Patient Education and Counseling - Articles in Press

Evaluation of the Dutch AIDS STI information helpline: Differential outcomes of telephone versus online counseling - Corrected Proof

2012-05-18

Abstract: Objective: Health information helplines have an important function in health education, prevention and counseling. Information and help services are increasingly provided online. This study focuses on the differences and similarities between online help services and telephone services.Methods: The telephone service of the Dutch AIDS STI helpline was compared to its e-mail equivalent. After consulting the helpline service, both callers and e-mailers (Ntot=455) were asked to participate in a survey that evaluated their background characteristics, contacting reasons, and satisfaction with the specific service and information received. The survey also included questions regarding the advice received from the helpline. A follow-up measure 4 weeks after the baseline survey evaluated to what extent clients acted upon the advice.Results: The study shows that both services are positively evaluated and are equally persuasive in their counseling. Differences between callers and e-mailers were found regarding background characteristics, content of the consultation, satisfaction, and the advice received.Conclusion: It can be concluded that online health information services are an important addition to, but not a replacement for, the traditional telephone helplines.Practice implications: In order to provide an optimal health service to a wide public, both online and telephone counseling should be offered.

Talking about smoking in primary care medical practice—Results of experimental studies from the US, UK and Germany - Corrected Proof

2012-05-17

Abstract: Objective: To analyse effects of patient and physician characteristics on questions and advice about smoking in primary care practice and to examine country differences.Methods: We conducted a factorial experiment, employing filmed scenarios in which actors played the role of patients with symptoms of coronary heart disease (CHD) or type 2 diabetes. Versions were filmed with patient–actors of different gender, age, race, and socioeconomic status. The videotapes were presented to primary care physicians in the US, UK and Germany. Physicians were asked whether they would ask questions about smoking or give cessation advice.Results: Female and older CHD patients are less likely to be asked or get advice about smoking in all three countries. Effects of physician attributes are weak and inconsistent. Compared to physicians in the US and the UK, German doctors are least likely to ask questions or give advice.Conclusions: Although all physicians viewed the same cases their questioning and advice giving differed according to patient attributes and country. Due to the experimental design external validity of the study may be limited.Practice implications: Findings have implications for medical education and professional training of physicians as well as for the organization and financing of health care.

Teaching compassion - Corrected Proof

William T. Branch, Kelli Davis, Mark Weng — 2012-05-11

“Good morning, doctors.” Mrs. M's big smile belied my resident's description of her as demented and confused. True, her left foot was gangrenous, infected and lacked circulation. A strong odor of sepsis rose when my gloved hand pulled back the covers.

Patient communication tools to enhance ART adherence counseling in low and high resource settings - Corrected Proof

2012-05-10

Abstract: Objective: Few articles have examined specific counseling tools used to increase antiretroviral therapy (ART) adherence. We present communication tools used in the context of Project MOTIV8, a randomized clinical trial.Methods: We developed, piloted, and evaluated pictorial images to communicate the importance of consistent dose timing and the concept of drug resistance. Electronic drug monitoring (EDM) review was also used to provide visual feedback and facilitate problem solving discussions. Adherence knowledge of all participants (n=204) was assessed at baseline and 48 weeks. Participant satisfaction with counseling was also assessed.Results: Adherence knowledge did not differ at baseline, however, at 48 weeks, intervention participants demonstrated significantly increased knowledge compared to controls F(1, 172)=10.76, p=0.001 (12.4% increase among intervention participants and 1.8% decrease among controls). Counselors reported that the tools were well-received, and 80% of participants felt the counseling helped them adhere to their medications.Conclusions: Counseling tools were both positively received and effective in increasing ART adherence knowledge among a diverse population.Practice implications: While developed for research, these counseling tools can be implemented into clinical practice to help patients; particularly those with lower levels of education or limited abstract thinking skills to understand medical concepts related to ART adherence.

Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters - Corrected Proof

Kristen Adams, Jenica E.W. Cimino, Robert M. Arnold, Wendy G. Anderson — 2012-05-10

Abstract: Objective: To describe hospital-based physicians’ responses to patients’ verbal expressions of negative emotion and identify patterns of further communication associated with different responses.Methods: Qualitative analysis of physician–patient admission encounters audio-recorded between August 2008 and March 2009 at two hospitals within a university system. A codebook was iteratively developed to identify patients’ verbal expressions of negative emotion. We categorized physicians’ responses by their immediate effect on further discussion of emotion – focused away (away), focused neither toward nor away (neutral), and focused toward (toward) – and examined further communication patterns following each response type.Results: In 79 patients’ encounters with 27 physicians, the median expression of negative emotion was 1, range 0–14. Physician responses were 25% away, 43% neutral, and 32% toward. Neutral and toward responses elicited patient perspectives, concerns, social and spiritual issues, and goals for care. Toward responses demonstrated physicians’ support, contributing to physician–patient alignment and agreement about treatment.Conclusion: Responding to expressions of negative emotion neutrally or with statements that focus toward emotion elicits clinically relevant information and is associated with positive physician–patient relationship and care outcomes.Practice implications: Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion.

Maintenance of lifestyle changes: 3-Year results of the Groningen Overweight and Lifestyle study - Corrected Proof

2012-05-07

Abstract: Objective: This study aims to evaluate the three-year effect of lifestyle counseling by a nurse practitioner (NP) on physical activity (PA) and dietary intake compared with usual care by a general practitioner (GP).Methods: At baseline, subjects were randomly allocated to the NP group (n=225) or to the GP group (n=232). The NP group received a low-intensive lifestyle intervention for three years by the NP and the GP group received one consultation by the GP and thereafter usual care. PA and dietary intake were assessed with questionnaires at baseline, 1 year follow-up and 3 year follow-up.Results: After three years, leisure-time activity increased and favorable improvements towards a healthy diet were made for both groups. These three-year changes in PA and diet did not differ significantly between groups. Changes in PA and dietary habits after one year were practically maintained after 3 years, because only small relapses were found.Conclusion: After three years, subjects were more physically active and had a healthier diet compared to baseline. Lifestyle counseling by NP resulted in similar lifestyle changes compared to GP consultation.Practice implications: NPs could also advice patients at cardiovascular risk by lifestyle counseling, to possibly reduce GP barriers.

Further examination of the impact of patient participation on physicians’ communication style - Corrected Proof

Donald J. Cegala, Deena J. Chisolm, Benedict C. Nwomeh — 2012-05-07

Abstract: Objective: Previous research in primary care has shown that physicians are more informative and/or patient-centered when they interact with high participation patients (e.g., those who ask questions, express preferences and concerns). This study contributes to this literature by examining parents’ participation and physicians’ discourse in a pediatric surgery context.Methods: The audiotapes of 7 pediatric surgeons and 68 of their patients’ parents/guardians were coded and examined for physicians’ information exchange and support utterances as they interacted with parents/guardians with varying degrees of participation.Results: The results of a multilevel regression analysis showed, consistent with related research, that the same physicians were more informative overall and provided more information in response to parents’ questions when interacting with high participation parents. However, participation was not associated with physicians’ volunteered information, general explanations, or support utterances.Discussion and conclusion: The results are discussed with respect to the impact of participation on physicians’ information provision and implications for future research, particularly with respect to general explanations, volunteered information, and medical context.Practice implications: This study suggests that surgeons may provide more detailed information to patients who are active participants in the preoperative interview, thereby improving the adequacy and validity of informed consent for surgical procedures.

