Communication In Consultations Research Articles

Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach.

To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.

“You Have to Find a Way for This Child to Be at the Center”: Pediatric Cardiologists’ Views on Triadic Communication in Consultations on Congenital Heart Defects

ABSTRACT Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children’s cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists’ views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents’ emotional needs, and (3) the physician’s role as mediator between parent(s) and child. In each category, three elements are discussed: The physician’s agenda, obstacles and challenges, and the physician’s practical methods. Physicians strongly support children’s involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents’ and children’s needs.

Content and Duration of Doctor-Patient Communication in Outpatient Oncology Follow-Up Consultations in China.

Purpose This study aimedto analyze the content of counseling between cancer patients and physicians during outpatient follow-up, assess the duration of different communication content, and explore the influencing factors. Patients and methods We observed consecutive cancer patients without a first diagnosis of malignancy who presented to the oncology outpatient clinic of a public hospital from October through December 2023. A structured observation form was used to record the content and duration of doctor-patient communication. All variables were electronically recorded and stored on a data management platform. Multiple linear regression was used to examine the determinants of consultation duration. Results Our study included 620 cancer patients, of whom 281 individuals had distant metastasis. The average consultation duration for 620 cancer patients was 4.85 minutes (standard deviation of 3.09 minutes). The category of doctor-patient communication was routine outpatient follow-up, involving 182 patients, with an average consultation duration of 3.81 minutes (standard deviation of 2.24 minutes). The main communication content for 51 patients was about the admission procedures, with an average consultation duration of 3.00 minutes (standard deviation of 1.92 minutes). For 67 patients, the primary communication involved the prescription of anti-tumor medications, with an average consultation duration of 3.70 minutes (standard deviation of 2.30 minutes). Symptom control discussions were the main communication content with 107 patients, with an average consultation duration of 5.91 minutes (standard deviation of 3.44 minutes). The main communication content of 24 patients involved medical insurance reimbursement, with an average duration of 7.75 minutes (standard deviation of 4.63 minutes). Consultations accompanied by caregivers and the presence of metastatic tumors were positively associated with consultation duration, whereas female patients with genital malignancies were negatively associated with consultation duration. Communication about symptom management and communication about medical insurance reimbursement waspositively associated with the duration of medical consultations. Communication about administering the formalities requisite for patient admission was negatively associated with the consultation duration. Conclusion We classified the main contents of doctor-patient communication in the oncology outpatient clinic and found that the contents of doctor-patient communication tended to be monotone and systematized. Oncology outpatient models should consider the integration of caregiver involvement. The reason for the shorter outpatient consultation duration in female patients of cancer primary in the reproductive system needs further investigation. The intricate medical insurance reimbursement process poses an increasing time challenge for outpatient clinicians. In addition, the adequacy and effectiveness of symptom management services provided to cancer patients during oncology outpatient follow-up requirefurther evaluation and review.

No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis.

No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis.

Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations.

Gynecological cancer and its treatment may cause sexual difficulties in terms of physical and psychosocial health. Considering the essential role that nurses play in cancer care, they are well positioned to be ideal providers for addressing sexual health concerns in the follow-up phase of gynecological cancer. The aim of this study was to gain in-depth knowledge of how gynecological cancer survivors experience sexual health communication in nurse-led follow-up consultations. Using a qualitative hermeneutic approach, we conducted individual semi-structured interviews with 17 women from five different hospitals in Norway between April 4, 2022, and June 2, 2022. The women participated in a large intervention study on cancer follow-up that included sexual health as one of several topics addressed by trained nurses in three consultations in the first year of follow-up. A five-stage Gadamerian-inspired research method was utilized for data collection and analysis. We identified three themes: (1) the importance of nurses listening to the women's own perceptions of sexuality, (2) post-treatment sexual challenges influence the women's need to communicate about sexual health, and (3) nursing communication can help women regain their sexual health. Women who have undergone treatment for gynecological cancer find communication with trained nurses regarding sexual health beneficial. We recommend integration of trained nurses in the follow-up team. The nurses should adjust communication according to each gynecological cancer survivor's unique understanding of sexuality and inform women with sexual health concerns at that end of treatment, that sexual health can improve during follow-up.

