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.     

Patient affect,physician liking for the patient,physician behavior,and patient reported outcomes: A modeling approach

ObjectiveTo determine associations between patient affect and physician liking of the patient, and their associations with physician behavior and patient-reported outcomes.MethodsStructural equation modeling based on coding of 497 videotaped hospital encounters, with questionnaires assessing pre-visit patient affect, post-visit patient affect and encounter evaluations, and physician liking of the patient, involving 71 physicians.ResultsIn first visits, patient reported outcomes were strongly correlated with physician behavior and less so with physician liking, while in later visits, patient reported outcomes were directly related to physician liking and not mediated by physician behavior. Physician liking predicted physician behavior, more for female physicians in first visits. Patient negative affect before the visit was negatively associated with male physicians’ liking. When acquainted, both patient positive and negative affect were associated with physician liking.ConclusionPhysician liking of the patient plays a dynamic role in a consultation, is influenced by patient pre-encounter affect, and influences physician behavior. The dynamics are different in first and later visits, and influenced by physician gender.Practice implicationsPhysicians should be aware how patient affect influences their behavior, and administrators should take any prior relationship between patient and physician into account when evaluating patient reported outcomes.     

The impact of gender on medical visit communication and patient satisfaction within the Japanese primary care context

Objective

This study was designed to address significant gaps in the predominantly western-centric research literature by examining the influence of gender concordance in medical communication and patient satisfaction within the Japanese context.

A personalized mobile patient guide system for a patient-centered smart hospital: Lessons learned from a usability test and satisfaction survey in a tertiary university hospital

ObjectiveThe present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information.Materials and methodsThe present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively.ResultsWe confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service.ConclusionThe innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system.     

Talking about depression: An analogue study of physician gender and communication style on patient disclosures

Objectives

To disentangle the effects of physician gender and patient-centered communication style on patients’ oral engagement in depression care.

Methods

Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS).

Results

Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p < .05). APs were more willing to continue treatment with gender-discordant HPC physicians (p < .05). No effects were evident in the LPC condition.

Conclusions

Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender.

Practice implications

High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.     

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.

Affect and neutrality in physician behavior: A study of patients' values and satisfaction

Physicians' emotional expressivity was contrasted with emotional neutrality in a study of consumers' preferences regarding physician behavior in the medical encounter. Two hundred twenty-seven health-science students completed instruments designed to measure the values they held regarding physicians' emotional expressions as well as their perceptions of and satisfaction with the emotional behavior of a physician presented in a videotape simulation. Overall, consumers attached a low value to neutrality and preferred affective behavior to it, although their previously held values did significantly influence their degree of satisfaction with neutral behavior by the physician. Values did not influence recognition of or satisfaction with the nonneutral emotions. This research also shed light on consumer reactions to other emotions including reassurance and humor.The authors would like to thank Barbara Leake, Ph.D., for her assistance with computer analyses. This research was partially supported by Intramural Research and Intercampus Opportunity Grants from the University of California, Riverside.     

Adapting a patient satisfaction instrument for low literate and Spanish-speaking populations: comparison of three formats

Objective

To compare responses to print versions of the Consumer Assessment of Healthcare Providers and Systems 2.0 survey (CAHPS™) to those for an illustration enhanced format and a telephone based interactive voice response format.

Methods

First, 2015 adult patients awaiting primary care visits completed: demographic information, Test of Functional Health Literacy (S-TOFHLA), CAHPS in one of three formats: print, illustrated, or interactive voice. A second sample of 4800 active patients was randomized to receive alternative formats.

Results

Response rates for the illustrated (31.3%) and print (30.4%) formats were significantly higher than for the interactive voice format (18.1%). The results of the illustrated format were comparable to the traditional text version, but required about 2 min more to complete by both low and high literacy groups. There were almost no invalid responses for the interactive voice format, but the format was associated with lower CAHPS satisfaction scores.

Conclusion

Despite extensive efforts to produce formats tailored to individuals with limited literacy, surprisingly we found no consistent advantages to either alternative format. In fact, the interactive voice format yielded lower satisfaction scores and lower response rates.