Factors associated with patient reports of positive physician relational communication - Corrected Proof

2012-05-03

Abstract: Objective: To evaluate the patient, physician, and visit-related factors associated with patient ratings of positive physician relational communication.Methods: Pre- and post-visit surveys were conducted with 485 patients attending a routine periodic health exam with one of 64 participating physicians. The audio-recorded visits were coded for elements of patient–physician communication including assertive responses, partnership building, question asking, supportive talk, and expressions of concern.Results: Patient reports of positive physician relational communication were associated with patient perceptions of how well the physician understood the patient's health care preferences and values, a patient–physician interaction outside of the exam room, and physician-prompted patient expressions of concern.Conclusion: In addition to a patient's perception of their relationship with their physician going into the visit, relatively simple acts like extending the interaction beyond the exam room and ensuring that patients feel invited to express concerns they may have during the visit may influence patient perceptions of physician relational communication.Practice implications: This study offers preliminary support for the idea that relational communication and its associated benefits may be fostered through simple physician-driven acts such as interacting with patients outside of the exam room and encouraging patients to express concerns within the visit.

Conveying empathy to hospice family caregivers: Team responses to caregiver empathic communication - Corrected Proof

2012-05-03

Abstract: Objective: The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members.Methods: Empathic opportunities and hospice team responses were analyzed from bi-weekly web-based videoconferences between family caregivers and hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data.Results: Data analysis identified 270 empathic opportunity-team response sequences. Caregivers expressed statements of emotion and decline most frequently. Two-thirds of the hospice team responses were implicit acknowledgments of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities.Conclusion: Although hospice team members frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for more empathic communication during team meetings that involve caregivers.Practice implications: Hospice clinicians should devote more time to discussing emotional issues with patients and their families to enhance patient-centered hospice care. Further consideration should be given to training clinicians to empathize with patients and family caregivers.

Development of PRIDe: A tool to assess physicians’ preference of role in clinical decision making - Corrected Proof

Anik Giguère, Michel Labrecque, Merlin Njoya, Robert Thivierge, France Légaré — 2012-04-30

Abstract: Objective: To develop and evaluate items for inclusion in PRIDe (Preferred Role in Decision Making), a new tool to assess changes of role preference among professionals exposed to training in shared decision making (SDM).Methods: This study was part of a pilot trial to evaluate the effectiveness of SDM training on the doctors’ prescription of antibiotics for acute respiratory infections. Thirty-nine family physicians were randomized to immediate exposure to training or to delayed exposure. Potential items for PRIDe and a questionnaire about physicians’ intention to engage in SDM were administered at baseline and at follow-up.Results: Following analysis, we retained five items that captured a change in physicians’ preference. The items’ scores were pooled and the resulting tool showed limited internal consistency (Cronbach's alpha=0.41) but significant test–retest reliability (immediate group: P=0.03; delayed group: P=0.008) and acceptable discriminant validity, with patients involved in decision making more actively after training than before (Fisher's test, P=0.02).Conclusion: This initial step to develop an evaluation tool to assess changes in doctors’ preference of role in decision making following SDM training shows promising results. The next step is to develop more clinical vignettes followed by questions inspired from this analysis.Practice implications: The PRIDe instrument can be used in the assessment of health professionals’ attitude towards shared decision making after training in shared decision making. Additional research is needed to evaluate its validity before it can be recommended for use.

Increasing readiness to decide and strengthening behavioral intentions: Evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: www.bresdex.com) - Corrected Proof

2012-04-30

Abstract: Objectives: To undertake a quantitative evaluation of a theory-based, interactive online decision aid (BresDex) to support women choosing surgery for early breast cancer (Stage I and II), based on observations of its use in practice.Methods: Observational cohort study. Website log-files collected data on the use of BresDex. Online questionnaires assessed knowledge about breast cancer and treatment options, degree to which women were deliberating about their options, and surgery intentions, pre- and post-BresDex.Results: Readiness to make a decision significantly increased after using BresDex (p<.001), although there was no significant improvement in knowledge. Participants that were ‘less ready’ to make a decision before using BresDex, spent a longer time using BresDex (p<.05). Significant associations between surgery intentions and choices were observed (p<.001), with the majority of participants going on to have BCS. Greater length of time spent on BresDex was associated with stronger intentions to have BCS (p<.05).Conclusion: The use of BresDex appears to facilitate readiness to make a decision for surgery, helping to strengthen surgery intentions.Practice implications: BresDex may prove a useful adjunct to the support provided by the clinical team for women facing surgery for early breast cancer.

Breast cancer genetic counseling after diagnosis but before treatment: A pilot study on treatment consequences and psychological impact - Corrected Proof

2012-04-30

Abstract: Objective: Female breast cancer patients carrying a BRCA1/2-mutation have an increased risk of second primary breast and ovarian tumors. Little is known about the psychological impact and treatment consequences of rapid genetic counseling and testing offered between breast cancer diagnosis and surgery.Methods: Female breast cancer patients, who had received rapid genetic counseling (and optional testing) (RGC(T)) at The Netherlands Cancer Institute between 2004 and 2008, received a questionnaire in 2009.Results: BRCA-mutations were found in 10 of the 26 participants. Six mutation-carriers (60%) had an immediate bilateral mastectomy, compared with 25% of those without a mutation. Five patients (19%) reported having frequent worries about cancer recurrence; none indicated that such worries impaired daily functioning. Six patients had clinically relevant levels of breast cancer-specific distress at the time of assessment.Conclusion: These results suggest that RGC(T) in high-risk breast cancer patients may influence surgical treatment, without causing long-term psychosocial distress in the majority.Practice implications: These results are important, since rapid genetic counseling and testing are expected to be offered to newly diagnosed breast cancer patients with increasing frequency in order to inform these women and their surgeons about the possible familial/hereditary nature of their disease before deciding on treatment.

I will always be with you: Traditional and complementary therapists’ perspectives on patient–therapist–doctor communication regarding treatment of Arab patients with cancer in Israel - Corrected Proof

Ariela Popper-Giveon, Elad Schiff, Eran Ben-Arye — 2012-04-25

Abstract: Objective: In 2008, an Integrative Oncology Program was implemented at the Clalit Oncology Service in Haifa, Israel, to promote patients’ well-being during chemotherapy and advanced stages of disease. We hypothesized that studying the perceptions of Arab complementary and alternative medicine (CAM) therapists would facilitate development of a cross-culturally integrative oncology approach.Methods: Semi-structured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran and various CAM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care.Results: Thematic analysis revealed that therapists act as go-betweens, mediating between patients and conventional physicians. Therapists translate diagnoses into Arabic and elucidate key concepts. They tend to perceive their role as gatekeepers accompanying patients through the conventional health system, referring them for further examinations, and providing CAM-based supportive care consultation.Conclusions: CAM therapists have an essential role in supportive care of Arab patients with cancer. Triangular patient–therapist–oncologist communication may have an impact on patients’ experience and treatment quality.Practice implications: Recognition of CAM therapists as mediators between patients’ health beliefs and conventional perceptions of care may improve doctor–patient dialogue and facilitate supportive care provision in a cross-cultural context.

