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Jackson JL, Murphy MG, Fletcher KE. The difficult inpatient, prevalence and characteristics. PATIENT EDUCATION AND COUNSELING 2025; 137:108785. [PMID: 40311178 DOI: 10.1016/j.pec.2025.108785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 03/04/2025] [Accepted: 04/12/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND Up to 18 % of ambulatory clinic patients are considered difficult by their primary care providers. Two qualitative studies suggest that inpatient medicine providers also commonly experience hospitalized patients as difficult. There have been no quantitative studies of how often hospitalized patients on medicine services are perceived as difficult. Our study purpose was to assess the prevalence and characteristics of difficulty. METHODS Hospitalized patients were randomly selected and their inpatient providers (hospitalist, non-hospitalist medicine faculty, medicine resident and interns) completed surveys on experiencing patients as difficult. Difficulty was rated on a dichotomous (yes/no) and continuous (0-10) scale. Characteristics extracted from the chart included patient demographics, cognitive status, Charlson comorbidity index, length of stay, and whether the patient had a chart diagnosis of depression, anxiety, PTSD, chronic pain, somatization disorders or personality disorders. RESULTS There were 322 surveys completed on 202 unique inpatients; 24.5 % were considered difficult. Age, mental health comorbidities (depression, anxiety), and medical complexity were not associated with being perceived as difficult. On multivariate analysis, personality disorders (OR: 5.4, 95 % CI: 2.6-10.9) and chronic pain (OR: 2.1, 95 % CI: 1.2-3.8) were the only characteristics independently associated with increased difficulty ratings. LIMITATIONS Single site, VA patients, potential response bias. CONCLUSION Medicine inpatients are commonly experienced as difficult by their providers. Chronic pain and personality disorders increased the likelihood of being experienced as difficult.
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Affiliation(s)
- Jeffrey L Jackson
- Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki VAMC, Milwaukee, WI, USA.
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2
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Quinn MA, Fletcher KE, Floden SL, Zelenski AB. A Visual Arts Activity to Support Residents as They Care for "Difficult Patients". J Grad Med Educ 2025; 17:89-95. [PMID: 39980952 PMCID: PMC11838048 DOI: 10.4300/jgme-d-24-00469.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 09/02/2024] [Accepted: 12/03/2024] [Indexed: 02/22/2025] Open
Abstract
Background Certain patients significantly challenge the care team, increasing the risk of burnout as clinicians struggle to perform their best work while meeting the needs of their patients. Imagining another's perspective, a clinical empathy skill, can increase compassion and lower distress when interacting with these patients. Objective To evaluate the effectiveness of an art-based perspective-taking activity on clinicians' feelings of discomfort when anticipating encounters with challenging patients. Methods This museum-based session was conducted from 2017 to 2022 (virtual sessions in 2020) by faculty trained in using arts-based methods to teach. Residents (n=142) in a university-based internal medicine residency program along with health professionals, trainees, and faculty (n=12) attending an international conference were invited to participate. Participants recalled a challenging patient, chose a piece of art that might be meaningful to this person, and discussed their choice and insights gained. Participants completed pre-post ratings of anticipated discomfort. Inaugural participants submitted written reflections on these ratings. Data were analyzed using paired t tests and content analysis. Results Five 90-minute sessions were conducted with 65 internal medicine residents and 12 faculty; 75 of 77 total participants completed pre-post discomfort ratings (response rate 97.4%). Anticipated discomfort decreased after sessions (mean pre=5.38; post=4.13; P<.01). Open-ended responses aligned with a transition from self to other focus in perspective-taking. Costs were minimized by using art from a campus museum, paper and pencil surveys, and faculty academic time. Conclusions This innovative visual arts-based activity to increase empathy for challenging patients is simple, feasible, self-contained, and cost-effective.
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Affiliation(s)
- Mariah A. Quinn
- Mariah A. Quinn, MD, MPH, is an Associate Professor, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and Chief Wellness Officer, UW Health, Madison, Wisconsin, USA
| | - Kathlyn E. Fletcher
- Kathlyn E. Fletcher, MD, MA, is a Professor, General Internal Medicine, Program Director, Internal Medicine Residency Program, and Co-Director of Graduate Medical Education Pillar, Kern Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah L. Floden
- Sarah L. Floden, MD, is an Assistant Professor, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Amy B. Zelenski
- Amy B. Zelenski, PhD, is an Associate Professor, Division of General Internal Medicine, and Director of Education Innovation and Scholarship, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Bilgic N, Avci MZ, Sutcu H. Exploring Nurses' Perceptions of Patients in the Workplace: The Case of Difficult Patients. Niger J Clin Pract 2025; 28:203-211. [PMID: 40326902 DOI: 10.4103/njcp.njcp_114_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 12/18/2024] [Indexed: 05/07/2025]
Abstract
BACKGROUND Communication is a vital aspect of life. It is vital that all healthcare professionals maintain reliable communication with their patients. AIM This study aimed to exploring how nurses perceive "difficult patients" in their work environments and their approaches to these patients. METHODS This is a cross-sectional study. Data were collected from nurses who participated in the study via social media platforms between March 15 and June 15, 2021. In addition to the introduction section, the data were gathered using the "Difficult Patients and Communication Form" and the "Difficult Patients Questionnaire." RESULTS Of 359 participating nurses, 274 (75.2%) reported encountering difficult patients. On average, they scored three (3) points on the Difficult Patient Questionnaire (DPQ) and its sub-dimensions, indicating that nurses face challenges in communicating with patients perceived as difficult. The majority of nurses identified patients who were non-communicative (73%, n = 200), refused treatment and cooperation (52.9%, n = 145), or had emotional problems (35.8%, n = 98). Nurses aged 51 and over showed statistically significant differences in the Patient Difficulty and Staff Discomfort subscales and in total scores on the Patient Difficulty Scale (P < 0.05). These nurses also reported encountering difficult patients less frequently, whereas those in both the private and public hospitals encountered them more often. Most nurses reported experiencing communication difficulties primarily in clinical settings (62.4%, n = 171) and during nursing practice (44.9%, n = 123). DATA ACCESS STATEMENT The research data supporting this publication are available from Google Drive. CONCLUSION Nurses frequently encountered patients with difficulties. To manage such interactions, patients should be actively involved in the care process in order to help align their expectations. Additionally, in-service training can be offered to nurses to enhance their communication and problem-solving skills when dealing with challenging patients.
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Affiliation(s)
- N Bilgic
- Cyprus World Peace University, Health Sciences School, Yenişehir, Nicosia, TRNC
| | - M Z Avci
- Cyprus Science University, Dean of Health Sciences Faculty, Kyrenia, TRNC
| | - H Sutcu
- Cyprus International University, Health Sciences School, Lefkosa, TRNC
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Khazen M, Shalev L, Golan-Cohen A, Rose AJ. Responsibility of follow-up regarding medical recommendations in primary care and challenging patients: The perspective of doctors, nurses, pharmacists, and administrative staff. PATIENT EDUCATION AND COUNSELING 2025; 130:108456. [PMID: 39393327 DOI: 10.1016/j.pec.2024.108456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 09/17/2024] [Accepted: 09/24/2024] [Indexed: 10/13/2024]
Abstract
OBJECTIVE This study examines the way healthcare staff describe challenging patients and perceive responsibility for follow-up of patients with chronic conditions. METHODS Interviews were conducted with 46 healthcare staff (15 primary care physicians/12 nurses/15 administrative staff/4 pharmacists) at 12 clinics in Israel. They were audiotaped, transcribed, and thematically analyzed using Atlas qualitative data analysis software. RESULTS Participants defined patients as "challenging" either because they are less likely to follow medical recommendations or are felt to overconsume care. Staff believed that patients did not follow medical recommendations because they were indifferent, unaware, in denial about deteriorating medical condition, or fear of the unknown. Participants generally perceived a shared responsibility for follow-up between the staff and the patient. Staff who endorsed closer relationships with staff members expressed empathy toward challenging patients and felt responsible for follow-up. CONCLUSIONS Healthcare staff perceive themselves as partially responsible for helping patients follow up with medical recommendations. Cohesive staff relationships may promote higher levels of empathy toward challenging patients and may contribute to helping patients follow up with recommended care. Practice implications To improve follow-up with medical recommendations, there is a need to develop and test interventions to promote more cohesive ties among clinic staff.
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Affiliation(s)
- M Khazen
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Health Systems Management, the Max Stern Yezreel Valley College, Israel.
| | - L Shalev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - A Golan-Cohen
- Leumit Health Services, Research Institute, Tel Aviv, Israel
| | - A J Rose
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Hegedüs L, Van Der Feltz-Cornelis CM, Papini E, Nagy EV, Weetman AP, Perros P. Medically not yet explained symptoms in hypothyroidism. Nat Rev Endocrinol 2024; 20:685-693. [PMID: 39138377 DOI: 10.1038/s41574-024-01022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/15/2024]
Abstract
Persistent symptoms are common in the general population and even more so in people with hypothyroidism. When symptoms are unexplained and brought to medical attention, they can be referred to as medically not yet explained symptoms (MNYES), a term preferred to other descriptors by patients, care-givers and experts. MNYES might be neglected by endocrinologists or misattributed to hypothyroidism. Awareness of MNYES could open up more effective and less harmful interventions for patients who present to endocrinologists with unexplained symptoms than costly over-investigations and over-treatment with thyroid hormones (such as levothyroxine and liothyronine). The role of the endocrinologist is to recognize and acknowledge that MNYES could be underlying a patient's presentation, to communicate effectively with the patient and others involved in the patient's care, to apply a 'two-track approach' in management by paying equal attention to physical and psychosocial contributors, and to collaborate with other relevant health professionals. Categorization of patients into levels of risk for symptom deterioration helps in selecting suitable therapies. Effective management of MNYES demands time, training, expertise and resources.
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Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Petros Perros
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Kleinstäuber M, Diefenbach MA, Rief W. "It is not just in your mind" - Improving physician-patient communication in individuals with persistent somatic symptoms. J Psychosom Res 2024; 185:111580. [PMID: 38176986 DOI: 10.1016/j.jpsychores.2023.111580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, USA.
| | - Michael A Diefenbach
- Institute of Health System Science at the Feinstein Institutes for Medical Research, Northwell Health, 600 Community Dr, Manhasset, NY 11030, USA
| | - Winfried Rief
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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Porcerelli JH, Richardson LA, Huprich SK. The Role of Object Relations in the Physician-Patient Relationship in a Primary Care Setting. J Nerv Ment Dis 2024; 212:507-512. [PMID: 39207293 DOI: 10.1097/nmd.0000000000001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
ABSTRACT A good physician-patient relationship is essential for the delivery of quality health care and is associated with better health outcomes. This study explored the association between patients' object relations and the physician-patient relationship. Primary care patients (n = 72) and physicians (n = 21) participated in the study. Patients' early memories were obtained prior to their medical visit and were coded with the Social Cognition and Object Relations-Global Method (SCORS-G). Patients and physicians independently rated the quality of the physician-patient encounter. Results indicated that object relations (SCORS-G Cognitive-structural and Self factors) incrementally predicted physician-patient relationship ratings, as rated by the patient, above and beyond psychological distress, somatization, and level of physician training. Patient education, psychological distress, and level of physician training predicted physician ratings of the medical encounter. The authors discuss the discrepancy between physician and patient ratings as they relate to patients' object relations.
