Clinician-patient Relationship Research Articles

Understanding the therapeutic toolkit for inflammatory bowel disease.

Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn's disease, is a group of chronic, immune-mediated disorders of the gastrointestinal tract that present substantial clinical challenges owing to their complex pathophysiology and tendency to relapse. A treat-to-target approach is recommended, involving iterative treatment adjustments to achieve clinical response, reduce inflammatory markers and achieve long-term goals such as mucosal healing. Lifelong medication is often necessary to manage the disease, maintain remission and prevent complications. The therapeutic landscape for IBD has evolved substantially; however, a ceiling on therapeutic efficacy remains and surgery is sometimes required (owing to uncontrolled disease activity or complications). Effective IBD management involves comprehensive care, including medication adherence and a collaborative clinician-patient relationship. This Review discusses current therapeutic options for IBD, detailing mechanisms of action, efficacy, safety profiles and guidelines for use of each drug class. We also explore emerging therapies and the role of surgery. Additionally, the importance of a multidisciplinary team and personalized care in managing IBD is emphasized, advocating for patient empowerment and involvement in treatment decisions. By synthesizing current knowledge and emerging trends, this Review aims to equip healthcare professionals with a thorough understanding of therapeutic options for IBD, enhancing informed, evidence-based decisions in clinical practice.

N14 Patients and clinicians have different priorities when discussing pain in the IBD clinic

Abstract Background Pain affects approximately 70% of patients with inflammatory bowel disease (IBD), persisting for five or more years in nearly half, and significantly impacts their quality of life.1 However, surveys indicate it is not routinely discussed in the IBD clinic.1,2 Clinicians often focus on objective measures of IBD activity rather than on pain and its management, assuming that addressing disease-related factors will alleviate pain.3 Compounding this, patients find it hard to articulate their pain and may not report it because they believe that pain is not taken seriously by clinicians.4 This study aimed to identify communication barriers and opportunities for improvement by comparing clinicians' understanding and management of pain with reports of patients' lived experiences. Methods Semi-structured interviews with nurses and doctors (n=13), analysed alongside 83 pre-existing transcripts from nurses, doctors and patients in other IBD-pain studies using reflective thematic analysis, led to the identification of three primary themes. Results Clinicians reported that pain is a stronger indicator of complications in Crohn’s disease than in ulcerative colitis, leading them to ask about it more often in consultation with patients with Crohn’s disease. However, patients felt that pain inquiries were minimal in both conditions. Discrepancies between intentions and practices were noted, with clinicians showing empathy for pain but not following through on its management. The study revealed power imbalances in the clinician-patient relationship. Clinicians were perceived by patients as having the authority to make decisions and prioritise disease management. Limited time and restricted options for pain management exacerbated imbalances, leading some clinicians to default to secondary irritable bowel syndrome diagnoses when pain persisted during remission. Inadequate acknowledgment of pain contributed to patients feeling uncared for. Addressing pain in patients who do not complain posed challenges. Some patients refrained from reporting pain due to a need to remain positive, concerns about clinician busyness, or the hassle of additional tests. One clinician expressed not wanting to exacerbate the pain by drawing attention to it. However, avoiding discussion is likely counterproductive with some clinicians relating that educating patients on "normal" and "abnormal" symptoms could be effective, although time constraints posed challenges. Conclusion The study emphasises the importance of comprehensive pain evaluation and management, advocating for more open dialogues between clinicians and patients. Understanding the biological basis of pain and the role of dysregulated modulation in maintaining it may help bridge the gap in perspectives.

Gynecologic health care for LGBTQIA+ people.

Gender relations are a set of socially determined norms and rules that assign values, characteristics, and expectations to individuals based on their biological sex. These aspects also influence the clinician-patient relationship, since it has been for a long time based on cisheteronormativity. However, this attitude alienated the LGBTQIA+ community from health services. Global and specific gynecologic care needs to be offered to the LGBTQIA+ population, which has demands for sexual and reproductive health care. In this narrative review, we bring conceptual aspects, gender identity and expression, sexual history, screening for cancer and other care to the community.

