Provider–patient interaction in rural Cameroon—How it relates to the patient's understanding of diagnosis and prescribed drugs,the patient's concept of illness,and access to therapy

Objective

This cross-sectional survey examines the relation between provider–patient interaction and several patient-outcomes in a rural health district in Cameroon.

Methods

We used structured patient interviews and the Roter Interaction Analysis System (RIAS) for analysis of audio-recorded consultations.

Results

Data from 130 primary care consultations with 13 health-care providers were analysed. 51% of patients correctly named their diagnoses after the consultation; in 47% of prescribed drugs patients explained correctly the purpose. Patients’ ability to recall diagnoses was related to the extent of clarity a provider used in mentioning it during consultation (recall rates: 87.5% if mentioned explicitly, 56.7% if mentioned indirectly and 19.2% if not mentioned at all; p < 0.001). Two thirds of patients were able to describe their concept of illness before the consultation, but only 47% of them mentioned it during consultations. On average patients who mentioned their disease concept were faced with more remarks of disapproval from providers (1.73 vs 0.63 per consultation; p < 0.01). Although 41% of patients admitted problems with financial resources to buy prescribed drugs, discussion about financial issues was very rare during consultations. Providers issued financial questions in 32%, patients in 21% of consultations.

Conclusion

This study shows that provider–patient interaction in primary health care in a rural Cameroon district deserves more attention. It might improve the patients’ knowledge about their health condition and support them in beneficial health behaviour.

Practice implications

Our findings should encourage providers to give more medical explanation, to discuss patients’ health beliefs in a non-judgemental manner, and to consider financial issues more carefully.     

Avoiding the term ‘obesity’: An experimental study of the impact of doctors’ language on patients’ beliefs

Objective

GPs sometimes use euphemisms rather than medical terms. The present study aimed to explore the relative impact of using the term ‘obese’ compared to GPs’ preferred euphemism on patients’ beliefs about the problem.

Methods

A cross sectional survey followed by an experimental study was used with two conditions: the term ‘obese’ versus the GPs’ preferred euphemism. In the cross sectional survey, GPs’ (n = 19) described their preferred use of term. In the experimental study, patients (n = 449) from one General Practice in West London then completed a set of ratings about their beliefs following a vignette using either the term ‘obese’ or the GPs’ preferred euphemism.

Results

The first stage of the study showed that GPs avoided using the term ‘obese’ and preferred to use a euphemism. The most commonly used euphemism was ‘your weight may be damaging your health’. The second stage showed that the term ‘obese’ made patients believe that the problem had more serious consequences and made them feel more anxious and upset than when the same symptoms were labelled using the euphemism. When analysed according to the patient's own BMI, however, the results showed that the term ‘obese’ had a greater emotional impact than the euphemism only on patients who were not obese; obese patients found the euphemism more upsetting.

Conclusion

GPs avoid using the term ‘obese’ for fear of upsetting patients. This term, whilst making the problem appear more serious is only more upsetting for non-obese patients.

Practice implications

GPs choice of term therefore needs to reflect whether they want the patients to be upset or whether they want them to accept the seriousness of their problem.     

Unraveling the relationship between literacy,language proficiency,and patient–physician communication

Objective

To examine whether the effect of health literacy (HL) on patient–physician communication varies with patient–physician language concordance and communication type.

Methods

771 outpatients rated three types of patient–physician communication: receptive communication (physician to patient); proactive communication (patient to physician); and interactive, bidirectional communication. We assessed HL and language categories including: English-speakers, Spanish-speakers with Spanish-speaking physicians (Spanish-concordant), and Spanish-speakers without Spanish-speaking physicians (Spanish-discordant).

Results

Overall, the mean age of participants was 56 years, 58% were women, 53% were English-speakers, 23% Spanish-concordant, 24% Spanish-discordant, and 51% had limited HL. Thirty percent reported poor receptive, 28% poor proactive, and 56% poor interactive communication. In multivariable analyses, limited HL was associated with poor receptive and proactive communication. Spanish-concordance and discordance was associated with poor interactive communication. In stratified analyses, among English-speakers, limited HL was associated with poor receptive and proactive, but not interactive communication. Among Spanish-concordant participants, limited HL was associated with poor proactive and interactive, but not receptive communication. Spanish-discordant participants reported the worst communication for all types, independent of HL.

Conclusion

Limited health literacy impedes patient–physician communication, but its effects vary with language concordance and communication type. For language discordant dyads, language barriers may supersede limited HL in impeding interactive communication.

