Do medical images aid understanding and recall of medical information? An experimental study comparing the experience of viewing no image,a 2D medical image and a 3D medical image alongside a diagnosis

ObjectiveThis study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis.MethodsWe conducted two laboratory experiments, each with 126 healthy participants. Participants heard three diagnoses; one accompanied by 3D medical images, one accompanied by 2D medical images and one with no image. Participants completed a questionnaire after each diagnosis rating their experience. In Experiment 2, half of the participants were informed that image interpretation can be susceptible to errors.ResultsParticipants preferred to view 3D images alongside a diagnosis (p < 0.001) and reported greater understanding (p < 0.001), perceived accuracy (p < 0.001) and increased trust (p < 0.001) when the diagnosis was accompanied by an image compared to no image. There was no significant difference in trust between participants who were informed of errors within image interpretation and those who were not.ConclusionWhen presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information.Practical considerationsMedical images may be a powerful resource for patients that could be utilised by clinicians during consultations.     

Perspectives on wellness self-monitoring tools for older adults

PurposeOur purpose was to understand different stakeholder perceptions about the use of self-monitoring tools, specifically in the area of older adults’ personal wellness. In conjunction with the advent of personal health records, tracking personal health using self-monitoring technologies shows promising patient support opportunities. While clinicians’ tools for monitoring of older adults have been explored, we know little about how older adults may self-monitor their wellness and health and how their health care providers would perceive such use.MethodsWe conducted three focus groups with health care providers (n = 10) and four focus groups with community-dwelling older adults (n = 31).ResultsOlder adult participants’ found the concept of self-monitoring unfamiliar and this influenced a narrowed interest in the use of wellness self-monitoring tools. On the other hand, health care provider participants showed open attitudes toward wellness monitoring tools for older adults and brainstormed about various stakeholders’ use cases. The two participant groups showed diverging perceptions in terms of: perceived uses, stakeholder interests, information ownership and control, and sharing of wellness monitoring tools.ConclusionsOur paper provides implications and solutions for how older adults’ wellness self-monitoring tools can enhance patient-health care provider interaction, patient education, and improvement in overall wellness.     

Undergraduate medical students. Simulation-based activity to conduct the informed consent process for health research studies

IntroductionTraining through medical simulation allows for continuous learning under controlled conditions. Simulation-based training activities can be used simultaneously with other educational strategies to strengthen the attitudinal skills needed to develop an informed consent process in the context of health research.ObjectiveTo facilitate learning in undergraduate medicine students, and to evaluate their competences to carry out an informed consent process in a scenario that resembles reality.Materials and methodsIn this semi-longitudinal study, a simulation-based activity was conducted with 136 medical students of the fourth (Group A) and fifth year (Group B) of the Marist University of Mérida, in southern Mexico.ResultsThe mean score for both groups was 72.48 ± 1.05 (95% CI = 70.4–74.5); 86.2 ± 0.96 (95% CI = 84.2–88.0); and 77.7 ± 0.72 (95% CI = 76.3–79.1), in the pre-test, the simulation and the post-test, respectively. The students of group A self-evaluated their performance with 3.93/5.00, and those of Group B, 4.04/5.00.DiscussionThis study showed that Group A students did not score lower on simulation-based activity when compared to students in Group B, suggesting that before the fifth year of undergraduate medical education, students could properly develop an informed consent-process for health research if they receive early education about medical ethics and research bioethics. Issues related to bioethics in human health research can be included as soon as medical students initiate research methodology courses.     

