Patient-health Care Provider Communication Research Articles

Patient-health care provider communication among patients with newly diagnosed prostate cancer: Findings from a population-based survey

Patient-health care provider communication among patients with newly diagnosed prostate cancer: Findings from a population-based survey

Medications in the news: Addressing concerns

For 2013, Pharmacy Today is partnering with the National Council on Patient Information and Education (NCPIE) to bring pharmacists and other health care providers valuable counseling tips aimed at enhancing communication with patients. One of NCPIE's key missions is to empower patients to be more informed about and active in decisions affecting their use of medicines by stimulating communication between patients and providers on the safe and appropriate use of medicines.

Patient-healthcare provider communication: Perspectives of African American cancer patients.

African Americans are often viewed as ineffective communicators during medical encounters. However, most previous studies have been conducted among noncancer populations and based on the perceptions of health care providers (HCP) and researchers. This study aimed to explore African American cancer patients' perspectives of HCPs' communication behaviors and how these communication patterns facilitate or hinder their cancer management and survivorship experiences. This is a secondary data analysis of qualitative interviews with 28 African American cancer patients residing in the Southeastern U.S. Participants were purposefully selected to represent patients of both genders with varied sociodemographic characteristics. Grounded theory techniques of constant comparison were used to identify patterns of responses from the participants. Four major themes were identified about communication patterns between these cancer patients and their HCPs during diagnosis and treatment: (1) communication of cancer information; (2) communication of shared decision making; (3) communication of empathy and understanding; and (4) communication of respect. This study also described the effects of patient-HCP communication (e.g., satisfaction with oncology care, emotional distress, patient loyalty, treatment adherence, decisional regrets). African American cancer patients in this study perceived that HCPs demonstrated different levels of communication sensitivity and skills during cancer diagnosis and treatment. They also believed that HCPs' communication behaviors directly affected their survivorship experiences. Our findings help to gain knowledge of patient-HCP communication and to identify potential strategies for better communication between patients and HCPs among middle-aged and older African American cancer patients, which will ultimately promote culturally sensitive oncology care.

Development of a quality of patient–health care provider communication scale from the perspective of patients with rheumatoid arthritis

To devise a patient-perspective driven measure of the quality of patient-health care provider communication and to evaluate the psychometric properties of this scale in a sample of 150 patients with rheumatoid arthritis. Items were developed from interviews with 15 patients with rheumatoid arthritis. Two rheumatologists, a behavioral scientist, and a nurse researcher provided item feedback. Exploratory factor analysis with Oblimin rotation was used to examine the dimensionality of the newly developed Patient-Health Care Provider Communication Scale (PHCPCS). Cronbach's alpha was computed to assess internal consistency. Test-retest reliability was determined using the intraclass correlation coefficient. Construct validity was tested by comparing the PHCPCS with the Perceived Involvement in Care Scale (PICS) using correlation analysis. The PHCPCS measured two dimensions of the quality of patient-health care provider communication [Quality Communication (α = 0.94) and Negative Patient-Health Care Provider Communication (α = 0.73)]. The total PHCPCS score and its Quality Communication Subscale were positively correlated with the total score on the PICS and with the doctor facilitation subscale of the PICS. This new measure of the quality of patient-health care provider communication has the potential for use in clinical practice, provider education, and further studies to improve health care to patients with rheumatoid arthritis.

Patient's Perception of Quality Patient–Provider Communication

To develop a model of patients' perception of quality patient-healthcare provider communication. Fifteen patients with rheumatoid arthritis participated in in-depth, audiorecorded interviews. Following transcription verification, interviews were analyzed using constant comparative analysis to identify primary themes and develop a model of patients' perception of quality patient-healthcare provider communication. The participants described a multifaceted, dynamic process of quality patient-healthcare provider communication involving the interrelationship between appropriate time and 4 key communication exchanges: patient honesty when explaining symptoms, patients asking questions and offering opinions, healthcare providers asking questions and offering opinions, and healthcare providers disseminating information. By understanding patient-healthcare provider communication from the patient perspective within the rubric of this model, healthcare providers can adapt interactions with patients with rheumatoid arthritis to incorporate dimensions of the exchange that their patients feel create effective communication.

