Communication In Clinical Practice Research Articles

Case report: Poor prognosis or poor prognostication?

This case highlights the limitations of current prognostication and communication in clinical practice. We report a case of a 50 year old patient with metastatic melanoma following admission to intensive care unit and later transferred to palliative care unit for end-of-life care. The patient had clinical improvement despite signs of predictors of death and was later transferred back to care of oncology team. Physicians frequently overestimate or underestimate survival time which can be distressing to patients and families. There is need for further research to improve the accuracy of these tools for the sake of our patients and their families.

Moral challenges and understanding of clinical ethics in Tanzanian hospitals: Perspectives of healthcare professionals.

Healthcare professionals encounter many moral challenges in their daily clinical practice. However, there have been few studies on the subject matter in Tanzania. This study aims to provide an account of moral challenges faced by healthcare professionals in Tanzanian hospitals, their understanding of clinical ethics, and the ethics education they have received. Many participants reported receiving some kind of ethics training through formal education and on-the-job training. Some participants understood ethics in healthcare settings as adherence to established laws, regulations, guidelines, procedures, norms, and rules essential in clinical practice. Analysis of the data identified four themes of moral challenges. These challenges are related to 1) decision-making and communication in clinical practice, 2) scarcity of medical resources and prioritization in clinical practice, 3) withdrawal of curative treatment, and 4) conflicts between professional judgment, religious convictions and adherence to alternative treatments. Based on the findings, we suggest a context-sensitive form of clinical ethics training to prepare healthcare professionals to recognize and address these moral challenges.

Based on Medicine, The Now and Future of Large Language Models.

This review explores the potential applications of large language models (LLMs) such as ChatGPT, GPT-3.5, and GPT-4 in the medical field, aiming to encourage their prudent use, provide professional support, and develop accessible medical AI tools that adhere to healthcare standards. This paper examines the impact of technologies such as OpenAI's Generative Pre-trained Transformers (GPT) series, including GPT-3.5 and GPT-4, and other large language models (LLMs) in medical education, scientific research, clinical practice, and nursing. Specifically, it includes supporting curriculum design, acting as personalized learning assistants, creating standardized simulated patient scenarios in education; assisting with writing papers, data analysis, and optimizing experimental designs in scientific research; aiding in medical imaging analysis, decision-making, patient education, and communication in clinical practice; and reducing repetitive tasks, promoting personalized care and self-care, providing psychological support, and enhancing management efficiency in nursing. LLMs, including ChatGPT, have demonstrated significant potential and effectiveness in the aforementioned areas, yet their deployment in healthcare settings is fraught with ethical complexities, potential lack of empathy, and risks of biased responses. Despite these challenges, significant medical advancements can be expected through the proper use of LLMs and appropriate policy guidance. Future research should focus on overcoming these barriers to ensure the effective and ethical application of LLMs in the medical field.

How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals

BackgroundDevelopments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative care professionals of using digital health to support communication during the pandemic. We aimed to describe how palliative care professionals used technology to support communication (multidisciplinary team working, education and with patients and family caregivers) during the COVID-19 pandemic.Method(s)UK based palliative care healthcare professionals completed an electronic questionnaire to describe their use of digital health, during the COVID-19 pandemic, to support (1) communication within the multidisciplinary team (MDT), (2) education and (3) to support communication with patients and carers.ResultsTwo hundred and thirty-four palliative care professionals participated. Most (n = 227, 97%) described an increase in their use of digital health, to support communication, since the start of the COVID-19 pandemic. We identified benefits and challenges for digital health communication, which we summarised into themes, including ‘a new way of working’, ‘developing a new approach to learning’ and ‘impacting care’.Conclusion(s)Since the pandemic, palliative care professionals have increased their use of digital health to support communication in clinical practice. We have identified facilitators and barriers for future practice. Further work should identify the levels of support needed for organisations to ensure that digital health interventions are meaningfully used to help palliative care professionals effectively communicate with patients, caregivers and staff.

