Quasi-Experiment Study on Effectiveness Evaluation of Health Communication Strategies

This experimental study examined differences in doctor-patient relationships according to the health communication strategies during cases of medical malpractices occurred at primary medical institution. A total of 116 subjects aged in their 20s-50s was sampled. The first medical malpractice scenario chosen was the medical malpractice case most frequently registered at the Korean Medical Association Mutual Aid and the second scenario was associated with materials and devices as the cause of malpractice. Four types of crisis communication strategy messages were utilized, consisting of denial, denial + ingratiation, apology, and apology + ingratiation. Subjects were classified into four research groups by crisis communication strategy to measure levels of trust, control mutuality, commitment, and satisfaction, before and after the occurrence of medical malpractice and application of communication strategies. The findings of this study revealed that the apology strategy, compared with the denial strategy, showed a smaller difference before and after the application of communication strategies in all variables of trust (F = 8.080, F = 5.768), control mutuality (F = 8.824, F = 9.081), commitment (F = 9.815, F = 8.301), and satisfaction (F = 8.723, F = 5.638). Further, a significant interaction effect was shown between variables. The apology strategy, compared with the denial strategy, was effective in the improvement of doctor-patient relationships in both Scenarios I and II. For Scenario I, the apology strategy without ingratiation boosted commitment and satisfaction, but for Scenario II, utilizing the apology strategy with ingratiation boosted the effectiveness of trust and commitment.     

Epistemic Mistrust: A Crucial Aspect of Mentalization in People with a History of Abuse?

I explore the development of implicit mentalizing, its roots in internal working models of early attachment relationships and how these contribute to the emergence of epistemic trust. I discuss the respective contributions of caregiver sensitivity and congruent ‘marking’ to the development of secure attachment and epistemic trust. I discuss the ways in which early relational trauma and sexual abuse directly contribute to the emergence of epistemic mistrust and the implications of this for the role of mentalizing in psychotherapy.     

Effective Decision-making: A Negotiation Perspective for Health Psychology and Health Communication

This article examines the critical role of communication and interpersonal negotiation in provider/consumer relations. Only through the use of strategic and competent communication can providers and consumers work cooperatively to make effective health-care decisions. A conflict resolution/shared negotiation model is presented to illustrate how communication can facilitate cooperative decision- making in health care. The model emphasizes cooperation, trust and mutual adaptation between providers and consumers. A case study is then presented to illustrate further the model and cooperative health-care decision-making processes.     

Making communication research matter: What do patients notice,what do patients want,and what do patients need?

OBJECTIVE: To explore limitations of current communication theory by considering different perspectives of researchers, clinicians, patients and teachers of communication. METHOD: Theory development based on limitations of the current communication research literature due to inconsistencies between patient reports and observed communication behavior. RESULTS: While researchers focus on the mechanics and techniques of communication, patients seek relationships in which they experience trust, the right amount of autonomy, caring, and expertise. Patients', physicians', and communication experts' perspectives do not always define the same problems and often point to different solutions. CONCLUSIONS: In addition to studying clinician behaviors and patient perceptions of care, communication research should focus on five additional factors: what patients notice, want and need, and how their perspectives differ from those of physicians and researchers; the context, including illness severity and type and family influences; how complex health systems facilitate and impede communication; patients' influences on physician communication behavior; and habits of mind that promote attentive care.     

Does source of patient recruitment affect the impact of communication on trust?

Objectives

To investigate how comparable outcomes of medical communication research are when using different patient accrual methods by comparing cancer patients organization members with outpatient clinic patients.

Methods

In an experimental video-vignettes study, the impact of oncologist communication on trust was tested. Background characteristics (socio-demographics, trait anxiety, health locus of control and attachment style), reported trust, and the impact of communication on trust were compared between the two groups.

Results

Cancer patient organization members (n = 196) were younger and higher educated than clinical patients (n = 148). Members felt more personal control over their health (p < .01) but were also more anxious (p < .05). They reported lower trust in general health care (p < .05), in their own oncologist (p < .001) and in the oncologist in the videos (p < .05). The impact of oncologist communication on trust was similar for both groups.

Conclusions

Despite considerable differences in trust levels, both groups appear equally affected by oncologist communication. Thus, although including cancer patient organization members may impact the generalizability of some findings, using these participants to investigate communication appears justified.

Practice implications

Cancer patient organization members may regard their oncologist more critically. Research including both members and patients recruited through hospital clinics could take group membership into account as a possible confounder. Nonetheless, communicating competence, honesty and caring may benefit the relation with these patients similarly as with other patients.     

Thank you for letting me be your physician

I believe this article emphasizes how emotionally valuable receiving patients' trust is to the practicing physician. It also gives new insight into understanding the emotional loss a physician may experience when leaving private practice, even if they remain active in medicine. Finally, for those entering medicine, it explains the profound personal satisfaction they can experience from long term trusting relationships with patients.     

How does patient-provider communication influence adherence to asthma medications?

