Medical Dialogue Research Articles

Advancing the field of communication research in pediatric oncology: A systematic review of the literature analyzing medical dialogue.

Historically, communication research in pediatric oncology has relied on surveys and interviews, resulting in cross-sectional and retrospective studies constrained by selection, recognition, and recall biases. This systematic review identifies and synthesizes the published literature analyzing primary data from recorded conversations between pediatric oncologists, patients with cancer, and their families, with the following objectives: (1) to identify the extent and content of the evidence base, (2) to describe methodological strategies utilized in the analysis of recorded medical dialogue, (3) to aggregate salient findings, and (4) to generate recommendations for future prospective research related to analysis of medical dialogue in pediatric oncology.

‘Hold on’ (Bambelela)! Lyrical interpretations of participation in an HIV prevention clinical trial

During a five-day workshop, former clinical trial participants and local musicians wrote the lyrics and recorded a song about an HIV prevention trial. Born of concerns about misconceptions regarding experimental drug trials, the aim was to engender engagement with medical researchers and open dialogue about the risks and benefits of trial participation. Composing lyrics that highlighted their credibility as communicators of medical scientific knowledge and their selfless sacrifice to stem the transmission of HIV, women performed their social positioning and cultural authority in contrast to men as well as other women not part of the trial. While involvement in HIV prevention initiatives often attracts stigma, scorn and criticism, the song’s lyrics highlighted women’s new-found identities as heroines searching for a solution to the spread of HIV, challenging these stereotypes. Methodologically, the paper describes a novel approach that uses artistic expression for public engagement with biomedical research.

Mary Putnam Jacobi's Influential Arguments from Biology

Over the course of her illustrious career, Doctor Mary Putnam Jacobi (1842-1906) persuasively challenged the biologically-determined, sexually-polarized theories that are still considered essential to the medical orthodoxy of her day. Inspired by her clinical research and professional observations, Putnam Jacobi sought to supplant the flawed arguments of some of her more famous colleagues with her own vision of physiology, which underscored a unifying similarity among all living beings. The concepts of motility and vibrant materiality frequently operate in her writings as rich metaphors for healthily functioning individual and social bodies. Taking her influential views into account would help us develop less settled, more complex, and more fully historicist understandings of how both medicine and biology were constituted at the time. In turn, making this more robust medical dialogue the framework for our interpretations of fictional depictions of medical women helps bring hitherto underappreciated thematic and formal elements to light.

СТРУКТУРНО-КОМПОЗИЦІЙНІ ОСОБЛИВОСТІ АНГЛІЙСЬКОГО ПРОФЕСІЙНО ОРІЄНТОВАНОГО ДІАЛОГІЧНОГО МОВЛЕННЯ МАЙБУТНІХ ЛІКАРІВ

Background. English professionally oriented dialogue is an integral part of medical professional sphere. It is closely connected to professional responsibilities and professional competence in medicine. English professionally oriented medical dialogue is a complex, multi-faceted process of workplace communication between a doctor and a patient arising from the needs of professional medical practice. It includes perception and understanding of the patient’s needs, information analysis and specific professional interaction between physicians and patients. Purpose. The current paper aims to analyze structural and compositional characteristics of English professionally oriented dialogue of prospective physicians as well as to classify main functional types of dialogues according to phases of the medical consultation. Results. While carrying out the research, the author analyzed more than 150 professional dialogues and authentic audiovisual fragments to select 50 of them for training purposes. The samples correlated with major functional types of workplace dialogues and became the basis for teaching professionally oriented interaction to students majoring in Medicine. Instruction is arranged in such a way that teaching functional dialogic communication (information-seeking and negotiation dialogues) follows the main structural phases of medical consultation. The major structural elements of the medical consultation include: contact, orientation, argumentation, corrective phase. In the course of training, special attention was also given to language aspects of professional dialogues of physicians. Discussion. Developed materials are open to improve the quality of educational programs, manuals and textbooks for future physicians as additional prospects at medical higher education institutions.