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Affiliation(s)
| | - Laura A Richardson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Fan Z, Shi X, Xu M, Wen H. The Chinese version of Defensive Medicine Scale (DMS): reliability and validity test among physicians. BMC Psychol 2024; 12:462. [PMID: 39217402 PMCID: PMC11365130 DOI: 10.1186/s40359-024-01957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Physicians are inclined to resort to defensive medicine (DM) for self-protection due to the increasing potential risk of medical litigation. DM is globally prevalent and has become an impediment to the development of healthcare. However, there is a lack of validated tools specifically designed to assess DM in China. Therefore, this study aimed to evaluate the psychometric properties of the Chinese version of Defensive Medicine Scale (DMS) among clinicians to provide a practicable tool for relevant research. METHODS The present research consists of two phases. In Phase 1, DMS was administered to survey 327 physicians, and the collected data were obtained for item analysis and exploratory factor analysis. Phase 2 applied DMS to survey 323 physicians, from which the data was used for confirmatory factor analysis, and reliability and cross-cohort consistency tests. Moreover, the participants of Phase 2 were required to complete Workplace Well-Being Scale (WWBS), Career Commitment Scale (CCS), Occupational Disidentification Scale (ODS), Intent to Leave Scale (ILS), and Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) to test the convergent validity of DMS. RESULTS The Chinese version of DMS consists of 10 items divided into 2 dimensions, Positive Defensive Medicine (PDM) and Negative Defensive Medicine (NDM). The confirmatory factor analysis showed that the two-factor model fitted well (χ2/df = 2.540, RMSEA = 0.069, CFI = 0.981, IFI = 0.981, TLI = 0.971, PNFI = 0.646, PCFI = 0.654, SRMR = 0.044). Furthermore, the total score and the score of each dimension for DMS had a significant negative correlation with WWBS and CCS scores, and a significant positive correlation with ODS, ILS, and DDPRQ-10 scores. The Cronbach's α coefficients for the total DMS and PDM and NDM dimensions were 0.917, 0.935, and 0.842, respectively; the split-half reliability coefficients were 0.922, 0.947, and 0.839, respectively. In addition, DMS showed cross-gender invariance. CONCLUSION The Chinese version of DMS has been demonstrated to be an effective tool to assess defensive medicine among Chinese physicians with good psychometric properties.
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Affiliation(s)
- Zhiguang Fan
- Department of Psychology, School of Teacher Education, Shaoxing University, Shaoxing, 312000, People's Republic of China
- School of Education, Jilin International Studies University, Changchun, 130117, People's Republic of China
| | - Xiaoli Shi
- School of Education, Jilin International Studies University, Changchun, 130117, People's Republic of China
| | - Minglu Xu
- The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, 130117, People's Republic of China
| | - Hongjuan Wen
- School of Health Management, Changchun University of Chinese Medicine, Changchun, 130117, People's Republic of China.
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Jackson JL, Murphy MG, Fletcher KE. The "Difficult" Inpatient, a Qualitative Study of Physician Perspectives. J Gen Intern Med 2024; 39:1858-1869. [PMID: 38769258 PMCID: PMC11281999 DOI: 10.1007/s11606-024-08802-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Previous studies exploring difficult inpatients have mostly focused on psychiatric inpatients. OBJECTIVE To explore the characteristics of difficult medicine inpatients. DESIGN Qualitative study using focus groups and semi-structured interviews. Transcripts were recorded, transcribed, and coded (MAXQDA) using thematic content analysis. PARTICIPANTS Medicine inpatient providers at a tertiary care facility. KEY RESULTS Our sample consisted of 28 providers (6 hospitalists, 10 medicine attendings, 6 medicine residents, and 6 interns). Theme 1: Provider experience: Difficult inpatients were time-consuming and evoked emotional responses including frustration and dysphoria. Theme 2: Patient characteristics: Included having personality disorders or mental health issues, being uncooperative, manipulative, angry, demanding, threatening, or distrustful. Difficult patients also had challenging social situations and inadequate support, unrealistic care expectations, were self-destructive, tended to split care-team messages, and had unclear diagnoses. Theme 3: Difficult families: Shared many characteristics of difficult patients including being distrustful, demanding, manipulative, threatening, or angry. Difficult families were barriers to care, disagreed with the treatment plan and each other, did not act in the patient's best interest, suggested inappropriate treatment, or had unrealistic expectations. STRATEGIES Approaches to dealing with difficult patients or families included building trust, being calm, and having a consistent message. Communication approaches included naming the emotion, empathetic listening, identifying patient priorities and barriers, and partnering. CONCLUSIONS Difficult patients induced emotional responses, dysphoria, and self-doubt among providers. Underlying personality disorders were often mentioned. Difficult patients and families shared many characteristics. Communication and training were highlighted as key strategies.
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Affiliation(s)
- Jeffrey L Jackson
- Clement J Zablocki VAMC, Milwaukee, WI, USA.
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | | | - Kathlyn E Fletcher
- Clement J Zablocki VAMC, Milwaukee, WI, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Hall D, Smiley Y, Slovin A, Manget J, Bost JE, Chokshi B. Applying a Trauma-Informed Lens to Challenging Adolescent Encounters: A Faculty Development Session for Pediatricians. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11408. [PMID: 38957524 PMCID: PMC11219089 DOI: 10.15766/mep_2374-8265.11408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/29/2024] [Indexed: 07/04/2024]
Abstract
Introduction Patient encounters perceived to be challenging are common and contribute to both suboptimal patient health outcomes and provider burnout. A trauma-informed care (TIC) approach to these encounters is critical, as many of the characteristics associated with challenging patient encounters can be linked to a history of trauma exposure. Methods Our team created and delivered a 1-hour synchronous virtual session intended to bolster provider knowledge of TIC principles and their application to challenging adolescent encounters. Participants were all faculty and staff engaged in pediatric primary care at an urban academic center, including physicians, nurse practitioners, psychologists, and social workers. The content was rooted in adult learning principles and included didactic components anchored to case-based learning with facilitated group discussions and opportunities for reflection. We used paired pre- and postsession self-assessments of provider knowledge, confidence, and practice related to TIC using Likert-scale and free-text questions. Descriptive statistics and a paired t test were used to determine the impact of the session on these metrics. Results In 24 paired surveys, there were statistically significant increases (p ≤ .001) in participant perceived knowledge, confidence, and practice, with 100% of participants having a statistically significant improvement in one or more of these domains. There were also strongly positive Likert-scale and free-text responses regarding content relevance and delivery. Discussion We demonstrate that a brief session can create improvement in pediatric providers' perceived knowledge about the application of TIC principles to challenging adolescent encounters as well as confidence in their ability to put these into practice.
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Affiliation(s)
- Deborah Hall
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Yael Smiley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Ariella Slovin
- Instructor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Jaytoya Manget
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - James E. Bost
- Research Division Chief, Center for Translational Research, Children's National Hospital; Associate Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Binny Chokshi
- Associate Professor, Division of Military Child and Family Research, Department of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine
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Li H, Zhang C, Li L, Liu T, Zhang L, Hao J, Sun J. Bibliometric and visualization analysis of risk management in the doctor-patient relationship: A systematic quantitative literature review. Medicine (Baltimore) 2024; 103:e37807. [PMID: 38640335 PMCID: PMC11029958 DOI: 10.1097/md.0000000000037807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/21/2024] Open
Abstract
OBJECTIVES This paper analyzed the research on risk management in the doctor-patient relationship (DPR) based on a systematic quantitative literature review approach using bibliometric software. It aims to uncover potential information about current research and predict future research hotspots and trends. METHODS We conducted a comprehensive search for relevant publications in the Scopus database and the Web of Science Core Collection database from January 1, 2000 to December 31, 2023. We analyzed the data using CiteSpace 6.2.R2 and VOSviewer 1.6.19 software to examine the annual number of publications, countries/regions, journals, citations, authors, and keywords in the field. RESULTS A total of 553 articles and reviews that met the criteria were included in this study. There is an overall upward trend in the number of publications issued; in terms of countries/regions, the United States and the United Kingdom are the largest contributors; Patient Education and Counseling is the most productive journal (17); Physician communication and patient adherence to treatment: a meta-analysis is the most cited article (1637); the field has not yet to form a stable and obvious core team; the analysis of high-frequency keywords revealed four main research directions: the causes of DPR risks, coping strategies, measurement tools, and research related to people prone to doctor-patient risk characteristics; the causes of DPR risks, coping strategies, measurement tools, and research related to people prone to doctor-patient risk characteristics; the keyword burst analysis revealed several shifts in the research hotspots for risk management in the DPR, suggesting that chronic disease management, is a future research direction for the continued development of risk management in the DPR. CONCLUSIONS The visualization analysis of risk management literature in the DPR using CiteSpace and VOSviewer software provides insights into the current research status and highlights future research directions.
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Affiliation(s)
- Hui Li
- Health Management College, Anhui Medical University, Hefei, China
| | - Chenchen Zhang
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Limin Li
- Health Management College, Anhui Medical University, Hefei, China
| | - Tong Liu
- Health Management College, Anhui Medical University, Hefei, China
| | - Liping Zhang
- School of Marxism, Anhui Medical University, Hefei, China
| | - Jiqing Hao
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Jiangjie Sun
- Health Management College, Anhui Medical University, Hefei, China
- Clinical Medical College, Anhui Medical University, Hefei, China
- School of Management, Hefei University of Technology, Hefei, China
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Bornstein RF, Porcerelli JH, Jones JR. Dependency, Detachment, and Health-Related Behavior in Adult Primary Care Patients. J Clin Psychol Med Settings 2023; 30:699-707. [PMID: 36781518 DOI: 10.1007/s10880-023-09943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
This investigation examined links between three related personality styles as assessed with the Relationship Profile Test-destructive overdependence, dysfunctional detachment, and healthy dependency-and indices of health and health-related behavior in a mixed-sex (74% female) sample of 100 primary care patients with a mean age of 38.62 (SD = 12.99). Fourteen primary care physicians also participated. As hypothesized, destructive overdependence and dysfunctional detachment scores were positively correlated with number of contacts with the emergency department; healthy dependency scores were inversely related to emergency department contacts and number of overnight hospitalizations. Healthy dependency scores were associated with an array of positive health behaviors; destructive overdependence scores were negatively associated with positive health behaviors. In addition, healthy dependency scores were inversely related to physician ratings of a difficult doctor-patient relationship. These results demonstrate that destructive overdependence, dysfunctional detachment and healthy dependency scores are associated in expected ways with indices of health and health-related behavior, and help illuminate the underlying factors that contribute to comparatively poor health and variations in health service use among overdependent and detached medical patients.
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Affiliation(s)
| | - John H Porcerelli
- Department of Psychology, University of Detroit Mercy, Detroit, MI, 48221-3038, USA.
- Doctoral Program in Clinical Psychology, University of Detroit Mercy, 4004 W. McNichols Road, 142 Reno Hall, Detroit, MI, 48221-3038, USA.
| | - John R Jones
- United States Air Force, Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
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Du J, Wang Y, Wu A, Jiang Y, Duan Y, Geng W, Wan L, Li J, Hu J, Jiang J, Shi L, Wei J. The validity and IRT psychometric analysis of Chinese version of Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). BMC Psychiatry 2023; 23:900. [PMID: 38041038 PMCID: PMC10693043 DOI: 10.1186/s12888-023-05385-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE The doctor-patient relationship (DPR) plays a crucial role in the Chinese healthcare system, functioning to improve medical quality and reduce medical costs. This study examined the psychometric properties of the Chinese version of the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) among general hospital inpatients in China. METHODS The research recruited 38 resident doctors responsible for 120 participants, and factor analyses were used to assess the construct validity of the scale. Convergent validity was evaluated by examining the correlation between DDPRQ-10 and depressive symptoms, burnout, and self-efficacy, using the Patient Health Questionnaire Depression Scale-9 item (PHQ-9), and the Maslach Burnout Inventory (MBI). Both multidimensional item response theory (MIRT) and unidimensional item response theory (IRT) frameworks were used to estimate the parameters of each item. RESULTS The Chinese version of DDPRQ-10 showed satisfactory internal consistency (Cronbach's alpha = 0.931), and fitted in a modified two-factor model of positive feelings and negative feelings (χ2/df = 1.494, GFI = 0.925, RMSEA = 0.071, SRMR = 0.008, CFI = 0.985, NFI = 0.958, NNFI = 0.980, TLI = 0.980, IFI = 0.986). Significant correlations with PHQ-9 with DDPRQ-10 and both subscales were revealed (r = 0.293 ~ 0.333, p < .001), while DDPRQ-10 score also significantly correlated with doctors' MBI score (r = -0.467, p < .001). The MIRT model of full scale and IRT models of both subscales showed high discrimination of all items (a = 2.30 ~ 10.18), and the test information within the range of low-quality relationship was relatively high. CONCLUSION The Chinese version of DDPRQ-10 displayed satisfactory reliability and validity and thus was appropriate for measuring the DPR in Chinese medical settings.