Virtual care in the health care system: A concept analysis.

Health care providers need a better understanding of virtual care to recognise and use it for service delivery. To provide a more comprehensive definition of the concept of virtual care. This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.

Personalization reactance in online medical consultations: effects of two-sided personalization and health topic sensitivity on reactance

Abstract Personalization strategy in commercial contexts has often been criticized for eliciting individuals’ reactance. Will this happen to physician–patient communication in online medical consultations (OMCs)? Two experiments attempted to probe the direct, indirect, and conditional effects of personalization on reactance in OMC. Specifically, perceived threats to freedom and perceived physician caring were examined as two mediators underlying the relationship between personalization and reactance. Health topic sensitivity was investigated as a moderator. Results from both studies revealed that there was no main effect of personalization on reactance, yet personalization induced perceived threats to freedom and perceived physician caring, which affected reactance in a way that might cancel out each other. The effects of personalization (versus depersonalization) on perceived threats to freedom and reactance were more salient at the lower level of health topic sensitivity. These suggest that personalization with its two-sided nature exerts both desired and undesired influences and health topic sensitivity can be a prominent contextual factor in personalization reactance during OMC.

The Art of the Consult Call: Improving Communication Through Shared Mental Models.

The Accreditation Council for Graduate Medical Education cites effective communication with physicians as a core competency for emergency medicine (EM) residents. However, there is no standardized curriculum dedicated to communication beyond practice in the clinical setting. We developed a 1-hour EM didactic session on effective consultations using experiential education principles. Learners were placed in pairs of one junior learner and one senior learner. The junior learner performed a mock phone consultation using an EM patient case; the senior learner completed an online evaluation, assessing the junior learner on 13 core components of a successful consult call, based on Kessler's 5Cs consultation model. Subsequently, learners participated in an intervention, which included an artistic activity and facilitated debrief, connecting their reflections to clinical practice. Postintervention, the same paired learners completed a second mock consultation call and reevaluation. Finally, learners completed a feedback survey. Fifteen pairs completed both the pre- and postintervention evaluations. Of the junior learners simulating the consultation call, 47% were clinical medical students, and 53% were first-year EM residents. Preintervention, learners completed a mean of 51% of core consult call components compared to a mean of 84% postintervention. This 33% improvement was statistically significant (p < .001; 95% CI, 19.9-46.1). Eight participants completed the feedback survey; 100% agreed or strongly agreed with positive statements regarding overall session content. This engaging interactive session utilizing a mock communication exercise, unique artistic activity, and guided reflection can effectively increase junior learners' phone consultation communication skills.

Consideration of First Nations’ cultural values in mine site rehabilitation by environmental professionals

Rehabilitation of mined land on First Nations’ country after mine closure must achieve particular criteria to be considered successful. Generally, these conditions are based on achieving a habitable condition that is more or less similar to analogue sites or to the pre–mining state. Rehabilitating a site to a habitable condition requires the restoration of cultural values, as well as environmental and economic values. This study investigates the extent to which First Nations’ cultural values are considered in mine rehabilitation in northern Australia. Interviews were conducted with environment professionals who had experience rehabilitating mine sites on First Nations’ land in the Northern Territory, Australia. The participants were asked about their experiences restoring First Nations’ cultural values to mined land. Thematic analysis found six main themes: “Values” (which need to be restored); “Planning” (of rehabilitation activities); “Impediments/barriers” (to successful rehabilitation); “Solutions” (to the barriers); “Traditional Owners” and “Principles”. This study shows that mining environmental professionals argue that, with suitable political and corporate support, many cultural values could be restored. However, it was generally agreed that government oversight and regulation in relation to reinstatement of First Nations’ cultural values needed to be improved. Several participants suggested that greater consideration should be given to closure plans generally, to financial means to carry out rehabilitation, and specifically to planning to identify and address the rehabilitation of First Nations’ cultural values prior to approval. Other findings were also that First Nations’ cultural values and environmental values are closely aligned, and that consultation and effective communication with Traditional Owners are the key to integrating awareness of First Nations’ cultural values into mine rehabilitation practices.

Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors

BackgroundEffective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists. ObjectiveThis study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals. MethodsA communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States–Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores. ResultsA total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training. ConclusionsCST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.

1059-P: Spotlight-AQ RCT and AI Results—Improving Physical and Mental Health Outcomes for Adults with Type 1 or Type 2 Diabetes

Background: Existing therapeutic interventions are well known, yet most people with diabetes do not consistently achieve blood glucose targets for optimal health, despite the large range of treatment options available. Aim: To explore the efficacy of a novel clinical intervention addressing physical and mental health within routine consultations across healthcare settings. Methods: A multi-centre, parallel group, individually randomised trial comparing consultation length in adults with T1D or T2D for ≥6 mths to the Spotlight Consultations platform compared to usual care. Secondary outcomes: HbA1c and validated measures of depression, diabetes distress, anxiety, functional health status and HCP burnout. Results: n=98 adults with T1D or T2D; any HbA1c and receiving any diabetes treatment participated (n=49 intervention). Consultation duration for intervention participants was reduced in intervention consultations by 0.5-4.1 mins (3-14%) versus no change in the control group (-0.9 - +1.28 mins) across 15 and 30 consultations. HbA1c improved in the intervention group by 6mmol/mol (range 0-30) versus control group 3mmol/mol (range 0-8). Moderate improvements in psychosocial outcomes observed in intervention group: functional health status; reduced anxiety, depression and diabetes distress; improved well-being. None were statistically significant. HCPs reported improved communication and greater focus in consultations. Artificial Intelligence examination highlighted therapy and psychological burden were most important in predicting HbA1c levels. Conclusion: Spotlight-AQ was associated with shorter, more useful consultations; with improved HbA1c and moderate benefits on psychosocial outcomes. Results reflect the importance of a biopsychosocial approach to routine care visits. Spotlight-AQ is viable across healthcare settings for improved outcomes. Disclosure K.Barnard: Advisory Panel; Abbott Diabetes, Roche Diabetes Care, Sanofi, Consultant; LifeScan Diabetes Institute, Tandem Diabetes Care, Inc., Research Support; Novo Nordisk. R.C.Kelly: None. L.Cohen: None. E.Barnard: None. Y.Liu: None. P.Phiri: None. O.Mendez: None. H.Price: Consultant; AstraZeneca, Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance. Funding Southern Health NHS Foundation Trust

A Maturity Model for Content Strategy Development and Technical Communicator Leadership

While technical communication consultants and researchers agree that content strategy requires attention to both customer needs and business goals, we found no evidence that technical communication educators promote an accurate understanding of business goals among their content strategy students. Through industry–academia collaboration, we integrate two existing models, using content tactics within organizational characteristics that define the maturity level of an organization's content operations. Analyzing the current state of maturity for each characteristic highlights gaps that can define a content strategy with prioritized tactics and, ultimately, encourages the growth of technical communicator leadership and the empowerment of our profession.

The Value of Communication Consulting for Public Authorities

The system of communication management of public authorities faces the task create and support a positive image in order to increase the index of citizens’ trust in the government institution of the country as a whole. Due to the of problems related to the lack of control of information flows and a low level of trust in public authorities, the successful completion of this task it is not always possible through internal human and expert resources. In solving such problems, it is important to involve external consultants who, using the expertise and experience, should increase the effectiveness and ensure the effectiveness of communication solutions. In this paper, the author actualises the importance of the use of communication consulting for public authorities, and draws out the key communication problems of the institution together with the applied tools of communication consulting.