“It’s a delicate balance”: clinicians’ experiences of providing heroin-assisted treatment

BackgroundLittle attention has been paid to the experiences of clinicians and health personnel who provide heroin-assisted treatment (HAT). This study provides the first empirical findings about the clinicians’ experiences of providing HAT in the Norwegian context.Methods23 qualitative interviews were conducted with 31 clinicians shortly after HAT clinics opened in Norway’s two largest cities: Oslo and Bergen. By inductive thematic analysis of interview transcripts, we identified what research participants experienced and viewed as the chief rewards and challenges of providing HAT. The study aimed to offer an overview of these key rewards and challenges, with insights potentially transferable to HAT programs internationally.ResultsParticipants experienced three aspects of providing HAT as particularly rewarding, and three as most challenging. The rewarding aspects were observing harm reduction outcomes; providing holistic care; and having a positive clinic milieu and patient–clinician relationships. The challenging aspects were dosing and overdose risk; rule enforcement and aggression management; and the difficulty of initiating treatments beyond medication and harm reduction. The rewarding and challenging aspects of providing HAT overlapped and were at times contradictory, thus reflecting the duality and tensions in clinicians’ work to provide HAT. The challenges were reported to vary between patient subgroups, according to their degree of instability. The most unstable patients were seen as involving more difficulties as regards the challenging aspects of HAT. Participants expressed uncertainty about HAT’s utility for a small group of the most unstable patients.ConclusionWhile studies about clinical experiences of HAT have usually examined individual or limited aspects of treatment provision, this study provided an overview of the main aspects of the rewards and challenges of providing HAT. Importantly, it also showed the tensions between these overlapping and sometimes contradictory aspects of HAT provision. Because a positive patient–clinician relationship is crucial to patient satisfaction and treatment outcomes in HAT, the provision of training for clinicians on navigating the inherent tensions of HAT provision, nurturing therapeutic alliances with patients, and managing their role as gatekeepers to medical heroin and valuable services, seem particularly important for ensuring that care is patient-centered and staff are adequately supported.

A systematic review on patient perceptions and clinician-reported outcomes when comparing digital and analog workflows for complete dentures.

To compare digitally fabricated complete dentures to conventionally fabricated dentures using patient- and clinician-reported outcome measures. This review was structured according to PRISMA guidelines with the protocol registered in the PROSPERO database (CRD42024526069). An electronic search of the databases with a defined search strategy was completed within PubMed/MEDLINE and Web of Science from January 2000 to March 2024. Grey literature and article references were searched. Articles were screened by title and abstract, and the remaining articles were screened by full-text review. Articles accepted for inclusion were subjected to a risk-of-bias assessment using Cochrane Collaboration tools (RoB 2 and ROBINS-I). From an initial pool of 704 articles, 15 studies met the selection criteria, of which the majority were published within the past 3 years. Within the included studies, there was inconsistency in the assessment methods of patient- and clinician-reported outcomes, making it challenging to draw definitive conclusions. Generally, digital dentures had superior cost-effectiveness and prosthesis fabrication time. Patient satisfaction and denture quality were not consistently improved with digital technology. Studies showed indications of patient satisfaction with digital and conventional dentures. Digital technology may enhance clinical workflows. A trend emerged that milled dentures performed better than printed dentures. Clinicians adopting digital technology into removable prosthodontics may have a learning curve to overcome, and they should consider the patient-clinician relationship in addition to clinical outcomes to achieve patient satisfaction. Additional studies with standardized tools for assessing patient satisfaction are required to enable meaningful comparisons between digital and conventional workflows.