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Affiliation(s)
- Jianhua Du
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yufei Wang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Aoxue Wu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanping Duan
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenqi Geng
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lin Wan
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiarui Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiaojiao Hu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Kollányi Z, Bálint L, Susovits K, Csépe P, Kovács K. Inequalities in Diabetes Mortality Between Microregions in Hungary. Int J Public Health 2023; 68:1606161. [PMID: 38024213 PMCID: PMC10643225 DOI: 10.3389/ijph.2023.1606161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: Regional differences in diabetes mortality are high in Hungary. In our cross-sectional study, we aim to reveal the drivers of the inequalities in diabetes mortality across the 197 microregions of Hungary. To account for the influence of changes in healthcare and social conditions, we compared two periods (2009-12 and 2013-16). Methods: Traditional and re-conceptualized deprivation- and healthcare provison measures were used in OLS regression models. Results: Microregions with a high proportion of population living in "service deserts," especially in regard to the lack of grocery stores, suffer the highest rates of diabetes mortality. Alcohol-related mortality has been proven to be a similarly and surprisingly strong predictor of diabetes mortality. Conclusion: Food provision should be supported in areas characterized by low service density, and alcohol policy should be strengthened and targeted.
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Affiliation(s)
- Zsófia Kollányi
- Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Lajos Bálint
- Hungarian Demographic Research Institute (HDRI), Budapest, Hungary
- Department of Sociology, Faculty of Humanities and Social Sciences, University of Pécs, Pécs, Hungary
| | - Kitti Susovits
- National Institute of Pharmacy and Nutrition (Hungary), Budapest, Hungary
| | - Péter Csépe
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Kovács
- Hungarian Demographic Research Institute (HDRI), Budapest, Hungary
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Goebel-Stengel M, Paulsen U, Bennerscheidt P, Zipfel S, Stengel A. Patients with functional gastrointestinal disorders-importance of communication between physician and patient assessed in a cross-sectional cohort study. Front Psychiatry 2023; 14:1252268. [PMID: 37720898 PMCID: PMC10501798 DOI: 10.3389/fpsyt.2023.1252268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/08/2023] [Indexed: 09/19/2023] Open
Abstract
Functional gastrointestinal disorders are frequent diseases often associated with a pronounced burden reflected in a greatly reduced quality of life. Patients are seeking medical help but may be perceived as demanding and challenging. For successful diagnosis and treatment of these patients, a good doctor-patient communication is key. However, so far, only few studies focus on the physicians' perspective of the doctor-patient communication. The present study cross-sectionally investigated 520 physicians using the validated difficult doctor-patient relationship questionnaire and the treatment satisfaction questionnaire from the physician's perspective along with several ad hoc questions. Data from 5,354 physician-patient conversations (one conversation per patient) was included. Physicians participating in this study mostly suspected stress-related burdens as the cause of functional gastrointestinal disorders (65.4%), while patients rather suspected food (55.4%) or other somatic causes (43.6%). The physician-patient relationship was rated just below the threshold for difficult interactions (cut-off ≥30, mean ± SD in the current sample: 28.6 ± 9.6) with 49.1% of physicians reaching a score of ≥30. Although physicians overall felt confident in the doctor-patient communication even in difficult conversations (61.9%), only 33.1% reported to have enough time for these patients and only 5.6% felt sufficiently compensated for discussions with patients with functional gastrointestinal disorders. Therefore, education of physicians on functional gastrointestinal disorders, training of physicians in physician-patient communication as well as an improved reimbursement of speaking medicine should help to further improve care for these patients and also treatment satisfaction on both the side of the patients as well as the physicians.
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Affiliation(s)
- Miriam Goebel-Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Internal Medicine, Helios Clinic, Rottweil, Germany
| | - Ute Paulsen
- Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | | | - Stephan Zipfel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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16
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Long V, Chen Z, Du R, Chan YH, Yew YW, Oon HH, Thng S, Lim NQBI, Tan C, Chandran NS, Valderas JM, Phan P, Choi E. Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling. JAMA Dermatol 2023; 159:811-819. [PMID: 37436741 PMCID: PMC10339220 DOI: 10.1001/jamadermatol.2023.2008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/12/2023] [Indexed: 07/13/2023]
Abstract
Importance Patients and physicians often have differing opinions on the patient's disease severity. This phenomenon, termed discordant severity grading (DSG), hinders the patient-physician relationship and is a source of frustration. Objective To test and validate a model explaining the cognitive, behavioral, and disease factors associated with DSG. Design, Setting, and Participants A qualitative study was first performed to derive a theoretical model. In this subsequent prospective cross-sectional quantitative study, the qualitatively derived theoretical model was validated using structural equation modeling (SEM). Recruitment was conducted between October 2021 and September 2022. This was a multicenter study in 3 Singapore outpatient tertiary dermatological centers. Dermatology patients and their attending physicians were recruited by convenience sampling. Patients were aged 18 to 99 years with psoriasis or eczema of at least 3 months' duration and recruited only once. The data were analyzed between October 2022 to May 2023. Main Outcomes and Measures The outcome was the difference between global disease severity (0-10 numerical rating scale with a higher score indicating greater severity) as independently scored by the patient and the dermatologist. Positive discordance was defined as patient-graded severity more than 2 points higher (graded more severely) than physicians, and negative discordance if more than 2 points lower than physicians. Confirmatory factor analysis followed by SEM was used to assess the associations between preidentified patient, physician, and disease factors with the difference in severity grading. Results Of the 1053 patients (mean [SD] age, 43.5 [17.5] years), a total of 579 (55.0%) patients were male, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Of 44 physicians recruited, 20 (45.5%) were male, 24 (54.5%) were aged between 31 and 40 years, 20 were senior residents or fellows, and 14 were consultants or attending physicians. The median (IQR) number of patients recruited per physician was 5 (2-18) patients. Of 1053 patient-physician pairs, 487 pairs (46.3%) demonstrated discordance (positive, 447 [42.4%]; negative, 40 [3.8%]). Agreement between patient and physician rating was poor (intraclass correlation, 0.27). The SEM analyses showed that positive discordance was associated with higher symptom expression (standardized coefficient B = 0.12; P = .02) and greater quality-of-life impairment (B = 0.31; P < .001), but not patient or physician demographics. A higher quality-of-life impairment was in turn associated with lower resilience and stability (B = -0.23; P < .001), increased negative social comparisons (B = 0.45; P < .001), lower self-efficacy (B = -0.11; P = .02), increased disease cyclicity (B = 0.47; P < .001), and greater expectation of chronicity (B = 0.18; P < .001). The model was well-fitted (Tucker-Lewis: 0.94; Root Mean Square Error of Approximation: 0.034). Conclusions and Relevance This cross-sectional study identified various modifiable contributory factors to DSG, increased understanding of the phenomenon, and set a framework for targeted interventions to bridge this discordance.
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Affiliation(s)
- Valencia Long
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
| | - Zhaojin Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ruochen Du
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yik Weng Yew
- Dermatology, National Skin Centre, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Steven Thng
- Dermatology, National Skin Centre, Singapore
| | | | - Chris Tan
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jose M. Valderas
- Centre for Research in Health System Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Family Medicine, National University Healthcare System, Singapore
| | - Phillip Phan
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | - Ellie Choi
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
- Centre for Research in Health System Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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17
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Huff NR, Chimowitz H, DelPico MA, Gleason KT, Nanavati JD, Smulowitz P, Isbell LM. The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: An experimental study using simulated patient cases. Int J Nurs Stud 2023; 143:104507. [PMID: 37196607 PMCID: PMC11999539 DOI: 10.1016/j.ijnurstu.2023.104507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Engaging with human emotions is an integral but poorly understood part of the work of emergency healthcare providers. Patient factors (e.g., irritable behavior; mental illness) can evoke strong emotions, and evidence suggests that these emotions can impact care quality and patient safety. Given that nurses play a critical role in providing high quality care, efforts to identify and remedy factors that may compromise care are needed. Yet to date, few experiments have been conducted. OBJECTIVE To examine the effects of emotionally evocative patient behavior as well as the presence of mental illness on emergency nurses' emotions, patient assessments, testing advocacy, and written handoffs. DESIGN Experimental vignette research. SETTING Online experiment distributed via email between October and December 2020. PARTICIPANTS Convenience sample of 130 emergency nurses from seven hospitals in the Northeastern United States and one hospital in the mid-Atlantic region in the United States. METHODS Nurses completed four multimedia computer-simulated patient encounters in which patient behavior (irritable vs. calm) and mental illness (present vs. absent) were experimentally varied. Nurses reported their emotions and clinical assessments, recommended diagnostic tests, and provided written handoffs. Tests were coded for whether the test would result in a correct diagnosis, and handoffs were coded for negative and positive patient descriptions and the presence of specific clinical information. RESULTS Nurses experienced more negative emotions (anger, unease) and reported less engagement when assessing patients exhibiting irritable (vs. calm) behavior. Nurses also judged patients with irritable (vs. calm) behavior as more likely to exaggerate their pain and as poorer historians, and as less likely to cooperate, return to work, and recover. Nurses' handoffs were more likely to communicate negative descriptions of patients with irritable (vs. calm) behavior and omit specific clinical information (e.g., whether tests were ordered, personal information). The presence of mental illness increased unease and sadness and resulted in nurses being less likely to recommend a necessary test for a correct diagnosis. CONCLUSIONS Emergency nurses' assessments and handoffs were impacted by patient factors, particularly irritable patient behavior. As nurses are central to the clinical team and experience regular, close contact with patients, the effects of irritable patient behavior on nursing assessments and care practices have important implications. We discuss potential approaches to address these ill effects, including reflexive practice, teamwork, and standardization of handoffs. TWEETABLE ABSTRACT Simulated experimental study found that despite having received identical clinical information, emergency nurses believed that patients displaying irritable behaviours were less likely to return to work soon and were less likely to recover than patients who displayed calm behaviour.
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Affiliation(s)
- Nathan R Huff
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Hannah Chimowitz
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Maria A DelPico
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Kelly T Gleason
- School of Nursing, Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD 21205, United States of America
| | - Janvi D Nanavati
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America
| | - Peter Smulowitz
- Department of Emergency Medicine, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA 01605, United States of America
| | - Linda M Isbell
- Psychological and Brain Sciences, University of Massachusetts Amherst, 135 Hicks Way, Amherst, MA 01003, United States of America.
