Patient accounts for nonadherence: A critical window into the patient experience

ObjectivesThis paper explores patient use of excuses to better understand the patient experience during clinical interactions.MethodsA content analysis of 32 residents treating 99 different patients was used to reveal accounts of nonadherence. Using grounded theory, these accounts were coded into types and then reduced using a Q-sort.ResultsAnalysis revealed 163 accounts of nonadherence. When questioned about their adherence to treatment, 68% of patients offered at least one account for nonadherence during the visit. These accounts were coded into fourteen types and then the Q-sort identified four types of accounts: healthcare system failures, treatment failure, situational exigencies, and self-directed. Of the accounts offered, 7% of the patients provided 6 or more accounts and 25% provided between 3 and 5 accounts.ConclusionsThe examination of excuses provides a unique way to gain insight into how patients communicate with their physicians. Patient accounts ranged from those where patients indicated adherence was within their control (self-directed) and accounts outside their control (healthcare system failure, treatment failure, and situational exigency).Practice implicationsThe types of accounts of nonadherence patients could provide doctors insight into the patient experience. Recognizing these types could allow opportunities for doctors to develop communication strategies for encouraging patient adherence.     

Humble doctors,healthy patients? Exploring the relationships between clinician humility and patient satisfaction,trust, and health status

ObjectiveIn medicine, numerous commentaries implore clinicians (e.g., physicians, physician assistants, nurse practitioners) to display more humility. However, given the complex power dynamics between patients and clinicians, one should not presume that patients desire and appreciate humble clinicians. This paper examines the relationship between clinician humility and patient outcomes, and aims to provide empirical evidence for the significance of clinician humility.MethodsIn two studies, patients (N = 497) recalled their most recent visit to a clinician through an online survey platform (Qualtrics). Patients rated their clinician’s humility, satisfaction and trust with their clinician, and health status. They also provided demographic information (e.g., gender, race, subjective SES), details about their clinician (e.g., gender, race, professional status) and information about their last medical visit with this clinician (e.g., purpose of visit, wait time during visit).ResultsThrough hierarchical multiple regression, we demonstrated that clinician humility positively predicted patient satisfaction, trust, and self-report health (only in Study 2) above and beyond patient, clinician, and visit characteristics.ConclusionThe results demonstrated that clinician humility can predict important patient outcomes above and beyond objective characteristics of the medical interaction.Practice ImplicationsThese findings may shape clinician-patient interactions by validating the pursuit of humility during medical encounters.     

Online Social Networking: A Primer for Radiology

Online social networking is an immature, but rapidly evolving industry of web-based technologies that allow individuals to develop online relationships. News stories populate the headlines about various websites which can facilitate patient and doctor interaction. There remain questions about protecting patient confidentiality and defining etiquette in order to preserve the doctor/patient relationship and protect physicians. How much social networking-based communication or other forms of E-communication is effective? What are the potential benefits and pitfalls of this form of communication? Physicians are exploring how social networking might provide a forum for interacting with their patients, and advance collaborative patient care. Several organizations and institutions have set forth policies to address these questions and more. Though still in its infancy, this form of media has the power to revolutionize the way physicians interact with their patients and fellow health care workers. In the end, physicians must ask what value is added by engaging patients or other health care providers in a social networking format. Social networks may flourish in health care as a means of distributing information to patients or serve mainly as support groups among patients. Physicians must tread a narrow path to bring value to interactions in these networks while limiting their exposure to unwanted liability.     

The impact of residents’ training in Electronic Medical Record (EMR) use on their competence: Report of a pragmatic trial

ObjectivesEven though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor–patient–computer communication (DPCC).Methods36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training.ResultsPerformance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction.ConclusionWe assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills.Practice implicationSimulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.     

Revisiting patient communication training: An updated needs assessment and the AGENDA model

Objective

To assess physician needs for patient-centered communication training for medical consultations and to develop an updated patient training curriculum.

Methods

An online needs assessment was distributed through physician email listserves at the University of Florida College of Medicine. Frequency tabulation and content analyses were conducted to assess patient communication themes.

Results

Responses were received from 336 physicians. Physicians reported that patients are reluctant to ask questions when they do not understand information related to their medical condition, treatment plan, or medical advice. Furthermore, physicians reported that a lack of patient negotiation inhibits patient-centered communication and may negatively influence patient adherence and compliance. Based on these results the AGENDA model was created for patient training and consists of (1) agenda setting; (2) goals for health; (3) expressing concerns, questions, and negotiations; (4) navigating health literacy issues; (5) disclosing detailed information; and (6) active types of listening.