Decision-making for wāhine Māori facing breast cancer surgery: a qualitative study

ABSTRACT Wāhine Māori (women/females) are disproportionally affected by breast cancer in Aotearoa New Zealand. Following a breast cancer diagnosis, wāhine must make important surgical decisions while navigating a Westernised health system that can be dismissive of Māori views of health and tikanga (customary practices). We investigated the decision-making process of wāhine who had undergone surgery for breast cancer within the preceding 12 months. Fifteen wāhine shared their perspectives on surgery, shared decision-making and information provided prior to surgery. Thematic analysis revealed that fear was a primary influence on decision -making, but this emotion could be mitigated by a good quality patient-clinician relationship fostered by the shared decision-making process. In particular, whakawhanaungatanga (establishing connection and relationships) was an essential basis for shared decision-making. Shared decision-making, in turn, enabled tino rangatiratanga (self-determination) and provided support during the difficult decision-making period. Multi-modal presentation of medical information, with inclusion of Te Reo Māori is relevant to many wāhine and could offer more equitable access to diagnostic information. These findings raise awareness of the importance of recognising tikanga, in particular, whakawhanaungatanga for wāhine Māori diagnosed with breast cancer.

The Impact of Language Discordance on Acquiring Broad Social History: A Qualitative Study of Patients, Clinicians, and Interpreters.

By acquiring a broad social history (BSH), which includes aspects of patients' social needs in addition to their hobbies and activities, values, and perspectives on care, clinicians can provide more patient-centered care, which is known to improve health outcomes. However, the impact of patient-clinician language discordance on acquisition of BSH has not been well studied. To ascertain whether language discordance impacts clinicians' acquisition of patients' BSH by interviewing patients, clinicians, and medical interpreters. Qualitative study based on semi-structured interviews, followed by thematic analysis using rapid qualitative data analysis methods. We interviewed 8 Spanish-speaking and 5 English-speaking patients seen for primary care within a public hospital in San Francisco, 6 primary care clinicians, and 8 medical interpreters. All interviews were recorded and transcribed. The transcriptions were summarized into domains using rapid qualitative data analysis. The summaries were displayed in a matrix and used to generate themes and subthemes. Analysis of interviews highlighted two overarching themes concerning BSH acquisition. One theme was the importance of BSH: namely, it is critical for patient-clinician relationships and personalized care. Commonly elicited BSH facets were social drivers of health, but leisure activities were less frequently asked. The second theme described ways in which language discordance, via the need for interpretation, affects the collection of BSH, both through increasing time pressure, and hindering rapport-building strategies. Cultural barriers pose an obstacle to BSH acquisition and may operate independently of language discordance. Our results suggest two action steps for health systems: (a) apportioning more time for language-discordant visits to increase rapport-building and BSH acquisition, and (b) increasing training for clinicians on acquiring BSH when working with interpreters. Further research is needed to investigate the relationship between language discordance, acquisition of BSH, and patient outcomes.

Bioethics and Controversies in the Use of Artificial Intelligence Technologies in Cosmetic Surgery

Artificial intelligence (AI) tools have become an essential part of modern medicine and surgery in recent years. Potential cosmetic surgery patients can visualize possible outcomes of a surgical procedure with the swipe of a finger and get a quote for surgical treatments without leaving their homes. Most of these AI tools use high-quality 2D or 3D photographs, as well as sensitive personal data regarding medical history and other important parameters, which certainly raise concerns about the bioethical aspects, accountability, and personal data protection. This article points out the key ethical principles and issues that may arise in the implementation of these tools, especially in facial cosmetic surgery. It discusses the possible pre-programmed bias and other considerations and controversies that can lead to unintentional violation of sensitive information and resulting legal issues. A search was performed across PubMed and Web of Science, using a combination of keywords related to “cosmetic surgery” and “artificial intelligence,” such as “bioethics,” “AI preprogrammed bias,” and “AI liability.” The search was focused on published articles in the past 5 years to point out the recent trends and opinions among plastic cosmetic surgeons about the use of AI in the field. The main potential issues associated with the use of AI in plastic cosmetic surgery were summarized as “Possible pre-programmed Bias,” “Key ethical principles” and “Other considerations and controversies,” such as compromised traditional patient-clinician relationships, including loss of empathy and patient-centered care. Further considerations include the potential dehumanization of health care, AI-generated threats to patients’ safety and efficacy, and limited liability. The current experts’ opinions regarding the use of AI in cosmetic surgery and health care seem to be very controversial despite the increase in its use and the recent improvements in the quality and versatile facets of AI tools and their implementation. There are supporters and opponents, whose common goal remains to be the quality of care, patient safety, and bioethics, including data protection and liability. Artificial intelligence technologies can potentially improve patient care by supporting surgeons without having to replace them. Strict regulations are crucial for any kind of AI technology, especially the one involved in direct patient care, such as cosmetic surgery.

