Healthcare Professional-patient Relationship Research Articles

Operationalizing a shared decision making model for work rehabilitation programs: a consensus process.

The objective of this study was to design and operationalize shared decision making (SDM) rehabilitation model for worker rehabilitation programs. SDM has previously been shown to improve decision outcomes in patient-health care professional relationships. To date, SDM has not yet been adapted to work rehabilitation, although it could be a valuable approach to better understand and agree on return-to-work decisions. We designed a preliminary model for return-to-work decisions for workers suffering from pain due to musculoskeletal injuries. We submitted the preliminary model and a questionnaire to expert health care professionals. Using the Technique for Research of Information by Animation of a Group of Experts method, a group consensus process was used to discuss and refine the experts' responses to operationalize a model adapted for rehabilitation. Eleven occupational therapists (three were clinical coordinators) and four psychologists participated in three group consensus sessions. The final version of the model included one general longitudinal objective (the maintenance of a working alliance and assuring mutual comprehension among all stakeholders), and 11 specific objectives: establishing a working alliance, seven in the deliberation phase of the SDM process, and three in the implementation of the decision. Participants also reached consensus on between 1 and 8 indicators per objective. We developed and operationalized an SDM rehabilitation model intended for a return-to-work implementation plan. The next step will be to document its feasibility among the main stakeholders (employer, union, insurer and worker) taking part in decisions about return to work.

Cardiovascular medicine at face value: a qualitative pilot study on clinical axiology

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion.

National Cancer Information Service in Italy: An information points network as a new model for providing information for cancer patients

The international literature data report that good information and communication are fundamental components of a therapeutic process. They contribute to improve the patient-health care professional relationship, to facilitate doctor-patient relationships, therapeutic compliance and adherence, and to the informed consent in innovative clinical trials. We report the results of a multicentric national initiative that developed a 17-information-structure network: 16 Information Points located in the major state-funded certified cancer centers and general hospitals across Italy and a national Help-line at the nonprofit organization AIMaC (the Italian oncologic patients, families and friends association), and updated the already existing services with the aim to create the National Cancer Information Service (SION). The project is the result of a series of pilot and research projects funded by the Italian Ministry of Health. The Information Service model proposed is based on some fundamental elements: 1) human interaction with experienced operators, adequately trained in communication and information, complemented with 2) virtual interaction (Help line, Internet, blog, forum and social network); 3) informative material adequate for both scientific accuracy and communicative style; 4) adequate locations for appropriate positioning and privacy (adequate visibility); 5) appropriate advertising. First results coming from these initiatives contributed to introduce issues related to "Communication and Information to patients" as a "Public Health Instrument" to the National Cancer Plan approved by the Ministry of Health for the years 2010-2012.

Justice in health care - the role of health care workers in advocacy.

When we remove all the dynamics that encase the health care system, it becomes apparent that the patient-health care professional relationship is in essence the foundation of health care. Crucial questions must be answered in order to fully understand the boundaries of the association between these two key role players, doctor and patient. Does this relationship only exist in hospital corridors, or does it extend further into patients’ lives? Are health care workers obliged to play multiple roles of advocate, social worker and advisor to their patients? In order to answer these questions and explore other relevant issues this essay will probe socio-economic factors affecting the role that might be expected of a professional, especially in the context of South African communities in the era of HIV/AIDS and economic uncertainty.

Maximizing patient adherence for optimal outcomes in psoriasis

Psoriasis is a chronic, disabling disease in which adherence to treatment is often poor. The aim of this article is to highlight the problem of adherence to long-term treatment in psoriasis and the factors that contribute to it, and to discuss how adherence, and thus outcomes, can be improved. This article is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. Adherence to topical medication is a major problem in psoriasis. Not only are prescriptions not being filled by patients (primary adherence) but topical medications are not being used as recommended (secondary adherence). The issue is complex due to the many factors which affect adherence, including efficacy, ease of use and convenience of application, and the healthcare professional-patient relationship. Due to the nature of the disease, patients suffer poor self-image and feel stigmatized, particularly when psoriasis is present on a visible part of the body. Consequently, the negative impact of psoriasis on patient quality of life underlies many adherence issues. It is therefore important for treatment to address the psychological aspects as well as the physical symptoms of psoriasis. Improvements in several areas of disease management may lead to benefits in medication adherence and hence clinical benefit. Prescribing therapy in line with patient preference for treatment vehicle and improving the healthcare professional-patient relationship may be key factors. Nurses have an important role in educating patients and delivering long-term care. This individualized, personal, approach may help improve treatment adherence, outcomes, and the quality of life for patients with psoriasis.