Maxillary Sinus Impaction of a Core Carrier Causing Sustained Apical Periodontitis, Sinusitis, and Nasal Stenosis: A 3-year Follow-up

IntroductionThe aim was to present a case report of a full-length extrusion of an obturator's core carrier into the maxillary sinus, causing clinical symptoms from the nose region with differential diagnostics aspects, which, in turn, led to several surgical treatments of the nostrils before diagnosis and correct endodontic retreatment of a maxillary right first molar. A 36-year-old man presented in 2012 with complaints from the right nostril region. Medical treatment with antibiotics and surgical procedures because of nasal stenosis resulted only in partial improvement. Five years earlier, a root canal treatment was performed on the maxillary right first molar. Intraoral radiographs revealed 10-mm overfilling of root filling material into the maxillary sinus from the palatal root of tooth #3. MethodsBefore surgical removal of the excess root filling material, orthograde revision was performed. Cone-beam computed tomographic imaging was used to localize the position of the root filling material, which protruded through the maxillary sinus and reached the inferior nasal wall. ResultsSurgical removal from the palatal aspect revealed that the root filling material was a core carrier of an obturator. Scanning electron microscopy and transmission electron microscopy showed evidence of microbial biofilm on the core carrier as well as remnants of sinus mucosa. At the long-term follow-ups, the tooth had healed apically, and symptoms of nasal stenosis were markedly reduced. ConclusionsThis case report represents a challenging differential diagnostic topic urging the importance of a medical and dental interdisciplinary dialogue. The use of cone-beam computed tomographic imaging was crucial for the surgical retreatment.

Ellipsis and Coreference Resolution in a Computerized Virtual Patient Dialogue System.

This paper describes the design of an ellipsis and coreference resolution module integrated in a computerized virtual patient dialogue system. Real medical diagnosis dialogues have been collected and analyzed. Several groups of diagnosis-related concepts were defined and used to construct rules, patterns, and features to detect and resolve ellipsis and coreference. The best F-scores of ellipsis detection and resolution were 89.15% and 83.40%, respectively. The best F-scores of phrasal coreference detection and resolution were 93.83% and 83.40%, respectively. The accuracy of pronominal anaphora resolution was 92% for the 3rd-person singular pronouns referring to specific entities, and 97.31% for other pronouns.

An Integrated Process and Outcome Evaluation of a Web-Based Communication Tool for Patients With Malignant Lymphoma: Randomized Controlled Trial.

BackgroundThe complex nature of the medical dialogue and the often emotional context in cancer care present challenges to health care professionals (HCPs) and patients. Patients are increasingly expected to be informed participants and to be able to make conscious decisions, which they often find very difficult. In an attempt to support patients with malignant lymphoma in clinical communication, we developed a stand-alone, Web-based intervention called “PatientTIME.” The development of PatientTIME was based on a participatory intervention mapping framework. Its primary aim is to boost patients’ self-efficacy in patient-professional communication (ie, their confidence when interacting with their HCP). Patients can use this intervention before their hospital visit to prepare for their clinical consultation. PatientTIME is fully automated and use is patient-initiated.ObjectiveThe aim of this study was to evaluate if and in what way patients benefit from PatientTIME and if it enhances their confidence in clinical communication.MethodsThe intervention was evaluated in a closed randomized controlled trial with continuous recruitment (using online and offline methods to reach potential participants) and data collection. In accordance with the Medical Research Council guidance, we started with a process evaluation. Subsequently, an outcome evaluation was performed focusing on the patients’ perceived confidence in communication with their HCP, measured with the validated PEPPI questionnaire at baseline and at 3 months after participation. Process and outcome data were obtained through Web-based questionnaires, log files (automatically generated files mapping the interactions between program and users), and a logbook (comprising a record of actions and interactions kept by the researchers). Participants were not blinded. A total of 146 patients registered online, of whom 97 gave their informed consent and were assigned at random to the control group (N=34) or 1 of the 2 intervention groups (N=63). Ultimately 87/97 (90%) of these patients actually participated in the study, producing 87 datasets for analysis.ResultsMore than half of the intervention group patients reported that the intervention helped them prepare for a clinical consultation; it created awareness about the importance of communication and reinforced their existing communication skills. In the postvisit test, the control group showed a small, nonsignificant improvement in perceived communication efficacy. The intervention group showed a significant improvement in perceived efficacy. However, the interaction effect was not significant, indicating that the improvement solely as a result of the intervention may not be significant.ConclusionsA considerable number of patients reported that PatientTIME did provide support. We found a trend indicating that in the long run, patients with access to PatientTIME scored better on the perceived efficacy scale than patients without access. However, at this stage we cannot conclude that PatientTIME improves patients’ confidence when interacting with HCPs.ClinicalTrialNetherlands National Trial Register (NTR): 3779; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3779 (archived by WebCite at http://www.webcitation.org/6iztxJ5Nt)