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Cruvinel PVQ, Grosseman S. [In the final analysis, who is "problematic"? An integrative review of patients, physicians and problematic relationships]. CIENCIA & SAUDE COLETIVA 2023; 28:1685-1701. [PMID: 37255146 DOI: 10.1590/1413-81232023286.16812022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/09/2023] [Indexed: 06/01/2023] Open
Abstract
The scope of this study was to assess the literature on the characteristics of patients, physicians, and physician-patient relationships considered 'problematic.' An integrative review of primary studies published between January 1, 2016, and September 30, 2021, in Portuguese, English and Spanish was conducted, Of the 3,414 papers identified in the PubMed, Embase, Scopus and Lilacs databases, 19 were selected for qualitative analysis. Seven studies were carried out in Europe, eight in North America, two in South America and two in China, totaling 1,694 patients, 1,903 assistant physicians, 101 residents and 160 medical academics. Physicians and academics considered the following to be problematic: patients with clinical conditions such as psychosomatic and chronic illnesses; symptoms and complaints such as pain; powerful emotions; problems in obtaining and sharing information, in decision-making, in the adherence to the therapeutic plan and in their self-care; and some sociodemographic and vulnerability characteristics. Among other aspects, patients, or their relatives, considered physicians to be problematic when they did not listen to them or appear to care about their children, Teaching medical communication and systemic interventions are recommended to improve physician-patient relationships.
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Affiliation(s)
| | - Suely Grosseman
- Departamento de Pediatria, Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina. Hospital Universitário Polydoro Ernani de São Thiago, Campus Universitário, R. Professora Maria Flora Pausewang s/n, Trindade. 88036-800. Florianópolis SC Brasil.
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Sugiyama Y, Mutai R, Matsushima M. Association between patient complexity and healthcare costs in primary care on a Japanese island: a cross-sectional study. BMJ Open 2023; 13:e068497. [PMID: 36963794 PMCID: PMC10040045 DOI: 10.1136/bmjopen-2022-068497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES This study aimed to elucidate the relationship between patient complexity and healthcare costs in a primary care setting on a Japanese island. DESIGN Cross-sectional study. SETTING Tarama Clinic, Okinawa Miyako Hospital, on Tarama Island, Okinawa Prefecture, Japan. PARTICIPANTS Patients who visited Tarama Clinic from 1 April 2018 to 30 June 2018, were aged 20 years or above, were resident in Tarama Village and had decision-making capacity. OUTCOME MEASURES Patient complexity scored using Patient Centred Assessment Method (PCAM), healthcare costs per person per year/visit and participant characteristics. RESULTS We included 355 study participants. The means (SD) of the total PCAM scores and healthcare costs per person per year/visit were 21.4 (5.7) and 1056.4 (952.7)/125.7 (86.7) in US dollars, respectively. Spearman's rank correlation coefficients between the total PCAM scores and healthcare costs per person per year/visit were 0.33 and 0.28 (p values <0.0001 and <0.0001), respectively. The healthcare costs per person tended to be relatively low in the patient groups with the highest complexity. In the groups, the proportion of those with psychological conditions tended to be higher and those with cardiovascular diseases tended to be lower than in the other groups. Multiple regression analysis showed that total PCAM scores were associated with healthcare costs per person per year/visit, which were log-transformed: the regression coefficients were 3.87×10-2 and 2.34×10-2, respectively; the p values were <0.001 and <0.001, respectively. CONCLUSIONS This study clarified the association between patient complexity and healthcare costs in a primary care setting on a Japanese island. We found that such costs tended to be relatively low in patient groups with the highest complexity. In primary care, healthcare costs probably do not accurately reflect the value of services provided by medical institutions; it may be essential to introduce a system that provides incentives for problem-solving approaches to social issues.
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Affiliation(s)
- Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Tarama Clinic, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
- Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Rieko Mutai
- Department of Adult Nursing, The Jikei University School of Nursing, Chofu, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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20
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van Veen M, Koekkoek B, Kloos M, Braam AW. Suicidal Behavior and Difficulty of Patients, as Perceived by Community Mental Health Nurses. J Psychiatr Pract 2023; 29:113-121. [PMID: 36928198 DOI: 10.1097/pra.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Mental health professionals who work in community mental health services play an important role in treating patients after attempted suicide or deliberate self-injury. When such behaviors are interpreted negatively, patients may be seen as difficult, which may lead to ineffective treatment and mutual misunderstanding. OBJECTIVE The goal of this study was to assess the association between the grading of suicidality and perceived difficulty. We hypothesized that a higher grading of suicidality is associated with increased perceived difficulty. METHODS We analyzed cross-sectional data from 176 patients who participated in 2 cohort studies: 92 patients in the MATCH-cohort study and 84 patients in the Interpersonal Community Psychiatric Treatment (ICPT) study. The dependent variable was perceived difficulty, as measured by the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ) and the Difficulty Single-item (DSI), a single item measuring the difficulty of the patient as perceived by the professional. Grading of suicidality was considered as the independent variable. Multiple linear and logistic regression was performed. RESULTS We found a significant association between perceived difficulty (DDPRQ) and high gradings of suicidality (B: 3.96; SE: 1.44; β: 0.21; P=0.006), increasing age (B: 0.09; SE: 0.03; β: 0.22; P<0.003), sex (female) (B: 2.33; SE: 0.83; β: 0.20; P=0.006), and marital status (being unmarried) (B: 1.92; SE: 0.85; β: 0.17; P=0.025). A significant association was also found between the DSI and moderate (odds ratio: 3.04; 95% CI: 1.355-6.854; P=0.007) and high (odds ratio: 7.11; 95% CI: 1.8.43-24.435; P=0.005) gradings of suicidality. CONCLUSION In this study, we found that perceived difficulty was significantly associated with moderate and high gradings of suicidality, increasing age, female sex, and being unmarried.
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Caspi I, Freund O, Pines O, Elkana O, Ablin JN, Bornstein G. Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions. World J Clin Cases 2023; 11:821-829. [PMID: 36818615 PMCID: PMC9928691 DOI: 10.12998/wjcc.v11.i4.821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/12/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in patient care worldwide. Vaccinations, which have proven efficacious in lowering the COVID-19 hospital burden, are still avoided by large populations. We, therefore, hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.
AIM To evaluate whether patient vaccine hesitancy affected the hospital care team (HCT) perceptions.
METHODS We performed a prospective clinical study using structured questionnaires. We approached physicians and nurses with previous experience caring for COVID-19 patients from 11 medical centers across Israel during the fourth COVID-19 surge (September and October 2021). The participants completed a questionnaire with the following parts: (1) Sociodemographic characteristics; (2) Assessment of anger (STAXI instrument) and chronic workplace stress (Shirom-Melamed burnout measure); and (3) Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions (the difficult doctor-patient relation questionnaire, the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire). Results were evaluated according to each part of the questionnaire and the questionnaire as a whole. Associations between HCT perceptions and their baseline characteristics, anger or chronic workplace stress were assessed.
RESULTS The HCT experienced their relationship with unvaccinated patients as more difficult (P < 0.001, Cohen’s d = 0.85), perceived unvaccinated patients as responsible for their medical condition (P < 0.001, d = 1.39) and perceived vaccinated patients as having a higher character value (P < 0.001, d = 1.03). Unvaccinated patients were considered selfish (P < 0.001), less mature (P < 0.001) and less satisfying to care for (P < 0.001). The relationship with unvaccinated patients was more difficult among HCT with higher burnout (r = 0.37, n = 66, P = 0.002). No correlations with baseline characteristics were found. All three study tools showed high internal consistency (α between 0.72 and 0.845).
CONCLUSION Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients. In order to minimize the potential negative impact on patient care, designated departments should promote specific patient-centered preparations. Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.
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Affiliation(s)
- Inbar Caspi
- Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ophir Freund
- Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Omer Pines
- Behavioral Sciences Department, Academic College of Tel Aviv-Yaffo, Tel Aviv 6818211, Israel
| | - Odelia Elkana
- Behavioral Sciences Department, Academic College of Tel Aviv-Yaffo, Tel Aviv 6818211, Israel
| | - Jacob N Ablin
- Internal Medicine Department H, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv 6423906, Israel
| | - Gil Bornstein
- Internal Medicine Department B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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22
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Lyu B, Xu M, Lu L, Zhang X. Burnout syndrome, doctor-patient relationship and family support of pediatric medical staff during a COVID-19 Local outbreak in Shanghai China: A cross-sectional survey study. Front Pediatr 2023; 11:1093444. [PMID: 36861079 PMCID: PMC9968926 DOI: 10.3389/fped.2023.1093444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES To explore burnout syndrome (BOS) incidence, doctor-patient relationship, and family support on pediatric medical staff in Shanghai comprehensive hospitals during a COVID-19 local outbreak. METHODS A cross-sectional survey of pediatric medical staff from 7 comprehensive hospitals across Shanghai was conducted from March to July 2022. The survey included BOS, doctor-patient relationships, family support, and the related factors of COVID-19. The T-test, variance, the LSD-t test, Pearson's r correlation coefficient, and multiple regression analyses examined the data. RESULTS Using Maslach Burnout Inventory-General Survey (MBI-GS), 81.67% of pediatric medical staff had moderate BOS, and 13.75% were severe. The difficult doctor-patient relationship was positively correlated with emotional exhaustion(EE), cynicism(Cy), and negatively with personal accomplishment(PA). When medical staff need help, the greater the support provided by the family, the lower the EE and CY, and the higher the PA. CONCLUSION "In our study, the pediatric medical staff in Shanghai comprehensive hospitals had significant BOS during a COVID-19 local outbreak." We provided the potential steps that can be taken to reduce the increasing rate of BOS in pandemics. These measures include increased job satisfaction, psychological support, maintaining good health, increased salary, lower intent to leave the profession, regularly carrying out COVID-19 prevention training, improving doctor-patient relations, and strengthening family support.
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Affiliation(s)
- Baiyu Lyu
- Department of Pediatrics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meijia Xu
- Department of Pediatrics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lijuan Lu
- Department of Pediatrics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoying Zhang
- Department of Pediatrics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Crijns T, Al Salman A, Bashour L, Ring D, Teunis T. Which patient and surgeon characteristics are associated with surgeon experience of stress during an office visit? PEC INNOVATION 2022; 1:100043. [PMID: 37213725 PMCID: PMC10194092 DOI: 10.1016/j.pecinn.2022.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/11/2022] [Accepted: 04/16/2022] [Indexed: 05/23/2023]
Abstract
Objective To determine clinician and patient factors associated with the surgeon feelings of stress, futility, inadequacy, and frustration during an office visit. Methods A survey-based experiment presented clinical vignettes with randomized patient factors (such as symptom intensity, the number of prior consultations, and involvement in a legal dispute) and feeling behind schedule in order to determine which are most related to surgeon ratings of stress, futility, inadequacy, and frustration on 11-point Likert scales. Results Higher surgeon stress levels were independently associated with women patients, multiple prior consultations, a legal dispute, disproportionate symptom intensity, and being an hour behind in the office. The findings were similar for feelings of futility, inadequacy, and frustration. Conclusion Patient factors potentially indicative of mental and social health opportunities are associated with greater surgeon-rated stress and frustration. Innovation Trainings for surgeon self-awareness and effective communication can transform stressful or adversarial interactions into an effective part of helping patients get and stay healthy by diagnosing and addressing psychosocial aspects of the illness. Level of evidence N/a.
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Affiliation(s)
- Tom Crijns
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Aresh Al Salman
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Laura Bashour
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Corresponding author at: Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building; MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Teun Teunis
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fan Z, Cong X, Tao M, Wu S, Gao P. Development of the Chinese Version of the Physician Internalized Occupational Stigma Scale (PIOSS). Psychol Res Behav Manag 2022; 15:3445-3459. [PMID: 36471790 PMCID: PMC9719362 DOI: 10.2147/prbm.s386724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND/OBJECTIVE Internalized occupational stigma may develop in physicians as a result of their identification with the public negative labels and stereotypes about them, and then internalization of them as a part of their self-concept. This study aims to develop the Physician Internalized Occupational Stigma Scale (PIOSS) and to examine its reliability and validity. METHODS In study 1, the initial scale was used to investigate 356 physicians. While in study 2, a total of 346 physicians were investigated with the survey tools named the PIOSS, the Career Commitment Scale (CCS), the Workplace Well-Being Scale (WWBS), the Scale for the Doctor with Patient-doctor Relationship (DDPRQ-10), the Intent to Leave Scale (ILS) and the Occupational Disidentification Scale (ODS). RESULTS The PIOSS includes 19 items divided into 3 dimensions: label identification, status loss, and career denial. The results of confirmatory factor analysis (CFA) reveal that the three-factor model fitted well (χ 2/df=2.574, RMSEA= 0.068, CFI= 0.931, IFI= 0.931, TLI= 0.919, PNFI= 0.762, PCFI= 0.795). The PIOSS total and each dimension scores were significantly negatively correlated with the CCS and the WWBS scores and remarkably positively associated with the DDPRQ-10, the ILS, and the ODS scores. Cronbach's α coefficients for the PIOSS total scale and dimensions ranged from 0.775 to 0.914, and split-half reliability coefficients ranged from 0.801 to 0.931. In addition, the PIOSS exhibited cross-gender invariance. CONCLUSION Having good reliability and validity, the PIOSS can serve as a valid tool for the assessment of physician internalized occupational stigma.