Precepting in critical care: Communication and collaboration

Well-honed interpersonal and communication skills are essential in an effective preceptorship. Preceptors not only facilitate and develop positive interpersonal relationships between themselves, the preceptee, the patient and family, and the healthcare team, but they have a responsibility to foster and develop the preceptee’s interpersonal and communication skills as well. Doing so is even more important and more challenging in the complex, busy, and often overwhelming critical care environment. This article is the third in a series that aims to support new and experienced critical care nurse preceptors, as they guide those who will become the future of critical care nursing. Effective interpersonal and communication skills are essential to establish any constructive professional relationship in nursing practice, but even more so in the critical care environment due to its fast-paced, highly acute and complex nature. Effective communication skills help build trusting relationships, foster a caring environment, allow greater accuracy and understanding of information and, ultimately, lead to safer patient- and family-centred care (Arnold & Boggs, 2020). Strong interpersonal and communication skills can assist preceptors to be more effective personally and even more so in their role guiding preceptees (Hardie et al., 2022). At the same time, preceptees may have limited experience with communication in clinical practice, particularly in the high-pressure context of an intensive care unit (ICU), and it is the preceptor’s responsibility to assist their preceptees in developing these skills.

Evaluating the performance of Generative Pre-trained Transformer-4 (GPT-4) in standardizing radiology reports.

Radiology reporting is an essential component of clinical diagnosis and decision-making. With the advent of advanced artificial intelligence (AI) models like GPT-4 (Generative Pre-trained Transformer 4), there is growing interest in evaluating their potential for optimizing or generating radiology reports. This study aimed to compare the quality and content of radiologist-generated and GPT-4 AI-generated radiology reports. A comparative study design was employed in the study, where a total of 100 anonymized radiology reports were randomly selected and analyzed. Each report was processed by GPT-4, resulting in the generation of a corresponding AI-generated report. Quantitative and qualitative analysis techniques were utilized to assess similarities and differences between the two sets of reports. The AI-generated reports showed comparable quality to radiologist-generated reports in most categories. Significant differences were observed in clarity (p = 0.027), ease of understanding (p = 0.023), and structure (p = 0.050), favoring the AI-generated reports. AI-generated reports were more concise, with 34.53 fewer words and 174.22 fewer characters on average, but had greater variability in sentence length. Content similarity was high, with an average Cosine Similarity of 0.85, Sequence Matcher Similarity of 0.52, BLEU Score of 0.5008, and BERTScore F1 of 0.8775. The results of this proof-of-concept study suggest that GPT-4 can be a reliable tool for generating standardized radiology reports, offering potential benefits such as improved efficiency, better communication, and simplified data extraction and analysis. However, limitations and ethical implications must be addressed to ensure the safe and effective implementation of this technology in clinical practice. The findings of this study suggest that GPT-4 (Generative Pre-trained Transformer 4), an advanced AI model, has the potential to significantly contribute to the standardization and optimization of radiology reporting, offering improved efficiency and communication in clinical practice. • Large language model-generated radiology reports exhibited high content similarity and moderate structural resemblance to radiologist-generated reports. • Performance metrics highlighted the strong matching of word selection and order, as well as high semantic similarity between AI and radiologist-generated reports. • Large language model demonstrated potential for generating standardized radiology reports, improving efficiency and communication in clinical settings.

Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice

ObjectiveIn this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. MethodsThrough an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. ResultsThe framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. ConclusionThis work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. InnovationThis framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.

Effect of a prediction tool and communication skills training on communication of treatment outcomes: a multicenter stepped wedge clinical trial (the SOURCE trial)

For cancer patients to effectively engage in decision making, they require comprehensive and understandable information regarding treatment options and their associated outcomes. We developed an online prediction tool and supporting communication skills training to assist healthcare providers (HCPs) in this complex task. This study aims to assess the impact of this combined intervention (prediction tool and training) on the communication practices of HCPs when discussing treatment options. We conducted a multicenter intervention trial using a pragmatic stepped wedge design (NCT04232735). Standardized Patient Assessments (simulated consultations) using cases of esophageal and gastric cancer patients, were performed before and after the combined intervention (March 2020 to July 2022). Audio recordings were analyzed using an observational coding scale, rating all utterances of treatment outcome information on the primary outcome-precision of provided outcome information-and on secondary outcomes-such as: personalization, tailoring and use of visualizations. Pre vs. post measurements were compared in order to assess the effect of the intervention. 31 HCPs of 11 different centers in the Netherlands participated. The tool and training significantly affected the precision of the overall communicated treatment outcome information (p=0.001, median difference 6.93, IQR (-0.32 to 12.44)). In the curative setting, survival information was significantly more precise after the intervention (p=0.029). In the palliative setting, information about side effects was more precise (p < 0.001). A prediction tool and communication skills training for HCPs improves the precision of treatment information on outcomes in simulated consultations. The next step is to examine the effect of such interventions on communication in clinical practice and on patient-reported outcomes. Financial support for this study was provided entirely by a grant from the Dutch Cancer Society (UVA 2014-7000).