Development of a cancer clinical trials multi-media intervention: Clinical Trials: Are they Right for You? - Corrected Proof

2012-04-23

Abstract: Objective: To describe processes used to develop a multi-media psycho-educational intervention to prepare patients for a discussion about cancer clinical trials (CTs).Methods: Guided by a Steering Committee, formative research was conducted to develop an informative and engaging tool about cancer CTs. Twenty-three patients and caregivers participated in formative in-depth interviews to elicit information about perceptions of cancer CTs to inform production of a new media product.Results: Formative research revealed participants had concerns about experimentation, held beliefs that cancer CTs were for patients who had no other treatment options, and wanted a balance of information about pros and cons of CT participation. The value of physicians as credible spokespersons and the use of patients as role-models were supported. Using iterative processes, the production team infused the results into creation of a multimedia psycho-educational intervention titled Clinical Trials: Are they Right for You?Conclusion: An intervention, developed through an iterative consumer-focused process involving multiple stakeholders and formative research, may result in an engaging informative product.Practice implications: If found to be efficacious, Clinical Trials: Are they Right for You? is a low-cost and easily disseminated multimedia psycho-educational intervention to assist cancer patients with making an informed decision about cancer CTs.

Clients as conversational agents - Corrected Proof

Helen F. Massfeller, Tom Strong — 2012-04-23

Abstract: Objective: Conversational agency is our invented term that orients us to ways in which clients participate in therapeutic dialogues. In this study we examined how clients’ conversational correctives and initiatives influenced collaborative therapeutic consultations.Methods: Thirty-five single-session lifestyle consultations were videotaped in which adult clients volunteered to discuss concerns of non-clinical severity with a counselor. We discursively microanalyzed excerpts where clients initiated topic shifts or corrected counselor misunderstandings and how counselors responded to them.Results: Clients were actively involved in co-managing conversational developments during the consultations. They influenced the content and course of the conversations with the counselors by correcting, interrupting, or speaking from positions contrary or unrelated to those of the counselors.Conclusion: Clients observably influenced the conversational agenda through their correctives and initiatives if counselors were responsive during face-to-face consultations.Practice implications: Clinicians should demonstrate increased sensitivity and relational responsivity by intentionally engaging with clients’ agentive contributions to consultative dialogues.

A randomised controlled trial of a pilot intervention to encourage early presentation of oral cancer in high risk groups - Corrected Proof

2012-04-23

Abstract: Objective: Prognosis for oral cancer is substantially improved when diagnosed early. This research aimed to evaluate an intervention to promote early presentation of oral cancer.Methods: Participants were randomly assigned to a leaflet group (n=42), a one-to-one group (n=46) or a control group (n=24). Participants in the leaflet group read a theory-based (Extended Self-Regulatory Model; Social Cognitive Theory) leaflet on how to spot oral cancer early. Those in the one-to-one group received a brief, interactional discussion on early presentation of oral cancer and were then asked to read the leaflet. Participants in the control group received no information about oral cancer.Results: The leaflet and the one-to-one instruction led to more accurate knowledge of oral cancer, decreased anticipated delay, and increased understanding, likelihood and confidence to perform self-examination. Neither intervention raised participants’ anxiety. There were minimal differences between the two interventions, yet both were superior to the control group.Conclusion: This piloting indicates the initial effectiveness of an brief intervention purposefully designed for people at risk of developing oral cancer.Practice implication: A low cost intervention may be a useful tool to encourage early detection of oral cancer. This could be embedded into routine consultations or an early detection programme.

Teaching patients how to talk with biomedical providers about their complementary and alternative medicine use - Corrected Proof

Evelyn Y. Ho, Thomas A. D’Agostino, Vivien Yadegar, Adam Burke, Carma L. Bylund — 2012-04-16

Abstract: Objective: The goal was to examine the feasibility and impact of a face-to-face communication skills training intervention based on a current public health campaign to encourage patients to talk about complementary and alternative medicine (CAM) with their biomedical health providers.Methods: Current CAM users were invited to complete a survey about current/past CAM use and communication with biomedical providers before beginning a communication skills training workshop. In the 6-month period following the training, participants were asked to record information on any CAM conversations with those providers.Results: Of the 38 participants who received training, 32 finished the entire study. Over half of those participants reported discussing CAM in post-training visits with biomedical providers. Participants initiated the conversation in most cases, and were more likely to disclose CAM use than they were to ask questions about CAM. Participants who talked about CAM were significantly more likely to perceive CAM as relevant to their visit, compared with individuals who did not talk about CAM.Conclusions: Participants positively evaluated this patient communication workshop. Consistent with previous research, most CAM conversations were patient-initiated.Practice implications: These findings reinforce the importance of patient education interventions for improving patient–provider communication in general, and CAM communication specifically.

Mechanisms underlying the relationship between health literacy and glycemic control in American Indians and Alaska Natives - Corrected Proof

2012-04-13

Abstract: Objective: Research suggests that health literacy (HL) is associated with clinical outcomes. Few studies, however, have examined the mechanisms accounting for this relationship. To understand why HL is related to outcomes, we tested a theoretical framework proposing that diabetes-related knowledge and behavior mediate (explain) the relationship between HL and glycemic control (i.e., A1c).Methods: Analyses used baseline data from the Special Diabetes Program for Indians Healthy Heart Project (N=2594), an intervention to reduce cardiovascular risk among American Indians/Alaska Natives (AI/ANs) with diabetes. Three nested structural equation models tested the theoretical framework.Results: Model 1 demonstrated that participants with stronger HL skills had better glycemic control. Model 2 tested whether diabetes-related behaviors accounted for this relationship. Self-monitoring of blood glucose significantly mediated the HL-A1c relationship. Model 3 examined the role of diabetes knowledge, showing that it mediated the relationship between HL and dietary behavior. When knowledge was included, behavior was no longer a significant mediator, suggesting that knowledge was the main driver of the relationship between HL with A1c.Conclusion: Interventions to improve knowledge may be particularly important in enhancing outcomes among AI/ANs with diabetes.Practice implications: Strategies known to enhance patient comprehension may enable low-literate patients to develop needed diabetes knowledge.

Negotiating complementary and alternative medicine use in primary care visits with older patients - Corrected Proof

Christopher J. Koenig, Evelyn Y. Ho, Vivien Yadegar, Derjung M. Tarn — 2012-04-09

Abstract: Objective: To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits.Methods: Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning.Results: Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician–patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment.Conclusion: Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions.Practice implications: Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.