Exploring Patient, Proxy, and Clinician Perspectives on the Value and Impact of an Inpatient Portal: A Reflexive Thematic Analysis.

Research exploring perspectives on inpatient portals reports that patients desire the information affordances of inpatient portals, and clinicians recognize their value for improving patient experience but also express caution regarding sharing aspects of the medical record. This study contributed to theexisting literature on inpatient portals by considering the psychosocial dimension of clinician resistance to information sharing with inpatients and the power dynamic associated with clinician-patient information asymmetry. Along with the information affordances commonly discussed in this area, this study explored perspectives on the novel option to audio record consultations via an inpatient portal. This study aims to understand patient, proxy, and clinician perspectives on the value and impact of an inpatient portal within the Australian context. It explores clinician resistance and receptivity to sharing aspects of the medical record with patients and the power dynamic that characterizes the relationship between clinician and patient. It considers how an inpatient portal might assist in the transformation of this relationship such that this relationship could be characterized by greater information symmetry. Interviews were conducted with patients (n=20), proxies (n=4), and clinicians (n=21) recruited from 3 areas within the Royal Melbourne Hospital, where the portal would later be implemented. A largely inductive reflexive thematic analysis was conducted. Patient and proxy participants reported that they wanted to understand what is happening in their care for peace of mind and that an inpatient portal could support this understanding. Clinician participants reflected on how they might transform their information-sharing practice to provide greater transparency in their relationship with patients. Participants considered the types of information that could be shared and how this information could be shared via an inpatient portal. Four key themes were generated: (1) affording the patient and proxy awareness, control, and reassurance through sharing accessible and meaningful information; (2) protecting the clinician and safeguarding quality health care in information sharing; (3) flexibly deploying the functions depending upon clinician, patient, proxy, and context; and (4) moving toward person-centered care: empowerment and equity via an inpatient portal. An inpatient portal provides an opportunity to reconceptualize the medical record and how this information might be shared with patients while they are admitted to thehospital, such that they have more understanding as to what is happening in their care, which ultimately supports their well-being. The transition to a more transparent information-sharing culture in the Australian hospital context will take time. An inpatient portal is a critical step in facilitating this transition and creating more informational symmetry in the clinician-patient relationship.

Impact of Patient-Clinician Relationships on Pain and Objective Functional Measures for Individuals with Chronic Low Back Pain: An Experimental Study.

To compare the effects of enhanced and limited patient-clinician relationships during patient history taking on objective functional measures and pain appraisals for individuals with chronic low back pain (CLBP). Fifty-two (52) participants with CLBP, unaware of the two groups, were randomized using concealed allocation to an enhanced (n=26) or limited (n=26) patient-clinician relationship condition. Participants shared their history of CLBP with a clinician who enacted either enhanced or limited communication strategies. Fingertip-to-floor, one-minute lift, and Biering-Sorensen tests, and visual analogue scale for pain at rest were assessed before and after the patient-clinician relationship conditions. The enhanced condition resulted in significantly greater improvements in the one-minute lift test (F(1,49)=7.47, p<.01, ηp2=0.13) and pain at rest (F(1,46)=4.63, p=.04, ηp2=0.09), but not the fingertip-to-floor or Biering-Sorensen tests, compared with the limited group. Even without physical treatment, differences in patient-clinician relationships acutely affected lifting performance and pain among individuals with CLBP.