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Affiliation(s)
- Zhiguang Fan
- Department of Education, Jilin International Studies University, Changchun City, Jilin Province, People’s Republic of China
- Department of Marxism, Changchun University of Chinese Medicine, Changchun City, Jilin Province, People’s Republic of China
| | - Xiangxin Cong
- Department of Education, Jilin International Studies University, Changchun City, Jilin Province, People’s Republic of China
| | - Min Tao
- Department of Education, Jilin International Studies University, Changchun City, Jilin Province, People’s Republic of China
| | - Shijia Wu
- Department of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun City, Jilin Province, People’s Republic of China
| | - Peng Gao
- Department of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun City, Jilin Province, People’s Republic of China
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Lewis D, Salmi L, Staley A, Harlow J. From Individuals to Systems and Contributions to Creations: Novel Framework for Mapping the Efforts of Individuals by Convening The Center of Health and Health Care. J Particip Med 2022; 14:e39339. [DOI: 10.2196/39339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background
People with lived health care experiences (often referred to as “patients”) are increasingly contributing to health care and are most effective when they are involved as partners who can contribute complementary knowledge alongside other stakeholders in health care.
Objective
Convening The Center aimed to bring together “people known as patients”—the center of health care—to address priorities as they defined them.
Methods
According to the original project design, an in-person gathering was to be conducted; however, as a result of the COVID-19 pandemic, the in-person gathering was transformed into a series of digital gatherings, including an in-depth interview phase, small-group gatherings, and a collective convening of 25 participants (22 women and 3 men from the United States, India, Costa Rica, Sweden, and Pakistan). Each participant was interviewed on Zoom (Zoom Video Communications Inc), and the interview data were thematically analyzed to design a subsequent small group and then full cohort Zoom sessions. Visual note-taking was used to reinforce a shared understanding of each individual- and group-level conversation.
Results
The interviews and gatherings for Convening The Center offered unique perspectives on patient activities in research, health innovation, and problem-solving. This project further developed a novel, two-spectrum framework for assessing different experiences that patients may have or seek to gain, based on what patients actually do, and different levels of patients’ involvement, ranging from individual to community to systemic involvement.
Conclusions
The descriptors of patients in academic literature typically focus on what health care providers think patients “are” rather than on what patients “do.” The primary result of this project is a framework for mapping what patients “do” and “where” they do their work along two spectra: from creating their own projects to contributing to work initiated by others and from working at levels ranging from individual to community to systems. A better understanding of these spectra may enable researchers to more effectively engage and leverage patient expertise in health care research and innovation.
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Henry SG, Fenton JJ, Campbell CI, Sullivan M, Weinberg G, Naz H, Graham WM, Dossett ML, Kravitz RL. Development and Testing of a Communication Intervention to Improve Chronic Pain Management in Primary Care: A Pilot Randomized Clinical Trial. Clin J Pain 2022; 38:620-631. [PMID: 36037051 PMCID: PMC9481730 DOI: 10.1097/ajp.0000000000001064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Effective communication skills are essential for optimally managing chronic pain and opioids. This exploratory, sequential mixed methods study tested the effect of a novel framework designed to improve pain-related communication and outcomes. METHODS Study 1 developed a novel 5-step framework for helping primary care clinicians discuss chronic pain and opioids with patients. Study 2 pilot tested an intervention for teaching this framework using standardized patient instructors-actors trained to portray patients and provide immediate clinician feedback-deployed during regular clinic hours. Primary care physicians were randomized to receive either the intervention or pain management recommendations from the Centers for Disease Control and Prevention. Primary outcomes were pain-related interference at 2 months and clinician use of targeted communication skills (coded from transcripts of audio-recorded visits); secondary outcomes were pain intensity at 2 months, clinician self-efficacy for communicating about chronic pain, patient experience, and clinician-reported visit difficulty. RESULTS We enrolled 47 primary care physicians from 2 academic teaching clinics and recorded visits with 48 patients taking opioids for chronic pain who had an appointment scheduled with an enrolled physician. The intervention was not associated with significant changes in primary or secondary outcomes other than clinician self-efficacy, which was significantly greater in the intervention group. DISCUSSION This study developed a novel framework and intervention for teaching clinician pain-related communications skills. Although the intervention showed promise, more intensive or multicomponent interventions may be needed to have a significant impact on clinicians' pain-related communication and pain outcomes.
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Affiliation(s)
- Stephen G Henry
- Departments of Internal Medicine
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Joshua J Fenton
- Family and Community Medicine, University of California Davis, Sacramento, CA
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Mark Sullivan
- Department of Anesthesiology and Pain Medicine and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Gary Weinberg
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Hiba Naz
- University of California Davis Center for Healthcare Policy and Research, CA
| | - Wyatt M Graham
- University of California Davis School of Medicine, Sacramento, CA
| | | | - Richard L Kravitz
- Departments of Internal Medicine
- University of California Davis Center for Healthcare Policy and Research, CA
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Steinauer JE, O'Sullivan PS, Preskill F, Chien J, Carver C, Turk J, Ten Cate O, Teherani A. Residents' Experiences of Negative Emotions toward Patients: Challenges to their Identities. TEACHING AND LEARNING IN MEDICINE 2022; 34:464-472. [PMID: 34763598 DOI: 10.1080/10401334.2021.1988617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
PhenomenonMedical learners are more likely than practicing physicians to experience negative emotions toward some patients whom they find challenging, and medical students experience such emotions related to their identity as learners. Little is known about experiences of residents, who are further along in their physician identity formation and have greater autonomy and competence. We explored and characterized how residents understand their experiences of the phenomenon of feeling negative emotions toward patients in relation to their identities as residents. Approach: In 2018, 305 final-year obstetrics and gynecology residents were invited to participate in interviews, which we conducted until reaching theoretical sufficiency. In semi-structured interviews conducted by phone, we probed interactions when residents felt negative emotions toward patients, including reasons for their feelings related to their professional identities, strategies, and curricular desires. The authors coded data and identified patterns using thematic analysis. Findings: Nineteen residents were interviewed by phone. Residents experienced negative emotions toward patients because of challenges to their identities as: physicians - wanting respect and specific unexpected patient behaviors; learners - desiring complete autonomy and experiencing challenges with attending physicians; teachers - wanting to be a role model and protect junior learners; and workers - trying to complete tasks. Among the strategies used to manage feelings toward patients, they struggled with "venting", or complaining about patients, which was not always helpful and residents recognized as perceived negatively by students. They desired curricular support for these interactions such as debriefs and other supported reflection, faculty modeling, and communication skills training. Insights: Like medical students and physicians in practice, residents experience negative emotions toward patients, often because of and made more difficult by their identities as physicians, learners, teachers, and workers. Educators should support residents' reflections about these interactions, model compassionate behavior when feeling challenged by patients, and address unhealthy coping strategies.
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Affiliation(s)
- Jody E Steinauer
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
| | | | - Felisa Preskill
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Jessie Chien
- Department of Community Health Sciences, University of California, Los Angeles, California, USA
| | - Cassandra Carver
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Jema Turk
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arianne Teherani
- Division of General Internal Medicine, University of California, San Francisco, California, USA
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Mack JW, Jaung T, Uno H, Brackett J. Change in the Parent-Clinician Relationship Throughout the First Year of Treatment in Pediatric Oncology. JAMA Netw Open 2022; 5:e2230503. [PMID: 36074466 PMCID: PMC9459655 DOI: 10.1001/jamanetworkopen.2022.30503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Challenges in the therapeutic relationship between clinicians and parents of children with cancer have been shown to emerge immediately after diagnosis, but little is known about whether such relationships improve over time. OBJECTIVE To better understand the potential evolution of parent-clinician relationships over the first year after diagnosis of pediatric cancer. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted from November 2015 to September 2020 at Dana-Farber Cancer Institute/Boston Children's Hospital and Texas Children's Hospital. Participants were oncology clinicians (attending physicians and fellows or nurse practitioners) and parents of children (aged <18 years) with a cancer diagnosis. Surveys were completed at study enrollment (soon after diagnosis [baseline]) and at the 3-month and 12-month follow-up. EXPOSURES Children had to have had at least 3 previous clinical visits with a primary oncology clinician. MAIN OUTCOMES AND MEASURES Survey instruments included the parent and clinician versions of the Relationship Challenges Scale, and factors associated with changes in relationships, including parental, clinician, and health care system attributes, were measured. RESULTS Survey participants included 150 parents (118 women [78.7%]; 98 with White race and ethnicity [65.3%]) and 49 clinicians (39 [79.6%] women; 39 with White race and ethnicity [79.6%]). Parents reported on 175 relationships with clinicians, and clinicians reported on 98 relationships with parents at all 3 time points (baseline, 3-month follow-up, and 12-month follow-up). Of the 175 relationships, 33 (18.9%) were considered to be challenging by parents at baseline, 27 (15.4%) were considered to be challenging at the 3-month follow-up, and 32 (18.3%) were considered to be challenging at the 12-month follow-up. Of the 33 challenging relationships at baseline, 20 (60.6%) resolved at the 12-month follow-up, whereas 13 (39.4%) had persistent challenges. However, 19 relationships that were not challenging at baseline had new challenges at the 12-month follow-up, corresponding to 59.4% of all challenges at the 12-month follow-up. No clinician behaviors were associated with improvement. Strategies used frequently (≥50%) by clinicians in their relationships that were associated with improvement included holding family meetings, apologizing, adapting to the parent's communication style, and devoting extra time and attention. CONCLUSIONS AND RELEVANCE Results of this study showed that some parents experienced challenging relationships with their child's oncology clinicians beginning at diagnosis and throughout the first year after diagnosis. Although many such relationships improved, others worsened, reflecting the vulnerable and stressful nature of parent-clinician relationships.
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Affiliation(s)
- Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences’ Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
| | - Tim Jaung
- Division of Population Sciences’ Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hajime Uno
- Division of Population Sciences’ Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Julienne Brackett
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Texas Children’s Hospital, Houston, Texas
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Jøssang IH, Aamland A, Hjörleifsson S. Discovering strengths in patients with medically unexplained symptoms - a focus group study with general practitioners. Scand J Prim Health Care 2022; 40:405-413. [PMID: 36345858 PMCID: PMC9848323 DOI: 10.1080/02813432.2022.2139345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When patients suffer medically unexplained symptoms, consultations can be difficult and frustrating for both patient and GP. Acknowledging the patient as a co-subject can be particularly important when the symptoms remain unexplained. One way of seeing the patient as a co-subject is by recognizing any among their strong sides. OBJECTIVES To explore GPs' experiences with discovering strengths in their patients with medically unexplained symptoms and elicit GPs' reflections on how this might be useful. METHODS Four focus-groups with 17 GPs in Norway. Verbatim transcripts from the interviews were analyzed by systematic text condensation. RESULTS Recollecting patients' strengths was quiet challenging to the GPs. Gradually they nevertheless shared a range of examples, and many participants had experienced that knowing patients' strong sides could make consultations less demanding, and sometimes enable the GP to provide better help. Identifying strengths in patients with unexplained symptoms required a deliberate effort on the GPs' behalf, and this seemed to be a result of a strong focus on biomedical disease and loss of function. CONCLUSIONS Acknowledging patients' strong sides can bolster GPs' ability to help patients with medically unexplained symptoms. However, the epistemic disadvantage of generalist expertise makes this hard to achieve. It is difficult for GPs to integrate person-centered perspectives with biomedical knowledge due to the privileged position of the latter. This seems to indicate a need for system-level innovations to increase the status of person-centered clinical work. Key pointsMUS is challenging for both patients and GPs mainly because of the incongruence between symptoms and the dominating biomedical model.GPs' focus on pathology and loss of function can prevent them from discovering patients' strengths.Awareness of patients' strengths can make consultations less demanding for GPs and enable them to provide better help.A conscious effort is needed to discover patients' strengths.