The co-construction of empathic communication in interpreter-mediated medical consultations: A qualitative analysis of interaction

Current interpreter training programs pay increasingly more attention to the intricacies of the clinical context, such as doctors and patients’ communicative goals. However, to date, the conduit model remains influential when it comes to interpreters dealing with other participants’ emotions and their own emotions in interpreter-mediated consultations (IMCs). Consequently, establishing a good doctor-patient relationship by means of empathic communication (EC) might be jeopardized in IMCs. During EC, patients express their emotional or illness experiences to which doctors convey their empathic understanding. This study aimed to assess how doctors, patients, and interpreters verbally co-construct EC and the interpreter’s effect on this process. We analyzed 7 authentic IMCs using the Empathic Communication Coding System, as previously adapted for IMCs. We identified empathic opportunities (EOs) and empathic responses (ERs) as expressed by patients/doctors, and as rendered by interpreters. Our results showed that EC is the result of an interactive and collaborative process among all participants in IMCs. That is, the interplay between participants’ communicative actions determines how patients’ expressed lived experiences are addressed in IMCs. Our findings suggest that interpreters hold a central position in this process as they initiated EC about the patient’s illness experience and exerted control over the ways in which statements were rendered (e.g., interpreters omitted and altered original statements). In addition, our results indicated that EC in IMCs might be compromised by doctors and interpreters’ communicative actions.

What To Say When You Don't Know What to Say

Each "Communication Corner" essay is self-contained; however, they build on each other. For best results, before reading this essay and doing the exercise, go to the first essay "How an Ugly Duckling Became a Swan," then read each succeeding essay. Formal public speaking is when people are invited to come to hear what you have to say and for which you usually have plenty of time to prepare. Impromptu public speaking is when you are asked to say something of consequence at a moment's notice. For example, as a student during a class, as an employee during a company meeting, as a participant in a public forum, etc. On the internet, you can find loads of tips and tactics for successfully handling impromptu speaking. Here we present a tactic you won't find on the internet because it was invented (or rather discovered) by Philip Yaffe, Ubiquity's very own communication consultant, and has never before been published.

1357 THE ‘CONSULTATION COMMUNICATION’ PROFORMA: ENHANCING EFFECTIVE COMMUNICATION BETWEEN OUTPATIENTS AND INTERMEDIATE CARE

Abstract Introduction The Norman Power Centre (NPC) is a 32 bedded Intermediate Care Unit, run by an acute hospital trust in Birmingham, UK, for patients who require ongoing 24-hour care, rehabilitation or further assessment, but do not need to be in an acute hospital setting. These frail patients attend numerous outpatient hospital appointments, but rarely do staff receive communication back from these outpatient reviews. This can lead to delays in implementing specialist management plans, with potential for adverse outcomes for patients and increased staff workload in seeking out the required information. A ‘Consultation Communication’ proforma was designed, to be filled in at the appointment and brought back to NPC with the patient. Method Patients and escorts took proformas to outpatient appointments between March and June 2022. The information on the forms was then analysed to assess completeness and usefulness. Results Appointments were in surgical and medical specialities, as well as imaging in three hospitals within one trust. Proformas were taken to 19/20 appointments. 100% of these were at least partially completed, with only two forms being largely incomplete. 17/19 provided information about the assessment carried out. 12/19 included recommendations relevant to admission at NPC. 13/19 had information on medication changes. 14/19 stated whether follow up was required. Eight out of nine required follow-ups had specific details included. 13/19 had the professional’s details, 11 with contact numbers. Of those without details, two were imaging appointments where contact details were not relevant. Conclusions This easy to implement, simple intervention, with an excellent engagement rate from both NPC and outpatient appointment staff, has led to improved continuity of care for patients. The proforma has scope to be improved based on staff feedback, and its use could be expanded across other off-site facilities such as community hospitals or care homes.