Providing prenatal care to pregnant women with overweight or obesity: Differences in provider communication and ratings of the patient-provider relationship by patient body weight

ObjectiveTo examine the association of women’s body weight with provider communication during prenatal care.MethodsWe coded audio recordings of prenatal visits between 22 providers and 117 of their patients using the Roter Interaction Analysis System. Multivariate, multilevel Poisson models were used to examine the relationship between patient pre-pregnancy body mass index and provider communication.ResultsCompared to women with normal weight, providers asked fewer lifestyle questions (IRR 0.66, 95% CI 0.44–0.99, p = 0.04) and gave less lifestyle information (IRR 0.51, 95% CI 0.32–0.82, p = 0.01) to women with overweight and obesity, respectively. Providers used fewer approval (IRR 0.68, 95% CI 0.51–0.91, p = 0.01) and concern statements (IRR 0.68, 95% CI 0.53–0.86, p = 0.002) when caring for women with overweight and fewer self-disclosure statements caring for women with obesity (IRR 0.40, 95% CI 0.19–0.84 p = 0.02).ConclusionLess lifestyle and rapport building communication for women with obesity may weaken patient-provider relationship during routine prenatal care.Practice implicationsInterventions to increase use of patient-centered communication – especially for women with overweight and obesity – may improve prenatal care quality.     

The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity

ObjectiveTo examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association.MethodsWe conducted a cross-sectional secondary data analysis with the 2011–2013 Medical Expenditures Panel Survey of parents with children ages 6–12 (n = 5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity.ResultsParents of obese children were more likely to report that their child’s healthcare provider listened carefully (OR = 1.41, p = 0.002) and spent enough time (OR = 1.33, p = 0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p < 0.001) and spending enough time (p = 0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p = 0.043) and listened carefully (p = 0.012), respectively.ConclusionParents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian.Practice implicationsHealthcare providers should ensure effective communication with obese parents of obese children.     

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

ObjectiveTo qualitatively assess the influence of patient–provider communication on contraceptive choice among HIV-positive women in the context of universal antiretroviral therapy (ART) access.MethodsFocus 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.ResultsOf 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.ConclusionDespite 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.Practice implicationsAdequate 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.     

Airmen and health-care providers’ attitudes toward the use of genomic sequencing in the US Air Force: findings from the MilSeq Project

PurposeThe use of genomic sequencing (GS) in military settings poses unique considerations, including the potential for GS to impact service members’ careers. The MilSeq Project investigated the use of GS in clinical care of active duty Airmen in the United States Air Force (USAF).MethodsWe assessed perceived risks, benefits, and attitudes toward use of GS in the USAF among patient participants (n = 93) and health-care provider participants (HCPs) (n = 12) prior to receiving or disclosing GS results.ResultsParticipants agreed that there are health benefits associated with GS (90% patients, 75% HCPs), though more HCPs (75%) than patients (40%) agreed that there are risks (p = 0.048). The majority of both groups (67% HCPs, 77% patients) agreed that they trust the USAF with genetic information, but far fewer agreed that genetic information should be used to make decisions about deployment (5% patients, 17% HCPs) or duty assignments (3% patients, 17% HCPs). Despite their hesitancy, patients were supportive of the USAF testing for nondisease traits that could impact their duty performance. Eighty-seven percent of patients did not think their GS results would influence their career.ConclusionResults suggest favorable attitudes toward the use of GS in the USAF when not used for deployment or assignment decisions.     

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

ObjectiveComputerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug–drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug–drug interactions when ordering medications in an electronic medical record.Materials and methodsIn this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as “indeterminate.” Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses.ResultsTwenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p < 0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p < 0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p = 0.103). Free-text use was higher in the customized configuration overall (p < 0.001), and there was no difference in nonsensical response between configurations (p = 0.39).ConclusionThere is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts.     

Breast cancer patients’ trust in physicians: The impact of patients’ perception of physicians’ communication behaviors and hospital organizational climate

ObjectiveTo examine whether patients’ perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians’ communication behaviors as perceived by the patients and patient characteristics.MethodsPatients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed.Results80.5% of the patients responded to the survey. 37% of the variance in patients’ trust in physicians can be explained by the variables included in our final model (N = 2226; R² adj. = 0.372; p < 0.001). Breast cancer patients’ trust in their physicians is strongly associated with their perception of a hospital's organizational climate. The impact of their perception of physicians’ communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust.ConclusionsA trusting physician–patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians’ communication behaviors.Practice implicationsWith regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.     