HIV Treatment Adherence, Patient Health Literacy, and Health Care Provider–Patient Communication

Little is known about patients' health literacy regarding antiretroviral therapy (ART) adherence and drug resistance and patient-provider communication about these topics. The AIDS Treatment for Life International Survey was a multicountry cross-sectional study (January-March 2010) including 2035 HIV-infected adults. A 40-minute interview was conducted using a standardized self-report adherence questionnaire. Overall, 57% of patients reported a 30-day recall of 100% adherence (Latin America: 89%; Africa: 73% vs North America: 45% and Asia Pacific: 47%; P < .01). Overall, 18% identified HIV drug resistance as a "good thing" in North America (35%) and Africa (24%). Only 71% said their health care providers had offered practical recommendations about adherence, 62% of the patients in North America and 80% in Latin America and Africa. Optimal ART adherence remains a challenge globally. There is a critical need to improve patient-provider communication about the importance of ART adherence and its benefits for patient's health.

Childbearing Decision Making: A Qualitative Study of Women Living with HIV/AIDS in Southwest Nigeria

Using the PEN-3 model, the purpose of this qualitative study was to understand the factors responsible for the childbearing decisions of women living with HIV/AIDS (WLHA) in Lagos, Nigeria. Sixty WLHA who sought care at a teaching hospital in Lagos were recruited to participate in in-depth interviews. The average age of the participants was 30 years, and 48 participants were receiving antiretroviral therapy. Healthcare and spiritual practices, healthcare provider-patient communication about childbearing, and husband/partner support emerged as factors that contribute to the childbearing decisions of WLHA. The findings reveal the importance of discussing sexual reproductive health and childbearing issues with WLHA in the healthcare context prior to pregnancy.

Using Diabetes Therapy Management Software to Support Behavior Change—A Case-based Approach

The management of diabetes is complex and requires a team approach for optimal outcomes. This team is comprised of the patient, numerous healthcare providers, and various technologies to elicit the behavioral changes needed in the ongoing care of the disease. This paper uses a case-based approach to demonstrate the patient–healthcare provider relationship and the use of various technologies when managing diabetes. The use of diabetes therapy management software demonstrates enhanced patient–healthcare provider communication, provides data showing that behavioral changes can improve outcomes, and allows the patient to enact positive self-management practices.

Challenges in institutionalising electronic platforms for patient healthcare provider communication

Electronic platforms for patient?healthcare provider communication are instrumental for enabling a new, more active patient role supporting efficient and effective healthcare delivery. However, benefit realisation from implementing such communication platforms comes after they get established as parts of healthcare information infrastructures. In this paper, drawing from information infrastructure theory, we analyse the process of establishing a durable solution and identify the socio-technical challenges it entails. Based on a case study in the Norwegian healthcare context, the focus of the paper is on the ongoing institutionalising practices of the project management team. Three major challenges are identified. The first challenge is related to the constitution of identity for the new artefact. The second and third challenges are related to the difficulties in building a platform that is stable enough to allow the exploitation of technological potential, and at the same time flexible enough to provide exploration and adaptation possibilities.

"A Struggle Between Vanity and Life"

Understanding the role of sociocultural factors on women's experiences of breast reconstruction is needed to provide better care and avoid erroneous assumptions of these women's needs. The purpose of this study was to understand the lived experiences of Taiwanese women with breast cancer who receive breast reconstruction following mastectomy in Taiwan. A qualitative research design, guided by the philosophy of hermeneutic phenomenology, was selected to guide the study. In-depth interviews were conducted 1 to 2 times with each participant and explored the women's experiences related to making decisions about, undergoing, and recovering from breast reconstruction. Seven women who received either autologous breast reconstruction or saline implants were recruited in southern Taiwan. Five themes were identified, including "dream of a wonderful future," "unexpected reality," "struggling to accept," "balancing vanity with life priorities," and "coming to terms: no regret." Taiwanese women felt ambivalent about their new breasts, which failed to meet their expectations. This ambivalence, combined with a culture that values selflessness and the placement of family first, resulted in many women feeling guilty, vain, and superficial for requesting breast reconstruction. Clinical implications include the importance of regular and authentic patient-health care provider communication throughout the process of breast reconstruction, including recovery, and better acknowledgement of Taiwanese women's body image concerns associated with breast reconstruction.