Integrating cultural humility into health care professional education and training

As US populations become increasing diverse, healthcare professionals are facing a heightened challenge to provide cross-cultural care. To date, medical education around the world has developed specific curricula on cultural competence training in acknowledgement of the importance of culturally sensitive and grounded services. This article proposes to move forward by integrating the concept of cultural humility into current trainings, in which we believe, is vital in complementing the current model, and better prepare future professionals to address health challenges with culturally appropriate care. Based on the works of Chinese philosophers, cultural values and the contemporary Chinese immigrants' experience, we hereby present the QIAN (Humbleness) curriculum: the importance of self-Questioning and critique, bi-directional cultural Immersion, mutually Active-listening, and the flexibility of Negotiation. The principles of the QIAN curriculum reside not only between the patient and the healthcare professional dyad, but also elicit the necessary support of family, health care system as well as the community at large. The QIAN curriculum could improve practice and enhance the exploration, comprehension and appreciation of the cultural orientations between healthcare professionals and patients which ultimately could improve patient satisfaction, patient-healthcare professional relationship, medical adherence and the reduction of health disparities. QIAN model is highly adaptable to other cultural and ethnic groups in multicultural societies around the globe. Incorporating its framework into the current medical education may enhance cross-cultural clinical encounters.

Ethical and legal challenges for health telematics in a global world: Telehealth and the technological imperative

Telehealth is one of the more recent applications of ICT to health care. It promises to be both cost-effective and efficient. However, there lies a danger that focusing mainly on pragmatic considerations will ignore fundamental ethical issues with legal implications that could undermine its success. Implicated here are, among others, changes in the nature of the health care professional patient relationship and informed consent, etc. The position of health informatics professionals as well as hard- and software providers is also affected. A further complicating factor is outsourcing. This paper identifies relevant issues and outlines some of their implications.

Identity and psychological ownership in chronic illness and disease state.

Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient–healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity.

The Contemporary Healthcare Crisis in China and the Role of Medical Professionalism

The healthcare crisis that has developed in the last two decades during China's economic reform has caused healthcare and hospital financing reforms to be largely experienced by patients as a crisis in the patient-healthcare professional relationship (PPR) at the bedside. The nature and magnitude of this crisis were epitomized by the "Harbin Scandal"-an incident that took place in August 2005 in a Harbin teaching hospital in which the family of an elderly patient hospitalized in the intensive care unit (ICU) for 66 days paid over RMB yen6 million. The news was publicized globally and ended in the firing of six top hospital administrators including the hospital president and the ICU director. This paper seeks to show that the Chinese healthcare crisis is ultimately linked to a conflict of interests between patients and healthcare professionals (HCPs), which is inherent in the reformed healthcare system of China. Hence the crisis is, at its core, a crisis of fidelity and confidence that must be restored to the PPR. At the "macro" level, it is simplistic to blame the crisis on the failure of the market system, and at the "micro" level, it is naïve to expect that a contractual understanding of the PPR will effectively restore the confidence of patients. This paper will show that the fiduciary relationship and medical professionalism share similar attributes, with fidelity being the core value of both. It concludes that the loss of medical fidelity implies the dissolution of the PPR and the demise of the medical profession and challenges Chinese HCPs to keep their fidelity as a means to both protect their patients' interests and to preserve their profession's survival.

Elderly patients' experiences of care in the emergency department: a systematic review.