Exploring Communication Practices in Italian Physiotherapy: Knowledge and Use of Effective Communication Strategies-A National Descriptive Study.

This study aimed to investigate the knowledge and use of effective communication strategies among Italian physiotherapists. We utilized a questionnaire consisting of 19 questions to collect data on the knowledge and use of effective communication strategies among Italian physiotherapists. The results revealed that only 35.8% of the respondents reported being aware of communication strategies related to physiotherapy, with their first exposure occurring during their three-year degree. Despite the majority of respondents agreeing that communication is an effective strategy for improving patient adherence, only about half reported making moderate use of open-ended questions and metaphors during treatment sessions. Furthermore, more than half of the respondents reported being unaware of Motivational Interviewing. The results of this study found that there is a consensus among Italian physiotherapists about the importance of effective communication in clinical practice, though the knowledge and application of some communication strategies remain limited. These findings suggest that there is room for improvement in the training and education of physiotherapists in Italy, with a need for greater emphasis on communication strategies in the university educational curriculum, starting from the bachelor's degree.

Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions.

Bowel urgency (BU), the sudden or immediate need for a bowel movement, is one of the most common and disruptive symptoms experienced by patients with ulcerative colitis (UC). Distinct from the separate symptom of increased stool frequency, BU has a substantial negative impact on quality of life and psychosocial functioning. Among patients with UC, BU is one of the top reasons for treatment dissatisfaction and one of the symptoms patients most want improved. Patients may not discuss BU often due to embarrassment, and healthcare providers may not address the symptom adequately due to the lack of awareness of validated tools and/or knowledge of the importance of assessing BU. The mechanism of BU in UC is multifactorial and includes inflammatory changes in the rectum that may be linked to hypersensitivity and reduced compliance of the rectum. Responsive and reliable patient-reported outcome measures of BU are needed to provide evidence of treatment benefits in clinical trials and facilitate communication in clinical practice. This review discusses the pathophysiology and clinical importance of BU in UC and its impact on the quality of life and psychosocial functioning. Patient-reported outcome measures developed to assess the severity of BU in UC are discussed alongside overviews of treatment options and clinical guidelines. Implications for the future management of UC from the perspective of BU are also explored.

Definition, classification, and causes of short bowel syndrome.

The term "short bowel syndrome (SBS)" defines "the clinical feature associated with a remaining small bowel in continuity of less than 200 cm from the ligament of Treitz" and is characterized by malabsorption, diarrhea, fatty stools, malnutrition, and dehydration. SBS is the primary pathophysiological mechanism of chronic intestinal failure (CIF), defined as the "reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation (IVS) is required to maintain health and/or growth" in a metabolically stable patient. By contrast, the reduction of gut absorptive function that does not require IVS has been termed "intestinal insufficiency or deficiency" (II/ID). The classification of SBS can be categorized as follows: anatomical (anatomy and length of the residual bowel), evolutional (early, rehabilitative, and maintenance phases), pathophysiological (SBS with or without a colon in continuity), clinical (with II/ID or CIF), and severity of CIF (type and volume of the required IVS). Appropriate and homogeneous patient categorization is the mainstay of facilitating communication in clinical practice and in research.

Structured patient handover in high-risk areas : Evidence and recommendations for the practical implementation

The perioperative setting is ahigh-risk environment which is particularly susceptible to communication deficits and errors. The situation, background, assessment, recommendation (SBAR) approach provides an intuitive guideline for team communication, which is associated with an improved quality of the handover. The German Society for Anaesthesiology and Intensive Care Medicine (DGAI) has updated its recommendations in March 2022 and continues to endorse the use of the SBAR template. The impact of tools used for structured communication during patient handover are often studied in the context of alarger bundle of measures. The SBAR template is one option for establishing structured communication in clinical practice. Successful implementation is supported by clearly defined standard workflows to promote consistent use. This standardization identifies common communication barriers and assists in resolving them in ahigh-risk environment. Acommon understanding of the inherent values, and ashared interest in learning, applying, and training these techniques are paramount in establishing aculture of patient safety. This can only be reached through excellent interprofessional teamwork and supportive leadership.