The Danish version of the questionnaire on pain communication: preliminary validation in cancer patients

The modified version of the patients' Perceived Involvement in Care Scale (M-PICS) is a tool designed to assess cancer patients' perceptions of patient-health care provider pain communication process. The objective of this study was to examine the psychometric properties of the shortened Danish version of the M-PICS (SDM-PICS). The validated English version of the M-PICS was translated into Danish following the repeated back-translation procedure. Cancer patients were recruited for the study from specialized pain management facilities. Thirty-three patients responded to the SDM-PICS, Danish Barriers Questionnaire II, Hospital Anxiety and Depression Scale, and Brief Pain Inventory Pain Severity Scale. A factor analysis of the SDM-PICS resulted in two factors: Factor one, patient information, consisted of four items assessing the extent to which the patient shared information with his/her health care provider, and Factor two, health care provider information, consisted of four items measuring the degree to which a health care provider was perceived as the one who shares information. Two separate items addressed the perceived level of information exchange between the patient and the health care provider. The SDM-PICS total had an internal consistency of 0.88. The SDM-PICS scores were positively related to pain relief and inversely related to the measures of cognitive pain management barriers, anxiety, and reported pain levels. The SDM-PICS seems to be a reliable and valid measure of perceived patient-health care provider communication in the context of cancer pain.

Risk Assessment and Risk Distortion: Finding the Balance

Pregnancy and birth have been conceptualized as medically problematic, with all pregnant women considered at risk and in need of medical monitoring. Universal application of risk scoring and surveillance as preemptive strategies in an effort to reduce risk is now standard obstetric practice. Labeling women "high risk" can result in more unnecessary interventions and have negative psychologic sequelae. When perceived pregnancy risk is out of proportion to the real risk, and when risk management procedures are applied to all women with benefit for only a few, the use of technology in caring for pregnant women becomes normalized. A learned reliance on technology can diminish women's own authoritative knowledge of pregnancy and birth. This may also have the unintended consequence of contributing to birth fear, a phenomena becoming more widely recognized. Health care provider-patient communication about pregnancy risk can be presented in a manner that encourages informed compliance rather than informed choice. Evidence-based risk assessment is essential to providing optimal prenatal care. Using tools such as the Paling Palette can help health care providers present balanced and readily understood information about risk.

Facilitating communication with patients for improved migraine outcomes

Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. However, skill level and training remain problematic in this area. Fortunately, research has shown that medical communication skills can be successfully taught and acquired, and that improvement in communication skills improves outcomes. The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.

Healthcare provider–patient communication and migraine assessment: results of the American Migraine Communication Study, phase II

ABSTRACTObjective: The American Migraine Communication Study I (AMCS I) revealed communication deficits illustrated by differing healthcare professional (HCP) and patient reports about issues such as impairment and frequency. AMCS II was designed to assess an intervention using open-ended questions about impairment and ’ask-tell-ask‚ sequences to confirm headache frequency in days versus attacks.Research design and methods: HCPs who participated in AMCS I completed an internet-based intervention. Researchers were sent to HCPs' offices, and patients likely to discuss migraine were recruited immediately prior to normally-scheduled appointments. Post-consent, visits were recorded without a researcher present. Separate post-visit interviews were conducted with all parties. All interactions were transcribed.Main outcome measures: Transcripts were analyzed using validated sociolinguistic techniques, and study results were compared to AMCS I.Results: HCPs assessed impairment in 90 % of interactions compared to 10 % in AMCS I (p < 0.0001) and used open-ended questions to assess impairment in 55 % of visits (95 % CI: 0.4261–0.6598). Impairment between attacks was discussed in 37 % of visits vs. 0 % in AMCS I (p < 0.0001). HCPs completed full ask-tell-ask sequences in 29 % of visits (95 % CI: 0.1921–0.4070). AMCS II contained more discussions of migraine preventive therapy with appropriate candidates compared to AMCS I (74 vs. 50 % ; p = 0.069) without statistically increasing median visit length (9:36 vs. 11:00; p = 0.668). Post-visit, HCPs and patients were often aligned about impairment and frequency and reported high levels of satisfaction.Conclusions: Although further research with a larger sample is needed, a brief, internet-based intervention appears to promote positive communication changes not associated with increased visit length.

