Provider-patient dialogue about Internet health information: an exploration of strategies to improve the provider-patient relationship

OBJECTIVE: This study examined patients' experiences talking to their providers about internet health information. METHODS: Participants (n=770) recruited from internet health message boards completed an online survey, including questions focusing on a recent interaction with a provider about internet health information. RESULTS: Face-saving patient introduction strategies were associated with providers validating patients' efforts. Providers' validation of patients' efforts was associated with higher patient ratings of satisfaction, validation, and reduced concern, while providers' disagreement with the information was associated with lower ratings. The provider taking the information seriously was associated with higher patient satisfaction. CONCLUSION: An understanding of the occurrence of provider-patient talk about internet health information and its relationship to patient satisfaction, validation, and reduced concern is important for providers and medical educators who seek to better understand, and thus improve, provider-patient communication. PRACTICE IMPLICATIONS: Showing the patient that the information is being seriously considered and validating the patients' efforts in researching the information may ameliorate some of the negative effects of disagreement.     

Discharge planning,self-management,and community support: Strategies to avoid psychiatric rehospitalisation from a service user perspective

ObjectivePsychiatric rehospitalisation is often seen as a negative outcome in terms of healthcare quality and cost, as well as potentially hindering the process of recovery. The purpose of our study was to explore psychiatric rehospitalisation from a service-user perspective, paying attention to how rehospitalisation can be avoided.MethodEight focus groups, including a total of 55 mental health service users, were conducted in six European countries (Austria, Finland, Italy, Norway, Romania, and Slovenia). The results were analysed using systematic text condensation.ResultsAll participants had been in touch with mental health services for at least one year, and had experienced more than one psychiatric hospitalisation. Participants emphasised the importance of discharge planning and psychoeducation both during and after the hospital stay, as well as the benefits of structured plans, coping strategies, self-monitoring techniques, and close contact with local community services.Social contacts and meaningful activities were also considered to be critical, as was support from peers and family members.ConclusionEfforts to avoid psychiatric rehospitalisation should include actions that support a functional day-to-day life, improve coping strategies, and build on cross-sectoral collaboration.Practice implicationsThe study emphasises the need for psychoeducational and psychosocial interventions, starting already during the inpatient stay.     

Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information

ObjectiveThis study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking.MethodsWe analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy.ResultsHalf of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients’ online health information-seeking seriously or affirming patients’ beliefs.ConclusionThis exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients’ online health information-seeking.Practice implicationsResults of this study could guide interventions to train providers in talking about patients’ online health information-seeking.     

Developing an 'interactive' booklet on respiratory tract infections in children for use in primary care consultations

Objective

To construct a systematic process for developing an ‘interactive’ booklet for use in primary care consultations and to use this process to develop a booklet on respiratory tract infections in children.

Methods

Booklet development occurred through a number of stages, which included: expert group brainstorming and literature review, professional graphic design, readability assessment, and consultation with users. Consultation was achieved through the use of focus groups and interviews with parents, focus groups and independent booklet review by general practitioners, and booklet review and feedback by paediatricians.

Results

All development stages led to meaningful enhancements to the booklet. Consultation with parents demonstrated a desire for more information than anticipated, with a particular emphasis on the interpretation of signs and symptoms, and the recognition of serious illness. General practitioners contributed to the design and clarity of the booklet and helped to ensure that it would be acceptable for use within consultations.

Conclusion

Written material needs to be developed in a systematic way and include consultation with the intended users. Focus groups are a valuable tool for consulting with consumers and practitioners in this regard.

Practice implications

The process described can be used as a guide for those wishing to develop similar written materials.     

Exploring the community pharmacist's role in palliative care: focusing on the person not just the prescription

Objective

Changes in health care provision have led to an emphasis on providing end of life care within the home. community pharmacists are well positioned to provide services to community-based palliative care patients and carers.

Methods

A multiple qualitative case study design was adopted. A total of 16 focus groups and 19 interviews with pharmacists, nurses, general practitioners and carers were undertaken across metropolitan and regional settings in Western Australia, New South Wales, Queensland and Victoria. Data were analysed thematically using a framework that allowed similarities and differences across stakeholder groups and locations to be examined and compared.