Clinician and Patient Perspectives on the Exchange of Sensitive Social Determinants of Health Information

Social determinant of health (SDOH) data are essential to individualized care and reducing health disparities. However, there is little standardization in the way that SDOH data are collected, and barriers to increasing the collection of such data exist at both the patient and clinician levels. To evaluate clinician, patient, and care partner perspectives on the barriers to and facilitators of patients sharing SDOH information with their clinicians. This qualitative study included clinicians, patients, and care partners across the United States. Focus groups were conducted between September 2022 and February 2023 to understand the experience of collecting, documenting, and exchanging SDOH data. Rapid assessment procedures were used to analyze focus group transcripts, creating summaries, codes, and themes mapped directly to the project research questions. A total of 235 individuals participated, including 109 (46.4%) clinicians (60 [55.0%] male; 25 [22.9%] Asian, 2 [1.8%] Black, and 74 [67.9%] White) and 126 (53.6%) patients and care partners (45 [35.7%] male; 1 [0.8%] Asian, 48 [38.1%] Black, and 64 [50.8%] White). Clinicians and patients agreed that SDOH data are important for clinicians to know. Both clinicians and patients wanted a structured, standardized way to collect SDOH data in the future, accompanied by time for more in-depth discussion during the visit. However, they highlighted numerous issues that impact collecting these data, including beliefs about how the information will be used, the clinician-patient relationship, having enough of the right staff, time needed to collect SDOH information, and technology used to collect the data (eg, usability, standardization). This qualitative study of the experience of collecting, documenting, and exchanging SDOH data underscores the ongoing barriers to widespread adoption of uniform approaches to SDOH data documentation as well as factors that may help lower those barriers, such as trusting patient-clinician relationships, greater transparency in how the data will be used, and targeted resources. A multifaceted approach to addressing the concerns raised by clinicians, patients, and care partners is required to ensure that such data can be captured in a way that improves care and allows for progress toward an equitable health care system.

Patient trust in the use of machine learning-based clinical decision support systems in psychiatric services: A randomized survey experiment.

Clinical decision support systems (CDSS) based on machine-learning (ML) models are emerging within psychiatry. If patients do not trust this technology, its implementation may disrupt the patient-clinician relationship. Therefore, the aim was to examine whether receiving basic information about ML-based CDSS increased trust in them. We conducted an online randomized survey experiment in the Psychiatric Services of the Central Denmark Region. The participating patients were randomized into one of three arms: Intervention=information on clinical decision-making supported by an ML model; Active control=information on a standard clinical decision process, and Blank control=no information. The participants were unaware of the experiment. Subsequently, participants were asked about different aspects of trust and distrust regarding ML-based CDSS. The effect of the intervention was assessed by comparing scores of trust and distrust between the allocation arms. Out of 5800 invitees, 992 completed the survey experiment. The intervention increased trust in ML-based CDSS when compared to the active control (mean increase in trust: 5% [95% CI: 1%; 9%], p=0.0096) and the blank control arm (mean increase in trust: 4% [1%; 8%], p=0.015). Similarly, the intervention reduced distrust in ML-based CDSS when compared to the active control (mean decrease in distrust: -3%[-1%; -5%], p=0.021) and the blank control arm (mean decrease in distrust: -4% [-1%; -8%], p=0.022).No statistically significant differences were observed between the active and the blank control arms. Receiving basic information on ML-based CDSS in hospital psychiatry may increase patient trust in such systems.