Conclusion

This study supports revisiting patient communication training and tailoring future training interventions to specific communities.

Practice implications

The AGENDA model can be used to train patients to enhance patient-centered communication with physicians. Additionally, patient communication training could help to address the barriers to care identified by the physicians in our study.     

Should patients still be copied into their letters? A rapid review

Objective

To systematically identify, synthesise and evaluate the strength of the international evidence on copy letter practice.

An investigation into the empowerment effects of using online support groups and how this affects health professional/patient communication

Objective

The current research investigates the potential of online support groups (OSGs) to foster empowerment and how membership might affect the patient/health professional relationship.

Methods

246 participants across 33 OSGs completed an online questionnaire.

Results

All empowerment processes and outcomes identified by van Uden-Kraan et al. [1] were found to be present. All empowerment outcomes were adequately predicted by empowerment processes. The majority (82.2%) of participants had discussed information found online with their health professional and most (74.2%) were satisfied with the response. Around 60% of participants felt membership of an OSG had affected the relationship with their health professional and from qualitative responses the effects were mostly positive.

Conclusion

OSGs have the potential to produce empowerment outcomes for those who choose to use them. Furthermore, users report a positive reaction to information found online from their health professionals.

Practice implications

Although not all patients will benefit from using OSGs, health professionals suggesting their use could ensure that they reach the maximum receptive audience. Furthermore, this research could be used to encourage a more ‘net friendly’ attitude amongst health professionals.     

A family doctor contends with the unspoken face of the corona pandemic for the Reflective Practice section

A family physician discusses the indirect effects of the Covid-19 pandemic on her patients and their families. Although her clinic did not suffer any deaths due to the virus, two cases are presented that depict what she terms the “unspoken pandemic” – the detrimental psycho-social effects of Corona. The narrative illustrates how a family doctor who is authentically engaged with her clients over the years has the advantage of being able to identify and address these psycho-social issues, despite the limitations imposed due to Corona. It is suggested that the potentially destructive impact of issues such as violence, anxiety and depression on families and society is no less significant than that of the virus itself.     

Development and pilot testing of a novel education method for training medical interpreters

ObjectiveThe goal of this study was to determine core competencies by means of a systematic literature review and to design and test an interpreter training program.MethodsCore competencies in medical interpreting were searched using a systematic literature review. An intervention program was developed to improve core competencies. Pretests and posttests were conducted to pilot-test knowledge and interpreting skills in participants aged 22–62 years (n = 43). Results of the tests were compared.ResultsResults of the systematic review indicated five core competencies: (a) maintaining accuracy and completeness; (b) medical terminology and understanding the human body; (c) behaving ethically and making ethical decisions; (d) nonverbal communication skills; and (e) cross-cultural communication skills. Statistical analysis showed a significant improvement in knowledge and interpreting skills in the intervention program compared with the control program.ConclusionPosttest assessment showed that the developed training system can be useful in improving knowledge and quality in medical interpreting.Practice implicationsA 3-day training program for medical interpreters could bridge the gap between medical professionals and patients with limited English proficiency while being amenable to integration into clinical flow.     

Physicians’ views and experiences of discussing weight management within routine clinical consultations: A thematic synthesis

ObjectiveTo systematically search and synthesise qualitative studies of physicians’ views and experiences of discussing weight management within a routine consultation.MethodsA systematic search of four electronic databases identified 11,169 articles of which 16 studies met inclusion criteria. Quality was appraised using the Critical Appraisal Skills Programme tool and a thematic synthesis conducted of extracted data.ResultsFour analytical themes were found: (1) physicians’ pessimism about patients’ weight loss success (2) physicians’ feel hopeless and frustrated (3) the dual nature of the physician-patient relationship (4) who should take responsibility for weight management.ConclusionDespite clinical recommendations barriers remain during consultations between physicians and patients about weight management. Many of these barriers are potentially modifiable.Practice implicationsImproving training, providing clearer guidelines and placing a greater emphasis on collaboration within and between clinicians will help reduce barriers for both physicians and patients. In particular, there is an urgent need for more specialised training for physicians about weight management to promote knowledge and skills in behaviour change techniques and ways to broach sensitive topics without damaging patient relationships.     

Postoperative information needs and communication barriers of esophageal cancer patients

Objective

Given the poor prognosis of esophageal cancer and the impact of surgery on health-related quality of life (HRQL), addressing patients’ postoperative information needs is important. This study aimed to examine (1) the content and type of patients’ information needs and (2) patient perceived facilitators and barriers to patient participation.