Practice implications

Practitioners need to ensure the health instruments they use are aligned with literacy skills and delivery preferences of their consumers. The lack of benefit of the illustrated form does not support investment of resources in these formats to measure satisfaction. The interactive voice response deserves more study—do lower scores register limited access to or use of telephones, irritation or true signal?     

Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study

ObjectivesGender bias interferes with medical care for both men and women, leading to health inequalities. Reflexivity is used in medical education to improve health provision. This study aims to understand if a reflective approach integrated in medical practice enables raising awareness of gender bias during medical school teaching.MethodsWe conducted this study in general ambulatory medicine in Lausanne Hospital, Switzerland with 160 Master’s students. Through group discussions and reflection questionnaires, students were asked to discuss clinical cases they encountered focusing on potential gender bias. We analyzed the data using a thematic analysis approach.ResultsThe reflection on the clinical reasoning steps from a real case identified gender bias at each stage of the clinical case management. The analysis revealed two factors that facilitated gender reflexivity: guidance from a gender expert and peer-to-peer exchange.ConclusionsOur study shows that a reflective approach integrated in medical practice enables raising awareness of gender bias during medical teaching. It provides students with a systematic method they can apply in their future clinical work, thus improving care processes and experiences towards more equitable care.Practice implicationsAll gender and medicine curricula should include teaching such as this linking theory and practice through reflexivity.     

The impact of the use of video-based educational interventions on patient outcomes in hospital settings: A scoping review

Objective

To summarize the literature on the impact of video-based educational interventions on patient outcomes in inpatient settings as compared to standard education techniques.

Characteristics of teach-back as practiced in a university health center,and its association with patient understanding,self-efficacy,and satisfaction

ObjectivesThe purpose of this research was to investigate the extent to which recommended characteristics of teach-back were employed by providers in a university Student Health Services department, and to evaluate its association with patient understanding, self-efficacy, and satisfaction.MethodThe study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded for presence and characteristics of teach-back. Patients and providers filled out post-encounter questionnaires.ResultsWhen teach-back was used, most recommended characteristics of teach-back were regularly employed. However, providers rarely placed the onus for understanding on themselves, and almost never “closed the loop” by asking patients to repeat back information until they got it correct. Teach-back was associated with higher patient self-efficacy, and high fidelity of implementation with better patient understanding of the reason for the treatment plan.ConclusionsFindings add to existing evidence regarding effectiveness of teach-back. Additional benefits may be realized when implementation is true to recommended characteristics. More research is needed into the necessity of closing the loop and placing onus on the provider.Practice implicationsGiven that neither patients nor providers accurately gauged the level of patient understanding in the medical encounter, teach-back may offer a simple, quick means of reinforcing provider health information and raising patient self-efficacy.     

The patient perspective,experience and satisfaction of day case unicompartmental knee arthroplasty: A short-term mixed-methods study

BackgroundDay case unicompartmental knee arthroplasty (UKA) is increasingly being performed worldwide. When performed in the appropriate patient, day case UKA has been demonstrated to be safe, cost effective and improve resource allocation. Limited evidence highlights increased patient satisfaction of day case UKA when compared with inpatient UKA. A detailed study of the patient perspective, experience and satisfaction following day case UKA has not been described before.MethodsA retrospective case series review of 21 consecutive patients (19 unilateral, 2 bilateral) undergoing day case UKA in an elective orthopaedic centre was undertaken. A qualitative and quantitative patient assessment of the day case UKA experience was administered. A five-point Likert scale satisfaction questionnaire, Oxford Knee Score (OKS) and open-ended interview was undertaken. The qualitative responses underwent thematic analysis.ResultsOne hundred percent of patients expressed satisfaction (76.2% completely satisfied, 33.8% moderately satisfied) with day case UKA. The majority of patients (90.5%) reported that if they had to undergo UKA again they would prefer a day case over an inpatient procedure. Patients consider surgical outcome, physiotherapy provision, discharge planning, postoperative medications and follow up as key aspects of day case UKA care. One patient was re-admitted following discharge.ConclusionsThe present study demonstrates a high level of patient satisfaction with day case UKA. The results reported herein are subject to the study limitations of sample size, recall bias and inclusion criteria. We recommend that the themes identified by patients are addressed through a multidisciplinary approach with well-defined clinical pathways for a high-quality patient-centred experience.     