60 Exploring clinician perspectives on the utility and impact of psychosocial assessment on the management of hospitalized paediatric patients

Abstract Background A substantial number of paediatric inpatient, medical admissions may involve underlying psychosocial challenges. However, patients’ in-hospital care will focus on patients’ acute medical needs, despite growing evidence that holistic care incorporating patients’ broader psychosocial needs could improve physical health outcomes and health-related quality of life. Psychosocial assessment tools may facilitate clinicians’ ability to identify and address underlying mental health needs. Nonetheless, it remains unclear whether clinicians perceive these tools, and the clinical information they generate, as adding value to patient care planning. Objectives This study determines to explore the clinician-perceived views on the MyHEARTSMAP tool report and whether this report has impacted their patient care, and if so, how. Design/Methods We conducted a cross-sectional survey sub-study, within a larger randomized control trial at BC Children’s Hospital, sampling from nine inpatient specialties: general paediatrics, cardiology, nephrology, neurology, endocrinology, gastroenterology, orthopaedic surgery, urology, and general surgery. The survey was designed, validated, and administered using the Modified Dillman’s approach. Automated reminders were sent to participants if they did not respond to the survey after completing the consent form. . Eligible clinicians were asked to provide their perceptions towards the MyHEARTSMAP report through an online survey. Eligibility screening and consent retrieval were obtained prior to clinicians completing the survey. Qualitative and quantitative analyses of survey responses were conducted, summarizing proportions and counts of closed-ended responses and a content analysis of open-ended items. Results A total of 65 clinicians enrolled into our study (88% women, 85% nurses). Most clinicians (92%) found that patient-reported psychosocial assessment was beneficial for establishing patient-clinician relationships and providing information about the patient’s mental health that may not have been previously queried about. Of the clinicians who had read and used the MyHEARTSMAP screening report in their practice, a majority (84%) found it helpful for their patient care. Most clinicians felt that the MyHEARTSMAP screening report facilitated clinician-patient communication (87%) and patient involvement in the care process (90%). About half of the clinicians (52%) felt the screening report’s interface and design could be improved to allow for ease of use. Currently, the paper screening report is placed in the patients’ physical chart for clinicians to assess, but they would prefer it to be implemented onto the digital charting system used at BC Children’s Hospital. Conclusion Clinicians' perceptions towards the MyHEARTSMAP report showed acceptability amongst those who had previously encountered it. While clinicians believe psychosocial screening is beneficial, exploring options for better accessibility to the screening results is necessary to increase utilization.

Facilitators and Barriers in Palliative and End-of-Life Care in Prisons.

With an aging prison population facing various chronic diseases, the importance of palliative and end-of-life care (EOLC) in correctional facilities is heightened. This systematic review aimed to identify facilitators and barriers to palliative and EOLC in prisons. PubMed, Web of Science, Scopus, and Cochrane databases were searched for primary qualitative studies (January 2014 to December 2022) in English. Eligible studies focused on people in prison, health care professionals, administrators, and governors regarding palliative or EOLC provision within prison settings. Five studies were included, from Australia, France, the United Kingdom, and the United States, whose overall quality was moderate to high. Key facilitators included access to family, support from prison staff, specialized care availability, and cultural/spiritual support. Barriers encompassed discomfort, patient-clinician relationship constraints, time limitations, protocol uncertainty, restricted patient agency, negative attitudes, inequality, conflicting priorities, and lack of grief support. Addressing these barriers and leveraging facilitators will be crucial in ensuring equitable access to compassionate EOLC for individuals experiencing incarceration. Policymakers, health care providers, and correctional authorities must prioritize the enhancement of palliative care services within prisons, supported by further research and targeted interventions to address disparities and optimize care provision.

Remote Monitoring and Virtual Appointments for the Assessment and Management of Depression via the Co-HIVE Model of Care: A Qualitative Descriptive Study of Patient Experiences.