Methods

Interviews were conducted with 20 purposefully selected esophageal cancer patients. Open and structured questions were alternated. The transcribed interviews were analysed inductively and deductively, using MAXqda.

Results

Patients’ post-operative information needs concerned HRQL, medical care and prognosis, covering several sub-domains. Different types of needs were identified, e.g., requests for information about cause, course and self-management. Barriers to patient participation mostly reflected beliefs and skills, and could be categorized into agenda and communication barriers. Facilitators of patient participation reflected physician, patient and interaction characteristics, companion support and pre-visit preparation. Many patients saw merit in pre-visit preparation interventions; few endorsed skill-building interventions.

Conclusion

This study listed the postoperative information needs of esophageal cancer patients. Moreover, it gained insight into patient-perceived barriers and facilitators of patient participation.

Practice implications

The findings demonstrate what information physicians should have available and informs interventions to support patients in meeting their information needs.     

The good,the bad,and the contingency: How patients’ treatment verification behaviors are linked to doctors’ reactions

ObjectiveThis article introducesTreatment Verification Behavior (TVB) to conceptualize patient proactivity. The article also aims to examine doctors’ responses to patients’ TVBs.MethodsA doctor-patient paired, two-wave data set was collected from eight hospitals in North China. We collected data from 304 doctor-patient dyads with each doctor rating, on average, three inpatients.ResultsThe results show that when patients consulted their doctors about information regarding a diagnosis or treatment (i.e.,consulting TVB), it improved doctors’ perception of the patients’ ability, which further increased doctors’ work engagement. Alternatively, when patients challenged doctors about information regarding a diagnosis or treatment (i.e., challenging TVB), it induced doctors’ perception of threat but without significantly decreasing doctors’ work engagement. In addition, when doctors felt respected by patients, this feeling moderated the effects of patients’ TVBs on doctors’ reactions.ConclusionBoth the content (the “what”) and the manner (the “how”) of patients’ proactive communications with their doctors will influence doctors’ responses.Practice implicationsThese insights suggest that patient and doctor communication training should include components that address both the content and performance of communication.     

An online resource of digital stories about cancer genetics: qualitative study of patient preferences and information needs

Background

The Cancer Genetics Service for Wales (CGSW) was established in 1998 as an all-Wales service for individuals with concerns about their family history of cancer. CGSW offers a range of services such as risk assessment, genetic counseling, and genetic testing. Individuals referred to cancer genetics services often have unmet information and support needs, and they value access to practical and experiential information from other patients and health professionals. As a result of the lifelong nature of genetic conditions, a fundamental challenge is to meet the ongoing needs of these patients by providing easily accessible and reliable information.

Objectives

Our aims were to explore how the long-term information and support needs of CGSW patients could be met and to assess whether an online bank of digital stories about cancer genetics would be acceptable to patients.

Methods

In 2009, CGSW organized patient panels across Wales. During these events, 169 patients were asked for their feedback about a potential online resource of digital stories from CGSW patients and staff. A total of 75 patients registered to take part in the project and 23 people from across Wales agreed to share their story. All participants took part in a follow-up interview.

Results

Patient preferences for an online collection of cancer genetics stories were collected at the patient panels. Key topics to be covered by the stories were identified, and this feedback informed the development of the website to ensure that patients’ needs would be met. The 23 patient storytellers were aged between 28 and 75 years, and 19 were female. The digital stories reflect patients’ experiences within CGSW and the implications of living with or at risk of cancer. Follow-up interviews with patient storytellers showed that they shared their experiences as a means of helping other patients and to increase understanding of the cancer genetics service. Digital stories were also collected from 12 members of staff working at CGSW. The digital stories provide reliable and easily accessible information about cancer genetics and are hosted on the StoryBank website (www.cancergeneticsstorybank.co.uk).

Conclusions

The Internet is one mechanism through which the long-term information and support needs of cancer genetics patients can be met. The StoryBank is one of the first places where patient and staff stories have been allied to every aspect of a patient pathway through a service and provides patients with an experiential perspective of the cancer genetics “journey.” The StoryBank was developed in direct response to patient feedback and is an innovative example of patient involvement in service development. The stories are a useful resource for newly referred patients, current patients, the general public, and health care professionals.     

Illness perceptions and negative responses from medical professionals in patients with fibromyalgia: Association with patient satisfaction and number of hospital visits

Objective

To examine whether illness perceptions among patients with fibromyalgia and negative responses from medical professionals correlate with their satisfaction with their physicians or with their number of hospital visits.