Practice implications

Patient–physician communication interventions for diverse populations need to consider HL, language concordance, and communication type.     

团体咨询消解大学生交流恐惧的研究

目的 :探讨团体咨询对消解大学生交流恐惧的有效性及可行性。方法 :以团体咨询的形式对 12名与人交流时存在恐惧或焦虑的大学生进行为期 9周的训练 ,实验前后分别测查PRCA - 2 4、PRCS、FNE、SAD及SCL - 90中的人际敏感、抑郁、焦虑和恐怖 4个分量表 ,同时通过主观评价量表判断团体咨询的效果 ,团体咨询结束 5个月后对被试予以追踪调查。结果 :经 9周团体咨询后 ,除FNE量表无显著差异外 ,其余量表及自评测量项目表现为明显改善 (P <0 .0 5 ) ,追踪评估结果提示团体咨询活动结束 5个月后效果依然存在。结论 :团体咨询方法对消解大学生交流恐惧是有效的、可行的     

Medicine 2.0: social networking, collaboration, participation, apomediation, and openness

In a very significant development for eHealth, broad adoption of Web 2.0 technologies and approaches coincides with the more recent emergence of Personal Health Application Platforms and Personally Controlled Health Records such as Google Health, Microsoft HealthVault, and Dossia. "Medicine 2.0" applications, services and tools are defined as Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies and/or semantic web and virtual reality approaches to enable and facilitate specifically 1) social networking, 2) participation, 3) apomediation, 4) openness and 5) collaboration, within and between these user groups. The Journal of Medical Internet Research (JMIR) publishes a Medicine 2.0 theme issue and sponsors a conference on "How Social Networking and Web 2.0 changes Health, Health Care, Medicine and Biomedical Research", to stimulate and encourage research in these five areas.     

Information and Communication Technology to Support Self-Management of Patients with Mild Acquired Cognitive Impairments: Systematic Review

Background

Mild acquired cognitive impairment (MACI) is a new term used to describe a subgroup of patients with mild cognitive impairment (MCI) who are expected to reach a stable cognitive level over time. This patient group is generally young and have acquired MCI from a head injury or mild stroke. Although the past decade has seen a large amount of research on how to use information and communication technology (ICT) to support self-management of patients with chronic diseases, MACI has not received much attention. Therefore, there is a lack of information about what tools have been created and evaluated that are suitable for self-management of MACI patients, and a lack of clear direction on how best to proceed with ICT tools to support self-management of MACI patients.

Objective

This paper aims to provide direction for further research and development of tools that can support health care professionals in assisting MACI patients with self-management. An overview of studies reporting on the design and/or evaluation of ICT tools for assisting MACI patients in self-management is presented. We also analyze the evidence of benefit provided by these tools, and how their functionality matches MACI patients’ needs to determine areas of interest for further research and development.

Methods

A review of the existing literature about available assistive ICT tools for MACI patients was conducted using 8 different medical, scientific, engineering, and physiotherapy library databases. The functionality of tools was analyzed using an analytical framework based on the International Classification of Functioning, Disability and Health (ICF) and a subset of common and important problems for patients with MACI created by MACI experts in Sweden.

Results

A total of 55 search phrases applied in the 8 databases returned 5969 articles. After review, 7 articles met the inclusion criteria. Most articles reported case reports and exploratory research. Out of the 7 articles, 4 (57%) studies had less than 10 participants, 5 (71%) technologies were memory aids, and 6 studies were mobile technologies. All 7 studies fit the profile for patients with MACI as described by our analytical framework. However, several areas in the framework important for meeting patient needs were not covered by the functionality in any of the ICT tools.

Conclusions

This study shows a lack of ICT tools developed and evaluated for supporting self-management of MACI patients. Our analytical framework was a valuable tool for providing an overview of how the functionality of these tools matched patient needs. There are a number of important areas for MACI patients that are not covered by the functionality of existing tools, such as support for interpersonal interactions and relationships. Further research on ICT tools to support self-management for patients with MACI is needed.     

Patients feeling severely affected by multiple sclerosis: How do patients want to communicate about end-of-life issues?

Objective

Investigate multiple sclerosis patients’ desire to communicate with their physicians about their disease progression and end-of-life issues.

Methods

Persons meeting the inclusion criteria of feeling severely affected by MS were invited via the German MS society to complete a needs questionnaire. Replies to questions on physician empathy and wishes about communication regarding disease progression and death and dying were quantitatively analyzed. Endpoints (point 1 + 2/4 + 5) of 5-point-likert scales are summarized under results.