Objective: This qualitative study sought to explore patient experiences with technologies used in the Community Health in a Virtual Environment (Co-HIVE) pilot trial. Technology is becoming increasingly prevalent in mental healthcare, and user acceptance is critical for successful adoption and therefore clinical impact. The Co-HIVE pilot trialled a model of care whereby community-dwelling patients with symptoms of depression utilised virtual appointments and remote monitoring for the assessment and management of their condition, as an adjunct to routine care. Methods: Using a qualitative descriptive design, participants for this study were patients with symptoms of moderate to severe depression (based on the 9-item Patient Health Questionnaire, PHQ-9), who had completed the Co-HIVE pilot. Data was collected via semi-structured interviews that were audio-recorded, transcribed clean-verbatim, and thematically analysed using the Framework Method. Results: Ten participants completed the semi-structured interviews. Participants reported experiencing more personalised care, improved health knowledge and understanding, and greater self-care, enabled by the remote monitoring technology. Additionally, participants reported virtual appointments supported the clinician-patient relationship and improved access to mental health services. Conclusions: This experience of participants with the Co-HIVE pilot indicates there is a degree of acceptance of health technologies for use with community mental healthcare. This acceptance demonstrates opportunities to innovate existing mental health services by leveraging technology.

Persistent pain, long-term opioids, and restoring trust in the patient-clinician relationship

The erosion of trust in the patient-clinician relationship is an underappreciated, and vital, component of the prescription opioid crisis. Drawing from lived experience of patients and clinicians, and a narrative evidence review, this report discusses how opioid use for persistent pain can impact the patient-clinician relationship from the vantage points of the patient and the family physician. For patients, the stress of dealing with persistent pain, misalignment with clinicians regarding goals of care, experiences of disrespect and stigma, fear of abrupt tapers, and frustration with a fragmented health system, all combine to breed a lack of trust. Clinicians, for their part, experience challenges due to inadequate resources for pain management and opioid safety, pressure to deprescribe opioids rapidly, inconsistent prescribing practices of colleagues, ‘policing’ opioid prescriptions when concern arises for opioid use disorder and adversarial relationships with frustrated patients wary of clinician intentions. As a result, many clinicians struggle to maintain a therapeutic relationship with patients in great need of empathy and healing. To support implementation of evidence-based guidelines and achieve public health goals of safer prescribing and reducing harm from prescription opioids, we recommend steps health systems and clinicians can take to rebuild trust in the patient-clinician relationship, enable patient-centered pain care, and embed patient perspectives into opioid safety processes. PerspectiveErosion of patient-clinician trust is a barrier to implementing evidence-based guidelines that aim to improve opioid safety. This paper explores lived patient and clinician experiences and recommends steps for health systems and clinicians to rebuild this trust as a strategy to actualize the benefits of adherence to these guidelines.

Identifying and addressing health-related social needs: a Medicaid member perspective.

Multiple state and national health care organizations have invested in activities to screen for and address the health-related social needs (HRSNs) of their patients. However, patient perspectives concerning HRSN screening discussions and facilitated referrals to supports are largely unexplored. The main objectives of this study were to explore the ways in which Massachusetts Medicaid (MassHealth) members engage with their health care clinicians to discuss HRSNs, to identify common needs discussed, and to describe whether members feel these needs are being addressed by health care clinicians and staff. The study team performed a cross-sectional, qualitative research study that included in-depth, open-ended interviews with 44 adult MassHealth members. Interviews were conducted between June and October 2022. Interviews were recorded, transcribed, and systematically coded for analysis, and common themes were reported. The data collected for this study were part of a larger independent evaluation of MassHealth's 2017-2022 Section 1115 Demonstration that granted authority from CMS to implement health care delivery system reforms in Massachusetts. In this qualitative study of Medicaid members, some reportedly felt comfortable freely discussing all of their clinical and social needs with their health care clinicians, while others noted feelings of apprehension. Several members recalled being asked about their HRSNs in various clinical or community settings, while others did not. The majority of members endorsed having an unmet HRSN, including housing, nutrition, financial, or transportation issues, and many barriers to addressing these HRSNs were discussed. Finally, many members cited a preference for discussing HRSNs with community-based care coordinators and social workers at the community partner organizations rather than with their health care clinicians. Community-based care coordinators were lauded as essential facilitators in making the connection to necessary resources to help address HRSNs. Study results highlight an opportunity to increase the effectiveness of HRSN screening and referral practices within the health care setting through relationship building between Medicaid members and diverse interdisciplinary care teams that include staff such as community health workers. Continued investment in cross-sector partnerships, screening workflows, and patient-clinician relationships may contribute to establishing an environment in which members can comfortably discuss HRSNs and connect with needed services to improve their health.