Family presence and participation during medical visits of heart failure patients: An analysis of survey and audiotaped communication data

ObjectiveTo describe the frequency, roles, and utility of family companion involvement in the care of patients with Heart Failure (HF) care and to examine the association between audiotaped patient, companion, and provider communication behaviors.MethodsWe collected survey data and audiotaped a single medical visit for 93 HF patients (36 brought a companion into the examination room) and their cardiology provider. Communication data was analyzed using the Roter Interaction Analysis System.ResultsThere were 32% more positive rapport-building statements (p < 0.01) and almost three times as many social rapport-building statements (p < 0.01) from patients and companions in accompanied visits versus unaccompanied patient visits. There were less psychosocial information giving statements in accompanied visits compared to unaccompanied patient visits (p < 0.01.) Providers made 25% more biomedical information giving statements (p = 0.04) and almost three times more social rapport-building statements (p < 0.01) in accompanied visits. Providers asked fewer biomedical and psychosocial questions in accompanied versus unaccompanied visits. Providers made 16% fewer partnership-building statements in accompanied versus unaccompanied visits (p = 0.01).ConclusionsOur findings are mixed regarding the benefits of accompaniment for facilitating patient-provider communication based on survey and audiotaped data.Practice implicationsStrategies to enhance engagement during visits, such as pre-visit question prompt lists, may be beneficial.     

Women's cognitive and affective reactions to breast cancer survivor stories: A structural equation analysis

ObjectiveCompare the immediate affective and cognitive reactions to cancer survivor stories about mammography and breast cancer vs. a didactic, informational approach.MethodsParticipants (N = 489) were African American women age 40 years and older (mean = 61). Most had ≤high school education (67%), annual household income ≤$20,000 (77%), and a prior mammogram (89%). Participants completed surveys before and after watching the narrative or informational video. We used structural equation modeling to examine the large number of inter-related latent constructs.ResultsWomen who watched the narrative video experienced more positive and negative emotions, found it easier to understand the video, had more positive evaluations of the video, reported stronger identification with the message source (i.e., perceived similarity, trust, liking), and were more engaged with the video.ConclusionNarratives elicited immediate reactions consistent with theorized pathways of how communication affects behavior. Future studies should examine whether and how these immediate outcomes act as mediators of the longer term effects of narratives on affect, cognitions, and behavior.Practice implicationsStories of other women's experiences may be more powerful than a didactic presentation when encouraging African American women to get a mammogram.     

Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication

ObjectivesMedically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans’ MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement.MethodsVeterans experiencing MUS (n = 204) reported on their primary care providers’ communication about illness representations and interpersonal skills; correlation, regression, and bootstrap-mediation analyses were conducted to test hypotheses regarding veteran-reported outcomes. Main outcomes included satisfaction with the provider, MUS-treatment adherence, intentions to adhere, and expectations for MUS improvement.ResultsVeterans reported infrequent discussion of MUS illness representations but high degrees of provider interpersonal skills. Communication regarding patients’ illness representations and treatment expectations was significantly related to treatment adherence and adherence intentions; provider interpersonal skills were not. Both were related to veteran satisfaction.Conclusions and practice implicationsProviders’ interpersonal skills may be important in chronic illness contexts, such as MUS, by contributing to satisfaction with the provider. The current study suggests that providers may better promote MUS-treatment adherence through discussing MUS illness representations and treatment expectations.     

