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1.
《Patient education and counseling》2010,78(3):437-442
ObjectiveTo examine physician communication associated with prognosis discussion with cancer patients.MethodsWe conducted a study of physician–patient communication using trained actors. Thirty-nine physicians, including 19 oncologists and 20 family physicians participated in the study. Actors carried two hidden digital recorders to unannounced visits. We coded recordings for eliciting and validating patient concerns, attentive voice tone, and prognosis talk.ResultsActor adherence to role averaged 92% and the suspected detection rate was 14%. In a multiple regression, eliciting and validating patient concerns (β = .40, C.I. = 0.11–0.68) attentiveness (β = .32, C.I. = 0.06–0.58) and being an oncologist vs. a family physician (β = .33, C.I. = 0.33–1.36) accounted for 46% of the variance in prognosis communication.ConclusionEliciting and validating patient concerns and attentiveness voice tone is associated with increased discussion of cancer patient prognosis as is physician specialty.Practice implicationsEliciting and validating patient concerns and attentive voice tone may be markers of physician willingness to discuss emotionally difficult topics. Educating physicians about mindful practice may increase their ability to collect important information and to attend to patient concerns. 相似文献
2.
Kimberly R. Jacob Arriola Tamara A. Mason Kari Ann Bannon Carol Holmes Cecil Lamonte Powell Kandra Horne Ruth O’Regan 《Patient education and counseling》2014
Objective
Breast cancer incidence and mortality are declining due to improvements in early detection and treatment. One advance in treatment is the development of adjuvant endocrine therapy (AET) for women with hormone receptor positive breast cancer. Despite strong evidence linking AET to better health outcomes, AET adherence continues to be suboptimal. This study tests the hypothesis that patient beliefs about medication mediate the relationship between frequency of physician communication and AET adherence.Methods
This cross-sectional study utilizes data from patient self-report and medical chart abstraction (N = 200). Survey measures included frequency of physician communication, patient beliefs about medicine, AET adherence, and demographic characteristics.Results
Necessity beliefs mediated the relationship between frequency of physician communication and medication adherence (necessity beliefs β = .18, p < .05; physician communication β = .13, p > .05). There was no evidence of medication concerns mediating the relationship between frequency of physician communication and medication adherence.Conclusion
More frequent physician communication that shapes what patients believe about AET importance may be associated with greater AET adherence; however, frequent physician communication that shapes patient concerns about side effects may not be associated with greater AET adherence.Practice implications
Research is needed to enhance understanding of the type of physician communication that is most consistently associated with patient beliefs about medication and AET adherence. 相似文献3.
Renee Royak-Schaler Lisa D. GardnerMichelle Shardell Min ZhanSusan Racine Passmore Shahinaz M. GadallaM. Katherine Hoy Katherine H. Rak TkaczukKim Nesbitt 《Patient education and counseling》2009
Objective
To investigate patient reports of physician communication about the 2006 Institute of Medicine (IOM) Guidelines for Survivorship Care, and patient follow-up care behaviors in a sample of African American and Caucasian breast cancer survivors.Methods
Fifteen-minute telephone interviews were conducted in a cross-sectional study with a sample of African American (n = 30) and Caucasian (n = 69) breast cancer patients, who were within 5 years of their diagnosis and primary treatment for breast cancer at two Baltimore, Maryland medical centers, during the summer of 2006. Multiple items assessed patient reports of physician discussions about IOM Guidelines, their recurrence concerns, and their follow-up treatment, screening, diet and exercise practices.Results
Patients with higher incomes, more education, female physicians, and of younger ages reported more complete physician discussions of the IOM Guidelines. No significant differences were noted between African American and Caucasian patients.Conclusion
Patients at greatest risk for breast cancer recurrence – those with less education, income, and resources – report limited guidance from their physicians about evidence-based, follow-up care guidelines, designed to minimize their risk.Practice implications
Physicians need strategies for effectively delivering the IOM Guidelines for Survivorship Care to disadvantaged breast cancer patients, to promote enhanced quality of life and reduced risk of recurrence. 相似文献4.