Development,validation and evaluation of a patient information booklet for rectal cancer survivors with a stoma: A three-step approach

ObjectiveQuantitatively measure the degree of patient satisfaction and perceived acquired knowledge through the development of a patient information booklet for rectal cancer survivors with a stoma, according to a novel three-step approach.MethodsThe study included a systematic literature review to identify relevant information for the booklet, which was validated by experts based on relevance, clarity and essentiality. It underwent testing on quality, readability, and layout and design and was quantitatively evaluated by rectal cancer survivors with a stoma.ResultsIn total, 145 articles were used for the development of the booklet. It scored 91% for relevance according to 17 experts, 70% for readability, 75.63% for quality and 23 out of 32 for design. The mean score of patient satisfaction was 8.03 out of 10. All 20 patients found the booklet ‘useful’ and 95% felt better informed.ConclusionsThe booklet scored high for patient satisfaction and increased perceived acquired information. It ensured satisfactory levels of quality, readability, and layout and design.Practice implicationsThis study offers a novel three-step approach for development of informational tools for cancer survivors, assuring that a variety of newly created written patient materials would be of increased quality and relevance to any target population.     

The effects of an informational video on patient knowledge,satisfaction and compliance with venous thromboembolism prophylaxis: A pilot study

Objective

Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. Educational videos have been effectively used to increase patient satisfaction and knowledge. This study examined possible benefits of an educational video about VTE.

Methods

Medical patients receiving VTE prophylaxis were screened within 48 h of admission. Upon enrollment, patients were randomly assigned to either watch a 5 min educational video on VTE or not, in addition to standard VTE education. Within 24–48 h after randomization, all patients completed a survey assessing VTE prophylaxis knowledge and satisfaction.

Results

Patients who watched the video averaged 83% correct responses to knowledge-based questions (regarding VTE risk, symptoms, and preventative measures) versus an average score of 62% for patients in the no video group (p < 0.001). Patients who watched the video were more satisfied with their VTE education (4.8 vs. 3.4 out of 5, p < 0.001).

Conclusion

This educational video effectively provided baseline information to patients about VTE and improved patient satisfaction.

Practice implications

A VTE educational video can be an effective tool for improving patient knowledge of the condition.     

Provider and patient intervention to improve weight loss: a pilot study in a public hospital clinic

OBJECTIVE: To assess the efficacy of a literacy-appropriate weight loss intervention targeting providers and patients in improving physicians' weight loss counseling and patients' self-reported beliefs, and self-efficacy. METHODS: The study took place in a public hospital nephrology clinic. The intervention included two physician workshops and a small group patient education. Physician-patient communication was observed and coded. Structured interviews assessed patient recall of weight loss recommendations, weight-related beliefs, and self-efficacy. RESULTS: 64 patient visits were observed before and after the intervention. 75% of patients were African American, 96% lacked private insurance, 71% had low literacy skills; mean body mass index (BMI) of 35 kg/m(2). Physician counseling improved significantly post-intervention, particularly in assessing, supporting and advising patients about weight loss and exercise. Patients reported increases in recall of weight loss recommendations and were more likely to report greater confidence about losing weight (52% vs. 70%, p<0.01). CONCLUSIONS: This pilot study offers promising directions to address provider and patient barriers to weight loss education and counseling in a public hospital. PRACTICE IMPLICATIONS: Hospital-based weight loss interventions need to target both physicians and patients.     

Attitudes toward and experiences of gender issues among physician teachers: A survey study conducted at a university teaching hospital in Sweden

Background  

Gender issues are important to address during medical education, however research about the implementation of gender in medical curricula reports that there are obstacles. The aim of this study was to explore physician teachers' attitudes to gender issues.     

