The Patient–Provider Relationship: Predictors of black/African American Cancer Patients’ Perceived Quality of Care and Health Outcomes

ABSTRACT

We examined whether the patient–provider relationship (PPR) is associated with Black survivors’ health outcomes and whether this association was mediated by the quality of care. The outcome variables were survivors’ quality of care and health outcome, and the predictor variable was PPR (communication, emotional support, time spent, and survivors’ shared-decision making). A sample of 223 Black cancer survivors (age 63.0 ± 14.0 years) provided evaluable data. The most common cancer types reported by the participants were: gynecologic (32.7%), genitourinary (21.5%), and gastrointestinal cancers (11.2%). After controlling for covariates. A Structural Equation Model (SEM) showed that PPR was significantly associated with both health outcome (p = .015) and quality of care (p = .002). When PPR and quality of care were tested in the mediation model, the direct association between PPR and health outcome was attenuated, and it was no longer significant (b = ?0.05, SE = 0.11, p = .65). However, indirectly, there was a strong association between PPR and health outcome through the quality of care (b = 0.22, SE = 0.08, p = .003), indicating full mediation. Providers’ interpersonal relationships had a significant influence on the health of Black survivors, and this influence may be due to the increased positive perception of the quality of care. The implications of these findings for further research are discussed.     

The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication,Patient Care Processes,and Patient Outcomes

Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians (“techs”) and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.     

Predictors of Satisfaction With Doctor and Nurse Communication: A National Study

Prior research indicates that effective communication between medical providers and patients is associated with a number of positive patient outcomes, yet little research has examined how ecological factors (e.g., hospital size, local demographics) influence patients’ reported satisfaction with doctor and nurse communication. Given the current emphasis on improving patient satisfaction in hospitals across the United States, understanding these factors is critical to interpreting patient satisfaction and improving patient-centered communication, particularly in diverse and dense populations. As such, this study examined county-level data including population density, population diversity, and hospital structural factors as predictors of patient satisfaction with doctor and nurse communication. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), U.S. Census data, and number of hospital beds were obtained from publicly available Hospital Compare, U.S. Census, and American Hospital Directory websites, respectively. Multivariate regression modeling was performed for the individual dimensions of HCAHPS scores assessing doctor and nurse communication. Standardized partial regression coefficients were used to assess strengths of county-level predictors. County-level factors accounted for 30% and 16% of variability in patient satisfaction with doctor and nurse communication, respectively. College education (β = 0.45) and White ethnicity (β = 0.25) most strongly predicted a favorable rating of doctor and nurse communication, respectively. Primary language (non-English speaking; β = ?0.50) most strongly predicted an unfavorable rating of doctor communication, while number of hospital beds (β = ?0.16) and foreign-born (β = ?0.16) most strongly predicted an unfavorable rating of nurse communication. County-level predictors should be considered when interpreting patient satisfaction with doctor and nurse communication and designing multilevel patient-centered communication improvement strategies. Discordant findings with individual-level factors should be explored further.     

The Relative Importance of Provider,Program, School,and Community Predictors of the Implementation Quality of School-Based Prevention Programs

Previous research has demonstrated the importance of a variety of factors on the implementation of school-based prevention programs, specifically characteristics of program providers, program structure, school climate, and school and community structure. The current study expands this research by examining the potential relationships between all of these factors and implementation quality in a series of multilevel models. Using data from a nationally representative sample of 3,730 program providers surveyed in 544 schools, it was found that program structure characteristics were of greater importance in the prediction of high quality implementation than were characteristics of the program providers, school climate, and school and community structure. Implications of these findings are discussed.     

护士在护患沟通中行为态度对住院患者焦虑抑郁的影响

目的：探讨护士在护患沟通中的行为态度对住院患者焦虑抑郁的影响。方法：以某综合医院2008年1个月内不同科室住院病人为干预对象,采用前后对照方法,比较干预前后护士行为态度得分对病人焦虑、抑郁得分的影响。结果：调查病人483人,干预前焦虑、抑郁平均得分分别为9.32±3.21分、9.38±3.49分;干预后焦虑、抑郁平均得分分别为5.73±3.05分、5.39±4.31分,随着护士行为态度分值的升高,病人焦虑、抑郁得分有降低趋势,有统计学意义。结论：在护患沟通中护士良好的行为态度能减轻住院患者焦虑抑郁状况。     

Psychosocial Problems in Primary Care: Patient and Provider Perceptions

Primary care physicians and clinics have become the frontline of health care for most Americans—they are the first point of contact and the source of both treatment and referrals. Psychosocial problems, such as difficulty with finances, family, housing, and work, are associated with a high demand for medical care in primary care practice, yet little is known about the prevalence of psychosocial problems in primary care settings. The purpose of this study is to assess the type and level of psychosocial problems in primary care patients by examining patient and provider perceptions at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS). A purposive sample of 684 veterans and a convenience sample of 59 providers anonymously completed the Social Needs Checklist. Patients reported an average of five psychosocial problems, with finances, personal stress, transportation, employment, and legal issues being the most prevalent. Thirty-two percent of patients indicated a desire to see a social worker. Provider and patient differences were compared. Provider estimates of patients' problems were consistently lower than patient estimates in all psychosocial problem areas except need for nursing home placement and problem drinking or drug use. Implications for social work in primary care are discussed.     