Results

573 of 867 questionnaires meeting our criteria were analyzed. In response to a general question 64% (n = 358) indicated a wish for disease progression and death and dying to be addressed by their doctor. A majority (76%, n = 427) considered it important that progression of their disease be discussed, while 44% (n = 246) regard addressing death and dying as unimportant. No objective disease criteria could be identified to explain the wish for communicating end-of-life issues. Doctors who were retrospectively viewed as avoiding raising critical aspects of the illness were perceived as less empathetic (p < 0.001).

Conclusion

People with MS have a desire to talk about progression of their disease with their doctors.

Practice implications

Physicians should be empathetic in raising critical aspects of the patients’ illness individually.     

Should questionnaires of female sexual dysfunction be used in routine clinical practice?

Aims

The aim of this paper is to explore the potential value of questionnaires in routine clinical practice to assess female sexual dysfunction (FSD), and to identify if this could increase the competence of a physician in the initial management of women with these problems. The rationale to encourage Health Care Professionals (HCPs) to engage women in dialogue about their sexual health is that it may enhance a woman's quality of life (which may lead to improved general health) and might lead to timely interventions and possible preventative measures for certain diseases.

Method

A short literature review of the most relevant publications was undertaken evaluating current practice.

Results

FSD can have a negative impact on women's well-being and can also be an early symptom of underlying disease. Many HCPs do not broach the subject, consequently women do not get the opportunity either to voice their sexual concerns or access appropriate services. Review of currently available FSD questionnaires suggests that many but not all are generally inappropriate for use in routine clinical practice. Kriston et al.’s [1] STEFFI-2 may be an appropriate starting point. Evidence suggests that this would facilitate discussion of sexual matters between the HCP and the women, and increase the likelihood of FSD being diagnosed.

Conclusions

Following this review of the literature, the authors strongly recommend that HCPs include FSD questionnaires as part of their routine engagement with women. However, the questionnaire would need to be used as part of the overall assessment and cannot replace a detailed case history and examination, which should lead to effective treatment and management of FSD. The authors recommend further research in the following areas:

•

Effective training for HCPs.

•

FSD as an early presentation of sub-clinical disease.

•

The cost-benefit of early treatment of FSD.

•

A standardised, validated FSD screening tool.

•

Benefits of using FSD screener in routine clinical practice.

     

Developing a model of decision-making about complementary therapy use for patients with cancer: A qualitative study

Objective

To improve our understanding of patient participation in health care consultations and decision-making by exploring a consultation that lies at the interface between mainstream care and complementary therapies.

Methods

Thirty-four holistic consultations were observed at centres offering complementary therapies for cancer, followed by interviews with patients and focus groups with professionals.

Results

A model of decision-making about complementary therapy use emerged from the data: ‘Advice: Assessor led decision’, ‘Confirmation: Joint decision’, ‘Access: Patient-led decision’ and ‘Informed: Patient-led decision’. Decision-making style was contingent on identifiable communication strategies in the preceding information-sharing and discussion phases of the consultation.

Conclusion

This study confirms the importance of gauging patients’ preferences for level of participation in decision-making. Models of consultations are generally based on the assumption that a greater degree of patient participation is a good thing that access to information and decision-making power is sought by all patients. Data from this study suggest that, in this context at least, this is not necessarily the case. The study also stresses the dynamic nature of the consultation, in which roles are fluid rather than fixed.

Practice implications

Insight were gained into professionals’ communication strategies and patients’ role preferences in decision-making, which may be applicable more widely.     

Training faculty to facilitate communication skills training: development and evaluation of a workshop

OBJECTIVE: To develop a workshop for training faculty to facilitate small group role play sessions for a communication skills training program and assess the impact of that workshop on the trainees' self-efficacy about facilitation skills. METHODS: A multi-specialty group of 33 attending physicians at a Comprehensive Cancer Center were trained in a Facilitating Communication Skills Training workshop in order to prepare them to facilitate small group role play with fellows and residents. The workshop curriculum was based on theory and literature on teaching communication skills. RESULTS: The workshop had a significant effect on participants' self-efficacy in facilitating communication skills training. At least 75% of participants reported feeling comfortable facilitating communication skills training small groups. CONCLUSION: This facilitation workshop was successful in providing participants with confidence to successfully facilitate small group role play sessions in communication skills training. PRACTICE IMPLICATIONS: In order to evaluate the effectiveness of communication skills training programs, it is important to have trained facilitators who adhere to a set of facilitation guidelines. Workshops on facilitation skills provide the background and practice time necessary as a first step in the training process.