Asthma in relation to personality traits, life satisfaction, and stress: a prospective study among 11,000 adults

BACKGROUND: While patients' personality has been thought to affect allergic diseases, the association of asthma and psychological factors is still debated. Stress is believed to predispose to asthma, but no clear evidence of causality has been found. We have studied the role of psychological factors in prevalent as well as in incident asthma cases among the adult population. METHODS: A total of 11540 adults initially aged 18-45 years responded to three questionnaires in 1975, 1981, and 1990, respectively. The association of psychological factors (including extroversion and neuroticism scales, subjective stress, and life satisfaction) and prevalent asthma was studied, as well as the predisposing effect of these factors on the risk of adult onset asthma. Logistic regression was used for risk calculations. RESULTS: Low life satisfaction was associated with asthma prevalence (age- and sex-adjusted OR=2.27: 1.04-4.93 for prevalent asthma among those with low life satisfaction compared to those with high life satisfaction), as was neuroticism (age and sex-adjusted OR=1.78:1.12-2.84 for those with a high neuroticism score compared to those with a low score). A high extroversion score was significantly associated with the risk of adult onset asthma among women (age-adjusted OR=2.72: 1.44-5.12 for new asthma among those with high score compared to those with a low extroversion score). CONCLUSION: No specific personality type is associated with adult onset asthma, but there is a significant sex difference in the effect of psychological factors in asthma risk. A high extroversion score is a strong predictor of incident asthma among women. Prevalent asthma decreases life satisfaction and is associated with a high neuroticism score.     

A qualitative study of patient choices in using emergency health care for long-term conditions: The importance of candidacy and recursivity

Objective

We aimed to explore how patients with long-term conditions choose between available healthcare options during a health crisis.

Methods

Patients in North-West England with one or more of four long-term conditions were invited to take part in a questionnaire cohort study of healthcare use. Semi-structured interviews were conducted with a sub-sample of fifty consenting patients. Data were analysed qualitatively, using a framework approach.

Results

Patients described using emergency care only in response to perceived urgent need. Their judgements about urgency of need, and their choices about what services to use were guided by previous experiences of care, particularly how accessible services were and the perceived expertise of practitioners.

Conclusion

Recursivity and candidacy provide a framework for understanding patient decision-making around emergency care use. Patients were knowledgeable and discriminating users of services, drawing on experiential knowledge of healthcare to choose between services. Their sense of ‘candidacy’ for specific emergency care services, was recursively shaped by previous experiences.

Practice implications

Strategies that emphasise the need to educate patients about healthcare services use alone are unlikely to change care-seeking behaviour. Practitioners need to modify care experiences that recursively shape patients’ judgements of candidacy and their perceptions of accessible expertise in alternative services.     

Barriers to patient participation in a self-management and education website Renal PatientView: A questionnaire-based study of inactive users

ObjectivesThe Renal PatientView (RPV) website is an information and education tool aimed at increasing patient involvement in their care. We have conducted this study to elucidate why some users remain inactive on RPV despite initially signing up for the service.MethodsPatients at a teaching hospital in United Kingdom, who originally signed up for RPV but are no longer active (no logins during previous 6 months), were sent paper questionnaires. Responses were collected for up to 6 months.ResultsOf the 190 questionnaires, 69 (39%) were returned partially or fully completed. Majority of respondents could access computer (94%) and internet (91%) from home. Reasons for inactivity among survey respondents included: loss of login credentials (45%), perception that it did not add anything to existing care (37%), being too busy (13%) and anxiety of viewing results from home (10%). Thirty-seven respondents provided free-text comments. Thematic analysis of these reinforced above findings and also indicated that despite infrequent use, some patients valued RPV availability. Patients made very little reference to using sections of the website other than test results.ConclusionsPatients find RPV a valuable resource. It is, however, mainly seen as a portal to check blood test results; other sections of the website aimed at promoting self-management remain underutilized. Several local and central level changes, such as a robust system of user accounts handling, improved promotion, and emphasis on further development of self-management sections of RPV may help improve participation.