Gender differences in empathy, emotional intelligence and problem-solving ability among nursing students: A cross-sectional study

BackgroundEmpathy, emotional intelligence (EI) and problem-solving ability are three important characteristics that influence effective communication in clinical practice. Previous studies have not adequately explored the specific relationships between these three abilities and their gender differences among nursing students. ObjectiveWe sought to investigate the current state of emotional intelligence, empathy, and problem-solving ability in nursing students and to identify whether gender differences affect these three characteristics and how gender differences can be used to educate nurses on empathy. DesignWe conducted a cross-sectional survey. ParticipantsA total of 993 nursing students from two grade A tertiary hospitals in Hunan, China participated in this study. MethodsData were collected using the Empathy of Clinical Nurse Scale (ENCS), Emotional Intelligence Scale of Clinical Junior Nurses (EIS) and Social Problem-Solving Inventory (SPSI). Data were analyzed using an independent samples t-test, Pearson correlation and hierarchical multiple linear regression. ResultsThere was no significant difference in the ENCS and SPSI scores between male and female nursing students, but male nursing students had lower EIS scores (P < 0.05). A significant association was found between ENCS, EIS and SPSI on most dimensions among female nursing students, but no significant association was found between ENCS and EIS for total scores among males. We found that problem-solving ability was the most important factor affecting the variation in empathy for both male and female nursing students through hierarchical multiple regression analysis. ConclusionsGender differences are reflected not only in the level of emotional intelligence but also in the relationships between emotional intelligence, empathy, and problem-solving ability. Nursing educators should be aware of how gender differences can affect these three traits; this is particularly important for teaching based on students' aptitudes.

Effects of a Virtual Simulation on Student Understanding of Structured Communication in the Surgical Learning Environment

INTRODUCTION: Ineffective structured communication in handovers can result in medical errors and patient harm. Common frameworks include SBAR and IPASS. Simulation-based education can improve competency in structured communication. The goal of this project was to increase student understanding of structured communication in the surgical learning environment. METHODS: Students participated in a pilot for an asynchronous, virtual simulation focused on structured communication prior to their surgical rotation. The simulation was embedded into an existing module for teaching other teamwork competencies. In the simulation, students watched didactic videos about structured communication, reviewed patient documents, listened to pre-recorded patient calls, and created handover statements for 2 simulated discharged postoperative patients using either SBAR or IPASS: (1) an ileocecectomy patient without complications, and (2) a cholecystectomy patient with complications. Before and after the activity, students completed a survey assessing knowledge of, attitudes toward, and confidence in skills relating to structured communication. RESULTS: 14 students piloted the simulation and surveys. Students demonstrated significant improvement in knowledge of IPASS components (p = 0.0159) and maintained a high level of knowledge of SBAR components (92.9% for pre- and post-survey) (Table). Attitudes toward the importance of structured communication in clinical practice improved on a 5-point Likert scale of strongly disagree to strongly agree, although not significant (p = 0.38209). Improvement to confidence in using structured communication was significant (p = 0.00082). Table. - Knowledge, Attitudes, and Confidence in Skills Before and after Virtual Handover Simulation Pre-survey Post-survey p Value Knowledge (% Correct) IPASS Knowledge 57.1% 100% 0.0159 SBAR Knowledge 92.9% 92.9% 1 Attitudes (Likert Scale, Strongly Agree to Strongly Disagree) % Agree 14.3% 7.1% 0.38209 % Strongly Agree 85.7% 92.9% Confidence in Skills (0-100) Average Confidence Rating 27.4 63.8 0.00082 CONCLUSION: Asynchronous, virtual simulations may improve student competency in structured communication. Further implementation of the piloted simulation must adapt to time limitations of students on surgical rotations to optimize completion and fidelity outcomes.

Getting in touch: Communication in physical therapy practice and the multiple functions of language.

In physical therapy, communication that actively involves the patient is seen as the foundation of patient-centered treatment. Research on communication in physical therapy highlights how patients' opportunity to actively participate is often limited by the therapists' focus on biomedical facts and clinical tasks. Few studies have explored aspects of communication in clinical practice that may promote patients' active participation. The aim of this study is to shed light on verbal and nonverbal communication used by physical therapists to get in touch with patients and how this physical and linguistic touching may contribute to encouraging patients' participation. The selected case is from a qualitative observational case study of the first encounter between a female physical therapist and a male patient with chronic neck pain. Drawing on theories about communication and the metafunctions of language, the findings highlight how the therapist's use of unfinished sentences, repetitions of the patient's own words, touch, gaze and accepting interruptions from the patient promotes the patient's participation. Demonstrations of the use of linguistic communication theory in this study may contribute to enhancing physical therapists' self-awareness around communication and how to get in touch with patients, which is a fundamental element in patient-centered treatment.

