Interpersonal Aspects Of Care Research Articles

Analyzing Patient Experience on Weibo: Machine Learning Approach to Topic Modeling and Sentiment Analysis.

Social media platforms allow individuals to openly gather, communicate, and share information about their interactions with health care services, becoming an essential supplemental means of understanding patient experience. We aimed to identify common discussion topics related to health care experience from the public's perspective and to determine areas of concern from patients' perspectives that health care providers should act on. This study conducted a spatiotemporal analysis of the volume, sentiment, and topic of patient experience-related posts on the Weibo platform developed by Sina Corporation. We applied a supervised machine learning approach including human annotation and machine learning-based models for topic modeling and sentiment analysis of the public discourse. A multiclassifier voting method based on logistic regression, multinomial naïve Bayes, and random forest was used. A total of 4008 posts were manually classified into patient experience topics. A patient experience theme framework was developed. The accuracy, precision, recall, and F-measure of the method integrating logistic regression, multinomial naïve Bayes, and random forest for patient experience themes were 0.93, 0.95, 0.80, 0.77, and 0.84, respectively, indicating a satisfactory prediction. The sentiment analysis revealed that negative sentiment posts constituted the highest proportion (3319/4008, 82.81%). Twenty patient experience themes were discussed on the social media platform. The majority of the posts described the interpersonal aspects of care (2947/4008, 73.53%); the five most frequently discussed topics were "health care professionals' attitude," "access to care," "communication, information, and education," "technical competence," and "efficacy of treatment." Hospital administrators and clinicians should consider the value of social media and pay attention to what patients and their family members are communicating on social media. To increase the utility of these data, a machine learning algorithm can be used for topic modeling. The results of this study highlighted the interpersonal and functional aspects of care, especially the interpersonal aspects, which are often the "moment of truth" during a service encounter in which patients make a critical evaluation of hospital services.

Experience with the US health care system for Black and White patients with advanced prostate cancer.

The purpose of this study was to assess differences in reported information about treatment, integration into care, and respect by self-identified Black and White individuals with advanced prostate cancer in the United States. This is a prospective cohort study of 701 participants (20% identifying as Black) enrolled in the International Registry for Men with Advanced Prostate Cancer at 37 US sites from 2017 to 2022. Participants were asked six questions from the Cancer Australia National Cancer Control Indicators about their experience with care at study enrollment. Prevalence differences by self-reported race were estimated using marginal standardization of logistic-normal mixed effects models (adjusted for age at enrollment and disease state at enrollment), and 95% CIs were estimated using parametric bootstrapping. Most participants reported a high quality of care for each question. Black participants generally reported higher care quality compared with White participants. Black participants reported more frequently that they were offered a written assessment and care plan (71%) compared with White participants (58%; adjusted difference, 13 percentage points; 95% CI, 4-23). Black participants also reported more frequently being given the name of nonphysician personnel who would support them (64%) than White participants (52%; adjusted difference, 10; 95% CI, 1-20). Prevalence differences did not differ by disease state at enrollment. Black participants generally reported a higher quality of care compared with White participants. This study calls attention to the need to study potential mediating factors and interpersonal aspects of care in this population to improve survivorship.

'Localism and intimacy, and… other rather imponderable reasons of that sort': A qualitative study of patient experience of community hospitals in England.

Debates over the value and contribution of community hospitals are hampered by a lack of empirical assessment of the experience of patients using these services. This paper presents findings from a study which included a focus on patient and family-carer experiences of community hospitals in England. We adopted a qualitative design involving nine case study hospitals. Data collection included interviews with patients (n= 60), carers (n= 28) and staff (n= 89). Through patients and carers highlighting the value of community hospitals feeling 'close to home', providing holistic and personalised care and supporting them through difficult transitions, the study confirms the importance of functional and interpersonal aspects of care, while also highlighting the importance of social and psychological aspects. These included having family, friends and the community close, maintaining social connections during periods of hospital treatment, and feeling less anonymous and anxious when attending the hospital due to the high levels of familiarity and connectedness. Although the experiences uncovered in this study were not uniformly positive, patients and carers placed a high overall value on the care provided by community hospitals, often arguing that these were distinctive when compared to their experiences of using other health and care services. The study suggests the need to weigh the full range of these dimensions of patient experience-functional, interpersonal, social and psychological-when assessing the role and contribution of community hospitals.