The church and paediatric HIV care in rural South Africa: a qualitative study

ABSTRACTReligion has substantial – positive and negative – influence on South Africa's HIV context. This qualitative study explored possibilities for positive church engagement in paediatric HIV care in a rural district in Limpopo Province, South Africa. Opinions, attitudes and experiences of various stakeholders including religious leaders, healthcare workers and people infected/affected with/by HIV were investigated through participant observation, semi-structured interviews and focus group discussions. During the research the original focus on paediatric HIV care shifted to HIV care in general in reaction to participant responses. Participants identified three main barriers to positive church engagement in HIV care: (a) stigma and disclosure; (b) sexual associations with HIV and (c) religious beliefs and practices. All participant groups appreciated the opportunity and relevance of strengthening church involvement in HIV care. Opportunities for positive church engagement in HIV care that participants identified included: (a) comprehensive and holistic HIV care when churches and clinics collaborate; (b) the wide social reach of churches and (c) the safety and acceptance in churches. Findings indicate that despite barriers great potential exists for increased positive church engagement in HIV care in rural South Africa. Recommendations include increased medical knowledge and dialogue on HIV/AIDS within church settings, and increased collaboration between churches and the medical sector.

Abstract A07: Included in the debate: Women's perspectives on mammography after experiencing a false positive screen

Abstract Background: The utility of mammography screening as an efficacious tool for early detection is being contested due to the risk of potential harms including false positives and over-diagnosis. Yet there is little research regarding women's experiences, values or preferences for participating in mammography programs. Our aim was to explore women's actual experiences of a false positive mammography screen and their perceptions of the value, risks and benefits given their recent experience among a diverse group of mammography screeners. Methods: Semi-structured interviews were completed with 40 women who experienced a recent false positive mammogram at an academic hospital that provides care to low-income, medically underserved women. Interviews were recorded and transcribed verbatim. A directed content analysis was used to identify and explore primary themes. Knowledge of breast cancer risk was also assessed. Findings: Unlike most cancer screening samples, women in our study were quite diverse; 45% were African American, 27% were uninsured or insured through Medicare/Medicaid and 22.5% reported incomes less than $30,000. Receiving a false positive mammography screen generated worry among 60% (n=24) of women. Yet 70% maintained that mammography screening was necessary despite the worry incurred. Women also described the experience as stimulating greater interest in additional cancer prevention activities (32.5%; n=13) and one third discussed needing more information about the risks and benefits of mammography screening. Less than one quarter of women (22.5%; n=9) correctly identified a women's lifetime risk of developing breast cancer, 20% (n=8) overestimated and 57.5% (n=23) underestimated this risk. Conclusion: Our findings represent the experiences of a diverse sample of women whose voices are typically underrepresented and often excluded from the ongoing and contentious medical dialogue regarding mammography. Women reported needing more information about the risks and benefits of mammography screening but also considered false positives an acceptable risk. It is clear that women require and are demanding, more information regarding breast cancer prevention in general and mammography screening in particular. Further, our results suggest that breast cancer screening programs may provide a unique opportunity to deliver additional breast cancer prevention interventions. Citation Format: Maria D. Thomson. Included in the debate: Women's perspectives on mammography after experiencing a false positive screen. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A07.

Psychosomatic primary care for urinary incontinence

Urinary incontinence is a significant impairment of the quality of life. Many patients are treated insufficiently or even suffer from complications of incontinence surgery. Psychosomatic primary care serves to improve the diagnostic work-up and helps to select the appropriate therapeutic option. It also optimizes the treatment outcome by supplementing the somatically oriented urological therapy with the psychosomatically aligned extended medical dialogue and body-oriented methods. Psychosomatic primary care is based on the biopsychosocial model and uses theoretical knowledge and practical techniques that can be learnt under professional guidance.