Communication consulting and outreach

Communication consulting and outreach

New age and conventional communication

kspite 14 joint years of working for two large Parastatal corporations and the largestFinancial Services institution on the African continent, and of late three years as anindependent communication consultant, I still have no clear-cut answer to the questionof what the future holds for conventional communication. Note that I am steeringclear of the word communications.Communications would in my view be referring to those information-technology-trainedexperts driving luxury cars at an age when they had barely qualified for a legal driver'slicence, or to the richest person in the world who has, by starting a dot.com business,surpassed in stock wealth the software wunderkid of the eighties. They are indeed alsopart and parcel of communication. The only thing is that they seem to be successfulon a large scale where people electing to qualify and practise in the field of conventionalcommunication appear to have much less to be happy about.This statement would probably further demoralise current students of communication,academia, starter-up practitioners, those who are in fact making it and let us notforget communication advisers. The question is are we making it professionally or arewe practising an unnecessary art and science? Let us, explore this issue by lookingobjectively at some pertinent communication industry (not IT) mind teasers, turningthem into statements and then arguing the realities surrounding them.

Who Should Be Identified as Internal Stakeholders? An Internal Communication Practitioner and Consultant Perspective in the South African Corporate Context

Healthy, mutually beneficial relationships with internal stakeholders within an organisation are crucial for its survival, for achieving long-term goals, and for ensuring value for the organisation and the stakeholders. Organisations should therefore manage internal communication strategically. However, there is no practical or academic consensus as to how to identify “internal stakeholders”, which poses challenges in the diverse South African corporate context. This qualitative study attempted to clarify how best to identify internal stakeholder groupings as recipients of communication. Semi-structured interviews were conducted with ten internal communication practitioners employed by ten of the Top 500 companies in various sectors in South Africa and with eight independent internal communication consultants in South Africa. The participants were purposively selected for their achievements, responsibilities, knowledge, and experience in corporate internal communication. We found that the traditional view of internal stakeholders as comprising employees only has become obsolete, and that the volatile South African corporate environment requires a wider range of stakeholders to be included in the organisation's internal circle. The article concludes with recommendations for future research.

THE ROLE OF CULTURAL CAPITAL ON CAREER SUCCESS

Bu çalışma, kültürel sermayenin kariyer başarısındaki rolünü incelemektedir. Kariyer başarısını etkileyen hususlar, yazında çoğunlukla demografik, beşerî sermaye, sosyal sermaye ve yapısal faktörler ekseninde ele alınmış ancak bireyin erken çocukluk döneminden itibaren edinmeye başladığı kültürel sermayenin etkisi yeterli ilgiliyi görmemiştir. Yapılmış sınırlı çalışma, kültürel sermayenin işe girişte destekleyici bir unsur olduğunu savunmakla birlikte kişinin kariyer başarısında nerede durduğuna yönelik sonuçların bulanık olduğu görülmektedir. Nicel veri toplama yönetiminin tercih edildiği araştırmada, İletişim Danışmanlığı Şirketleri Derneği’ne (İDA) bağlı şirketlerde çalışan 126 halkla ilişkiler profesyoneline ulaşılmıştır. Ayrıca, kolayda örnekleme tekniği ile diğer sektörlerde çalışan 199 uzmana ölçekler uygulanmış ve elde edilen veriler analiz edilmiştir. Araştırmanın bulgularına göre, Türkiye’deki çalışanların kültürel sermayeleri ile kariyer başarıları (nesnel ve öznel) arasında pozitif yönde anlamlı bir ilişki vardır. Bununla birlikte halkla ilişkiler uzmanlarının kültürel sermaye düzeyleri diğer çalışanlara göre yüksek olsa bile söz konusu kültürel kaynakların kariyer başarısı üzerindeki etkisinin diğer çalışanlara göre çok daha sınırlı olduğu bulgulanmıştır.