Review Questions/Objectives This systematic review seeks to synthesise the evidence on the experiences of care received by elderly patients in the emergency department in the hospital setting. Review questions The specific review questions to be addressed are: What is the evidence on elderly patients’ experiences of the overall care received in the emergency department? What is the evidence on elderly patients’ experiences of the nursing care received in the emergency department? What is the evidence on the needs identified by elderly patients in the emergency department? Inclusion Criteria Types of participants The review will consider studies that include male and female patients of all ethnic groups who are 65 years old and above, and admitted into the emergency department with urgent as well as non-urgent health-related issues. Phenomena of interest The review will consider studies that include the following phenomena of interest: elderly patients’ experiences of care at an emergency department. Context The review will consider studies that will include contexts such as the emergency department in the acute care hospital settings in all countries. Outcomes of Interest The outcomes of interest include but are not restricted to the following: Experiences of overall care received by elderly patients in the emergency department. Experiences of nursing care received by elderly patients in the emergency department. Identified needs of elderly patients when receiving care in the emergency department.

Questionário para avaliação de desempenho de serviços de atenção básica no controle da TB no Brasil

The objective of this study was to provide access to and disseminate a questionnaire used as an instrument to assess the organizational elements and the performance of primary health care clinics regarding TB control in Brazil, comparing selected organizational dimensions by health care clinic, by municipality and by actor (patients, health care workers and managers). The results show that municipalities where the coverage of supervised treatment was more extensive presented more favorable indicators regarding access to TB treatment. The organizational format of the health care clinics involved in TB treatment-family health programs and referral centers with specialized teams in TB Control Programs (TCPs)-was not a factor that expanded access to diagnosis. The TCPs involving a smaller number of patients presented better performance regarding health care professional-patient relationship. The majority of the patients faced economic and social difficulties, and most managers were unaware of the amount of resources allocated to TB control activities. The instrument proved to be viable and to have the potential to adequately assess the performance of health care clinics in the urban areas studied.

"Sharing Ends" as an Attempt at Securing a Trusting Healthcare Professional-Patient Relationship

"Sharing Ends" as an Attempt at Securing a Trusting Healthcare Professional-Patient Relationship

Living with cancer and perception of care: Icelandic oncology outpatients, a qualitative study

This qualitative study was set out to explore oncology outpatient experiences of having cancer, to illuminate coping strategies and to explore perceptions of care and service provided while treated for cancer. Thirty patients undergoing chemotherapy or radiotherapy were consecutively selected for the study in three oncology outpatient clinics in Iceland; mean age was 55 years. All participants gave written consent but five dropped out of the study. Twenty-five semi-structured single interviews were conducted and analysed using manifest and latent content analysis. The descriptive level of the text could be understood as: (a) getting cancer: alarming experience; (b) coping: balancing life as it was before cancer against present situation to achieve normality; (c) satisfaction: encountering caring behaviour enhances satisfaction and well being. Each of the categories encompassed variation of subcategories. All the categories were summarised in the core category: "Being in the alarming situation of getting cancer evokes a strong need to maintain normality and keep uncertainty at distance with support from caring and sensitive encounters." This reflected patients' overall experiences of being diagnosed with cancer, how they coped and their perception of quality of care while going through treatment. Reactions to the diagnosis of cancer indicate strong emotional reactions. A strong will to handle the situation and determination to maintain normality in life was prominent. Establishment of positive patient-health care professional relationships, caring encounters, faith, believing in treatment and support from family was highly valued as support and giving hope.

UK GPs' and practice nurses' views of continuity of care for patients with type 2 diabetes

Continuity of care is widely regarded as a core value of primary care. Type 2 diabetes is a common chronic disease with major health, social and economic impacts. Primary health care professionals in many countries are involved in the management of patients with type 2 diabetes, but their perspectives on continuity remain neglected in research. To explore UK GPs' and nurses' experiences of continuity of care for patients with type 2 diabetes in primary care settings. Semi-structured individual interviews were conducted with 16 GPs and 18 practice nurses who manage patients with type 2 diabetes recruited from 20 practices with various organizational structures in Leeds, UK. Three types of continuities were identified: relational continuity from the same health care professional, team continuity from a group of health care professionals and cross-boundary continuity across primary-secondary care settings. Relational continuity was influenced by the quality of the patient-health care professional relationship, policy of the National Health Service (NHS) in the UK (new General Medical Services contract), walk-in centres, the behaviour of receptionists and the structure and systems of the practice. Team and cross-boundary continuities were influenced by the relationship between team members and by effective communication. Relational continuity contributed to more 'personal care', but the usual health care professional might know less about diabetes. Team continuity was important in providing 'physical care', but patients could be confused by conflicting advice from different professionals. Cross-boundary continuity helps to provide 'expert advice', but is dependent upon effective communication. GPs and practice nurses dealing with patients with type 2 diabetes identified three types of continuities, each influenced by several factors. Relational continuity deals better with psychosocial care while team continuity promotes better physical care; therefore, imposing one type of continuity may inhibit good diabetic care. Cross-boundary continuity between primary and secondary care is fundamental to contemporary diabetic services and ways should be found to achieve more effective communication.

