Editorial

Patients in context: Recognizing the companion as part of a patient-centered team

This paper explores the unique phenomenon of “other” patient participation in Traditional Chinese Medicine (TCM). Specifically, it focuses on cases where doctors enlist the help of bystanders to address patient resistance and advance their medical agendas. By analyzing video-recorded practitioner-patient interactions in TCM hospitals, this study uncovers the various roles that third parties can assume during these medical interactions. The research identifies three distinct forms of “other” patient participation: the “other” patient as an illness-free individual providing a contrasting case, the “other” patient as a lay witness to the patient's clinical manifestations, and the “other” patient as a recovered fellow patient demonstrating treatment effectiveness. The findings of this study contribute to existing research on patient resistance and triadic medical interactions, offering insights into the dynamics and implications of third-party involvement in medical consultations.

Valorar la influencia del acompañante en consulta sobre la calidad de la comunicación médico-paciente y la duración de la consulta.

Descriptivo transversal.

Diez centros de salud.

Médicos residentes de Medicina Familiar y Comunitaria.

Auditoría por pares de videograbaciones de consultas a demanda.

Habilidades en comunicación utilizando el cuestionario CICAA-2 (mejorable, aceptable o adecuada); edad (MIR), sexo (MIR, paciente y acompañante), motivos de consulta y duración de la entrevista. Análisis bivariante y multivariante. Autorización del CEI, consentimiento informado oral y custodia de las videograbaciones.

Participaron 73 MIR (53,8% mujeres, 32,9 ± 7,7 años) valorando 260 entrevistas (60,3% mujeres, 2,1 ± 1,0 motivos de consulta). Un 27,7% de consultas con acompañante (sexo femenino 65,3%). La duración media de las entrevistas fue de 8,5 ± 4,0 minutos, superior 2,7 ± 0,5 minutos en consultas con acompañante (p < 0,001 t de Student) y con mayor número de motivos de consulta (40% con ≥ 3 motivos, p = 0,048 X²). El valor medio de la puntuación total de la escala CICAA-2 (46,9 ± 16,5) fue superior en las consultas con acompañante (diferencia 4,6 ± 2,3), al igual que la tarea 2 (39,3 ± 15,8 con diferencia 4,4 ± 2,2) (p < 0,05 t de Student). El modelo obtenido con regresión logística binaria muestra una mayor duración de la consulta con acompañante (OR 1,2; IC [1,1-1,3]) y posiblemente mejor puntuación en la tarea 2 (OR 1,02; IC [0,99-1,1]).

Las comunicaciones triádicas suponen un desafío para las habilidades de comunicación del médico, que mejora sus capacidades para identificar y comprender los problemas del paciente, aunque a costa de una mayor inversión de tiempo.

To know the influence of the companion in triadic clinical encounter on the quality of doctor–patient communication and the duration of the interview.

Cross-sectional descriptive study.

10 Primary Care Centers.

Resident doctors of Family and Community Medicine.

Peer review of video recordings of clinical demand consultations.

CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings.

73 RD (53.8% women, 32.9 ± 7.7 years) participated with 260 interviews (60.3% women and 2.1 ± 1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5 ± 4.0 min. Clinical encounters lasted longer when a companion attended (2.7 ± 0.5 min more; p < .001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p = 0.048 X²). The mean value of the total score of the CICAA-2 scale (46.9 ± 16.5; difference 4.6 ± 2.3) and Task 2 (39.3 ± 15.8 with difference 4.4 ± 2.2) were higher when companion was present (p < .05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1–1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99–1.1]).

Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.

This research investigated people's affective reaction to and cognitive evaluation of risks taken by close others. Five experimental studies showed that individuals were more anxious when a significant other (e.g., their partner) intended to engage in behavior implying risk to health or safety than when they intended to engage in the same behavior themselves. This discrepancy did not emerge if the other was emotionally distant (e.g., an acquaintance), suggesting that the self-other discrepancy in anxiety is moderated by the quality of the relationship. Neither a perceived higher personal control, nor a perceived lower probability of encountering negative events, as suggested by research on self-other biases in risk assessment, accounted for the effect. However, it was partially mediated by individuals' tendency to imagine more severe consequences of others' (vs. own) risk behavior. Results are discussed with regard to their theoretical implications for the study of risk taking and close relationships.

As shared decision makes increasing headway in healthcare policy, it is under more scrutiny. We sought to identify and dispel the most prevalent myths about shared decision making.

In 20 years in the shared decision making field one of the author has repeatedly heard mention of the same barriers to scaling up shared decision making across the healthcare spectrum. We conducted a selective literature review relating to shared decision making to further investigate these commonly perceived barriers and to seek evidence supporting their existence or not.

Beliefs about barriers to scaling up shared decision making represent a wide range of historical, cultural, financial and scientific concerns. We found little evidence to support twelve of the most common beliefs about barriers to scaling up shared decision making, and indeed found evidence to the contrary.

Our selective review of the literature suggests that twelve of the most commonly perceived barriers to scaling up shared decision making across the healthcare spectrum should be termed myths as they can be dispelled by evidence.

Our review confirms that the current debate about shared decision making must not deter policy makers and clinicians from pursuing its scaling up across the healthcare continuum.