Results

Three main themes emerged: effective communication; challenges to effective communication; and: towards best practice, which comprised two themes: community pharmacists’ skills and community pharmacists’ needs.

Discussion

A key component of the provision of palliative care was having effective communication skills. Although community pharmacists saw an opportunity to provide interpersonal support, they suggested that they would need to develop more effective communication skills to fulfil this role.

Conclusion

There is clear need for continuing professional development in this area - particularly in communicating effectively and managing strong emotions.

Practice implications

Community pharmacists are willing to support palliative care patients and carers but need education, support and resources.     

Association of conflicting information from healthcare providers and poor shared decision making with suboptimal adherence in direct oral anticoagulant treatment: A cross-sectional study in patients with atrial fibrillation

ObjectiveTo assess direct oral anticoagulant (DOAC) adherence and to determine possible determinants for suboptimal adherence in Dutch patients with atrial fibrillation (AF).MethodsCross-sectional study of DOAC users who completed a self-reported questionnaire. Adherence was measured with Morisky8-item Medication Adherence Scale (MMAS-8). Logistic regression analysis was conducted to investigate determinants affecting adherence.Results398 DOAC users completed the questionnaire (mean age 70.6 ± 9.2years). Approximately one in four patients had suboptimal adherence (MMAS-8 < 8). Multivariable analysis showed that patients who felt to have received conflicting information about the treatment, patients with higher educational level and patients who were not sufficiently involved in the treatment choice had a higher odds of suboptimal adherence.ConclusionDOAC adherence was suboptimal. Conflicting information received from different healthcare providers (HCPs), lack of shared decision making and the patients’ educational level were determinants negatively affecting DOAC adherence.Practice implicationsEfforts towards identifying suboptimally adherent DOAC patients are needed since they are at higher risk to develop thromboembolic events. Adherence counselling should be systematically and repeatedly encouraged and shared decision making should become more mainstream. Moreover, reinforced education of both patients and HCPs combined with interprofessional collaboration are potential solutions to prevent knowledge gaps and communication of conflicting information.     

Association of age, health literacy, and medication management strategies with cardiovascular medication adherence

Objective

To examine patients’ use of medication management strategies (e.g., reminders, pill boxes), and to determine how their use influences the relationship between patient characteristics and medication adherence.

Methods

Retrospective and cross-sectional study of 434 patients with coronary heart disease, examining both refill adherence and self-reported adherence.

Results

The most common strategy for managing refills was seeing a near empty pill bottle (89.9%), and for managing daily medications, it was associating medications with daily events (80.4%). Age < 65 (OR = 1.7), as well as marginal (OR = 2.0) or inadequate health literacy (OR = 1.9), was independently associated with low refill adherence. Patients <65 also had lower self-reported adherence (OR = 1.8). Adjustment for use of medication management strategies did not substantially change these relationships. Reliance on reminders from friends or family to take medications, or waiting to refill a medicine only when the bottle was near empty, each were associated with 3-fold greater odds of non-adherence.

Conclusion

Age <65 and marginal or inadequate health literacy were independently associated with medication non-adherence. Use of medication management strategies did not explain these relationships.

Practice implications

The strategies which patients report using to assist with managing medication refills and daily medication use may be ineffective.     

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

BackgroundDespite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented.ObjectiveTo explore nurses’ experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation.MethodsThis investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.ResultsThree themes and nine sub-themes emerged: (1) “Choice as facilitator for shared understanding and engagement in patients’ own care,” with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) “enhancing the patients’ strengths,” with two sub-themes: releasing patient's internal strengths and confirming “normalcy” for the patient; and (3) “new challenges for the nurse,” with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges.ConclusionsFindings suggest that, from nurses’ perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses’ professional roles and created dilemmas such as nurses’ ambivalence regarding patients’ levels of disclosure of sensitive issues and the nurses’ ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.     

