The role of weight bias and role-modeling in medical students’ patient-centered communication with higher weight standardized patients

ObjectivePatients with obesity may experience less patient-centered care. We assessed whether medical students’ implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity.MethodsThird and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed.ResultsStudent perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=?0.19, p = 0.01), friendliness (b=?0.28, p < 0.001), responsiveness (b=?0.21, p = 0.002), respectfulness (b=?0.17, p = 0.003), interactivity (b=?0.22, p = 0.003), likelihood of being recommended by observers (b=?0.34, p < 0.001), and patient-centeredness index scores (b=?0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=?0.16, p = 0.03), recommendation likelihood (b=?0.22, p = 0.04), and patient-centeredness index score (b=?0.12, p = 0.03).ConclusionsNegative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity.Practice implicationsEfforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.     

Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar

ObjectiveWomen with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters.MethodsAs part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist.ResultsPatients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS.ConclusionFindings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making.Practice implicationsOncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings.     

Improving secure messaging: A framework for support,partnership & information-giving communicating electronically (SPICE)

BackgroundPatient-centered communication benefits patients and is widely endorsed. However, it is primarily associated with face-to-face contexts, although patients are increasingly using electronic platforms, such as secure messaging in patient portals, to communicate with providers.PurposeGiven the popularity of secure messaging and its ability to impact the patient-provider relationship, this study aimed to determine which attributes of patient-centered communication are most desired by cancer patients using secure messaging.MethodsA 2⁶ balanced incomplete block design discrete choice experiment was conducted using the best-worst scaling technique. Respondents were asked to select their most and least preferred attributes of two simulated patient-provider exchanges within each of eight choice sets.Results210 respondents indicated that either level of partnership (high and low) and either level of information-giving (high and low) were most preferred, while response times greater than 24 hours and low levels of support were least favored.ConclusionsSimilar to face-to-face communication, patients value aspects of patient-centered communication in the secure messaging setting and desire them to be included in provider replies.Practice ImplicationsPatient-centered communication is important to patients using secure messaging. Providers should incorporate SPICE (Support, Partnership, and Information-giving while Communicating Electronically).     

Family-centered communication: A pilot educational intervention using deliberate practice and patient feedback

ObjectiveThere are few opportunities in medical education dedicated to learning skills for effective communication in life altering patient scenarios. We therefore aimed to develop and assess a longitudinal advanced communication curriculum for pediatric residents using patient feedback and deliberate practice.MethodsPediatric residents at a large academic center were randomized into 2 groups. The intervention group received 6 educational sessions from 2019 to 2020, parent feedback of performance via the Communication Assessment Tool (CAT), and monthly communication tips. Communication skills of both groups were assessed at the end of the intervention.ResultsWe collected 937 CAT assessments on 36 first-year residents. The intervention group demonstrated statistically significant improvement in communication skills from pre to post assessment (p = 0.0063, (odds ratio (OR) 1.76, 95 % confidence interval (CI) [1.17, 2.63]) compared to the control group (p = 0.080, OR 1.41, 95 % CI [0.96, 2.05]).ConclusionsThere are patient and self-identified performance gaps in communication skills for pediatric residents, underscoring the need for formalized curricula dedicated to these skills.Practice implicationsOur study highlights the value of deliberate practice and the integration of family feedback as an educational tool in communication skills development.     

Parent-child emotion communication,attachment, and affective narratives

Forty-four pre-schoolers (ages 4.3 to 5.8 years) and their primary caregivers participated in a study on the connections between parent-child emotion communication and a narrative assessment of pre-schoolers' attachment. Children completed the Separation Anxiety Test (SAT), a narrative assessment of children's responses to attachment-related separations (including self-reliance, avoidance, attachment and coherence scores). Several aspects of parent-child discussions of emotion-eliciting events were also assessed in the Emotion Communication Task. Results indicated that SAT coherence was positively related to SAT attachment and negatively related to SAT avoidance. Furthermore, SAT coherence was positively related to parental scaffolding and negatively related to parental and child negativity during the Emotion Communication Task. Parental scaffolding and child reciprocity were positively related to each other and, in general, were negatively related to parental and child negativity. Discussion focused on the potential contributions of children's interactions with caregivers to the development of children's attachment narratives and emotion-related understanding.     