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Affiliation(s)
- Ingjerd Helene Jøssang
- Department of global public health and primary care, University of Bergen, Norway
- Research unit for general practice, NORCE Norwegian Research Centre, Bergen, Norway
- CONTACT Ingjerd Helene Jøssang Research unit for general practice, NORCE Norwegian Research Centre, Årstadveien 17, Bergen5016, Norway
| | - Aase Aamland
- Research unit for general practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Stefan Hjörleifsson
- Department of global public health and primary care, University of Bergen, Norway
- Research unit for general practice, NORCE Norwegian Research Centre, Bergen, Norway
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“Difficult” dental patients: a grounded theory study of dental staff’s experiences. BDJ Open 2022; 8:24. [PMID: 35941125 PMCID: PMC9359978 DOI: 10.1038/s41405-022-00115-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The “difficult” patient is a well-known and potentially negative character in various care contexts. Objectives This study aimed to generate a conceptual framework explaining the main concerns about “difficult” dental patients, and obtain a deeper understanding of their characteristics, how they affect the dental staff and how the staff think and act in order to manage these patients. Methods Ten interviews were conducted with professional dental caregivers, including dentists, dental hygienists, and dental nurses. The audio-recorded interviews were transcribed and analyzed in accordance with the principles of grounded theory. Results The main concern regarding “difficult” dental patients generated a framework of seven descriptive interrelated lower-level categories grounded in the data, subsumed in the core category “balancing subjective difficulties”. The informants perceived the possession of “showing interaction difficulties” and “having bio-psycho-social complexity”, as characteristic features of “difficult” patients, who could further adversely affect the dental staff by “evoking negative emotions and behaviors”, “hampering self-esteem and job satisfaction”, and “impairing life and health in general”. To manage the dental care of these patients, the staff used strategies aimed at “activating internal and external resources” and “creating adaptive treatment relations” with patients. Conclusions The dental staff’s meaning of the phenomenon of “difficult” dental patients points to specific characteristics, effects, and handling strategies. The core category captures the contradictory dynamics of characteristics and affects as these concepts seem interrelated to the caregivers’ handling capacity. The dental staff’s possibility of handling the main concern through balancing subjective difficulties depends on contextual conditions regarding time, to bring the patient and/or oneself at the center of attention. This indicates a need for further research regarding dental interactions and studies generalizing the outlook on “difficult” dental patients.
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Integrating Palliative Care into Physiatric Care: Perspective of the Association of Academic Physiatrists Physiatry Palliative Care Task Force. Am J Phys Med Rehabil 2022; 101:888-896. [DOI: 10.1097/phm.0000000000002001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Soo MS, Lowell DA, Destounis SV. Managing Challenging Patient Interactions in Breast Imaging. JOURNAL OF BREAST IMAGING 2022; 4:183-191. [PMID: 38422424 DOI: 10.1093/jbi/wbab089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 03/02/2024]
Abstract
Managing challenging patient interactions can be a daily stressor for breast imaging radiologists, leading to burnout. This article offers communication and behavioral practices for radiologists that help reduce radiologists' stress during these encounters. Patient scenarios viewed as difficult can vary among radiologists. Radiologists' awareness of their own physical, mental, and emotional states, along with skillful communications, can be cultivated to navigate these interactions and enhance resiliency. Understanding underlying causes of patients' emotional reactions, denial, and anger helps foster empathy and compassion during discussions. When exposed to extremely disruptive, angry, or racially abusive patients, having pre-existing institutional policies to address these behaviors helps direct appropriate responses and guide subsequent actions. These extreme behaviors may catch breast imaging radiologists off guard yet have potentially significant consequences. Rehearsing scripted responses before encounters can help breast imaging radiologists maintain composure in the moment, responding in a calm, nonjudgmental manner, and most effectively contributing to service recovery. However, when challenging patient encounters do trigger difficult emotions in breast imaging radiologists, debriefing with colleagues afterwards and naming the emotion can help the radiologists process their feelings to regain focus for performing clinical duties.
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Affiliation(s)
- Mary Scott Soo
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Dorothy A Lowell
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
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Altamura M, D’Andrea G, Angelini E, Tortorelli FMP, Balzotti A, Porcelli P, Margaglione M, Brunetti ND, Cassano T, Bellomo A. Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients. PLoS One 2022; 17:e0265282. [PMID: 35271674 PMCID: PMC8912235 DOI: 10.1371/journal.pone.0265282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Psychosomatic syndromes have emerged as an important source of comorbidity in cardiac patients and have been associated with increased risk for adverse outcomes in patients with heart failure (HF). Understanding of the mechanisms underlying this connection is limited, however immune activity represents a possible pathway. While there have been numerous studies connecting immune activity to psychosomatic psychopathology, there is a lack of research on patients with HF. We examined forty-one consecutive outpatients affected by HF. We assessed psychosomatic psychopathology using the Diagnostic Criteria for Psychosomatic Research (DCPR) and the Patient Health Questionnaire-15 (PHQ-15). The Psychosocial Index (PSI) was used for assessing stress and psychosocial dimensions. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Circulating levels of proinflammatory cytokines IL-6 and TNF-alpha were ascertained. Univariate and multivariable regression models were used to test for associations between inflammatory cytokines and psychosomatic psychopathology (i.e., DCPR syndromes, PHQ-15) and psychological dimensions (i.e., BDI-II, PSI). A significant positive correlation was found between IL-6 levels and psychosomatic psychopathology even when controlling for any confounding variables (i.e., Body-mass index (BMI), New York Heart Association (NYHA) class, smoking habits, alcohol consumption, statin use, aspirin use, beta blockers use, age, and gender). In contrast, the associations between TNF-alpha levels were non-significant. These findings can contribute to research in support of a psychoneuroimmune connection between psychosomatic psychopathology and HF. Findings also suggest the possibility that elevated IL-6 levels are more relevant for the pathogenesis of psychosomatic syndromes than for depression in patients with HF.
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Affiliation(s)
- Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- * E-mail:
| | - Giovanna D’Andrea
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Eleonora Angelini
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Angela Balzotti
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, D’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Natale D. Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tommaso Cassano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Desai V. Managing an Unhappy Patient. Indian J Plast Surg 2022; 54:495-500. [PMID: 34984091 PMCID: PMC8719954 DOI: 10.1055/s-0041-1739249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
A clinical study has noted that one out of six patients is perceived as "difficult" by clinicians. Not surprisingly, patient dissatisfaction has to do with multiple factors, both within and outside the control of the surgeon. In the present times of electronic information and ratings, managing difficult patients is a critical skill-a patient's dissatisfactory review could adversely affect a practitioner's reputation built over years of meticulous practice. Patient expectations are often more pronounced in case of elective medical procedures such as hair transplants. The subject of managing an unhappy patient in the context of hair transplantation is, therefore, one that requires due enquiry and is the subject that this article seeks to explore.
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Affiliation(s)
- Viral Desai
- Cosmetic Plastic Surgery and Laser Super specialities, Mumbai, Maharashtra, India.,Desai Hospitals Ventures LLP, Mumbai, Maharashtra, India.,Desai Hospitals Private Limited, Mumbai, Maharashtra, India.,Sarla Hospital, Mumbai, Maharashtra, India
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35
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Ryan M. Care of the Challenging Patient. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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White AEC, Hood-Medland EA, Kravitz RL, Henry SG. Visit Linearity in Primary Care Visits for Patients with Chronic Pain on Long-term Opioid Therapy. J Gen Intern Med 2022; 37:78-86. [PMID: 34159543 PMCID: PMC8738805 DOI: 10.1007/s11606-021-06917-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration. OBJECTIVE This study creates a novel measure, "visit linearity," to assess visit organization and examines whether visits that require less shifting back and forth between topics are associated with better patient and physician visit experiences. It also explores whether visit linearity differs depending on the following: (1) whether or not pain is a major topic of the visit and (2) whether or not pain is the first topic raised. DESIGN This study analyzed 41 video-recorded visits using inductive, qualitative analysis informed by conversation analysis. We used linear regression to evaluate associations between visit organization and post-visit measures of participant experience. PARTICIPANTS Patients were established adult patients planning to discuss pain management during routine primary care. Physicians were internal or family medicine residents. MAIN MEASURES Visit linearity, total topics, return topics, topic shifts, time per topic, visit duration, pain main topic, pain first topic, patient experience, and physician difficulty. KEY RESULTS Visits had a mean of 8.1 total topics (standard deviation (SD)=3.46), 14.5 topic shifts (SD=6.28), and 1.9 topic shifts per topic (SD=0.62). Less linear visits (higher topic shifts to topic ratio) were associated with greater physician visit difficulty (β=7.28, p<0.001) and worse patient experience (β= -0.62, p=0.03). Visit linearity was not significantly impacted by pain as a major or first topic raised. CONCLUSIONS In primary care visits for patients with chronic pain taking opioids, more linear visits were associated with better physician and patient experience. Frequent topic shifts may be disruptive. If confirmed in future research, this finding implies that reducing shifts between topics could help decrease mutual frustration related to discussions about pain.
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Affiliation(s)
- Anne Elizabeth Clark White
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Richard L. Kravitz
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Stephen G. Henry
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
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Halverson CME, Clayton EW, Garcia Sierra A, Francomano C. Patients with Ehlers-Danlos syndrome on the diagnostic odyssey: Rethinking complexity and difficulty as a hero's journey. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2021; 187:416-424. [PMID: 34524722 DOI: 10.1002/ajmg.c.31935] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022]
Abstract
Patients with hypermobile Ehlers-Danlos syndrome, an hereditary disorder of the connective tissue, often face a long and difficult diagnostic odyssey in pursuit of a name for their condition. Clinicians may dismiss subjective symptoms of chronic pain, thus prolonging patients' odysseys and worsening their care and satisfaction and creating antagonisms in the patient-provider relationship. A greater understanding of patient experiences is necessary in order to decrease burdens of this relationship and to improve care. To that end, we conducted 22 in-depth, semistructured interviews with individuals who had undergone this diagnostic odyssey. We focused on the impact that the odyssey had on their lives, both inside and outside the clinic. Through narrative analysis, we found a sort of "hero's journey" in the description of their cases, highlighting issues of uncertainty and integration as well as honoring their struggles. Interviewees had encountered difficulties in working with clinicians, in multiplying symptoms, and in negative psychosocial consequences. Attention to patients' lived experience may help to build empathy and understanding for the difficult and complex clinical situation presented by Ehlers-Danlos syndrome. Using the hero's journey as a lens onto this experience allows for a more patient-centered approach to this understanding and has potential value for comprehension of other complex diseases and invisible illnesses.