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

2012-04-06

Abstract: Objective: Investigate multiple sclerosis patients’ desire to communicate with their physicians about their disease progression and end-of-life issues.Methods: Persons meeting the inclusion criteria of feeling severely affected by MS were invited via the German MS society to complete a needs questionnaire. Replies to questions on physician empathy and wishes about communication regarding disease progression and death and dying were quantitatively analyzed. Endpoints (point 1+2/4+5) of 5-point-likert scales are summarized under results.Results: 573 of 867 questionnaires meeting our criteria were analyzed. In response to a general question 64% (n=358) indicated a wish for disease progression and death and dying to be addressed by their doctor. A majority (76%, n=427) considered it important that progression of their disease be discussed, while 44% (n=246) regard addressing death and dying as unimportant. No objective disease criteria could be identified to explain the wish for communicating end-of-life issues. Doctors who were retrospectively viewed as avoiding raising critical aspects of the illness were perceived as less empathetic (p<0.001).Conclusion: People with MS have a desire to talk about progression of their disease with their doctors.Practice implications: Physicians should be empathetic in raising critical aspects of the patients’ illness individually.

Discrepancy between patients’ use of and health providers’ familiarity with CAM - Corrected Proof

Yan Zhang, Kim Peck, Mary Spalding, Betsy G. Jones, Ronald L. Cook — 2012-04-05

Abstract: Objective: To compare patients’ complementary and alternative medicine (CAM) use and physicians’ familiarity with certain CAM modalities in the same setting and to assess patient–provider dialogue about patients’ CAM use.Methods: An observational survey study with convenience sampling at ambulatory family medicine clinics in two Texas cities. A total of 69 healthcare providers and 468 patients completed the surveys. Patients’ surveys assessed use of 27 CAM therapies, perception of CAM use and interaction with providers. Providers’ survey assessed perception and attitude toward CAM use.Results: CAM modalities most used by the patients are not those modalities that providers best understood. Of the 330 patients (70%) who responded to the relevant questions about discussing CAM, 44.5% reported never having discussed CAM use with their providers. Binomial logistic regression revealed no link between age, gender or ethnicity for discussing CAM with providers. College-educated patients (adjust OR=2.8, 95%CI=1.3–6.0) and US citizens were both about three times more likely to discuss CAM than their counterparts.Conclusion: Lack of knowledge and unfamiliarity with CAM modalities might prevent important patient–provider discussions.Practice implications: Providers should use existing resources and encourage a bilateral dialogue that involves transferring of information and assisting patients in decisions making about CAM use and health care.

Communicating shared decision-making: Cancer patient perspectives - Corrected Proof

Sally Thorne, John L. Oliffe, Kelli I. Stajduhar — 2012-04-05

Abstract: Objective: To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients’ perspectives.Methods: Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients.Results: Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care.Conclusion: In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities.Practice implications: Shared decision-making as a practice standard must be balanced against individual patient preferences.

Complementary and alternative medicine use of women with breast cancer: Self-help CAM attracts other women than guided CAM therapies - Corrected Proof

2012-04-05

Abstract: Objective: Examine stability of use of complementary and alternative medicine (CAM) of breast cancer patients, reasons for CAM use, and sociodemographic, clinical, and psychological predictors of CAM use.Methods: CAM use was assessed after adjuvant therapy and six months later. Following the CAM Healthcare Model, CAM use was divided into use of provider-directed (guided) and self-directed (self-help) CAM. Stability and reasons for CAM use were examined with McNemar's tests and descriptive statistics. Cross-sectional and longitudinal associations between predictors and CAM use were examined with univariate and multivariate logistical analyses.Results: Use of provider-directed and self-directed CAM was stable over time (N=176). Self-directed CAM was more often used to influence the course of cancer than provider-directed CAM. Both were used to influence well-being. Openness to experience predicted use of provider-directed CAM, while clinical distress predicted use of self-directed CAM, after adjusting for other predictors. Perceived control did not predict CAM use.Conclusion: CAM use is stable over time. It is meaningful to distinguish provider-directed from self-directed CAM.Practice implications: Providers are advised to plan a ‘CAM-talk’ before adjuvant therapy, and discuss patients’ expectations about influence of CAM on the course of cancer. Distressed patients most likely need information about self-directed CAM.

Do the public share practitioners’ views about the best evidence? - Corrected Proof

Elizabeth J. Robinson, Deborah Biggerstaff, Sally Jennings, Elizabeth A. Maylor — 2012-04-05

Abstract: Objective: To investigate whether general practitioners (GPs) and patients agree on what constitutes the best evidence for the effectiveness of treatments.Methods: GPs and members of the public aged 18–83 read five scenarios describing comparisons between hypothetical treatments for common ailments. Each scenario reported that one treatment was the more effective, as determined by randomised controlled trial (RCT), audit of treatment outcomes from many doctors’ patients, a single doctor's clinical experience, a friend's experience, or a web-based sales site. Participants rated how confident they would be that the treatment reported to be more effective would work for them.Results: All participants had least confidence in the web-based sales site, more confidence in a friend's experience and more still in one doctor's experience. For doctor's experience, audit and RCT, amongst the public there were some differences by age but, importantly, only GPs had most confidence in evidence from an RCT.Conclusion: GPs may treat evidence from RCTs as the gold standard while members of the public (their patients) may not afford it that same respect.Practice implications: GPs engaged in shared decision-making should be alert to possible differences from their patients in the weight given to different types of evidence.

Development and psychometric properties of the Shared Decision Making Questionnaire – physician version (SDM-Q-Doc) - Corrected Proof

Isabelle Scholl, Levente Kriston, Jörg Dirmaier, Angela Buchholz, Martin Härter — 2012-04-05

Abstract: Objective: To develop and psychometrically test a brief instrument for assessing the physician's perspective of the shared decision-making process in clinical encounters.Methods: We adapted the 9-item Shared Decision Making Questionnaire (SDM-Q-9) for patients to generate a new version for physicians (SDM-Q-Doc). The physician version was tested in clinical encounters between 29 physicians and 324 patients in German outpatient care contexts. Analyses of the extent to which the instrument was accepted, the reliability of the instrument, and the factorial structure of the scale were performed.Results: Physicians showed a high level of acceptance toward the SDM-Q-Doc. Item discrimination parameters were above .4 for all but one item. An analysis of internal consistency yielded a Cronbach's α of .88. Factor analysis confirmed a one-dimensional structure.Conclusion: The results of this study suggest that the SDM-Q-Doc is a well-accepted and reliable instrument for assessing the physician's perspective during SDM processes in clinical encounters. To our knowledge, the SDM-Q-Doc is the first psychometrically tested scale available for assessing the physician's perspective.Practice implications: The SDM-Q-Doc can be used in studies that analyze the effectiveness of the implementation of SDM and as a quality indicator in quality assurance programs and health service assessments.

Trailblazing healthcare: Institutionalizing and integrating complementary medicine - Corrected Proof

2012-04-03

Abstract: Objectives: This study examines three integrative health centers to understand their (1) historical development, organizational goals, and modalities, (2) the processes and challenges of integrating complementary and allopathic medicine, while encouraging staff collaboration, and (3) how each center becomes institutionalized within their community.Methods: We focus on three organizational case studies that reflect varying forms of integrative health care practices in three U.S. cities. Participant-observation and in-depth interviews with center directors were analyzed qualitatively.Results: Important patterns found within the three cases are (1) the critical role of visionary biomedical practitioners who bridge complementary and allopathic practices, (2) communicating integration internally through team interaction, and (3) communicating integration externally through spatial location, naming, and community outreach.Conclusion: IM centers continue to blaze new trails toward mainstream access and acceptance by gathering evidence for IM, encouraging team collaboration within organizational contexts, constructing organizational identity, and negotiating insurance reimbursements.Practice implications: IM is not the enactment of specific modalities, but rather a philosophy of healing. Though scheduling conflicts, skepticism, and insurance coverage may be obstacles toward IM, collaboration among specialists and with patients should be the ultimate goal.