The Reliability and Test-Retest Stability of the Treatment Perception Questionnaire (TPQ) in the Oncology Field: A Pilot Study.

Background:Patients' satisfaction is an indicator of technical, instrumental, environmental, and interpersonal aspects of care. It shows how much the health service “as a whole organization” meets the patients’ psychosocial expectations and if the health professionals combine their technical competence with relational skills. The Treatment Perception Questionnaire (TPQ) is a brief instrument developed in the United Kingdom for research with substance abuse disorder populations. The present study aimed at evaluating the reliability and test-retest stability of the TPQ Italian translation in a sample of patients with solid and blood cancers. Methods:The TPQ was administered to 263 people with solid and blood cancers. Test-retest reliability was evaluated in a subgroup of 116 participants who completed the TPQ again after 3 months.Results:The reliability of TPQ was good. Cronbach’s alpha: 0.83 (95%CI: 0.79-0.86), 0.66 (0.59-0.72), 0.71 (0.65-0.769), respectively, in the total test, and in subscales on “staff perception”, and “program perception”. Test-retest reliability was 0.82 (0.77-0.87). The mean difference between the first and the second assessment was 1.0 (SD = 7.1; 95% CI -0.35 to 2.33). By plotting the differences and the means of the two assessments, 5/116 cases (4.3%) were outside the upper and lower limits of agreement.Conclusions:This study points out good reliability and test-retest stability of the TPQ in the oncology field. The TPQ can be used to assess variation over time about satisfaction with care in patients with oncological diseases, favoring the identification of unmet patients’ needs about the quality of the service.

It\u2019s a small bit of advice, but actually on the day, made such a difference\u2026: perceptions of quality in abortion care in England and Wales

BackgroundQuality of care (QOC) is increasingly identified as an important contributor to healthcare outcomes, however little agreement exists on what constitutes quality in abortion care or the recommended indicators from the service-user perspective. Our study aimed to explore perceptions and experiences of abortion QOC in England and Wales.MethodsWe performed in-depth interviews (via phone or in-person) with participants who had an abortion at a nationwide independent sector provider in the previous 6 months. We explored their experiences of the abortion service at each point in the care pathway, their perspectives on what contributed to and detracted from the experience meeting their definitions of quality, and their reflections on different aspects of QOC. We used content analysis to generate themes.ResultsFrom December 2018 to July 2019, we conducted 24 interviews. Ten participants had a surgical and 14 had a medical abortion. Seventeen (71%) were treated in the first 12 weeks of pregnancy and 7 (29%) beyond that, with an average gestational age of 10 weeks + 5 days (range 5–23 + 6). We identified 4 major themes that contributed to participant’s perception of high quality care: (1) interpersonal interactions with staff or other patients, (2) being informed and prepared, (3) participation and choices in care and (4) accessibility. Nearly all participants identified interpersonal interactions with staff as an important contributor to quality with positive interactions often cited as the best part of their abortion experience and negative interactions as the worst. For information and preparation, participant described not only the importance of being well prepared, but how incongruencies between information and the actual experience detracted from quality. Participants said that making choices about their care, for example, method of abortion, was a positive contributor. Finally, participants identified access to care, specifically in relation to waiting times and travel, as an important aspect of QOC.ConclusionsParticipants situated quality in abortion care in 4 domains: interpersonal aspects of care, information and preparation, choices, and accessibility. Indicators identified can be used to develop standard metrics to ensure care meets service-user needs.