Participation in Clinical Research: Perspectives of Adult Patients and Parents of Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation

Despite major improvements over the past several decades, many patients undergoing hematopoietic stem cell transplantations (HSCT) continue to suffer from significant treatment-related morbidity and mortality. Clinical research studies (trials) have been integral to advancing the standard of care in HSCT. However, 1 of the biggest challenges with clinical trials is the low participation rate. Although barriers to participation in cancer clinical trials have been previously explored, studies specific to HSCT are lacking. The current study was undertaken to examine the knowledge, attitudes, and perceptions of HSCT patients regarding clinical trials. As members of focus groups, participants responded to open-ended questions that assessed factors influencing decision-making about HSCT clinical trials. Suggestions for improvements in the recruitment process were also solicited among participants. Seventeen adult HSCT patients and 6 parents of pediatric HSCT patients participated in the study. The median age was 56 years (range, 18 to 70) and 44 years (range, 28 to 54) for adult patients and parents, respectively. Participants universally indicated that too much information was provided within the informed consents and they were intimidated by the medical and legal language. Despite the large amount of information provided to them at the time of study enrollment, the participants had limited knowledge retention and recall of study details. Nevertheless, participants reported overall positive experiences with clinical trial participation and many would readily choose to participate again. A common concern among participants was the uncertainty of study outcome and general lack of feedback about results at the end of the study. Participants suggested that investigators provide more condensed and easier to understand informed consents and follow-up of study findings. These findings could be used to help guide the development of improved consent documents and enhanced participation in research studies, thereby affecting the future design of HSCT research protocols.     

Motivators,Barriers, and Facilitators to Weight Loss and Behavior Change Among African American Adults in Baltimore City: A Qualitative Analysis

Background

African American adults achieve smaller amounts of weight loss than their white counterparts when exposed to the same intervention and are more likely to regain weight during long-term follow-up.

The Health Literacy Management Scale (HeLMS): A measure of an individual's capacity to seek,understand and use health information within the healthcare setting

Objective

Health literacy refers to an individual's ability to seek, understand, and use health information. This paper describes the development and psychometric testing of the Health Literacy Management Scale (HeLMS).

Methods

Content areas were identified from a conceptual framework derived from interviews and concept mapping. Items were generated from statements from concept mapping participants. Construction (N = 333) and replication (N = 350) samples were participants in chronic disease self-management programs and emergency department attendees. Factor analysis was used to refine constructs and define psychometric properties.

Results

Consultations generated 8 scales each with 4–5 items: Understanding health information, Accessing GP healthcare services, Communication with health professionals, Being proactive and Using health information, Patient attitudes towards their health, Social support, and Socioeconomic considerations. Confirmatory factor analyses indicated good fit of the data with the model (RMSEA = 0.07, SRMR = 0.05, CFI = 0.97) and all domains had high internal consistency (Cronbach alpha > 0.82).

Conclusion

The HeLMS has acceptable psychometric properties and assesses a range of health literacy constructs important to patients when seeking, understanding and using health information within the healthcare system.

Practice implications

The HeLMS presents a new approach to assessing health literacy in healthcare settings.     

Patterns of family communication and preferred resources for sharing information among families with a Lynch syndrome diagnosis

Objectives

To explore patterns of communication among families with a Lynch syndrome diagnosis and understand what resources could facilitate family communication.

"Four Habits" goes abroad: report from a pilot study in Norway

OBJECTIVE: "Four Habits" is the first larger generic clinical communication program to have a documented effect. It has not been evaluated outside USA. In a pilot study, Norwegian hospital physicians assessed its usefulness, and we developed a questionnaire where patients reported "Four Habits"-specific physician behaviour. METHODS: We ran a 3-day course with 16 participants and three US facilitators. The questionnaire mapping "Four Habits" with 23 items was distributed by participating physicians to 210 patients. Participating physicians met in evaluative focus groups 3 months after the course. RESULTS: The questionnaire was condensed to 10 items after factorial analysis. The resulting scale performed well. A large amount of missing data on some items suggested that patients found it difficult to evaluate details of "Four Habits"-specific physician behaviour. Participants found that the "Four Habits" short course led to improvement of their encounters. Some elements of the method were not perceived as relevant for all types of encounters (habits II and III). CONCLUSION: "Four Habits" is applicable outside US with some adjustments. A shortened version of the questionnaire will be used in a planned randomized controlled trial.     