Decision making and coping in healthcare: The Coping in Deliberation (CODE) framework - Corrected Proof

Jana Witt, Glyn Elwyn, Fiona Wood, Kate Brain — 2012-04-02

Abstract: Objective: To develop a framework of decision making and coping in healthcare that describes the twin processes of appraisal and coping faced by patients making preference-sensitive healthcare decisions.Methods: We briefly review the literature for decision making theories and coping theories applicable to preference-sensitive decisions in healthcare settings. We describe first decision making, then coping and finally attempt to integrate these processes by building on current theory.Results: Deliberation in healthcare may be described as a six step process, comprised of the presentation of a health threat, choice, options, preference construction, the decision itself and consolidation post-decision. Coping can be depicted in three stages, beginning with a threat, followed by primary and secondary appraisal and ultimately resulting in a coping effort.Conclusions: Drawing together concepts from prominent decision making theories and coping theories, we propose a multidimensional, interactive framework which integrates both processes and describes coping in deliberation.Practice implications: The proposed framework offers an insight into the complexity of decision making in preference-sensitive healthcare contexts from a patient perspective and may act as theoretical basis for decision support.

The challenges of facilitating primary healthcare discussions on traditional, complementary and alternative medicine for childhood eczema: Piloting a computerized template - Corrected Proof

Nicola Robinson, Ava Lorenc, Andrew Falinski, Ricky Banarsee — 2012-04-02

Abstract: Objective: Healthcare practitioners (HCPs) experience barriers to changing routine consultation practice. Communication and recording of traditional, complementary and alternative medicines (TCAM) is inadequate. This pilot study explored the challenges of implementing a computerized template in primary care to facilitate communication on TCAM for paediatric eczema.Methods: A computerized template to record TCAM use, with links to evidence-based TCAM databases, was designed, based on qualitative research with patients and HCPs. Four London general practices implemented the template integrated with usual practice. Twelve focus groups during the 6 month study period explored HCPs’ knowledge, communication and information sources regarding TCAM and perceived barriers to template implementation.Results: HCPs were initially enthusiastic about discussing TCAM, for improving communication and understanding patient's choices, but the template was used in under a third of consultations. HCPs were surprised at low TCAM use (10%) and lack of correlation with eczema or ethnicity. Reported barriers were time and remembering, due to busy, target-driven practice.Conclusion: HCPs recognize the importance of discussing TCAM use for childhood eczema, and potential benefits for HCP–patient communication.Practice implications: Future tools to facilitate TCAM discussion should prioritise use of existing IT systems and address barriers to use, especially lack of time.

When activation changes, what else changes? the relationship between change in patient activation measure (PAM) and employees’ health status and health behaviors - Corrected Proof

Lisa Harvey, Jinnet Briggs Fowles, Min Xi, Paul Terry — 2012-03-29

Abstract: Objective: To test whether changes in the patient activation measure (PAM) are related to changes in health status and healthy behaviors.Methods: Data for this secondary analysis were taken from a group-randomized, controlled trial comparing a traditional health promotion program for employees with an activated consumer program and a control program. The study population included 320 employees (with and without chronic disease) from two U.S. companies: a large, integrated health care system and a national airline. Survey and biometric data were collected in Spring 2005 (baseline) and Spring 2007 (follow-up).Results: Change in PAM was associated with changes in health behaviors at every level (1–4), especially at level 4. Changes related to overall risk score and many of its components: aerobic exercise, safety, cancer risk, stress and mental health. Other changes included frequency of eating breakfast and the likelihood of knowing about health plans and how they compare.Conclusion: Level 4 of patient activation is not an end-point. People are capable of continuing to make significant change within this level.Practice implications: Interventions should be designed to encourage movement from lower to higher levels of activation. Even people at the most activated level improve health behaviors.

Patient knowledge of blood pressure target is associated with improved blood pressure control in chronic kidney disease - Corrected Proof

Julie A. Wright-Nunes, J. Matthew Luther, T. Alp Ikizler, Kerri L. Cavanaugh — 2012-03-29

Abstract: Objective: To describe patient hypertension knowledge and associations with blood pressure measurements.Methods: Patients with chronic kidney disease (CKD) were asked about the impact of high blood pressure on kidneys and their target blood pressure goal. Systolic blood pressure was measured using automated sphygmomanometers.Results: In 338 adults with hypertension and pre-dialysis CKD, the median [IQR] age was 59 [47,68] years, 45% [n=152] were women, and 18% [n=62] were non-white. Lower systolic blood pressure (SBP) was associated with female sex (SBP mmHg median [IQR] 132 [117,149] women vs. 137 [124,152] men; p=0.04), less advanced CKD (SBP 134 [122,147] stages 1–2 vs. 132 [118,148] stage 3 vs. 140 [125,156] stages 4–5; p=0.01), and patient ability to correctly identify SBP goal (SBP 134 [119,150] correct vs. 141 [125,154] incorrect; p=0.05). In adjusted analysis, knowledge of blood pressure goal remained independently associated with lower SBP (−9.96mmHg [−19.97, −1.95] in correct respondents vs. incorrect; p<0.001).Conclusion: Patient knowledge of goal blood pressure is independently associated with improved blood pressure control.Practice implications: Interventions to improve patient knowledge of specific blood pressure targets may have an important role in optimizing blood pressure management.

Communication about self-care in traditional acupuncture consultations: The co-construction of individualised support and advice - Corrected Proof

2012-03-27

Abstract: Objective: To analyse the co-construction of self-care advice in traditional acupuncture consultations.Method: Analysis of 27 audio-recorded and transcribed consultations, involving 7 practitioners, augmented by integrating the data from 15 patient interviews and regular practitioner discussions.Results: Self-care talk was initiated equally by practitioner and patient, and was threaded through and between acupuncture consultations. It involved interactive discussions that were interwoven with other types of talk, especially life-world and acupuncture talk. Practitioner engagement in self-care talk appeared to increase with experience. The self-care talk was co-constructed within the context of a relationship that was characterised by continuity, mutuality and trust.Conclusion: Self-care support and advice was integral to the practice of traditional acupuncture and individualised in terms of the patient's life-world and/or the Chinese medicine diagnosis. The co-construction of self-care talk did not replicate the asymmetry of conventional medical consultations.Practice implications: The active participation of both patients and acupuncture practitioners in self-care talk may be related to professional practice that is underpinned by a holistic theory base such as Chinese medicine and is delivered in the context of therapeutic relationships based on continuity, mutuality and trust. These findings may inform professional education and the design of multi-disciplinary care pathways.