Self-Management Systems for Patients and Clinicians in Parkinson's Disease Care: A Scoping Review.

Digital self-management tools including mobile apps and wearables can enhance personalized care in Parkinson's disease, and incorporating patient and clinician feedback into their evaluation can empower users and nurture patient-clinician relationships, necessitating a review to assess the state of the art and refine their use. This review aimed to summarize the state of the art of self-management systems used in Parkinson's disease management, detailing the application of self-management techniques and the integration of clinicians. It also aimed to provide a concise synthesis on the acceptance and usability of these systems from the clinicians' standpoint, reflecting both patient engagement and clinician experience. The review was organized following the PRISMA extension for Scoping Reviews and PICOS frameworks. Studies were retrieved from PubMed, CINAHL, Scopus, ACM Digital Library, and IEEE Xplore. Data was collected using a predefined form and then analyzed descriptively. Of the 15,231 studies retrieved, 33 were included. Five technology types were identified, with systems combining technologies being the most evaluated. Common self-management strategies included educational material and symptom journals. Only 11 studies gathered data from clinicians or reported evidence of clinician integration; out of those, six studies point out the importance of raw data availability, data visualization, and integrated data summaries. While self-management systems for Parkinson's disease are well-received by patients, the studies underscore the urgency for more research into their usability for clinicians and integration into daily medical workflows to enhance overall care quality.

Discordance Between Clinician and Person-With-Diabetes Perceptions Regarding Technology Barriers and Benefits.

The quality of clinician-patient relationship is integral to patient health and well-being. This article is a narrative review of published literature on concordance between clinician and patient perspectives on barriers to diabetes technology use. The goals of this manuscript were to review published literature on concordance and to provide practical recommendations for clinicians and researchers. In this review, we discuss the qualitative and quantitative methods that can be applied to measure clinician and patient concordance. There is variability in how concordance is defined, with some studies using questionnaires related to working alliance, while others use a dichotomous variable. We also explore the impact of concordance and discordance on diabetes care, barriers to technology adoption, and disparities in technology use. Published literature has emphasized that physicians may not be aware of their patients' perspectives and values. Discordance between clinicians and patients can be a barrier to diabetes management and technology use. Future directions for research in diabetes technology including strategies for recruiting and retaining representative samples, are discussed. Recommendations are given for clinical care, including shared decision-making frameworks, establishing social support groups optimizing clinician-patient communication, and using patient-reported outcomes to measure patient perspectives on outcomes of interest.

Cultural Humility in Nursing: A Concept Analysis.

The ability of nurses to deliver culturally mindful health care may be vital to improving the patient-clinician relationship and subsequent health outcomes for marginalized populations. Continuing education in cultural training should be designed to enhance a nurse's cultural humility. This study explores the concept of nurse cultural humility using the methods outlined by Walker and Avant (2018): define the attributes, offer a model case exemplifying the attributes, discuss the antecedents and consequences, and determine empirical referents. The defining attributes of cultural humility in nursing are a lifelong process of reflexivity, an understanding and appreciation that the cultural backgrounds of both nurse and patient influence health care encounters, and a commitment to redress and mitigate power imbalances in the patient-clinician relationship. By clearly defining nurse cultural humility, leaders will be able to develop cultural training interventions to enhance nurse cultural humility and measure the concept accurately. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].