Objective
Aim was to investigate the psychometric properties of a Dutch version of the “Wake Forest Physician Trust Scale”, which intends to measure patients’ trust in their physician.Methods
A random sample of internal medicine patients visiting the outpatient clinic completed the questionnaire (N = 201). Dimensionality, reliability and validity of the instrument were examined.Results
The structure of the questionnaire was best explained by a unidimensional construct. Reliability was confirmed: internal consistency was high (α = .88), and mean item-total correlations were all above .40. Construct validity was indicated by patients’ trust in their physician correlating significantly and as hypothesized with (1) satisfaction with their physician (r = .64), (2) with the length of the patient–physician relationship (r = .28), (3) with their willingness to recommend their physician (r = .71) and (4) their unwillingness to switch their physician (r = .61).Conclusion
The results suggest the Dutch version of the Wake Forest Physician Trust Scale to be a psychometrically sound instrument to assess patients’ interpersonal trust.Practice implications
Trust is a key feature of the patient–physician relationship, yet has been scarcely researched in other than Anglophone cultures. An adequate Dutch trust questionnaire forms the first step to gaining more knowledge about patient–physician trust in another culture and health care setting. 相似文献5.
Objective
To Examine physician eye contact (EC), patient understanding and adherence.Methods
Secondary analysis of National Institute of Aging videotapes (N = 52) of physician–elder patients in two visit types: (1) routine (n = 20); (2) anxiety-provoking (n = 32) was conducted. Self-reports of understanding and adherence were used. History-taking segments were qualitatively and quantitatively analyzed for relationships between EC, understanding and adherence.Results
Qualitative analysis showed: (1) two salient EC elements – frequency, type (brief or sustained) – and verbal synchronicity were commonly invoked; (2) conjoint unfolding of three communication elements – “looking, listening and talking” – may be salient for patient outcomes; (3) despite differing EC patterns in routine and anxiety provoking visits, statistical analyses showed patient understanding and adherence ratings were similar in the sample population comprising two visit types; no significant correlations between EC elements and understanding and adherence were found.Conclusions
Salience of EC for patient-centered communication is shown in prior research. Present findings broaden the significance of EC by including verbal synchronicity. Methodological limitations may account for no significant correlations between EC and patient outcomes.Practice implications
Using suggested framework for operationalizing EC elements, including verbally synchronous communication, may facilitate patient-centeredness and have positive implications for patient understanding and adherence. 相似文献6.
Claudia Meystre Céline Bourquin Jean-Nicolas Despland Friedrich Stiefel Yves de Roten 《Patient education and counseling》2013
Objective
The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance.Methods
Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N = 56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N = 57) who did not benefit from CST. The patient–clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory – Short Revised Form.Results
While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance.Conclusion
Patient–clinician alliance is related to specific verbal communication behaviors.Practice implications
Working alliance is a key element of patient–physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome. 相似文献7.
Severin Haug Christian Meyer Sabina Ulbricht Gudrun Schorr Jeannette Rüge Hans-Jürgen Rumpf Ulrich John 《Patient education and counseling》2010
Objective
To explore demographic-, health-, and smoking-related predictors and moderators of outcome in smokers who participated in two different brief smoking cessation interventions.Methods
Data were acquired using a quasi-randomized controlled trial that tested the efficacy of computer-generated tailored letters and physician-delivered brief advice against assessment only. Daily smokers (n = 1499) were recruited from 34 general medical practices. We used Generalized Estimating Equation analyses to investigate the relationship between 6-month prolonged smoking abstinence assessed at 12-, 18-, and 24-month follow-ups and potential predictors and moderators.Results
Female gender (OR = 1.49, 95% CI = 1.01–2.19), higher level of education (OR = 1.82, 95% CI = 1.18–2.82), intention to quit smoking (OR = 1.66, 95% CI = 1.16–2.38), and smoking cessation self-efficacy (OR = 1.30, 95% CI = 1.03–1.64) were positively, nicotine dependence (OR = 0.84, 95% CI = 0.76–0.94) and the presence of a smoking partner (OR = 0.60, 95% CI = 0.42–0.85) were negatively associated with smoking abstinence. Compared to assessment only, physician advice was less effective for people without an intention to quit smoking and for unemployed.Conclusion
Smoking cessation interventions might be improved by tailoring them to demographic- and smoking-related variables which were identified as predictors in this study.Practice implications
The results suggest that tailored letters are a more universally applicable brief intervention in general medical practice than physician advice. 相似文献8.
Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes
Jennifer Elston Lafata Heather L. Morris Elizabeth Dobie Michele Heisler Rachel M. Werner Levent Dumenci 《Patient education and counseling》2013
Objective
Little is known about how patient–clinician communication leads to better outcomes. Among patients with diabetes, we describe patient-reported use of collaborative goal setting and evaluate whether perceived competency and physician trust mediate the association between collaborative goal setting and glycemic control.Methods
Data from a patient survey administered in 2008 to a cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000 and 2005 were joined with pharmaceutical claims data for the prior 12 months and laboratory data for the prior and subsequent 12 months (N = 1065). A structural equation model (SEM) was used to test mediation models controlling for baseline HbA1c.Results
The hypothesized mediation model was supported. Patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician (p < 0.05). In turn, both greater perceived competence and increased trust were associated with increased control (p < 0.05).Conclusions
Findings indicate that engaging patients in collaborative goal setting during clinical encounters has potential to foster a trusting patient–clinician relationship as well as enhance patient perceived competence, thereby improving clinical control.Practice implications
Fostering collaborative goal setting may yield payoffs in improved clinical outcomes among patients with diabetes. 相似文献9.
Sara N. Bleich Mary Margaret Huizinga Mary Catherine Beach Lisa A. Cooper 《Patient education and counseling》2010
Objective
Examine concordance between patient and physician assessments of patient self-reported use of weight-management activities.Methods
Analysis of baseline data from a randomized controlled trial of patient and physician interventions to improve patient–physician communication (41 physicians and 274 of their patients).Results
A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%) while physicians only perceived one-third of patients as engaging in those activities (exercise, 36.6%; weight loss, 33.3%). Kappa scores indicated small agreement between patient and physician assessments of patient self-reported use of exercise, mean kappa 0.28 (range 0.15 to 0.40) and no agreement between patient and physician assessments of patient self-reported efforts to lose weight, mean kappa −0.14 (range −0.26 to −0.01). Obese patients were more likely than non-obese patients to report trying to lose weight or exercising regularly (p < 0.05), but physicians were less likely to perceive obese patients as engaging in those activities (p < 0.05).Conclusions
Primary care physicians differed considerably from their patients, especially obese patients, in their assessments of patient use of weight-management activities.Practice implications
These results highlight the importance of improving patient–provider communication about weight-management activities, particularly among obese patients. 相似文献10.
Ruth Riley Marjorie C. Weiss Jo Platt Gordon Taylor Susan Horrocks Andrea Taylor 《Patient education and counseling》2013
Objective
Recognising patients’ cues and concerns is an important part of patient centred care. With nurses and pharmacists now able to prescribe in the UK, this study compared the frequency, nature, and professionals’ responses to patient cues and concerns in consultations with GPs, nurse prescribers and pharmacist prescribers.Methods
Audio-recording and analysis of primary care consultations in England between patients and nurse prescribers, pharmacist prescribers and GPs. Recordings were coded for the number of cues and concerns raised, cue or concern type and whether responded to positively or missed.Results
A total of 528 consultations were audio-recorded with 51 professionals: 20 GPs, 19 nurse prescribers and 12 pharmacist prescribers. Overall there were 3.5 cues or concerns per consultation, with no difference between prescriber groups. Pharmacist prescribers responded positively to 81% of patient's cues and concerns with nurse prescribers responding positively to 72% and GPs 53% (PhP v NP: U = 7453, z = −2.1, p = 0.04; PhP v GP: U = 5463, z = −5.9, p < 0.0001; NP v GP: U = 12,070, z = −4.9, p < 0.0001).Conclusion
This evidence suggests that pharmacists and nurses are responding supportively to patients’ cues and concerns.Practice implications
The findings support the importance of patient-centredness in training new prescribers and their potential in providing public health roles. 相似文献11.