The effect of peer support approach on communication skills of nursing students in pediatric clinical setting

Peer support is a valuable teaching-learning approach to enhance deep learning in the clinical environment. The purpose of the present study was to investigate the effect of peer support on the communication skills of undergraduate nursing students when interacting with hospitalized children and their parents. This was a pre-and post-test quasi-experimental study with two groups. Through the cluster random sampling method, six practical groups of students who undertook a 3-week pediatric practicum were selected. Three groups were allocated to the experimental (n = 51) and control groups (n = 52). Two volunteer post-graduate students in pediatric nursing formed the peer group. First, the peers participated in three 45-min sessions using different scenarios about communication skills. They then tutored the intervention group to improve their communication skills. The communication skills with 5 children and 5 parents were observed for each undergraduate student via the checklist. The experimental group demonstrated significantly higher mean scores of the communication skills than the control groups in post-test (P < 0.001). Moreover, the mean scores of communication skills was significantly higher in post-test than pre-test in both the experimental and control groups (p < 0.001). Peer support approach promoted the communication skills of undergraduate nursing students in pediatric clinical setting.     

The Strategic Use of Noise in Pragmatic Reasoning

We combine two recent probabilistic approaches to natural language understanding, exploring the formal pragmatics of communication on a noisy channel. We first extend a model of rational communication between a speaker and listener, to allow for the possibility that messages are corrupted by noise. In this model, common knowledge of a noisy channel leads to the use and correct understanding of sentence fragments. A further extension of the model, which allows the speaker to intentionally reduce the noise rate on a word, is used to model prosodic emphasis. We show that the model derives several well-known changes in meaning associated with prosodic emphasis. Our results show that nominal amounts of actual noise can be leveraged for communicative purposes.     

Urinary endometriosis: MR Imaging appearance with surgical and histological correlations

ObjectivesThe goals of the study were to describe the MR imaging features of endometriosis of the urinary tract and identify those that suggest intrinsic involvement of ureteric wall.Materials and methodsThirty-five women with proven urinary tract endometriosis and who had preoperative MR imaging between 2001 and 2011 were included retrospectively. MR images were intrepreted by one junior and one senior radiologists. To characterize the intrinsic parietal involvement, the ureteric circumference involved by the lesion of endometriosis was noted.ResultsThirty-eight ureteric and 13 bladder lesions were analyzed. They were found in association in nine women. Ureteric lesions were bilateral in seven women. Of the 38 ureteric lesions, 27 were extrinsic and 11 intrinsic at histopathological analysis. Sixteen women with extrinsic lesions and 10 with intrinsic ones were correctly identified on MR imaging. When the ureter was included less than 360° in the lesion, extrinsic involvement was confirmed in 80% of cases.ConclusionMR imaging appears to be more sensitive (91%vs 82%) but less specific (59% vs 67%) than surgery for the diagnosis of intrinsic form of ureteric location.     

百日咳再现及其应对策略的研究进展

20世纪80年代国外将百日咳发病水平控制在低点后陆续出现百日咳发病反弹的报道,研究学者将该现象称为"百日咳再现"。"百日咳再现"对免疫规划时期百日咳的防控提出新的挑战。百日咳发病率上升的同时,其流行特征亦发生改变,原先的应对策略已无法满足"百日咳再现"的防控需求。该文将对国内外"百日咳再现"的流行病学特征、传播模式的改变、"百日咳再现"的原因及其应对策略进行综述,对我国面对"百日咳再现"的防控形势提出建议。     

Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

ObjectivesThis study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.MethodsWe use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.ResultsResults show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.ConclusionThese results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.Practice implicationsWe therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.