Breaching Patient Confidentiality: A Study of Physician Assistantsʼ Awareness and Attitudes

INTRODUCTION All health care providers, including physician assistants (PAs), have a longstanding ethical obligation to maintain patient confidentiality, which dates back to the Hippocratic Oath and continues to be reflected in contemporary codes of ethics.1,2 The duty of confidentiality is grounded in the ethical principle of respect for autonomy and honors the patient’s right to decide with whom to share personal information. An implicit or explicit promise of confidentiality can also help build trust in the health care professional-patient relationship, which may affect the patient’s willingness to seek professional help, reveal relevant information, and adhere to treatment plans.1,3 Thus, the promise of confidentiality is essential for the health care professional to fulfill his or her fiduciary responsibility to protect and promote the patient’s health-related interests. In addition to an ethical obligation, health care professionals have a legal obligation to protect patient confidentiality. This legal duty can be found in both federal and state law. The privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) sets a national floor for protecting patient confidentiality by restricting the ability of covered entities to use and disclose identifiable protected health information without written authorization. However, many state laws provide even greater protection than HIPAA. For example, according to the Texas Occupations Code, all written, verbal, or observed communications with the patient are generally held to be confidential and may not be disclosed to outside parties, unless an exception either requires or permits disclosure.4 These exceptions are explicitly listed in the statute and vary on a case-by-case basis. It is therefore important that all health care professionals are aware of what these exceptions are and how they apply in specific cases. In the state of Texas, all physicians are required to take and pass a Karmen Slabic was a PA student at the Baylor College of Medicine, Houston, Texas, when this research was conducted. Amy Maguire is an assistant professor of medicine and medical ethics at Baylor College of Medicine.

Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients

Focus groups were conducted with HIV-infected, monolingual Spanish-speaking patients (N=81) taking antiretrovirals in order to: (1) determine what barriers impede medication adherence; (2) determine what strategies facilitate adherence; and (3) investigate the health care provider-patient relationship and whether it impacts adherence. Both quantitative and qualitative information was gathered. Participants were prescribed an average of 11 pills per day (M=11.4, SD=7.0, range=1-30). Only 32% of participants were consistently adherent when self-report of medication taking (yesterday, the day before yesterday, and last Saturday) was compared to prescribed regimen. The most frequently reported strategies were: learning more about the medications (77%), accepting the need to take them (75%) and refilling prescriptions early or on time (70%). Barriers most often reported were: feeling depressed or overwhelmed (21%), simply forgetting (19%) and sleeping through a dose (17%). From the qualitative data, four main issues emerged: patient characteristics, the health care professional-patient relationship, language and cultural barriers within the health care system, and the medication regimen. Among this Latino sample, having someone to live for was extremely important in terms of patient adherence. Language barriers were reported, and the use of translators was not always seen as a sufficient remedy. Differences between monolingual Spanish-speaking patients' and English-speaking patients' strategies and barriers are discussed.

Telling the truth to patients: a clinical ethics exploration.

In this essay I will examine why the truth is so important to human communication in general, the types of truth, and why truth is only a relative value. After those introductory points, I will sketch the ways in which the truth is overridden or trumped by other concerns in the clinical setting. I will then discuss cases that fall into five distinct categories. The conclusion emphasizes the importance of truth telling and its primacy among secondary goods in the healthcare professional-patient relationship.