坚持以病人为中心 改善医疗服务质量

为探讨以病人为中心，及时更新观念，提高医疗质量，本文阐述了围绕以病人为中心，更新医疗服务观念；强化以病人为中心，树立新型工作导向；确立以病人为中心，提高医疗服务质量，为在新形势下，坚持以病人为中心，进一步提高医疗服务质量提供经验。     

Conditions of Caregiving, Provider Nurturance and Quality Care

Participants included 36 licensed family day care providers from six rural counties who had been providing care for a mean of 8.3 years (SO = 6.8 years). Fourteen of the providers had earned high school diplomas; twenty-two had some post high school education. At least one child from an economically strained home (as measured by AFDC receipt) was present in 44.4% of the FDC homes.

Dependent measures included: The Caregiver Interaction Scale (Arnett, 1989); Elaboration Scale from The Family Day Care Rating Scale (FDCRS, Harms and Clifford, 1989); FDCRS Total Score; and FDC program structure (e.g. frequency of enrichment activities, Kontos and Riessen, 1993). Professional self-perceptions and perceptions of job significance were assessed by self-report (adapted from Whitebook, Howes and Phillips, 1990).

Provider nurturance was influenced by the presence of children from economically strained homes and by provider education levels. Positive provider self-perceptions negatively influenced program structure. When provider self-perceptions were high, but when day care clients were experiencing economic strain, program structure involved fewer enrichment activities such as field trips, painting, singing, etc.     

Mental Health Screening Results Associated with Women Veterans' Ratings of Provider Communication,Trust, and Care Quality

Background

Identifying factors influencing patient experience and communication with their providers is crucial for tailoring comprehensive primary care for women veterans within the Veterans Health Administration. In particular, the impact of mental health (MH) conditions that are highly prevalent among women veterans is unknown.

Better Self-report Health Status and Provider–Patient Communication in Dental Service Can Improve the Patient Experience: A Cross-year Comparison from the NHI Survey

ABSTRACT

Several factors, including healthcare outcomes and quality, influence patients’ expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012–2016. This study used the annual NHI survey to explore patients’ experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83–10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients’ experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients     

Communication,Aging, and Health: Toward Understanding Health Provider Relationships with Older Clients

This special issue on communication, aging, and health draws attention to the ways in which communication issues are central to the health and health care of older adults. This introduction provides a theoretical framework for the other articles in this issue based on the Communication Predicament of Aging model, and it highlights priorities for future collaborative interdisciplinary studies.     

Enhanced Provider Communication and Patient Education Regarding Return to Work in Cancer Survivors Following Curative Treatment: A Pilot Study

Background: For employed cancer survivors, returning to work and maintaining employment is an important aspect of their quality of life. We developed an intervention aimed at enhancing this by means of (a) providing the patient with an educational leaflet on return to work and (b) enhancing communication between attending and occupational physicians. The purpose of this study is to test the feasibility of this intervention and to examine the relation of patient adherence to the advice of the leaflet and return to work. Methods: A patient series of 35 employed cancer survivors was used to evaluate the intervention. Survivors completed a baseline questionnaire prior to their treatment. Survivors and occupational physicians were interviewed by telephone eight weeks following all curative treatment. Our measure of feasibility included satisfaction of survivors with the intervention, adherence to the advice, time to return to work, satisfaction of occupational physicians with the intervention, and perceived influence on their rehabilitation efforts. Results: Interviews of 26 survivors and 24 occupational physicians, revealed that those groups perceived the leaflet as useful (i.e., 7 on a 0–10 scale. Also seven out of ten suggestions in the leaflet was adhered to and half of the occupational physicians perceived the guidance they provided was helpful. However there was no effect of level of adherence on actual return to work. Conclusion: This pilot study demonstrated the feasibility of the approach used. However level of adherence to eduactional leaflet was not associated with an improvement in return to work in cancer survivors.     

The Role of Written Provider Communication in External Client Participation

Abstract

In certain classes of services, the client's role in the service delivery process often extends beyond the face-to-face exchange. With compliance dependent services (CDS), the client is expected to continue to perform for him or herself once away from the service provider in order to ensure positive outcomes and customer satisfaction (Dellande and Gilly, 1998). This study examined the effectiveness of written provider communication in influencing client motivation and role clarity in CDS. Two exploratory investigations examining written provider communication were conducted. In study 1, written material of three different types of health care related CDS (dialysis, prenatal care and weight loss) were examined; in study 2, dialysis written material was further examined. The findings suggest that, in the majority of the materials examined, written provider communication does not seem to clearly communicate the consequences of noncompliance (a source of customer motivation). However, the materials examined were effective in clarifying the client's external service roles.