Group clinical supervision for nurses: process, group cohesion and facilitator effect

Objective: This qualitative research project set out to explore how, and by what means, participation in group clinical supervision might impact nurses. It aimed to describe participant perceptions of the processes within a long running reflective practice group for intensive care nurses and explore these in relation to relevant theory. Background: Interpersonal aspects of care are central to the nursing role, however, the associated emotional labour can develop into moral distress, compassion fatigue and burnout. Australia’s peak nursing and midwifery bodies have released a joint position statement on the importance of supervision for nurses. Group supervision interventions, such as reflective practice groups, mitigate stress, promote learning and support interpersonal aspects of nursing. Method: Twenty-two intensive care nurses from a reflective practice group that had been running for 10 years, participated in focus groups convened by an independent researcher. Thematic analysis identified key perceptions relating to process and outcomes. Results: Group identification, voluntary participation and skilled facilitation created an enabling environment for nurses to self-disclose. The sense of universality experienced by participants, along with increased empathy, enabled reflection and self-evaluation relevant to the group prototype of the ideal nurse. Authentic emotional expression was seen to provide respite from emotional labour, thereby regenerating resources for nurses to cope with job demands. Discussion: Key themes can be aligned to social psychology constructs of group identity, task interdependence and homogeneity, supporting earlier studies that suggest group cohesion is comprised of measurable factors. By developing and aligning with these constructs, the facilitator assists the group to establish a safe space whilst conceptualizing and aspiring to a model for the professional and compassionate nurse. Conclusion: Social psychology constructs can help develop practice and research of group supervision for nurses. In clinical nursing settings, group identity is particularly salient and facilitator interventions should aim to strengthen this. The development of a sense of universality, when combined with voluntary participation and a focus on intra-group process, can enhance cohesion and create a safe space for self-disclosure. This enables nurses to examine actions and responses to clinical situations and explore emotions incongruent with the ideal nurse prototype, thereby promoting restorative and formative benefits. Implications for research, policy, and practice: This study adds to our understanding of processes in group clinical supervision for nurses and suggests that it is appropriate to apply social identity theory to improve practice and research. It will be of interest to nurses and nursing leaders who wish to develop supervision programs. What is already known about this topic? Compassion fatigue, emotional labour and moral distress contribute to nurse burnout. Group Clinical Supervision can help mitigate stress, enhance learning and support interpersonal aspects of nursing care. The supervisory alliance is an important factor in effective clinical supervision whilst group cohesion is an important factor in the effectiveness of group work. What this paper adds: Reflective Practice Groups (RPG) are defined as a form of Group Clinical Supervision that utilize social support as a resource. RPG facilitation principles are aligned with social psychology constructs of group identity, task interdependence and homogeneity. Alliance with the facilitator and cohesion within the group, enhanced by voluntary participation and facilitation techniques, allow group members to access restorative and formative benefits whilst prompting self-evaluation against the group ideal nursing prototype.

Therapeutic adherence of patients with breast and prostate cancers

Objective: to analyze the treatment compliance of patients with breast and prostate cancers. Methods: cross-sectional study with 303 patients with breast and prostate cancers. A semi-structured instrument and the Adherence Determinants Questionnaire Scale Brazilian version were used, and the data were analyzed using descriptive and inferential statistics. Results: mean adherence was found among all participants (100.0%). In patients with prostate cancer, we observed weak correlations between age and interpersonal aspects of care (r=0.198; p=0.048); and between treatment time and intentions (r=-0.295; p=0.049). In breast cancer patients, there was a positive correlation between age and perceived support/severity (r=0.174; p=0.013); and between years of study and interpersonal aspects of care (r=0.145; p=0.038) and intentions (r=0.156; p=0.026). Conclusion: patients with breast and prostate cancers showed moderate adherence to treatment, with higher means in the Support/Severity domain and lower in the Perceived Susceptibility domain.