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Affiliation(s)
- Colin Michael Egenberger Halverson
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Anthropology, Indiana University, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,School of Law, Vanderbilt University, Nashville, Tennessee, USA
| | - Abigail Garcia Sierra
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Clair Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Mack JW, Jaung T, Uno H, Brackett J. Parent and Clinician Perspectives on Challenging Parent-Clinician Relationships in Pediatric Oncology. JAMA Netw Open 2021; 4:e2132138. [PMID: 34787658 PMCID: PMC8600390 DOI: 10.1001/jamanetworkopen.2021.32138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Parents of children with cancer value strong therapeutic relationships with oncology clinicians, but not every relationship is positive. OBJECTIVE To identify the prevalence of challenging parent-clinician relationships in pediatric oncology and factors associated with these challenges from parent and clinician perspectives. DESIGN, SETTING, AND PARTICIPANTS This survey was conducted among parents and oncology clinicians of children with cancer within 3 months of diagnosis from November 2015 to July 2019 at Dana-Farber Cancer Institute/Boston Children's Hospital and Texas Children's Hospital. Participants were 400 parents of children with cancer and 80 clinicians (ie, oncology physicians and nurse practitioners). Parents completed surveys about relationships with 1 to 2 primary oncology clinicians; clinicians completed surveys about relationships with parents. Data were analyzed from July 2020 to August 2021. EXPOSURES At least 3 previous clinical visits between parent and clinician. MAIN OUTCOMES AND MEASURES The Relationship Challenges Scale Parent Version and Clinician Version were developed and used to measure threats to the therapeutic alliance. For the Relationship Challenges Scale-Parent version, relationships were considered challenging if a parent responded to any single question in the 2 lowest of 4 possible categories. For the Relationship Challenges Scale-Clinician version, challenges were considered to be present if a clinician reported responses in the 3 lowest of 6 possible response categories to any question. RESULTS Among 400 parents, there were 298 [74.5%] women, 25 Asian individuals (6.3%), 28 Black individuals (7.0%), 97 Hispanic individuals (24.3%), 223 White individuals (55.8%), and 10 individuals (2.4%) with other race or ethnicity; race and ethnicity data were missing for 17 (4.3%) individuals. Among 80 clinicians, there were 57 (71.3%) women, 38 attending physicians (47.5%), 32 fellows (40.0%), and 10 nurse practitioners (12.5%). Parents identified 676 unique relationships with clinicians, and clinician reports were available for 338 relationships. Among 338 relationships with paired parent and clinician surveys, 81 relationships (24.0%) were considered challenging by parents, 127 relationships (37.6%) were considered challenging by clinicians, and 33 relationships (9.8%) were considered challenging by parent and clinician. Parents with Asian or other race or ethnicity (odds ratio [OR] vs White parents, 3.62; 95% CI, 1.59-8.26) or who had lower educational attainment (OR for ≤high school vs >high school, 3.03; 95% CI, 1.56-5.90) were more likely to experience relationships as challenging. Clinicians used a variety of strategies more frequently in 127 relationships in which they perceived challenges vs 211 relationships in which they did not perceive challenges, such as holding regular family meetings (22 relationships [17.3%] vs 13 relationships [6.2%]; P = .009) and offering extra time and attention (66 relationships [52%] vs 60 relationships [28.4%]; P < .001). However, these strategies were not used with increased frequency when parents experienced relationships as challenging vs when parents did not experience this. CONCLUSIONS AND RELEVANCE This survey study found that nearly one-quarter of parents of children with cancer reported challenges in the therapeutic relationship with their oncologist and that clinicians used strategies to improve relationships more frequently when they experienced the relationship as challenging. These findings suggest that new strategies are needed to improve experiences for parents and to help clinicians recognize and attend to parents whose experiences are suboptimal.
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Affiliation(s)
- Jennifer W. Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Population Sciences Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
| | - Tim Jaung
- Division of Population Sciences Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hajime Uno
- Division of Population Sciences Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Julienne Brackett
- Department of Pediatrics, Section of Pediatric Hematology/Oncology, Texas Children’s Hospital, Houston
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Jørgensen R, Christensen AE, Pristed SG, Jepsen I, Telléus GK. Burnout in Mental Health Care Professionals Working with Inpatients in Open or Closed Wards in Psychiatric Hospitals. Issues Ment Health Nurs 2021; 42:1030-1037. [PMID: 34129429 DOI: 10.1080/01612840.2021.1931582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mental health care professionals are at risk of experiencing burnout. This cross-sectional study aims to investigate burnout in two settings: open and closed psychiatric wards, and two professions: registered nurses and social healthcare assistants in eight psychiatric wards in Denmark. A total of 114 professionals completed the Copenhagen Burnout Inventory and a demographic questionnaire. No statistically differences in burnout in professionals working in closed and open wards were found. However, we found professionals to score highest on personal and work-related burnout and lowest on client-related burnout. This indicates that patients may only play a minor role in burnout in health professionals.
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Affiliation(s)
- Rikke Jørgensen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Ingrid Jepsen
- Nursing Education, University College Northern Denmark, Aalborg, Denmark
| | - Gry Kjaersdam Telléus
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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40
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Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021; 161:1670-1688.e7. [PMID: 34331912 DOI: 10.1053/j.gastro.2021.07.037] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Albena Halpert
- Gastroenterology,Harvard University Health Services, Boston, Massachusetts
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Johannah Ruddy
- Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina
| | - Julie Snyder
- Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts
| | - Ami Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Nijhof D, Ingram A, Ochieng R, Roberts EJ, Poulton B, Ochieng B. Examining GP online consultation in a primary care setting in east midlands, UK. BMC Health Serv Res 2021; 21:1030. [PMID: 34592980 PMCID: PMC8482740 DOI: 10.1186/s12913-021-07039-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Increasing pressure threatens to overwhelm primary care services, affecting the quality of care and their role as gatekeepers to specialised care services. This study investigated healthcare users’ acceptability of – and the effectiveness of – an e-consultation system in primary care services. Methods Seven GP practices in East-Midlands, all of whom use online consultation system participated in the study, with a retrospective review being undertaken of 189 electronic patients’ records (age range of 18–76 years) over 5 months. The focus was on the electronic records of patients who accessed the service for five different conditions identified as presenting common conditions seen by the GPs practices. Statistical analysis was done using SPSS to perform an exploratory data analysis and descriptive statistics. Results The results showed a positive reception of the online consultation platform, with an average satisfaction score of 4.15 (most likely to recommend score = 5). Given the nature of the conditions, 47.6% of patients had experienced a previous episode of the health condition they were seeking consultation for, and a total of 72% had existing comorbidities. Follow-up activity occurred for 87.3% of patients, 66.1% of which included at least one follow-up visit for the same condition as the initial online consultation. Conclusion The results suggest that online consultation is convenient for patients, and it also has the potential to relieve pressure placed on primary care services. Although a number of challenges were identified, such as patient verification, this study gives insight into – and enhances our understanding of – the use of online GP consultations.
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Affiliation(s)
- Dewy Nijhof
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | | | - Rebecca Ochieng
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | | | | | - Bertha Ochieng
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK.
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Spruill TE. Vexing visits: Variables correlating with physician perceptions of patients as "difficult" and overall enjoyment of their delivery of primary ambulatory care. Int J Psychiatry Med 2021; 56:354-363. [PMID: 34338000 DOI: 10.1177/00912174211032037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
All physicians experience some patients described as "difficult." Their prevalence negatively impacts work satisfaction. Prior research identified factors present when physicians perceive patients as difficult. Numerous variables are unrelated to vexing patient visits. Three additive patient characteristics predict difficult encounters: 1) depressive or anxiety comorbidity, 2) polysymptomatic patients, and 3) high symptom severity. The sole physician variable was their score on the Physician Belief Scale (PBS) which quantifies negative attitudes towards psychosocial problems. When all three patient predictors exist, high PBS scorers judge twice as many patients as difficult. Five clinic milieu variables correlated weakly with clinic satisfaction among primary care residents. They are: 1) minimal role conflict, 2) autonomy, 3) collegiality, 4) encouragement of professional growth, and 5) work group loyalty. "Positive affect" was among the strongest physician variables but the author labeled it a confounding variable. Finally, a small "n" QI study conducted in this author's residency explored the role of physician affectivity and identified additional physician characteristics and clinic milieu factors correlating with overall enjoyment of ambulatory clinic practice. Surprisingly, none of the five previously identified clinic milieu variables correlated directly with resident clinic satisfaction. "Supportive staff cohesion" was one milieu variable that correlated significantly with clinic satisfaction. Resident affective characteristics that significantly reduced clinic satisfaction were "hostility" and "negative affectivity." "Joviality" was positively related to clinic satisfaction. While patient variables are uncontrollable, it is plausible that by physicians changing their beliefs and affectivity the percentage of vexing visits could be cut in half improving work satisfaction.
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Affiliation(s)
- Timothy Eugene Spruill
- Department of Graduate Medical Education, 23071AdventHealth East Orlando, AdventHealth East Orlando, Orlando, FL, USA
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43
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Miller JJ, Serwint JR, Boss RD. Clinician-family relationships may impact neonatal intensive care: clinicians' perspectives. J Perinatol 2021; 41:2208-2216. [PMID: 34091604 PMCID: PMC8178652 DOI: 10.1038/s41372-021-01120-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Collaborative clinician-family relationships are necessary for the delivery of successful patient- and family-centered care (PFCC) in the NICU. Challenging clinician-family relationships may undermine such collaboration and the potential impacts on patient care are unknown. STUDY DESIGN Consistent caregivers were surveyed to describe their relationships and collaboration with families of infants hospitalized ≥ 28 days. Medical record review collected infant and family characteristics hypothesized to impact relationships. Mixed methods analysis was performed. RESULTS Clinicians completed 243 surveys representing 77 families. Clinicians reported low collaboration with families who were not at the bedside and/or did not speak English. Clinicians perceived most clinician-family relationships impact the infant's hospital course. Negative impacts included communication challenges, mistrust or frustration with the team and disruptions to patient care. CONCLUSION This study identifies features of clinician-family relationships that may negatively impact an infant's NICU stay. Targeting supports for these families is necessary to achieve effective PFCC.
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Redelmeier DA, Najeeb U, Etchells EE. Understanding Patient Personality in Medical Care: Five-Factor Model. J Gen Intern Med 2021; 36:2111-2114. [PMID: 33506393 PMCID: PMC7840072 DOI: 10.1007/s11606-021-06598-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/01/2021] [Indexed: 12/27/2022]
Abstract
Personality is the description of an individual's tendencies when acting or reacting to others. Clinicians spontaneously form impressions of a patient's apparent personality yet such unstructured impressions might lead to snap judgments or unhelpful labels. Here we review the evidence-based five-factor model from psychology science for understanding personalities (OCEAN taxonomy). Openness to experience is defined as the general appreciation for a variety of experiences. Conscientiousness is the tendency to exhibit self-discipline. Extraversion is the degree of engagement with the external world. Agreeableness is the general concern for social harmony. Neuroticism is the tendency to experience negative emotions. An awareness of these five dimensions might help clinicians avoid faulty judgments from casual contact. Expert assessment of personality requires extensive training and data, thereby suggesting that clinicians should take a humble view of their own unsophisticated impressions of a patient's personality.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Canada. .,Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada. .,Center for Quality Improvement & Patient Safety, University of Toronto, Toronto, Canada.