User preferences for and engagement with text messages to support antihypertensive medication adherence: Findings from a pilot study evaluating an emergency department-based behavioral intervention

ObjectiveWe examined users’ preferences for and engagement with text messages delivered as part of an emergency department (ED)-based intervention to improve antihypertensive medication adherence.MethodsWe recruited ED patients with elevated blood pressure for a pilot randomized trial evaluating a medication adherence intervention with text messages. Intervention participants chose text content and frequency, received texts for 45 days, and completed a feedback survey. We defined engagement via responses to texts. We examined participant characteristics associated with text preferences, engagement, and feedback.ResultsParticipants (N = 101) were 57% female and 46% non-White. Most participants (71%) chose to receive both reminder and informational texts; 94% chose reminder texts once per day and 97% chose informational texts three times per week. Median text message response rate was 56% (IQR 26–80%). Participants who were Black (p < 0.01), had lower income (p = 0.03), or had lower medication adherence (p < 0.01) rated the program as more helpful and wanted additional functionalities for adherence support.Conclusions and Practice ImplicationsWhile overall engagement was modest, participants at risk of worse health outcomes expressed more value and interest in the program. Findings inform the design of text messaging interventions for antihypertensive medication adherence and support targeting vulnerable patients to reduce health disparities.Clinical trials registrationNCT02672787     

The Phone: Communication in the Age of COVID-19

In April, as the COVID-19 outbreak intensified in New York City, a radiation oncology was redeployed to an internal medicine service. In this submission, he discusses his experience updating families on the statuses of their loved ones over the phone during the outbreak.     

Health-related information needs and preferences for information of individuals with cardiovascular disease from underserved populations: A systematic review

ObjectiveThis systematic review aimed to identify the information needs and preferences of individuals with CVD from underserved populations.MethodsFive databases were searched from data inception to February 2022. Pilot and case report studies, non-peer-reviewed literature, and studies published in a language other than English, Portuguese, or Spanish were excluded. Structured and thematic analysis of all included studies were performed. The Critical Appraisal Skills Program and the Downs and Black Checklist were used to assess the quality of the qualitative and quantitative studies, respectively.ResultsOf 35,698 initial records, 19 studies were included, most in observational design and classified as “fair” quality. Underserved populations – women, people living in rural areas, ethnic minority groups, older people, and those with low socioeconomic status – presented unique needs in four main groups, with some similarities across them: information about CVD, primary and secondary prevention of CVD, CVD management, and health care, policies and practices. Across the studies there was a lack of standardization on how individuals’ needs were assessed and reported.ConclusionUnderserved populations with CVD have unique information needs and preferences that should be address during their care.Practical implicationInformation from this study may assist health care professionals with the development of comprehensive strategies to improve their provision of care for specific CVD patient groups.     

Physician's gender,communication style,patient preferences and patient satisfaction in gynecology and obstetrics: A systematic review

Objective

Review of studies published in the last 10 years about women seeking gynecological- or obstetrical care and physician's gender in relation to patient preferences, differences in communication style and patient satisfaction.

Methods

Studies were identified by searching the online databases PubMed, PsycINFO, Embase and the Cochrane Library. The search strategies ‘gender’; ‘obstetrics’ and ‘gynecology’ were combined with ‘communication’; ‘physician–patient relations’; ‘patient preference’ and ‘patient satisfaction’.

Results

After screening title and abstract, evaluating full text and quality assessment, 9 articles were included in this review. Most patients preferred a female rather than a male gynecologist–obstetrician. This was partly explained by a more patient-centered communication style used by female gynecologists–obstetricians. Also experience and clinical competence were important factors in choosing a gynecologist–obstetrician. It was not clear whether patient's age or ethnicity influenced patients gender preference. Patient satisfaction increased when gynecologists–obstetricians used a patient-centered communication style.

Conclusion

Preference for a female gynecologist–obstetrician might be explained by a more patient-centered communication style used by female gynecologists–obstetricians. Using a patient-centered communication style increases patient satisfaction.

Practice implications

To increase patient satisfaction, gynecologists–obstetricians should learn to integrate patient-centered communication style into the consultation.