Doctor's attire influences perceived empathy in the patient–doctor relationship - Corrected Proof

2012-03-26

Abstract: Objective: This study investigated whether doctors’ attire influences the perception of empathy in the patient–doctor relationship during a therapeutic encounter.Methods: A total number of 143 patients were divided into four groups when they were consulting a Traditional Korean Medicine doctor. Depending on the group, the same doctor was wearing four different attires – Casual, Suit, Traditional dress, White coat – when having a clinical consultation with the patients.Results: The patients preferred white coat and traditional dress more than other attires, giving highest scores to white coat in competency, trustworthiness and preference of attire and to traditional dress in comfortableness and contentment with the consultation. The “Consultation and Relational Empathy (CARE)” score was significantly higher in the “White coat” and “Traditional” groups, compared to the “Casual” and “Suit” groups.Conclusion: The strong association between the patients’ preference of doctors’ attire and the CARE score indicates that the doctor's attire plays not only an important role for establishing confidence and trustworthiness but also for the perception of empathy in the patient–doctor relationship.Practice implications: The doctor's attire can function as an effective tool of non-verbal communication in order to signal confidence, trust and empathy and establish a good patient–doctor relationship.

Perceiving integration of a complementary medicine service within a general surgery department through documentation of consultations: A thematic analysis - Corrected Proof

2012-03-19

Abstract: Objective: This study aims to examine the meaning and practical implications of integration of a complementary medicine-based surgery service in a hospital setting (CISS – Complementary/Integrative Surgery Service) through analysis of consultation reports associated with this service.Methods: Thematic analysis was used to evaluate CISS consultation reports in a hospital electronic consultant charting system during the first half year of the service's activity.Results: 304 consultation reports were analyzed. Nurses initiated significantly more consultations than physicians (55% vs 7%). Consultation requests were gradually more focused on specific symptoms, possibly manifesting a better understanding of the scope of complementary medicine in the surgery setting. CISS practitioners responded in more biomedical language over time, albeit offering a more holistic perspective regarding patients’ needs as well as clarifications regarding the nature of the treatment they provided.Conclusions: Diverse communication patterns in consultations evolved over time representing dynamics in multiple levels of integration of the CISS.Practice implications: Documented communication through consultations can provide a window to the process of integration of complementary medicine-based services in health systems.

The impact of an empowering Internet-based Breast Cancer Patient Pathway programme on breast cancer patients’ knowledge: A randomised control trial - Corrected Proof

2012-03-19

Abstract: Objective: The aim of this study was to analyse the effect of Breast Cancer Patient Pathway program.Methods: In one Finnish university hospital during 2008–10 newly diagnosed breast cancer patients were randomised to the intervention (n=50) and the control groups (n=48). The breast cancer patient's knowledge expectations and perception of received knowledge, knowledge, the source of information and satisfaction in received patient education were measured. Baseline and one year follow up data collection was conducted.Results: No differences were found in knowledge expectations between the groups at baseline. Patients in the control group evaluated their perception of received knowledge to be higher and they were more satisfied with the patient education they received from the hospital staff. However, the Intervention group's knowledge level was higher. The most important source of information was the healthcare professionals in both groups.Conclusion: The results of study indicate that when patient education increases, patients’ knowledge expectations increase as well, while their perceptions of received knowledge decrease. Future research is needed to examine the relationship between patients’ knowledge expectations and perception of received knowledge as patients’ knowledge level increases.Practice implications: Patient education has to be individually adjusted, taking patients’ expectations into account.

Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey - Corrected Proof

2012-03-14

Abstract: Objective: The purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations.Methods: A randomly selected age-proportionate national sample of adults (aged 21–70 years) stratified on race, ethnicity, and gender (N=488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the Shared Decision Making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD.Results: After controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R2=.368, p<.001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD.Conclusion: SDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly.Practice implications: By identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes.

Making data more meaningful: Patients’ views of the format and content of quality indicators comparing health care providers - Corrected Proof

Zoe Hildon, Dominique Allwood, Nick Black — 2012-03-09

Abstract: Objective: Patient reported outcome measures (PROMs) are being used to inform national quality indicators for health care providers in England. Our objective was to explore patients’ views of different formats and content of these data displays.Methods: Six focus groups (N=45) considered different formats (tables, bar charts, caterpillar and funnel plots) and content (uncertainty displays, volume of outcomes, color, icons, and ordering). A thematic analysis was carried out based on transcripts.Results: Tables housing icons (star ratings) were the preferred display, having the most popular resonance and facilitating cognitive processing, appealing to most as the best format. Inferred meanings were overwhelmingly applied to unfamiliar formats (funnel plot) and content (uncertainty). Traffic light highlighting and using consistent and recognizable icons (five stars) helped understanding. Familiarity with the bar chart seemed to lend to false readings – error bars were not interpreted.Conclusion: Aspects of familiarity, meaningfulness (whether and how displays resonated with participants), and cognitive or choice processes informed views of displays.Practice implications: Tables with star ratings should be a primary display, ordered on statistical significance, including providers in the region plus England average. Caterpillar plots should be used to provide contextual information. More detailed numeric tables should also be accessible.

Hidden beauty - Corrected Proof

Thorsten Langer — 2012-03-09

She was the first patient this morning and I saw her already waiting as I unlocked my office prior to starting my work day. She was sitting in the waiting area which was still abandonded and would soon be a lively place filled with playing children and their caregivers. The baby that I was supposed to examine soon was in the pram in front of her. The woman had a slightly stooping stature, dry dishevelled hair, wore glasses, a yellow, bloomy shirt and brown pants. She looked older than most of the mothers we usually talk to in the developmental clinic to follow up former pre-term or at-risk babies.

A longitudinal study on engagement with dieting information as a predictor of dieting behavior among adults diagnosed with cancer - Corrected Proof

Andy S.L. Tan, Susan Mello, Robert C. Hornik — 2012-03-09

Abstract: Objective: This study explores cancer survivors’ engagement with information about dieting to control weight from doctors, interpersonal, and media sources and examines whether engagement from these sources impacts subsequent dieting behavior.Methods: A total of 1128 respondents diagnosed with colorectal, breast, or prostate cancers were surveyed over three years following their cancer diagnoses. Using weighted logistic regression analyses, the authors predicted the odds of dieting based on earlier information engagement with sources, controlling for dieting in the previous year and confounders.Results: Participants reported talking with doctors more frequently (37%) than seeking or scanning from interpersonal and media sources about dieting (15–22%). Seeking from interpersonal and media sources, and discussion with physicians, significantly predicted dieting behavior. In addition, discussions with physicians increased the odds of subsequent dieting behavior by 2.32 times (95% CI: 1.50–3.61; p=.002), over and above the effects of other information engagement.Conclusion: Cancer survivors reported engaging with a variety of information sources about dieting. Engagement with doctors and information-seeking from interpersonal or media sources predicted cancer survivors’ dieting behavior a year later.Practice implications: The results may inform strategies to encourage and empower cancer survivors to engage with information about healthy lifestyle changes for promoting long-term health.