Quality of Labor and Delivery Services: Maternal Satisfaction Study from a Tertiary Hospital

Introduction: Maternal satisfaction is an important indicator for any hospital to measure the quality of labor and delivery services. Satisfaction with the care received during labor and childbirth process influences the decision of institutional delivery for future utilisation. This study aims to identify the satisfaction of postnatal mothers towards labor and delivery service in a selected hospital. 
 Methods: It is a descriptive cross-sectional study. Non-probabilistic purposive sampling technique was used to select a sample. A total of 54 postnatal mothers were interviewed using a semi-structured interview schedule. It was adapted from Donabedian Model and Respectful Maternity Care (RMC) Scale focusing on four aspects i.e. health institution related aspect, interpersonal aspects of care, abuse free care and informative aspects of care in five-point Likert scales. Data were coded, entered and analyzed using Statistical Package for Social Science (SPSS) version 16 for windows. 
 Results: In this study, 79.6% of the postnatal mothers were satisfied with the overall aspects of the labor and delivery services. The component wise results show that 94.4% were satisfied in health institution related aspects while in the interpersonal aspect, 92.6% were satisfied. Similarly, all sampled mothers were satisfied with the abuse-free care system of the health institution. In informative aspects of care, 87% were satisfied and the rest (13%) were dissatisfied. 
 Conclusions: Although the majority of mothers were satisfied, there were dissatisfaction in regards to availability of drinking water, the behaviour of staffs and the health education provided to them. By improving these aspects, quality of service will improve and thus increase women's satisfaction with care received.

What weights on the user experience of hospital inpatient episodes? A Portuguese national study

Abstract Background Information about the users' experience is an essential element in patient-centered healthcare. We determined the score of the different elements of inpatient experiences of admission episodes in hospitals of the Portuguese health system and examined their contribution to the overall experience score. Methods A national cross-sectional study using randomized telephone interviews was conducted in the general population for the last episode of individuals who had an episode of hospitalization care between November 2016 and October 2017. Descriptive analysis of sociodemographic characteristics, care episode, hospital, elements of experience (16 dimensions), and global opinion was performed. The elements of experience were compared with the global experience through Spearman's correlation, with the contribution of each element to the global opinion calculated through weighted least squares regression. Results We obtained a total of 308 responses, 60.7% were female and the average age was 53.1 years, the average length of stay was 8.06 days; 35.1% were in medical departments; 56.5% were elective; 43.8% hospitals were in the Lisbon Metropolitan Area and 88.3% were from the public health service. All elements of experience and the overall opinion presented median values between 3 and (the maximum) 4. The correlation of each element with the global opinion is positive and statistically significant, having a contribution to the global opinion which varies between 11.5% and 51.6%, independently of demographic, episode of care or hospital characteristics. The domains of emotional support, empathy and respect; and communication, information and personal interaction make the greatest contribution to global opinion. Conclusions Elements of experience do not have the same weight on the global evaluation of inpatient individuals, which seem to privilege relational and interpersonal aspects of care. These findings have implications for patient-centered healthcare. Key messages Most users are satisfied with their hospitalization episodes of the Portuguese health system. The elements that contribute the most to the experience have to do with the healthcare workforce and their interaction with the users.

Patient Satisfaction of Care in the Treatment of Vaso-Occlusive Crises: A Comparison of Emergency Department and Infusion Centers in the Escaped Study