Patient knowledge and information-seeking about personalized cancer therapy

BackgroundUnderstanding patients’ knowledge and prior information-seeking regarding personalized cancer therapy (PCT) may inform future patient information systems, consent for molecular testing and PCT protocols. We evaluated breast cancer patients’ knowledge and information-seeking behaviors regarding PCT.MethodsNewly registered female breast cancer patients (n = 100) at a comprehensive cancer center completed a self-administered questionnaire prior to their first clinic visit.ResultsKnowledge regarding cancer genetics and PCT was moderate (mean 8.7 ± 3.8 questions correct out of 16). A minority of patients (27%) indicated that they had sought information regarding PCT. Higher education (p = 0.009) and income levels (p = 0.04) were associated with higher knowledge scores and with seeking PCT information (p = 0.04). Knowledge was not associated with willingness to participate in PCT research.ConclusionEducational background and financial status impact patient knowledge as well as information-seeking behavior. For most patients, clinicians are likely to be patients’ initial source of information about PCT. Understanding patients’ knowledge deficits at presentation may help inform patient education efforts.     

Health information exchange system usage patterns in three communities: Practice sites,users, patients,and data

ObjectivesPublic and private organizations are implementing systems for query-based health information exchange (HIE), the electronic aggregation of patient data from multiple institutions. However, existing studies of query-based HIE system usage have addressed a limited number of settings. Our goal was to quantify the breadth and depth of usage of a query-based HIE system implemented across multiple communities with diverse care settings and patient populations.MethodsWe performed a cross-sectional study in three communities in New York State using system access log files from January 2009 to May 2011 to measure usage patterns of a query-based HIE web portal system with respect to practice sites, users, patients, and data.ResultsSystem access occurred from 60% (n = 200) of practice sites registered to use the system in Community A, 59% (n = 156) in Community B, and 82% (n = 28) in Community C. In Communities A and B, users were primarily non-clinical staff in outpatient settings, while in Community C inpatient physicians were the main users. Across communities, proportions of patients whose data were accessed varied with 5% (n = 11,263) in Community A, 60% (n = 212,586) in Community B, and 1% (n = 1107) in Community C. In Community B, users updated patient consent through the HIE portal, whereas in the other communities, users updated patient consent through a separate system. Across communities, users most frequently accessed only patient summary data displayed by default followed by detailed laboratory and radiology data.ConclusionsThis study is among the first to illustrate large-scale usage of a query-based HIE system implemented across multiple communities. Patient summary data displayed by default may be an important feature of query-based HIE systems. User role, practice site type, and patient consent workflow may affect patterns of query-based HIE web portal system usage in the communities studied and elsewhere.     

Patient-provider communication in nephrology care for adolescents and young adults

ObjectiveTo compare the relative quantity of talk between providers, caregivers, and adolescents and young adults (AYAs) with chronic kidney disease (CKD) and how communication differs by age.MethodsDuring nephrology clinic visits, conversations between AYAs with CKD (N = 99, ages 11–20, median = 15), their caregivers, and providers (N = 19) were audiotaped and coded using the Roter Interaction Analysis System. Linear mixed models tested AYA age differences in talk frequency by AYAs, caregivers, and providers. Post-hoc analyses tested differences in talk using AYA age groups.ResultsDuring clinic visits, providers spoke the most (63.7%), and caregivers spoke more (22.6%) than AYAs (13.7%). Overall talk differed by AYA age in AYAs (p < 0.001) and caregivers (p < 0.05), but not providers. Higher AYA age was associated with more AYA talk (biomedical information-giving, partnering, rapport-oriented) and less caregiver biomedical information-giving (ps < 0.001–0.05). In post-hoc analyses, young adults talked more than adolescents; caregiver talk decreased in the middle-adolescent group.ConclusionsIncreases in AYA talk occur primarily in young adulthood, whereas caregiver talk decreases in middle adolescence. This may indicate an appropriate developmental shift but raises concerns about conversational gaps during middle-adolescence.Practice implicationsDuring transition-oriented treatment planning, providers should engage both AYAs and caregivers to avoid potential gaps in communication.     