Modeling an integrative oncology program within a community-centered oncology service in Israel - Corrected Proof

2012-03-09

Abstract: Objective: Describing the processes that preceded the opening of an integrative oncology program (IOP) within the oncology service (OS) of the largest health maintenance organization in northern Israel.Methods: The groundwork towards initiation of the IOP was based on three key elements (1) Interviews with patients, practitioners and directors were performed in order to explore perspectives regarding complementary medicine integration (CM) within the OS; (2) review of research data on CM efficacy and safety in cancer care; (3) critical comparative analysis of seven models of IOPs in Israel, Europe, and the U.S.Results: Ninety-three interviews included 24 patients, 34 conventional practitioners, 9 medical directors, and 26 CM-trained practitioners. The interviews revealed that there is a need for CM in the OS, aimed towards improving patients’ well-being during chemotherapy and advanced disease. An integrative oncology score (IOS) was formulated based on 6 themes considered promoters of successful integration.Conclusions: Integration of CM within an oncology service should address patients’ needs and research knowledge and be built upon mandatory practitioners’ communication.Practice implications: IOP modeling necessitates in-depth study aimed at revealing the OS needs and expectations, adjusting research data to the OS clinical challenges, and tailoring an appropriate model of integrative care.

Testing the utility of a cancer clinical trial specific Question Prompt List (QPL-CT) during oncology consultations - Corrected Proof

Richard F. Brown, Carma L. Bylund, Yuelin Li, Shawna Edgerson, Phyllis Butow — 2012-03-06

Abstract: Objective: A Question Prompt List (QPL) is a proven, simple intervention to aid patients to be active participants in consultations with their physicians by asking questions. We aimed to further develop and test the efficacy of a targeted QPL for clinical trials (QPL-CT).Methods: Breast, Lung and Genitourinary cancer patients who were facing a discussion about a therapeutic clinical trial completed short pre- and post-consultation questionnaires and used the QPL-CT in their discussions with their oncologists.Results: 30 participants were recruited from 6 oncologists. All QPL-CT questions were selected by at least one-third of participants. Participants mostly wanted and asked questions about personal trial benefit. Oncologists provided information about personal benefit to varying degrees, thus patients did not ask some questions. Patients were still left with some unasked and unanswered questions.Conclusion: The QPL-CT has potential as a simple, inexpensive intervention to aid such communication. Further investigation is needed to demonstrate the efficacy of the QPL-CT in improving cancer patient outcomes.Practice implications: These preliminary finding suggest that important areas of clinical trials are overlooked in clinical consultations. The QPL-CT may be an effective method to encourage oncologists to endorse patient question asking about clinical trials and prompt patient questions.

The impact on self-efficacy of different types of follow-up care and disease status in patients with rheumatoid arthritis—A randomized trial - Corrected Proof

2012-03-05

Abstract: Objective: To explore the impact from different types of outpatient care, demographic and disease related variables on self-efficacy beliefs (SE) in patients with established rheumatoid arthritis (RA) after completing an educational program.Methods: 287 adult RA outpatients with low disease activity and moderate physical disability from two Danish rheumatology clinics were randomized for follow-up care. 1: planned rheumatologist's consultations, 2: a shared care model without planned consultations, 3: planned nursing consultations. The participants’ SE were assessed by the Danish versions of the Rheumatoid Arthritis Self-Efficacy questionnaire (RASE) and the Arthritis Self-Efficacy Scale (ASES). Data were collected at baseline, 3 months and one-year follow up and were explored in random intercept models.Results: Following an educational programme the nursing group increased or stabilized their SE during the first year compared to the medical and the shared care group. SE in the shared care group did not differ significantly from the medical group. No difference between the groups was seen in disease activity at any time.Conclusion: Nursing consultations provide opportunities for maintenance of the patients’ SE after patient education.Practice implications: Implementation of nursing consultations as part of follow-up care in patients with stable RA is recommended.

Come on Little Lady - Corrected Proof

Matthew C. Howley — 2012-03-01

I was excited and nervous when I accepted a position on the pediatric critical care transport team. I was excited that I had achieved a long-term goal of making the team and nervous about the magnitude of responsibility the position would entail. Throughout my orientation I was exposed to many experiences, including the cardiac and neonatal intensive care units, where I learned about the wide range of clinical situations that the transport team addressed. Much to my dismay, one of the classes I was required to attend was the Program to Enhance Relational and Communication Skills (PERCS). During the class, I participated in different enactments with patients and families portrayed by professional actors. The focus was on how to convey difficult and unexpected news to patients and families with empathy and professionalism. This is an area I had tried valiantly to avoid in the past. Little did I know that this one-day course would become so valuable to me professionally and personally.

Diagnosing women with HPV: The impact of diagnosis disclosure methods - Corrected Proof

Jacquelyn A. Harvey-Knowles, Kami A. Kosenko — 2012-02-27

Abstract: Objective: Little data exists on women's HPV diagnosis encounters. This research focuses on impacts of the communicative medium used to inform women of their HPV status. We conducted a qualitative study to identify the mediums used to communicate HPV diagnoses and the impact of each medium on the diagnosis experience.Method: Twenty-five women with HPV completed semi-structured interviews, which we recorded and transcribed. We relied on grounded theory techniques in both data collection and analysis.Results: There are three primary mediums health care providers use to inform women of their HPV diagnosis: phone calls, mailed letters/email, and face-to-face interactions. Implications regarding each medium are identified and discussed.Conclusion: There are drawbacks associated with the use of each medium that healthcare practitioners should be aware of and seek to avoid.Practice implications: Healthcare providers can utilize descriptions of diagnosis encounters and the recommendations accompanying them to understand and modify ways they choose to inform individuals of an HPV diagnosis.

Forming connections in the homeopathic consultation - Corrected Proof

Caroline Eyles, Geraldine M. Leydon, Sarah B. Brien — 2012-02-27

Abstract: Objective: A previous study which explored homeopathic practitioners’ in depth understanding and experiences of homeopathic consultations identified “connecting” as a key component of the consultation. This paper reports on “connecting” and its role in the consultation.Method: Using a qualitative grounded theory approach data was collected from homeopaths using in-depth interviews, observations of homeopathic consultations and solicited practitioner reflective diaries. Constant comparison assisted code, concept and category formation to form a model of the UK classical homeopathic consultation.Results: “Connecting”, describes a complex notion of relationship in the homeopathic consultation consisting of four dimensions, and performs several roles within the consultation that enable practitioners to elicit symptoms, identify expectations, assist with prescribing, help patients engage with homeopathic principles and stimulate healing.Conclusion: This study shows the homeopath as an important component of the therapeutic context forming complex relationships and using communication that is skills based and inductively shaped to interpret and respond to each individual patient and their narrative in the consultation.Practice implications: This study could have implications for teachers, students and practitioners of homeopathy by influencing training needs, and could prove instructive for other clinicians as homeopaths’ communication style could be used to augment other consultations.

