of perceived discrimination. Black and Hispanic (vs. white) women had higher odds of perceived discrimination due to race/ethnicity. Higher education was associated with more reported communication problems among black women only. Although having diabetes was associated with perceptions of discrimination among all women, associations were stronger for black women. Race/ethnicity was associated with perceived racial discrimination, but diabetes and hypertension were consistent predictors of communication problems and perceptions of discrimination. Efforts to improve communication and reduce perceived discrimination are an important area of focus for improving patient-centered care in maternity services.

The development and preliminary testing of a multimedia patient-provider survivorship communication module for breast cancer survivors.

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Wen, Kuang-Yi; Miller, Suzanne M; Stanton, Annette L; Fleisher, Linda; Morra, Marion E; Jorge, Alexandra; Diefenbach, Michael A; Ropka, Mary E; Marcus, Alfred C

2012-08-01

This paper describes the development of a theory-guided and evidence-based multimedia training module to facilitate breast cancer survivors' preparedness for effective communication with their health care providers after active treatment. The iterative developmental process used included: (1) theory and evidence-based content development and vetting; (2) user testing; (3) usability testing; and (4) participant module utilization. Formative evaluation of the training module prototype occurred through user testing (n = 12), resulting in modification of the content and layout. Usability testing (n = 10) was employed to improve module functionality. Preliminary web usage data (n = 256, mean age = 53, 94.5% White, 75% college graduate and above) showed that 59% of the participants accessed the communication module, for an average of 7 min per login. The iterative developmental process was informative in enhancing the relevance of the communication module. Preliminary web usage results demonstrate the potential feasibility of such a program. Our study demonstrates survivors' openness to the use of a web-based communication skills training module and outlines a systematic iterative user and interface program development and testing process, which can serve as a prototype for others considering such an approach. Copyright © 2012. Published by Elsevier Ireland Ltd.

Studies of Physician-Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review.

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