Development and evaluation of a patient education video promoting pneumococcal vaccination

ObjectiveThis study aimed to develop and refine a patient education video about pneumococcal polysaccharide vaccination (PPSV23) and to assess patient perceptions regarding video content and receipt of video during a clinic visit.MethodsFocus groups were conducted to obtain patient feedback on a brief video focusing on personal susceptibility to pneumonia and highlighting the importance of both childhood and adult vaccines. Subsequently, interviews were conducted with patients ages 65 and 66 who were shown the revised video at an office visit. We assessed attitudes toward the video and perceptions about its presentation at the point of care. Participants responded to open-ended items as well as Likert-type items with responses from 1 (strongly disagree) to 5 (strongly agree).ResultsFocus group participants (n = 26) had positive reactions to the video, but suggested reducing the intensity of messages about pneumonia severity. Participants (n = 73) shown the revised video during a clinic visit perceived it to be easy to understand (M = 4.83, SD = 0.58) and informative (M = 4.8, SD = 0.75).ConclusionTarget audience feedback helped refine a video promoting PPSV23 vaccination; the video was well received by patients.Practice implicationsThis video may be an effective educational tool to increase rates of PPSV23 vaccination.     

Patient specific cutting guides versus an imageless,computer-assisted surgery system in total knee arthroplasty

BackgroundPatient specific cutting guides (PSC) in total knee arthroplasty (TKA) have recently been introduced, in which preoperative 3-dimensional imaging is used to manufacture disposable cutting blocks specific to a patient's anatomy. The purpose of this study was to compare the alignment accuracy of PSC to an imageless CAS system in TKA.MethodsThirty-seven patients (41 knees), received a TKA using an imageless CAS system. Subsequently, 38 patients (41 knees), received a TKA using a MRI-based, PSC system.Postoperatively, standing AP hip-to-ankle radiographs were obtained, from which the lower extremity mechanical axis, tibial component varus/valgus, and femoral component varus/valgus mechanical alignment were digitally measured. Each measurement was performed by two blinded, independent observers, and interclass correlations were calculated. A student's two-tailed t test was used to compare the two cohorts (p-value < 0.05 = significant).ResultsIn the PSC cohort, 70.7% of patients had an overall alignment within 3° of a neutral mechanical axis (vs. 92.7% with CAS, p = 0.02), 87.8% had a tibial component alignment within 2° of perpendicular to the tibial mechanical axis (vs. 100% with CAS, p = 0.04), and 90.2% had a femoral component alignment within 2° of perpendicular to the femoral mechanical axis (vs. 100% with CAS, p = 0.2). Interclass correlation coefficients were good to excellent for all radiographic measurements.ConclusionWhile PSC techniques appear sound in principle, this study did not demonstrate patient specific cutting guides to obtain the same degree of overall mechanical and tibial component alignment accuracy as a CAS technique.Level of evidenceIII: Retrospective cohort study.     

Pre-operative analysis of lower limb coronal alignment — A comparison of supine MRI versus standing full-length alignment radiographs

BackgroundIn this study we compare the results of pre-operative standing full-length alignment (SFLA) radiographs with supine MRI assessment of the lower limb alignment prior to MRI based patient specific total knee arthroplasty (TKA).MethodsImaging was performed in 45 knees (45 patients). Assessment of SFLA radiographs was performed by three independent assessors. Inter-observer correlation was high and so the mean values were calculated. This data was then compared to MRI alignment data used to create the patient specific cutting jigs.ResultsThe range of alignment on SFLA radiographs ranged from + 25° to − 13° versus + 20° to − 11° with MRI. The mean difference between techniques was 2° (range 0–8°, SD ± 3°). Supine MRI under-estimated the degree of deformity in 31/45 (69%) cases. In 25/45 (56%) cases the supine MRI result was within ± 2° of the value on SFLA radiographs, 31/45 (69%) were within ± 3° and 38/45 (84%) within ± 5°. There was no correlation between the degree of varus/valgus deformity and the magnitude of the difference between imaging modalities (Spearman's r² = 0.02, p = 0.41).ConclusionsThe findings from this study would indicate that supine MRI underestimates the degree of deformity at the knee joint, a conclusion which may be important for pre-operative planning or follow-up of corrective osteotomy or TKA.