| | - Umberin Najeeb
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.,Center for Quality Improvement & Patient Safety, University of Toronto, Toronto, Canada
| | - Edward E Etchells
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada.,Center for Quality Improvement & Patient Safety, University of Toronto, Toronto, Canada
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van Veen M, Koekkoek B, Teerenstra S, Adang E, Mulder CL. Effectiveness and cost effectiveness of interpersonal community psychiatric treatment (ICPT) for people with long-term severe non-psychotic mental disorders: a multi-Centre randomized controlled trial. BMC Psychiatry 2021; 21:261. [PMID: 34011328 PMCID: PMC8136177 DOI: 10.1186/s12888-021-03264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Long-term community mental health treatment for non-psychotic disorder patients with severe mental illness (SMI) who are perceived as difficult by clinicians, is poorly developed and lacks a structured, goal-centred approach. This study compares (cost-)effectiveness of Interpersonal Community Psychiatric Treatment (ICPT) with Care As Usual (CAU) on quality of life and clinician perceived difficulty in the care for non-psychotic disorder SMI-patients. A multi-centre cluster-randomized clinical tria was conducted in which Community Mental Health Nurses (Clinicians) in three large community mental health services in the Netherlands were randomly allocated to providing either ICPT or CAU to included patients. A total of 56 clinicians were randomized, who treated a total of 93 patients (59 in ICPT-group and 34 in CAU-group). METHODS Primary outcome measure is patient-perceived quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA). Secondary outcome measures include clinician-perceived difficulty, general mental health, treatment outcomes, illness management and recovery, therapeutic relationship, care needs and social network. Patients were assessed at baseline, during treatment (6 months), after treatment (12 months) and at 6 months follow-up (18 months). Linear mixed-effects models for repeated measurements were used to compare mean changes in primary and secondary outcomes between intervention and control group of patients over time on an intention to treat basis. Potential efficiency was investigated from a societal perspective. Economic evaluation was based on general principles of a cost-effectiveness analysis. Outcome measures for health economic evaluation, were costs, and Quality Adjusted Life Years (QALYs). RESULTS Half of the intended number of patients were recruited. There was no statistically significant treatment effect found in the MANSA (0.17, 95%-CI [- 0.058,0.431], p = 0.191). Treatment effects showed significant improvement in the Different Doctor-Patient Relationship Questionnaire-scores and a significant increase in the Illness Management and Recovery-scale Client-version scores). No effects of ICPT on societal and medical costs nor QALYs were found. CONCLUSIONS This is the first RCT to investigate the (cost)-effectiveness of ICPT. Compared with CAU, ICPT did not improve quality of life, but significantly reduced clinician-perceived difficulty, and increased subjective illness management and recovery. No effects on costs or QALY's were found. TRIAL REGISTRATION NTR 3988 , registered 13 May 2013.
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Affiliation(s)
- Mark van Veen
- Institute for Nursing studies, University of Applied Sciences, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
| | - Bauke Koekkoek
- grid.491369.00000 0004 0466 1666Research Group for Social Psychiatry and Mental Health Nursing, University of Applied Science, Nijmegen and Pro Persona Mental Health Services, Arnhem, the Netherlands
| | - Steven Teerenstra
- grid.10417.330000 0004 0444 9382Department for Health Evidence, section Biostatistics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Eddy Adang
- grid.10417.330000 0004 0444 9382Department for Health Evidence, section Biostatistics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Cornelis L. Mulder
- grid.5645.2000000040459992XDepartment of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands ,Psychiatric Institute, Rotterdam, the Netherlands
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Feingold JH, Drossman DA, Chey W, Kurlander JE, Morris CB, Bangdiwala S, Keefer L. Preliminary development and validation of the Patient-Physician Relationship Scale for physicians for disorders of gut-brain interaction. Neurogastroenterol Motil 2021; 33:e13976. [PMID: 32875659 PMCID: PMC8065374 DOI: 10.1111/nmo.13976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND An effective patient-physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). After developing a PPR questionnaire for patients, we sought to develop and validate an IBS-specific instrument to measure physician expectations of the PPR. METHODS We conducted focus groups about PPRs among 15 clinicians who treat patients with IBS from community and academic centers. Qualitative analysis was used to generate the Patient-Physician Relationship Scale -Physician RESULTS: The PPRS-Physician contained 35 questions pertaining to interpersonal and psychosocial features considered desirable or undesirable in a relationship with IBS patients. 1113 physicians (22%) completed the survey. Physicians were predominantly middle-aged (mean = 55.1 years), male (85.0%), white (74.5%), and practiced primarily within group settings (61.6%), with an average of 25.7% of their patients having IBS. Factor analysis revealed three relevant factors: interfering attributes, positive attributes, and personal connection. The scale ranged from possible 0 to 100 (mean = 83.8; SD = 8.38). Cronbach's alpha reliability measure of the scale was 0.938, indicating high internal consistency. There was a significant moderate, positive correlation between JSPE and the PPRS (P < 0.001, r = 0.488), establishing concurrent validity. CONCLUSIONS We describe the development and validation of the first questionnaire to measure physician expectations of the PPR. This instrument can be used clinically, and for future studies on physician communication.
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Affiliation(s)
- Jordyn H Feingold
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Douglas A Drossman
- Center for Education and Practice of Biopsychosocial Care, UNC Center for Functional GI and Motility Disorders and Drossman Gastroenterology, Chapel Hill, NC, USA
| | - William Chey
- Department of Gastroenterology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jacob E Kurlander
- Department of Gastroenterology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Carolyn B Morris
- Center for Education and Practice of Biopsychosocial Care, UNC Center for Functional GI and Motility Disorders and Drossman Gastroenterology, Chapel Hill, NC, USA
| | - Shrikant Bangdiwala
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Laurie Keefer
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hood-Medland EA, White AEC, Kravitz RL, Henry SG. Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain. BMC FAMILY PRACTICE 2021; 22:4. [PMID: 33397299 PMCID: PMC7780618 DOI: 10.1186/s12875-020-01317-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
Background Agenda setting is associated with more efficient care and better patient experience. This study develops a taxonomy of visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience. Methods This observational study analyzed 83 video recorded US primary care visits at a single academic medical center in California involving family medicine and internal medicine resident physicians (n = 49) and patients (n = 83) with chronic pain on opioids. Using conversation analysis, we developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discussed. Exploratory quantitative analyses were conducted to assess the relationship of agenda setting and visit opening styles with post-visit measures of both patient experience and physician perception of visit difficulty. Results We identified 2 visit opening styles representing agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda setting opening styles (open-ended question, patient launch, physician launch). Agenda setting was only performed in 11% of visits and was associated with fewer surprise patient topics than visits without agenda setting (mean (SD) 2.67 (1.66) versus 4.28 (3.23), p = 0.03). Conclusions In this study of patients with chronic pain, resident physicians rarely performed agenda setting, whether defined in terms of “agenda eliciting” or “agenda re-framing.” Agenda setting was associated with fewer surprise topics. Understanding the communication context and outcomes of agenda setting may inform better use of this communication tool in primary care practice.
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Affiliation(s)
- Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| | - Anne E C White
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA. .,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA.
| | - Richard L Kravitz
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| | - Stephen G Henry
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
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van Gils A, Tak LM, Sattel H, Rosmalen JGM. Development and User Experiences of a Biopsychosocial Interprofessional Online Course on Persistent Somatic Symptoms. Front Psychiatry 2021; 12:725546. [PMID: 34819884 PMCID: PMC8607516 DOI: 10.3389/fpsyt.2021.725546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Communication between healthcare providers and patients with persistent somatic symptoms (PSS) is frequently hampered by mutual misunderstanding and dissatisfaction. Methods: We developed an online, interprofessional course to teach healthcare providers the knowledge, skills, and attitude they need to diagnose and treat PSS in a patient-centered manner based on the biopsychosocial model. The course consisted of six modules of 45-60 min. Each module contained different types of assignments, based on six cases: videos, discussion boards, reading assignments, polls, and quizzes. For this study, we included (1) medical residents, following the course as part of their residency training, and (2) healthcare providers (general practitioners, medical specialists, physiotherapists, nurses, and psychologists), following the course as continuing vocational training. Throughout the course, participants were asked to fill out online surveys, enquiring about their learning gains and satisfaction with the course. Results: The biopsychosocial approach was integrated across the modules and teached health care workers about recent insights on biological, psychological and social aspects of PSS. In total, 801 participants with a wide variety in clinical experience started the course; the largest groups of professionals were general practitioners (N = 400), physiotherapists (N = 124) and mental healthcare workers (N = 53). At the start of the course, 22% of the participants rated their level of knowledge on PSS as adequate. At the end of the course, 359 participants completed the evaluation questionnaires. Of this group, 81% rated their level of knowledge on PSS as adequate and 86% felt that following the course increased their competencies in communicating with patients with PSS (N = 359). On a scale from 1 to 10, participants gave the course a mean grade of 7.8 points. Accordingly, 85% stated that they would recommend the course to a colleague. Conclusion: Our course developed in a co-design process involving multiple stakeholders can be implemented, is being used, and is positively evaluated by professionals across a variety of health care settings.
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Affiliation(s)
- A van Gils
- University of Groningen, University Medical Center Groningen, Departments of Psychiatry and Internal Medicine, Groningen, Netherlands
| | - L M Tak
- Specialist Center for Persistent Somatic Symptoms & Somatic Symptom Disorders, Dimence Mental Health Care, Deventer, Netherlands
| | - H Sattel
- Department of Psychosomatic Medicine and Psychotherapy, The Technical University of Munich, Munich, Germany
| | - J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Departments of Psychiatry and Internal Medicine, Groningen, Netherlands.,Specialist Center for Persistent Somatic Symptoms & Somatic Symptom Disorders, Dimence Mental Health Care, Deventer, Netherlands
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Ryan M. Care of the Challenging Patient. Fam Med 2021. [DOI: 10.1007/978-1-4939-0779-3_61-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hu L, Bai L, Zhao S, Lu R. Analysis of Doctor-Patient Relationship in Post-COVID-19 Period: Perspective Differences Between Citizen and Medical Staff. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060300. [PMID: 34865546 PMCID: PMC8652910 DOI: 10.1177/00469580211060300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the current views on doctor–patient relationship (DPR) between citizens and
medical staff in post-Corona Virus Disease 2019 (COVID-19) period and predict the possible
factors of DPR, we distributed questionnaires by a online questionnaire
platform--Questionnaire Star (https://www.wjx.cn) to evaluate DPR in post-COVID-19 period.
Overall, 312 questionnaires for citizens and 421 questionnaires for medical staff were
completed. Citizens felt that service attitude and communication with medical staff, and
registering process have been improved. And their trust in doctors has increased by 86.8%.
Majority of citizens (66.0%) preferred the tertiary hospitals. If doctor–patient
contradictions occurred, 62.9% citizens preferred internal negotiation (with the doctor
involved, 44.6%; with hospital management department, 18.3%). There was significant
difference of views on the causes of medical violence incidents and the reasons for
doctor–patient conflicts in the future between citizens and medical staff. The DPR score
of medical staff was lower than citizens at each stage, and even showed a downward
tendency in post-COVID-19 period. Furthermore, 20.4% medical staff believed that
harmonious DPR would not be maintained, which was distinct from that of the citizens.
Combating the COVID-19 provided an important opportunity to improve the DPR. However,
unbalanced allocation of high-quality medical resources, gap between the actual treatment
efficacy and patient’s expectation, fairness and efficiency issues, financial conflicts,
and medical information symmetry were still the influencing factors of DPR.
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Affiliation(s)
- Lingmin Hu
- Department of Reproduction, the Affiliated Changzhou Maternity and Child Health Care Hospital of Nanjing Medical University, Jiangsu, Changzhou 213000, China
| | - Lijing Bai
- Department of Reproduction, the Affiliated Changzhou Maternity and Child Health Care Hospital of Nanjing Medical University, Jiangsu, Changzhou 213000, China
| | - Shenyu Zhao
- Department of Neurology, the Third People's Hospital of Changzhou, Jiangsu, Changzhou 213000, China
| | - Renjie Lu
- Publicity Department, Changzhou Municipal Health Commission, Jiangsu, Changzhou 213000, China.,Business School, ISCTE University Institute of Lisbon, Lisbon 1649-026, Portugal.,School of Health Management, Southern Medical University, Guangdong, Guangzhou 510515, China
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