Patients’ medical knowledge and health counseling: What kind of information helps to make communication patient-centered? - Corrected Proof

Regina Jucks, Elisabeth Paus, Rainer Bromme — 2012-02-24

Abstract: Objective: To examine how physicians use information about a patient's background knowledge when both anticipating what a patient knows and producing actual answers in an email counseling setting.Methods: A fictitious patient used a (high vs. low) level of technical jargon in an email inquiry about diabetes and provided explicit information on prior knowledge (high vs. low) through self-report. Final-year medical students (semi-experts) were asked to gauge the patient's knowledge level (Experiment 1) and to produce an answer to the inquiry (Experiment 2). A total of N=150 participated in one of the two experiments.Results: Information from word usage and self-reports was used differently in the two experiments. A patient self-reporting low knowledge was assumed to have less background knowledge than one reporting some knowledge about the domain. The technicality of the patient's word use influenced the answers: these were more technical when the inquiry used technical jargon instead of everyday language.Conclusion: Knowledge anticipation and communication behavior in email health care seem to be guided by different hints regarding the patient, suggesting the existence of two separate mechanisms.Practice implications: Beyond merely teaching physicians or health care providers to be aware of the patient's knowledge level when formulating a patient-centered response, on-task methods should support health care providers during the actual communication phase by providing, for instance, metacognitive prompts.

Expert consensus on gender criteria for assessment in medical communication education - Corrected Proof

2012-02-24

Abstract: Objective: The aim of this study is to develop gender criteria that can be included in communication skills assessment in medical education.Methods: A three-round Delphi study was conducted. The invited 59 participants were experts in the field of gender medicine education (n=28) and doctor–patient communication (n=31). Each Delphi round comprised a questionnaire, an analysis, and a feedback report. In the first round, gender experts explored gender themes in doctor–patient communication from which initial gender criteria were defined. The second and third rounds were used to validate the importance and feasibility of gender criteria. Consensus was defined as a 75% panel agreement and a mean of 4 or higher on a 5-point Likert scale.Results: Four gender criteria achieved consensus after the third round. The importance of including the gender criteria in communication skills assessment was rated consistently higher than its feasibility. Gender criteria relating to the patients’ perspective, to gathering information and to gender and power were considered the most important.Conclusion: Using a Delphi study, we have developed gender criteria for inclusion in communication skills assessment to promote good communication between doctors and patients.Practice implications: Gender influences medical communication. Incorporating gender in communication skills assessment may be useful to improve the teaching and learning of communication skills.

Patient-centered care in chronic disease management: A thematic analysis of the literature in family medicine - Corrected Proof

2012-02-23

Abstract: Objective: The objective was to provide a synthesis of the results of the research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.’s model.Methods: We developed search strategies for the Medline, Embase, and Cochrane databases, from 1980 to April 2009. All articles addressing patient-centered care in the context of chronic disease management in family medicine were included. A thematic analysis was performed using mixed codification, based on Stewart's model of patient-centered care.Results: Thirty-two articles were included. Six major themes emerged: (1) starting from the patient's situation; (2) legitimizing the illness experience; (3) acknowledging the patient's expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system.Conclusion: The context of chronic disease management brings forward new dimensions of patient-centered care such as legitimizing the illness experience, acknowledging patient expertise, offering hope and providing advocacy.Practice implications: Chronic disease management calls for the adaptation of the family physician's role to patients’ fluctuating needs. Literature also suggests the involvement of the family physician in care transitions as a component of patient-centered care.

Cancer patients’ expressions of emotional cues and concerns and oncology nurses’ responses, in an online patient–nurse communication service - Corrected Proof

Gro Hjelmeland Grimsbø, Cornelia M. Ruland, Arnstein Finset — 2012-02-13

Abstract: Objective: To (1) investigate emotional cues and concerns (C&C) of cancer patients expressed in e-mail communication with oncology nurses in an online patient–nurse communication service (OPNC), and (2) explore how nurses responded to patients’ C&C.Methods: 283 e-messages sent from 38 breast and 22 prostate cancer patients and 286 e-responses from five oncology nurses were coded with the Verona Coding Definitions of Emotional Sequences.Results: We identified 102 cues and 33 concerns expressed in patients’ messages. Cues indicating expression of uncertainty or hope, occurred most frequently (in 38.5% of messages), followed by concerns (in 24.4% of messages). Nurses responded to 85.2% of patients’ C&Cs; more than half of patients’ C&Cs were met with a mixture of information giving and empathic responses.Conclusion: Patients with breast and prostate cancer express many C&C in e-mail communications with oncology nurses, who demonstrated satisfactory sensitivity to patients’ emotions in their responses to patients.Practice implications: Offering e-communication with oncology nurses to cancer patients is a promising and feasible supplement to usual care to address and relieve patients’ concerns and emotional distress during illness and recovery.

How emotions emerge and are dealt with in first diagnostic consultations in psychiatry - Corrected Proof

2012-02-13

Abstract: Objective: To illustrate how patients introduce cues and concerns during clinical consultations and how psychiatrists respond to them.Method: Sixteen psychiatrists recorded 104 first diagnostic consultations, coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Cues, concerns and responses were analyzed in relation to patient gender and ICD-10 diagnosis, and psychiatrists’ age, gender, clinical experience and consultation process.Results: Cues were more frequent among female patients and were equally distributed among diagnostic categories. Concerns were more frequent among patients with “Mood” or “Neurotic” disorders. Psychiatrists’ responses to cues tended to “provide space” without being explicit. Referral to the affective part was restricted to concerns which had been solicited by the psychiatrist. Empathic responses were infrequent. Cues and concerns received more attention by female psychiatrists.Conclusion: The study confirms gender differences in expressing and dealing with emotions both by patients and psychiatrists. Females tend to give more space to this topic. Psychiatrists ‘responses differed according to cues, concerns, gender, diagnosis and to who prompted the cue/concern, showing a preference for topics introduced by themselves.Practice implications: The VR-CoDES is a useful tool to define the strategies psychiatrists adopt when handling patients’ emotions in terms of cues and concern.

Optimizing the utility of communication OSCEs: Omit station-specific checklists and provide students with narrative feedback - Corrected Proof

Marc Van Nuland, Wim Van den Noortgate, Cees van der Vleuten, Goedhuys Jo — 2012-02-10

Abstract: Objective: To evaluate how the utility (reliability, validity, acceptability, feasibility, cost and educational impact) of a communication-OSCE was influenced by whether or not station-specific (StSp) checklists were used together with a generic instrument and whether or not narrative feedback was provided to students.Methods: At ten stations, faculty members rated standardized patient–student interactions using the Common Ground (CG) instrument (at all stations) and StSp-checklists. Both raters and patients provided written feedback. The impact of changing the design on the various utility parameters was assessed: reliability by means of a generalizability study, cost using the Reznick model and the other utility parameters by means of a survey.Results: Use of the generic instrument (CG) proved more reliable (G coefficient=0.67) than using the StSp-checklists (G=0.47) or both (G=0.65) while there was a high correlation between both scale scores (Pearsons’ r=0.86). The cost was 6.5% higher when StSp-checklists were used and 5% higher when narrative feedback was provided.Conclusion: The utility of a communication OSCE can be enhanced by omitting StSp-checklists and by providing narrative feedback to students.Practice implications: The same generic assessment scale can be used in all stations of a communication OSCE. Providing feedback to students is promising but it increases the costs.