ObjectiveTo assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence.MethodsA national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways.ResultsSignificantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence.ConclusionPatient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation.Practice implicationsTo promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients’ trust and increase patient motivation to use asthma medications.     

Intelligent meaning creation in a clumpy world helps communication

This article investigates the problem of how language learners decipher what words mean. In many recent models of language evolution, agents are provided with innate meanings a priori and explicitly transfer them to each other as part of the communication process. By contrast, I investigate how successful communication systems can emerge without innate or transferable meanings, and show that this is dependent on the agents developing highly synchronized conceptual systems. I present experiments with various cognitive, communicative, and environmental factors which affect the likelihood of agents achieving meaning synchronization and demonstrate that an intelligent meaning creation strategy in a clumpy world leads to the highest level of meaning similarity between agents.     

Commentary: Lost in translation? How electronic health records structure communication, relationships, and meaning

The media through which we communicate shape how we think, how we act, and who we are. Electronic health records (EHRs) may promote more effective, efficient, coordinated, safer care. Research is emerging, but more is needed to assess the effect of EHRs on communication, relationships, patients' trust, adherence, and health outcomes. The authors posit that EHRs introduce a "third party" into exam room interactions that competes with the patient for clinicians' attention, affects clinicians' capacity to be fully present, and alters the nature of communication, relationships, and physicians' sense of professional role. Screen-driven communication inhibits patients' narratives and diminishes clinicians' responses to patients' cues about psychosocial issues and emotional concerns. Students, trainees, and clinicians can, however, learn to integrate EHRs into triadic exam room interactions to facilitate information sharing and shared decision making.Student exposure to EHRs is currently limited. Educators and researchers should implement curricula and assessment tools to help learners integrate EHRs into clinical interactions in ways that foster, rather than diminish, communication and relationships. Further, educators must prioritize the teaching and modeling of self-awareness and self-calibration, mindful presence, and compassion within such curricula to prevent these important qualities and skills from being lost in translation in the digital era.     

Effects of communication about uncertainty and oncologist gender on the physician-patient relationship

Objective: Physicians are increasingly expected to share uncertain information, yet there is concern about possible negative effects on patients. How uncertainty is conveyed and by whom may influence patients’ response. We tested the effects of verbally and non-verbally communicating uncertainty by a male vs. female oncologist on patients’ trust and intention to seek a second opinion.Methods: In an experimental video vignettes study conducted in The Netherlands, oncologist communication behavior (verbal vs. non-verbal and high vs. low uncertainty) and gender (male vs. female) were systematically manipulated. Former cancer patients viewed one video variant and reported trust, intention to seek a second opinion, and experience of uncertainty.Results: Non-verbal communication of high uncertainty by the oncologist led to reduced trust (β = -0.72 (SE = 0.15), p < .001) and increased intention to seek a second opinion (β = 0.67 (SE = 0.16), p < .001). These effects were partly explained by patients’ increased experience of uncertainty (β = -0.48 (SE = 0.12), p < .001; and β = 0.34 (SE = 0.09), p < .001 respectively). Neither verbal uncertainty nor oncologists’ gender influenced trust or intention to seek a second opinion.Conclusion: Non-verbal communication of uncertainty by oncologists may affect patient trust and intention to seek a second-opinion more than verbal communication.Practice Implications: Further research to understand and improve oncologists’ non-verbal uncertainty behavior is warranted.     

Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study

Objective

To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening.

Methods

Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes.

Results

Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse.

Conclusions

Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women.

Practice implications

Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients’ trust.     

Breaking the Circle

SUMMARY. In this paper I explore some thoughts about the relationship between language, an awareness of separateness and the perception of linear time. I focus on work with a patient whose imagery resembled the myths of Paradise and the Fall. I look at how it is only when the circle of idealised omnipotent illusion is broken that language comes to be used as a communication across a gap rather than as the denial of a gap.     

Provider caring and structuring treatment information to improve cancer patients’ recall: Does it help?

ObjectivesPatient recall of medical information is usually poor. Healthcare providers can employ affect-oriented (i.e., showing care) or cognition-oriented communication styles (i.e., structuring information) to enhance recall, but research evidence is limited especially among clinical and/or older patient populations. This video-vignette study manipulated provider caring and information structuring to examine effects on recall and trust among cancer patients/survivors.MethodsIn an online survey, 148 participants (M_age = 62) were randomized to one of four video conditions in a two (standard communication vs. enhanced caring) by two (standard vs. enhanced structuring) design, and completed measures of active recall, recognition, and trust.ResultsIncreased caring or structuring did not enhance active recall or recognition, instead both were higher among younger, female, or highly educated participants. The caring condition induced higher perceived trust in the provider within the whole sample, but trust was significantly correlated with decreased recall (r = −.268) among younger participants.ConclusionsProvider caring can strengthen the patient-provider relationship by enhancing trust. Yet, increased trust may impair recall among younger patients. Structuring treatment information did not enhance recall and recognition, but additional research is needed.Practice implicationsProviders may use additional ways of structuring/organizing information to help enhance recall (e.g., written information).     