Exploring Doctor–Patient Communication in Immigrant Australians with Type 2 Diabetes: A Qualitative Study

OBJECTIVEThe study explored the perceptions of Australian immigrants about their interactions with doctors regarding the diagnosis, treatment, and management of type 2 diabetes mellitus.RESEARCH DESIGN AND METHODSIn-depth interviews were conducted with 30 men and women from Greek, Indian, Chinese, and Pacific Island backgrounds living in Melbourne, Australia, to elicit their perceptions of the management of diabetes and its impact. Participants were recruited through a convenience sample of general practitioners and community organizations providing support to people living with diabetes. Topics discussed included initial reaction to diagnosis, patient—health care provider communication, and the influence of message framing on the perception of the quality of the doctor–patient relationship. Transcripts were coded and analyzed by both authors.RESULTSNumerous issues facilitate or inhibit constructive and positive relationships between doctors and patients with type 2 diabetes. Patients reported difficulty in absorbing all the information provided to them at early consultations, and experienced difficulty comprehending the practical aspects of management. Styles of communication and discourses of normalization and catastrophe influenced participants’ responses.CONCLUSIONDoctors face a complex task in encouraging behavioral change and adherence and establishing and maintaining a supportive relationship with patients. The timing and technical complexity of communication about diabetes, its management, and the prevention of complications require further attention.

Patient-Physician Communication in the Context of Persistent Pain: Validation of a Modified Version of the Patients' Perceived Involvement in Care Scale

The purpose of this study was to evaluate the psychometric properties of a modified version of the Perceived Involvement in Care Scale (M-PICS), a measure designed to assess pain patients' perceptions of patient health care provider communication during the medical consultation. Eighty-seven breast cancer outpatients with persistent pain completed a battery of questionnaires, including the M-PICS. A factor analysis supported four factors. Factor 1 reflected health care provider information behaviors; Factor 2, health care provider facilitation of patient involvement; Factor 3, patient information provision; and Factor 4, patient participation in decision making. The M-PICS total had an internal consistency of 0.87; alphas for subscales ranged from 0.80 to 0.90. M-PICS scores related to measures of patient characteristics and outcomes, including pain-related communication barriers, psychological status, quality of life, and health care satisfaction, in predicted ways. The M-PICS is a reliable and valid measure of perceived patient-provider communication in the context of persistent pain.

Patient–provider communication and perceived control for women experiencing multiple symptoms associated with ovarian cancer

Objectives. Optimal cancer symptom management requires effective patient–health care provider (HCP) communication. The goals of this study were to 1) describe symptom experiences of women with ovarian cancer, 2) evaluate frequency of patient–HCP communication about symptoms, and 3) evaluate whether communication is associated with patients' confidence in managing symptoms. Methods. This was a cross-sectional mailed survey study. The Symptom Experience Survey, containing valid, reliable measures of symptom severity and controllability; symptom communication; and symptom-related coping strategies, was mailed to members of the National Ovarian Cancer Coalition. Descriptive statistics, t tests, correlations, and ANCOVA were used to address study objectives. Results. This analysis focuses on the 279 respondents who had active disease. The majority of women had recurrent disease (96%) and were on chemotherapy (57%). Women reported a mean of 12 concurrent symptoms. Fatigue, bowel disturbances, and peripheral neuropathies were the most severe and most noticed symptoms. Only 61% of women had discussed their most noticed symptom with an HCP in the past month, and only 50% of women reported that they had received symptom management recommendations. Women reported low levels of perceived control over symptoms ( M = 1.97 on a 0–4 scale). There was a significant interaction effect for symptom discussions and management recommendations on perceived control. Women who had never received recommendations had low perceived control whether or not they had discussed their symptom with an HCP in the past month. For women who had received recommendations, those who had discussed their symptom with an HCP in the past month had higher perceived control compared to those who had not discussed their symptom. Conclusions. Women with ovarian cancer experience multiple symptoms, but many do not discuss symptoms with their HCPs and fewer report receiving symptom management recommendations. Women would benefit from more active symptom assessment and discussion of management strategies by HCPs.

Benefits from an uncertainty management intervention for African–American and Caucasian older long‐term breast cancer survivors

In a randomized controlled design, this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors. The sample included 509 recurrence-free women (360 Caucasian, 149 African-American women) with a mean age of 64 years (S.D.=8.9 years) who were 5-9 years post-treated for breast cancer. Women were randomly assigned to either the intervention or usual care control condition. The intervention was delivered during four weekly telephone sessions, in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence, and a self-help manual designed to help women understand and manage long-term treatment side effects and other symptoms. Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward. Repeated measures MANOVA evaluating treatment group, ethnic group, and treatment by ethnic interaction effects indicated that training in uncertainty management resulted in improvements in cognitive reframing, cancer knowledge, patient-health care provider communication, and a variety of coping skills. Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention.