IntroductionPatients with sickle cell disease (SCD) suffer from frequent vaso-occlusive crises (VOC), the leading cause of hospitalization and emergency department (ED) visits for these patients. Patients and healthcare providers often report dissatisfaction with the quality of SCD pain management in the ED. Satisfaction has been defined as whether a patient's expectations about a health encounter were met. Infusion centers (IC) are alternatives to ED care for patients with VOC. The aim of this study is to describe adult patients' satisfaction with care for the treatment of uncomplicated VOC in EDs and ICs.MethodsAs part of a prospective cohort study (the ESCAPED study) comparing outcomes between ED and IC care for uncomplicated VOC, we conducted a descriptive analysis of patient satisfaction from the first acute visit of adult patients (>18 years) who were recruited from 4 sites (Baltimore, Baton Rouge, Cleveland, Milwaukee) from April 2015 to December 2016. Demographic and clinical variables were collected via medical record review. Participants were provided with a survey about their satisfaction of care within 72 hours after their acute visit to the ED or IC. The survey tool included questions about overall satisfaction with quality of care and with pain treatment received, satisfaction with pain management, communication with clinicians including physicians and nurses, interpersonal aspects of care, clinician competence, involvement of family and friends, and access to care. Responses were scored on a 7-point Likert scale from very strongly agree to very strongly disagree, except for “access to care” items, which were binary and categorical. We dichotomized Likert scale responses by grouping positive responses (very strongly agree, strongly agree, and agree) as being satisfied, and negative responses (very strongly disagree, strongly disagree, disagree, and uncertain) as being dissatisfied. Descriptive statistics were computed using Mann-Whitney U test for continuous variables and chi-squared test for categorical variables. All hypothesis testings were 2-sided and p values were not adjusted for multiple comparisons.ResultsWe enrolled 483 patients in ESCAPED and followed them for 18 months. We excluded 115 patients who did not have VOC visits during their observation period. Of the 368 patients with visits, 212 patients (58%) responded to the survey after their first acute visit: 89 (42%) had received care at an ED and 123 (58%) received care at an IC. Patients who received care at an IC were older, more likely to be married or with a significant other, and less likely to live alone. More patients who had a history of kidney disease received care at an IC than in an ED. Patients with higher numbers of ED visits in the previous year were more likely to seek care in an ED and those with higher numbers of IC visits in the previous year were more likely to seek care at an IC.The majority of patients (55%) in the ED responded to the survey by phone whereas the majority of patients (54%) in the IC responded to the survey in-person. Overall, patients who received care in an IC were more satisfied with the quality of care (95% vs. 73%, p< 0.001) and with their pain treatment (93% vs. 66%, p< 0.001) than patients who received care in an ED. (Table) Adults who received care at an IC were more satisfied with the pain management, communication with clinicians, interpersonal aspects of care, and clinician competence than adults who received care at an ED. The majority of patients in both groups (59%) came for care unaccompanied; ED-treated patients were more likely than IC-treated patients to agree that a companion helped improve the quality of care they received.ConclusionsPatients who received care in an IC were more satisfied with their care and with the quality of their pain management than patients who received care from an ED. Increasing access to IC models of care can improve delivery of patient-centered care for VOC. [Display omitted] DisclosuresBrooks:PCORI: Research Funding. Wang:PCORI: Research Funding. Seufert:PCORI: Research Funding. Haywood:PCORI: Research Funding. Varadhan:PCORI: Research Funding. Saheed:PCORI: Research Funding. Segal:PCORI: Research Funding. Field:Incyte: Research Funding; Ironwood: Consultancy, Research Funding; Prolong: Research Funding. Frymark:PCORI: Research Funding. Little:Doris Duke Charitable Foundations: Research Funding; NHLBI: Research Funding; Hemex: Patents & Royalties: Patent, no honoraria; PCORI: Research Funding. Griffin:PCORI: Research Funding. Arnold:PCORI: Research Funding. Shows:PCORI: Research Funding. Piehet:PCORI: Research Funding. Proudford:PCORI: Research Funding. Robertson:PCORI: Research Funding. Wallace:PCORI: Research Funding. Kincaid:PCORI: Research Funding. Green:PCORI: Research Funding. Burgess:PCORI: Research Funding. Lanzkron:Selexys: Research Funding; Pfizer: Consultancy, Research Funding; GBT: Consultancy, Research Funding; Prolong: Research Funding; NHLBI: Research Funding; PCORI: Research Funding; Ironwood: Research Funding.