Hypnosis in anesthesiology and neurosurgery

The review presents data on the use of hypnotic techniques in anesthesiology and neurosurgery. The authors describe the historical data, methodology of hypnotic communication, modern use of hypnosis, and methods of hypnotic communication in clinical practice. Hypnotherapy techniques have shown excellent results in pain management and can be effective in reducing preoperative anxiety and intraoperative surgical stress.

A Preliminary Study of the Validation for Children’s Social Communication Scale for Children Aged 6-7 Years

Objectives: Despite the classification of various children showing deficiencies in social communication that are distinct from autism spectrum disorder, interest in social communication has not increased. However, the development of social communication competence acts as an important indicator for adapting well to school life after entering elementary school. The purpose of this study was to develop a social communication scale regarding child development indicators required in clinical practice.Methods: In phase 1 of this study, a preliminary social communication scale (SCS) was conducted by modifying evaluation items that measure social cognition, pragmatic language, and social skills. Using the results from the SCS, an item analysis was conducted. In phase 2 of this study, an expert validity test was conducted to complete the final SCS.Results: As a result of item analysis, 51 items of the SCS were extracted. The SCS consisted of 16 questions in the social cognition area, 24 questions in the conversational language area, and 11 questions in the social technology area.Conclusion: The SCS is comprised of questions that can evaluate the social communication of children preparing for to enter school, and early school-age children. It is hoped that the results of this preliminary study contribute to the activation of social communication research and can help provide directions for improving children’s social communication in clinical practice.

Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice.

We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. This study was part of the large-scale implementation of a communication skills training program called "Clear-Cut Communication With Patients" at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers' participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35-2.3; P=0.01) for the overall score. The consultations did not last longer after the training. Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations.

Utilisation de l’outil SAED : évaluation de l’intérêt d’une formation courte sur la qualité de la communication entre soignants à court et à long terme

ObjectivesCommunication breakdown is one of the main causes of adverse events in clinical routine. The main objective of this study was to assess whether a short training course on medical communication based on the situation-background-assessment-recommendation (SBAR) tool improved the quality of communication in clinical practice. MethodsInterventional study, conducted at the Jeanne de Flandre maternity unit (Lille University Hospital, France) between January 2017 and December 2019. The training sessions lasted 1 hour and consisted of a theoretical part, based on the SBAR tool, and of a practical part (video-stimulated recall and role-play case scenarios). The main outcome measure was the evaluation of the quality of the telephone calls made by a caregiver to the on-call doctor, using a questionnaire completed before (Q1) and remotely from training (Q2). ResultsOne hundred and twenty health professionals were trained (n=120). Following the trainings, there was an improvement in communication in the short term, whether in terms of relevance (64.9 vs. 52.6, P<0.001) or conciseness of the message (36.9 vs. 32.2, P<0.001), but also in terms of long-term in a real clinical situation (Q2: 3.9 vs. Q1: 3.0, P<0.001). Finally, 81% of participants were satisfied with the training. ConclusionsShort training sessions on communication based on the SBAR tool appeared to improve participants’ knowledge and skills in the short-term, but also in the longer term in a real clinical situation.

Reframing Clinical Paradigms: Strategies for Improving Patient Care Relationships.

This article presents strategies for reframing clinical paradigms to build better therapeutic relationships with patients and the members of their support network from the unique and important lens of a parent and disability researcher. First, a brief history of the evolution of models of care is presented, and implementation of the current biopsychosocial model is discussed. Then, evidence-based practice and the role of the patient perspective is considered. Next, specific examples, tools, techniques, guidelines, and resources to foster the demonstration of patient-informed respect and patient-centered communication in clinical practice are provided. Examples and resources are presented that can be accessed and implemented immediately, without cost to the practitioner and with the vast potential to improve care, therapeutic relationships, and patient outcomes. It is important for health care providers and researchers in all practice areas and across all experience levels to regularly evaluate their psychosocial skills. It is critical that the voices of patients and the members of their support network are central in this process. This can enable health care providers to acknowledge areas for growth and to implement changes effectively and efficiently at the individual level to facilitate changes across the broader spectrum of health care practice.