Take the HEAT: A pilot study on improving communication with angry families

ObjectiveOur objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents’ skills in employing this method.Methods33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool.ResultsAfter the workshop, residents’ Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z = −3.428, p < 0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool.ConclusionFirst-year pediatric trainees’ communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further.Practice implicationsThis study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families.     

Dumping the information bucket: A qualitative study of clinicians caring for patients with early stage non-small cell lung cancer

ObjectiveTo evaluate the quality of patient-clinician communication and shared decision making (SDM) when two disparate treatments for early stage non-small cell lung cancer (NSCLC) are discussed.MethodsWe conducted a qualitative study to evaluate the experiences of 20 clinicians caring for patients with clinical Stage I NSCLC prior to treatment, focusing on communication practices. We used directed content analysis and a patient-centered communication theoretical model to guide understanding of communication strategies.ResultsAll clinicians expressed the importance of providing information, especially for mitigating patient worry, despite recognition that patients recall only a small amount of the information given. When patients expressed distress, clinicians exhibited empathy but preferred to provide more information in order to address patient concerns. Most clinicians reported practicing SDM, however, they also reported not clearly eliciting patient preferences and values, a key part of SDM.ConclusionCommunication with patients about treatment options for early stage NSCLC primary includes information giving. We found that only a few communication domains associated with SDM occurred regularly, and SDM may not be necessary in this clinical context.Practice implicationsClinicians may need to incorporate nurse navigators or more written materials for effectively discussing potentially equivalent treatment options with their patients.     

Principles of effective communication with patients who have intellectual disability among primary care physicians

ObjectiveExamine physicians’ implementation of effective communication principles with patients with intellectual disabilities (ID) and its predictors.MethodsFocus groups helped construct a quantitative questionnaire. The questionnaire (completed by 440 physicians) examined utilization of effective communication principles, attitudes toward individuals with ID, subjective knowledge and number of patients with ID.ResultsSubjective knowledge of ID and more patients with ID increased utilization of effective communication principles. Provision of knowledge that allows patients to make their own medical decisions was predicted by more patients with ID, lower attitudes that treatment of this population group is not desirable, less negative affect and greater perception that treatment of this group is part of the physician's role. Effective preparation of patients with ID for treatment was predicted by higher perception of treatment of this group as part of the physician's role, lower perception of this field as undesirable and higher perception of these individuals as unable to make their own choice. Simplification of information was predicted by a greater perception of treatment of this group as part of the physician's role and more negative affect.ConclusionGreater familiarity may enhance care for these patients.Practice implicationsIncrease exposure to patients with ID within training.     

Interprofessional working in diagnostic radiography

This paper considers interprofessional working within one diagnostic imaging department.The literature is still divided about the long-term impact of interprofessional learning in pre-registration health and social care education, and its impact on the quality of care provided. When reading the literature about interprofessional working the main topics considered by other authors are team working, communication between professionals, stereotyping and tribalism.The results presented are from an ethnographic study in one department with participant observation and semi-structured interviews.The three main aspects discussed in this paper are; tribalism and culture within the diagnostic radiography profession, communication between different professional groups, and a lack of understanding of the roles of other professional groups.It was evident from the results of this study that tribalism and culture, and a lack of understanding were significant barriers to interprofessional working.It was felt by the authors that pre-registration and post-registration interprofessional education could be significant in changing the culture of the NHS in the future as more professionals learn from and about one another.     

A pilot study on early home-based intervention through an intelligent baby gym (CareToy) in preterm infants

BackgroundCareToy is an intelligent system, inspired by baby gyms, aimed to provide an intensive, individualized, home-based and family-centred early intervention (EI) program.AimsA pilot study was carried out to explore the feasibility of CareToy intervention in preterm infants, aged 3–9 months of corrected age.MethodsTwenty low-risk preterm infants, without brain lesion or other clinical complications (14 allocated to CareToy intervention and 6 to Standard Care) were recruited. The Infant Motor Profile (IMP) was predefined as the primary outcome measure and Alberta Infant Motor Scale and Teller Acuity Cards as secondary measures. Moreover, 202 pre-programmed training scenarios were developed and instructions for the management of CareToy intervention were defined as general guidelines.Outcomes and resultsAll infants received 4 weeks of their allocated intervention and were evaluated with the selected tests before and immediately after the 4 weeks. The mean difference changes in IMP total score and Teller Acuity Cards over the intervention period were higher in the CareToy group than in the Standard Care group.Conclusions and implicationsCareToy seems a feasible device for providing EI. An adequately powered randomized clinical trial is warranted.     

“Who am I to disagree?” A qualitative study of how patients interpret the consent process prior to manual therapy of the cervical spine

BackgroundClinical practice standards dictate a requirement for osteopaths to gain informed consent prior to any examination or treatment. Despite previous research on adverse events, communication and patient preferences, no published studies were identified that looked qualitatively at patients experiences of informed consent. This study aimed to explore patient perceptions of the consent process in a student-led osteopathy clinic.MethodsSemi-structured interviews were carried out with a purposive sample of seven patients attending a student osteopathy clinic. Interviews were transcribed verbatim, and constructivist grounded theory was used as a framework for data collection, conceptualisation and analysis.ResultsOne core theme was identified to highlight participants' perception of a hierarchical power-divide. Three further themes were constructed to illustrate perceived key influencers of the consent experience: commitment to symptom resolution; lack of knowledge and; unwilling to cause friction.ConclusionsPatients’ experiences of consent were unified through the core theme of situational disempowerment, questioning the efficacy of current informed consent processes. This study has implications for further research into patient and practitioner perceptions and highlights a need for additional training and reflection on existing communication strategies and consent practices.