Promoting a patient-centred approach in clinical consultations: Summary of a Cochrane review.

BACKGROUND: In traditional Western medicine, there has been a tendency to focus on managing diseases, as separate to the whole person, their lives, and health problems. As a result, studies have found that many patients are dissatisfied with the quality of the interaction during a consultation (Epstein & Street, 2011; Verghese et al., 2011). Patient‐centred care was first introduced as a concept to medicine by Balint in the 1950s as a contrast to “illness‐centred medicine” (Balint, 1957) and is now promoted and increasingly advocated in the training of health care providers. Patient‐centred care has become a policy driver for safety, quality, and health care reform around the world. (Kitson et al., 2013). However, many barriers exist that prevent care being delivered in a way that is important to patients. Research has identified that many nurses feel overworked and do not have enough time to address patients' fears and concerns, or provide holistic, patient‐ centred care. Additionally, nurses have reported a lack of training for social and interpersonal aspects of care that would promote patient‐centredness (West, Barron, & Reeves, 2005).

Development and Validation of a Cross-Country Hospital Patient Quality of Care Assessment Tool in Europe.

Patient perceptions of quality of care (QoC) are directly linked with patient safety and clinical effectiveness. We need patient-designed QoC instruments that work across languages and countries to optimise studies across systems in this area. Few QoC measurement tools exist that assess all aspects of QoC from the patient perspective. This paper describes the development and validation of a comprehensive measure to assess patient perceptions of QoC that incorporates technical and interpersonal aspects of care and is grounded in the established Institute of Medicine (IOM) QoC framework. We conducted a multi-country cross-sectional study. Following a literature review and patient focus groups, an expert panel generated questionnaire items. Following a pilot study, item numbers were reduced. The final questionnaire consisted of three sections: demographics, perceived QoC and one open-ended question. Data was collected from patients (n=531) discharged from hospitals across seven countries in South East Europe (languages: Turkish, Greek, Portuguese, Romanian, Croatian, Macedonian and Bulgarian). Reliability and validity of the measure were assessed. Confirmatory factor analysis was used to compare various factor models of patient-perceived QoC. Good model fit was demonstrated for a two-factor model: communication and interpersonal care, and hospital facilities. The ORCAB (Improving quality and safety in the hospital: The link between organisational culture, burnout and quality of care) Patient QoC questionnaire has been collaboratively and exhaustively developed between healthcare professionals and patients. It enables patient QoC data to be assessed in the context of the IOM pillars of quality, considering both technical and interpersonal dimensions of care. It represents an important first step in including the patient perspective.

Verbal compliance-gaining strategies used by male physicians and patient healthcare experience.

This study explores male physicians' use of verbal compliance gaining strategies to encourage patients to adhere to medication regimens, lifestyle changes, or future appointments, and assesses which strategies are associated with patients' reported healthcare experiences. Five physicians from a family practice clinic in northern British Columbia, Canada, were audio-recorded while interacting with 31 patients during actual consultations. Compliance-gaining utterances were coded into five categories of strategies, while patient experience with care was assessed using a questionnaire. A number of intriguing findings emerged: direct orders were related to a more negative experience with interpersonal aspects of care, but were fairly frequently used, especially with female patients. Persuasion was the only strategy that promoted a positive patient experience, but was rarely used. However, the effect of persuasion on patient experience was no longer significant when adjusting for patients' health status. Physicians relied mostly on motivation strategies to encourage adherence, but these strategies were not related to patients' assessment of their healthcare experiences. These results suggest that the most frequently used verbal compliance gaining strategies by physicians are not always appreciated by patients. To be more effective, it is necessary to inform physicians about which compliance-gaining strategies promote a positive patient healthcare experience.

Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial

We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall. We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer the patient to a community-based falls service instead of transporting the patient to the emergency department. Control paramedics provided care as usual. The primary outcome was subsequent emergency contacts or death. One hundred five paramedics based at 14 intervention stations attended 3,073 eligible patients; 110 paramedics based at 11 control stations attended 2,841 eligible patients. We analyzed primary outcomes for 2,391 intervention and 2,264 control patients. One third of patients made further emergency contacts or died within 1 month, and two thirds within 6 months, with no difference between groups. Subsequent 999 call rates within 6 months were lower in the intervention arm (0.0125 versus 0.0172; adjusted difference -0.0045; 95% confidence interval -0.0073 to -0.0017). Intervention paramedics referred 8% of patients (204/2,420) to falls services and left fewer patients at the scene without any ongoing care. Intervention patients reported higher satisfaction with interpersonal aspects of care. There were no other differences between groups. Mean intervention cost was $23 per patient, with no difference in overall resource use between groups at 1 or 6 months. A clinical protocol for paramedics reduced emergency ambulance calls for patients attended for a fall safely and at modest cost.

The impact of personality on person-centred care: a study of care staff in Swedish nursing homes.

In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. A cross-sectional Swedish sample of elderly care staff (N=322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care.

A work-based learning approach for clinical support workers on mental health inpatient wards.

Background With a rise in the number of unqualified staff providing health and social care, and reports raising concerns about the quality of care provided, there is a need to address the learning needs of clinical support workers. This article describes a qualitative evaluation of a service improvement project that involved a work-based learning approach for clinical support workers on mental health inpatient wards. Aim To investigate and identify insights in relation to the content and process of learning using a work-based learning approach for clinical support workers. Method This was a qualitative evaluation of a service improvement project involving 25 clinical support workers at the seven mental health inpatient units in South London and Maudsley NHS Foundation Trust. Three clinical skills tutors were appointed to develop, implement and evaluate the work-based learning approach. Four sources of data were used to evaluate this approach, including reflective journals, qualitative responses to questionnaires, three focus groups involving the clinical support workers and a group interview involving the clinical skills tutors. Data were analysed using thematic analysis. Findings The work-based learning approach was highly valued by the clinical support workers and enhanced learning in practice. Face-to-face learning in practice helped the clinical support workers to develop practice skills and reflective learning skills. Insights relating to the role of clinical support workers were also identified, including the benefits of face-to-face supervision in practice, particularly in relation to the interpersonal aspects of care. Conclusion A work-based learning approach has the potential to enhance care delivery by meeting the learning needs of clinical support workers and enabling them to apply learning to practice. Care providers should consider how the work-based learning approach can be used on a systematic, organisation-wide basis in the context of budgetary restrictions.

Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey.

BackgroundDoctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups.AimTo determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender.Design and settingAnalysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders.MethodA composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group.ResultsThere was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’.ConclusionThe identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.

A Systematic Review of the Impact of Physicians' Occupational Well-Being on the Quality of Patient Care.

BackgroundIt is widely held that the occupational well-being of physicians may affect the quality of their patient care. Yet, there is still no comprehensive synthesis of the evidence on this connection.PurposeThis systematic review studied the effect of physicians’ occupational well-being on the quality of patient care.MethodsWe systematically searched PubMed, Embase, and PsychINFO from inception until August 2014. Two authors independently reviewed the studies. Empirical studies that explored the association between physicians’ occupational well-being and patient care quality were considered eligible. Data were systematically extracted on study design, participants, measurements, and findings. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess study quality.ResultsUltimately, 18 studies were included. Most studies employed an observational design and were of average quality. Most studies reported positive associations of occupational well-being with patient satisfaction, patient adherence to treatment, and interpersonal aspects of patient care. Studies reported conflicting findings for occupational well-being in relation to technical aspects of patient care. One study found no association between occupational well-being and patient health outcomes.ConclusionsThe association between physicians’ occupational well-being and health care’s ultimate goal—improved patient health—remains understudied. Nonetheless, research up till date indicated that physicians’ occupational well-being can contribute to better patient satisfaction and interpersonal aspects of care. These insights may help in shaping the policies on physicians’ well-being and quality of care.Electronic supplementary materialThe online version of this article (doi:10.1007/s12529-015-9473-3) contains supplementary material, which is available to authorized users.