Lixin Song Mark A. Weaver Ronald C. Chen Jeannette T. Bensen Elizabeth Fontham James L. Mohler Merle Mishel Paul A. Godley Betsy Sleath 《Patient education and counseling》2014
Objective
To examine the association between socio-cultural factors and patient–provider communication and related racial differences.Methods
Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims.Results
Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p < 0.01), prostate cancer communication (p < 0.001), and physician trust (p < 0.001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values <0.001). For both African and Caucasian Americans, better patient–provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values <0.01), and at least high school education (p < 0.05).Conclusion
Socio-cultural factors are associated with patient–provider communication among men with cancer. No evidence supported associations differed by race.Practice implication
To facilitate patient–provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information. 相似文献12.
Kathryn I. Pollak Cynthia J. Coffman Stewart C. Alexander Truls Østbye Pauline Lyna James A. Tulsky Alicia Bilheimer Rowena J. Dolor Pao-Hwa Lin Michael E. Bodner Terrill Bravender 《Patient education and counseling》2014
Objective
Physicians’ use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown.Methods
We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time.Results
Physicians used more MI consistent techniques with female patients (p = 0.06) and with heavier patients (p = 0.02). Physicians with prior MI training also used more MI consistent techniques (p = 0.04) and asked more open-ended questions (p = 0.05). Pediatricians had a higher MI Spirit score than family physicians (p = 0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p = 0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p = 0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p = 0.02).Conclusion
Physicians’ weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time.Practice implications
Physicians might consider using MI techniques more and attempt to use these equally with all adolescents. 相似文献13.
Objective
This study explored the impact of breast cancer patients’ experiences of physician–patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment.Methods
Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later.Results
Patients who rated their level of information at baseline as high were less depressed after three (p = .010) and six months (p < .001) and experienced higher quality of life after three (p < .001) and six months (p = .049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p < .001) and had lower depression scores three months later (p = .005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact.Conclusion
The findings reveal the significance of physician–patient communication and stress the meaning of baseline depression for later adjustment.Practice implications
A high level of information and tailoring the involvement in decision making to patients’ desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment. 相似文献14.
15.
Sebastian Kohlmann Mara S. Kilbert Kristin Ziegler Karl-Heinz Schulz 《Patient education and counseling》2013
Objectives
Unmet medical needs are a focus in cardiovascular disorder (CVD) research. However, few studies have investigated patients’ perceived needs. The present study examined supportive care needs in patients with CVD and their relation to health characteristics.Methods
In total 260 in-patients with CVD were consecutively assessed with the supportive care needs survey. Primarily, frequency and content of unmet needs were examined. Secondarily, CVD-diagnoses were compared and correlations with risk factors, treatment characteristics, mood-state and quality of life were analyzed.Results
Supportive care needs were indicated by 21% of all patients: unmet health information (37%) and psychological (23%) needs were most frequent. The number of unmet needs did not differ between most CVD-diagnoses. Unmet needs were not related to cardiac risk factors. However, treatment characteristics (r = .17–.23, p < .01), anxiety (r = .44–.71, p < .01), depression (r = .38–.63, p < .01), physical (r = .21–.47, p < .01) and mental (r = .29–.65, p < .01) quality of life were associated with unmet needs.Conclusions
Supportive care needs are common in patients with CVD. They are based on patients’ treatment characteristics, emotions and subjective well-being rather than on cardiac factors.Practice implications
Needs assessments in patients with CVD could detect unmet needs, enhance patient education and communication and, therefore, effectively target patients’ perceived needs and medical needs. 相似文献16.