女大学生网络交往依赖相关因素

目的:探讨影响女大学生网络交往依赖的相关因素。方法:采用大学生网络交往问卷(IIQUS)和人际信任量表(ITS)对321名女大学生进行调查。结果:1绝大多数女大学生主要的网络交往方式为即时聊天(97.82%)和空间或博客(87.23%),其中不同家庭经济状况、不同专业、不同网络重要性之间的女大学生网络交往依赖呈显著差异(F=5.950,5.666,10.797,P0.01);2女大学生人际信任与网络交往依赖呈正相关(r=0.149,P0.01)。结论:家庭经济、专业和网络重要性是女大学生网络交往依赖的影响因素;女大学生人际信任水平越高,其网络交往依赖程度越深。     

Factors associated with patients' trust in their general practitioner: a cross-sectional survey.

This study aimed to identify factors that are associated with patients' overall trust in their general practitioner (GP). A survey of patients in ten general practices in the East Midlands was conducted. Most patients (76%) reported high levels of trust in their GP. Regression analysis showed that measures of the quality of the GP-patient relationship (GP-patient communication, interpersonal care, and knowledge of the patient) were strongly associated with trust in a patient's usual GP, whereas patients' reports of duration of registration with the practice, and proportion of visits to the usual GP were not.     

民族院校大学生人际关系相关心理因素的调查研究

目的 对民族院校大学生人际关系中相关的心理因素(自我概念、人际困扰、人际应对、人际信任和人际敏感)进行调查,以了解当前民族院校大学生人际关系状况.方法 访谈法、问卷调查法.结果 除人际困扰外,自我概念、人际应对、人际信任、人际敏感因子得分在性别和家庭所在地之间不存在显著差异;汉族和少数民族在各维度得分中不存在显著差异;各维度的具体项目上,不同民族间的差异不尽一致;自我概念、人际困扰、人际应对、人际信任、人际敏感因子的得分在高低两端之间呈现出极显著差异.自我概念、人际困扰、人际应对、人际信任4维度中,专业、性别、民族主效应和交互作用都不明显;自我概念、人际困扰、人际应对因素对人际信任的贡献很小.结论 民族院校大学生的自我概念水平、人际应对能力相对是比较高的.民族院校大学生不仅存在人际困扰,而且有相当多的人困扰程度较严重;在人际交往方面普遍表现出不信任;民族院校大学生存在一定程度的人际敏感症状.     

Examining patients’ trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure

Objective

To examine the associations of several characteristics with patients’ trust in physician and the healthcare system.

Methods

A prospective cohort of patients were followed after an exacerbation of heart failure at one of two veterans affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression.

Results

After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P < 0.001), but was not significantly different by race. Trust in VA did not change significantly over time (P > 0.20), but was significantly lower for Black patients (P < 0.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P < 0.001).

Conclusions

Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among Black patients. Trust was higher when ratings of communication were higher.

Practice implications

Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system.     

A Mixed Methods Examination of Health Care Provider Behaviors That Build Patients’ Trust

ObjectivePatient trust in health care providers is associated with better health behaviors and utilization, yet provider trust has not been consistently conceptualized. This study uses qualitative methods to identify the key health provider behaviors that patients report build their trust, and data from a national U.S. survey of adults to test the robustness of the qualitative findings.MethodsIn this mixed methods study, we conducted 40 semi-structured interviews with a diverse sample to identify the provider behaviors that build trust. We then analyzed a nationally representative survey (n = 6,517) to examine the relationship between respondents’ trust in their usual provider and the key trust-related behaviors identified in the qualitative interviews.ResultsInterviewees reported that health providers build trust by communicating effectively (listening and providing detailed explanations), caring about their patients (treating them as individuals, valuing their experience, and showing commitment to solving their health issues), and demonstrating competence (being knowledgeable, thorough, and solving their health issues). Trust in one’s provider was highly correlated with all eight survey items measuring communication, caring, and competence.ConclusionsTo build trust with patients, health providers should actively listen, provide detailed explanations, show caring for patients, and demonstrate their knowledge.     

Black men in white coats - Barriers black men face in medicine,implications to decreased representation,and potential interventions at the uniformed services university of the health sciences

The number of black male applicants to US medical schools has remained stagnant over the last 30 years. The etiology behind the lack of applicants is multifaceted and involves greater systemic barriers, specifically, educational and social barriers. The lack of representation of black males in medicine also has downstream implications for the health of the African American/black community. African Americans exhibit some of the lowest levels of trust in the healthcare system, have less access to care than their non-minority peers, and have, comparatively, poorer healthcare outcomes than other populations in the US. Research has demonstrated that patient-provider race concordance improves communication, outcomes, culturally competent care, and satisfaction with care. The greater the gap between these two populations, the harder it becomes to improve healthcare outcomes, maintain a medically ready fighting force in the US military, and improve trust in the healthcare system. This article provides an analysis of the multifactorial barriers black male applicants face applying, matriculating, and graduating medical school and how decreased representation may affect healthcare delivery. Furthermore, this review explores next steps and potential implementations at the Uniformed Services University of the Health Sciences to address the above deficiencies.