A qualitative analysis of approaches to contraceptive counseling

The high rate of unintended pregnancy in the United States1 places a heavy burden on women, society and the health care system.2 One factor contributing to this high rate is the underuse and inconsistent use of contraceptives. Not only do 11% of women at risk of unintended pregnancy not use any contraceptive method,3 but 25% of women using a reversible method rely on condoms, a method with relatively low efficacy.4 In addition, female contraceptive users report high rates of discontinuation and incorrect use of their chosen method.5,6 Patient-provider communication during family planning visits is one influence on women’s contraceptive use. Health communication has been recognized as a marker of quality health care by the Institute of Medicine,7 and has been found to be correlated with patient outcomes, including patient satisfaction and medication adherence, across a range of health conditions.8,9 In family planning care, patient assessment of the quality of interpersonal aspects of care has been linked to contraceptive use and continuation.10–12 Despite this evidence of the importance of contraceptive counseling, little is known about what occurs during routine family planning counseling. Qualitative studies of U.S. women’s counseling experiences have found that women often report being dissatisfied with the counseling they receive,13 and that many are concerned that providers do not fully disclose the potential side effects of methods.14 Research that has directly documented the contraceptive counseling dynamic has been largely limited to studies in the developing world, and these studies have found that family planning counseling sessions are often dominated by the provider.15–18 Even when the patient is the one ultimately making the decision about which method to use, there is often minimal provider engagement with patients to determine their preferences and concerns about methods and how these issues relate to available options.19,20 Given the increasing recognition of the value of patient-centered care, in which there is a focus on patients’ preferences and experiences,21 interventions to enhance patient-provider engagement during contraceptive decision making could improve the counseling experience, which may positively influence contraceptive use.22 However, because it is unclear whether these findings are relevant in the United States, an investigation of contraceptive counseling would improve our understanding of the range of approaches used by U.S. family planning providers and potentially identify areas for improvement. Specifically, elucidating how providers guide conversations with women who are selecting a method could inform interventions to improve providers’ ability to assist women in choosing a method that they will be able to use correctly and consistently. This is of critical relevance, as previous counseling interventions in family planning have been largely unsuccessful.23,24 In this article, we report results of a qualitative analysis of audio recordings of contraceptive counseling visits at clinics in the San Francisco Bay Area that serve racially and ethnically diverse patient populations, and describe providers’ approaches to contraceptive counseling and patterns in their use.

Born in another country: Women's experience of labour and birth in Queensland, Australia

Women born outside Australia make up more than a fifth of the Queensland birthing population and like migrants in other parts of the world face the challenges of cultural dislocation and possible language barriers. Recognising that labour and birth are major life events the aim was to investigate the experiences of these women in comparison to native-born English speaking women. Secondary analysis of data from a population based survey of women who had recently birthed in Queensland. Self-reported clinical outcomes and quality of interpersonal care of 481 women born outside Australia who spoke a language other than English at home were compared with those of 5569 Australian born women speaking only English. After adjustment for demographic factors and type of birthing facility, women born in another country were less likely to be induced, but more likely to have constant electronic fetal monitoring (EFM), to give birth lying on their back or side, and to have an episiotomy. Most women felt that they were treated as an individual and with kindness and respect. However, women born outside Australia were less likely to report being looked after 'very well' during labour and birth and to be more critical of some aspects of care. In comparing the labour and birth experiences of women born outside the country who spoke another language with native-born English speaking women, the present study presents a largely positive picture. However, there were some marked differences in both clinical and interpersonal aspects of care.