Derjung M. Tarn Debora A. Paterniti Jeffrey S. Good Ian D. Coulter James M. Galliher Richard L. Kravitz Arun S. Karlamangla Neil S. Wenger 《Patient education and counseling》2013
Objective
Describe the content and frequency of provider–patient dietary supplement discussions during primary care office visits.Methods
Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, CA (2009–2010), geographically diverse practice settings across the United States (2004–2005), and Sacramento, CA (1998–1999).Results
Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: (1) reason for taking the supplement for 46.5% of dietary supplements; (2) how to take the supplement for 28.2%; (3) potential risks for 17.3%; (4) supplement effectiveness for 16.7%; and (5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD = 1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD = 1.2)) than for vitamin/mineral supplements (mean 0.99 (SD = 1.1); p < 0.001).Conclusion
While discussions about supplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use.Practice implications
Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements. 相似文献17.
18.
William G. Elder Jr. Paul L. Dassow Geza G. Bruckner Terry D. Stratton 《Patient education and counseling》2009
Objectives
Internet-based information has potential to impact physician–patient relationships. This study examined medical students’ interpretation and response to such information presented during an objective clinical examination.Method
Ninety-three medical students who had received training for a patient centered response to inquiries about alternative treatments completed a comprehensive examination in their third year. In 1 of 12 objective structured clinical exams, a SP presented Internet-based information on l-theanine – an amino acid available as a supplement. In Condition A, materials were from commercial websites; in Condition B, materials were from the PubMed website.Results
Analyses revealed no significant differences between Conditions in student performance or patient (SP) satisfaction. Students in Condition A rated the information less compelling than students in Condition B (z = −1.78, p = .037), and attributed less of the treatment's action to real vs. placebo effects (z = −1.61, p = .053).Conclusions
Students trained in a patient centered response to inquiries about alternative treatment perceived the credibility of the two types of Internet-based information differently but were able to respond to the patient without jeopardizing patient satisfaction. Approach to information was superficial. Training in information evaluation may be warranted. 相似文献19.
Jamie A. Green Alda Maria Gonzaga Elan D. Cohen Carla L. Spagnoletti 《Patient education and counseling》2014
Objective
To develop, pilot, and test the effectiveness of a clear health communication curriculum to improve resident knowledge, attitudes, and skills regarding health literacy.Methods
Thirty-one internal medicine residents participated in a small group curriculum that included didactic teaching, practice with a standardized patient, and individualized feedback on videotaped encounters with real patients. Outcomes were assessed using a pre-post survey and a communication skills checklist.Results
Mean knowledge scores increased significantly from 60.3% to 77.6% (p < 0.001). Residents also reported increased familiarity with the concept of health literacy (mean response 3.2 vs. 4.5 on a 5 point scale), importance placed on health literacy (4.2 vs. 4.9), frequency of considering health literacy in patient care (3.3 vs. 4.0), and confidence in communicating with low literacy patients (3.3 vs. 4.1) (all p < 0.001). Use of plain language increased significantly from 33% to 86% (p = 0.023). There were nonsignificant increases in the use of teach-back (0–36%, p = 0.116) and encouraging questions (0–14%, p = 0.502).Conclusion
Training in clear health communication improves resident knowledge, attitudes, and skills regarding health literacy.Practice implications
The increased use of clear health communication techniques can significantly improve the care and outcomes of vulnerable patients with limited health literacy. 相似文献20.
Julie W. Childers James E. Bost Kevin L. Kraemer Patricia A. Cluss Carla L. Spagnoletti Alda Maria R. Gonzaga Robert M. Arnold 《Patient education and counseling》2012