Changing healthcare professionals' behaviors to eliminate disparities in healthcare: What do we know? How might we proceed?

The patient-healthcare provider communication process--particularly the provider's cultural competency--is increasingly recognized as a key to reducing racial/ethnic disparities in health and healthcare utilization. A working group was formed by the Office of Minority Health, Department of Health and Human Services to identify strategies for improving healthcare providers' cultural competency. This expert panel, one of several working groups called together to explore methods of reducing healthcare disparities, was comprised of individuals from academic medical centers and health professional organizations who were nationally recognized as having expertise in healthcare communication as it relates to diverse populations. During the 2-day conference, the panel identified, from personal experience and knowledge of the literature, key points of intervention and interventions most likely to improve the cross-cultural competency of healthcare providers. Proposed interventions included introduction of cultural competence education before, during, and after clinical training; implementation of certification and accreditation requirements in cross-cultural competence for practicing healthcare providers; use of culturally diverse governing boards for clinical practices; and active promotion of workforce cross-cultural diversity by healthcare organization administrators. For each intervention, methods for implementation were specified. On-going monitoring and evaluation of processes of care using race/ethnicity data were recommended to ensure the programs were functioning.

Using Visuals to Communicate Medicine Information to Patients with Low Literacy

The patient was adamant that she had taken her medicine as instructed, pointing to the visual (Visual 1) illustrating the instructions to endorse this. Via an interpreter, she communicated that she took her tablet three times during the day and once at night (which was correct), but only on those days when the sun was shining (not on cloudy days) and the moon was visible (depending on both cloud cover and phases of the moon). [ILLUSTRATION OMITTED] Another patient who had been diagnosed with a vaginal infection, and who had received a cream to be inserted vaginally, reported no improvement in her infection. On further questioning, we found out that she had been rubbing the cream on the side of her leg like the picture tells me to do (Visual 2). [ILLUSTRATION OMITTED] Are pictures a so-called universal language? Maybe, but pictures are open to interpretation and potentially disastrous outcomes, when misinterpretation influences subsequent actions such as taking medicines. This fascinating area of research and practice has continued to interest and enthrall me over the years, and just when I think I have heard it all, along comes another oh wow, how did he get that? interpretation. Using visuals has many advantages (Doak, Doak & Root, 1996). Visual presentations are more persuasive, emotions are easily stimulated via the visual sense initiating a rapid response, memory systems in the brain favor visual storage, and materials including visuals are more user-friendly. Their usefulness is even more apparent in people with poor reading skills. We proudly call South Africa the Rainbow Nation. The name speaks for itself in describing the incredible diversity of its people. We have 11 official languages and 8 different African ethnic groups, each with its own culture, language and customs, and each with its unique perception and understanding of allopathic medicine. Literacy is a major challenge in South Africa with approximately 40% of South Africans aged 15 years and over having less than 7 years of formal schooling (grade 7 is often used as a minimum education level indicator of sustainable functional literacy) and 18% having no schooling at all, with the lowest functional literacy rate occurring in the Black population (Statistics South Africa, 2001). Apart from the nursing profession, the majority of doctors and pharmacists in South Africa are of a different culture from the average public health sector patient, with language constituting the most common communication barrier. In fact, it has been estimated that cross-cultural communication occurs approximately 80% of the time in health-care consultations (Adams, 1991). Unlike developed countries, where the problems with literacy and communication often occur with minority patients groups, in South Africa the reverse situation applies. Together, all these factors constitute a real challenge to effective patient-health care provider communication. Medicine-taking behavior is complex, multi-factorial, and depends on a dynamic interaction of several factors, including cognitive, behavioral, social, environmental, and physiologic factors (World Health Organization, 2003). However, a minimum requirement for appropriate medicine taking is a basic understanding of the medication instructions, and the ability to recall this information. Studies in patients with limited reading skills have demonstrated the value of visuals in enhancing understanding and recall of written or verbal information (Mansoor & Dowse, 2003; Dowse & Ehlers, 2005; Houts, Doak, Doak, & Loscalzo, 2006), but their use is not a strategy generally accepted and adopted by health authorities. Instead, using visuals to communicate information to low-literate patients appears to be restricted to relatively small-scale local initiatives, which are often driven by one person who is passionate about their effectiveness. These initiatives are not usually sustainable in the long term. …