‘I’m not complaining because I’m alive’: Barriers to the emergence of a discourse of cancer-related fatigue

Objective: Cancer-related fatigue (CRF) is a potentially chronic condition that is inadequately discussed, diagnosed and treated. This study examined the factors that contribute to the absence of a discourse of CRF.Method: A thematic discourse analysis was carried out on the ‘additional comments’ left by 73 fatigued cancer patients and survivors as part of a questionnaire study on CRF.Results: The findings indicated that conflict between patients’ own conceptualisations of CRF and those of family/friends and/or medical professionals hampers social and medical dialogue of CRF. Fatigue forms a part of patients’ ongoing cancer identity even after cancer treatment has been completed; however, because of the dominance of wider social discourses on recovery from illness and cancer survivorship, others fail to recognise individual narratives of CRF when these deviate from or oppose such established discourses. Furthermore, the development of a discourse of CRF is actively obstructed because the enormity of cancer invalidates and overshadows patients’ postcancer experiences.Conclusion: ‘Additional comments’ are a rich source of data that can give insight into issues facing patients. Beyond the lack of recognition, support and interventions available for CRF, broader discourses of health, illness and cancer hamper communication regarding this side effect.

Patient–provider communication and timely receipt of preventive services

ObjectiveTo estimate the association between how patients rate their health care provider's communication and the receipt of six clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP). MethodsThis study used national data from the 2009 Medical Expenditure Panel Survey (MEPS). The samples (sizes vary by service) included individuals aged 18years and older who have a usual source of care (USC). The outcomes indicated whether or not individuals received screening for breast cancer, cervical cancer, colon cancer, high cholesterol, hypertension, or were vaccinated against influenza per clinical guidelines. Multivariate logistic regression models were created for each dependent variable. The main independent variables consisted of ratings of four patient–provider communication behaviors. ResultsIn unadjusted analyses, respondents who rated their providers' communication higher reported greater utilization of preventive services. After controlling for confounding variables, only receipt of mammograms remained significantly associated with better communication (p<0.05). Screening for cervical cancer, colon cancer, high cholesterol, and influenza vaccination approached significance with better communication (p<0.10). ConclusionsPatient–provider communication is associated with receipt of regular mammograms. Clinicians should consider their medical dialogue with patients as a stimulus for appropriate screenings and vaccinations.

Knowledge-Base Medical Decision Support System for Knee Pain Management

In this paper an attempt has been made to develop a Knowledge-Base Medical Decision Support System for Knee Pain Management. The attention is focused on the Central Vision Exhibit Board, Medical Informatics Modules, Dialog Management and Central Decision Making Desk. The developed Medical Decision Support System will help the Health Care Professionals in making Medical Decisions by comparing the effectiveness of various alternate decisions devised with the objective of improving Quality of Life of Patients.

Health beliefs, treatment preferences and complementary and alternative medicine for asthma, smoking and lung cancer self-management in diverse Black communities

ObjectiveThe purpose of this literature review is to characterize unconventional health beliefs and complementary and alternative medicine (CAM) for asthma, smoking and lung cancer as those that are likely safe and those that likely increase risk in diverse Black communities. These findings should provide the impetus for enhanced patient–provider communication that elicits patients’ beliefs and self-management preferences so that they may be accommodated, or when necessary, reconciled through discussion and partnership. MethodsOriginal research articles relevant to this topic were obtained by conducting a literature search of the PubMed Plus, PsychINFO and SCOPUS databases using combinations of the following search terms: asthma, lung cancer, emphysema, chronic obstructive pulmonary disease (COPD), smoking, beliefs, complementary medicine, alternative medicine, complementary and alternative medicine (CAM), explanatory models, African American, and Black. ResultsUsing predetermined inclusion and exclusion criteria, 51 original research papers were retained. Taken together, they provide evidence that patients hold unconventional beliefs about the origins of asthma and lung cancer and the health risks of smoking, have negative opinions of standard medical and surgical treatments, and have favorable attitudes about using CAM. All but a small number of CAM and health behaviors were considered safe. ConclusionWhen patients’ unconventional beliefs and preferences are not identified and discussed, there is an increased risk that standard approaches to self-management of lung disease will be sub-optimal, that potentially dangerous CAM practices might be used and that timely medical interventions may be delayed. Practice implicationsProviders need effective communication skills as the medical dialog forms the basis of patients’ understanding of disease and self-management options. The preferred endpoint of such discussions should be agreement around an integrated treatment plan that is effective, safe and acceptable to both.

Developing &amp; Evaluating Collaborative Medical Physics Module for the First Year Medical Students at College of Medicine &amp; Medical Sciences, Arabian Gulf University Kingdom of Bahrain

Collaborative learning is emerging as an important learning method. It is an educational approach for teaching and learning; that involves groups of learners working together to solve a problem, complete a task, or create a product. This paper describes a comprehensive approach in collaborative inquiry of medical physics at College of Medicine &amp; Medical Sciences (CMMS) Arabian Gulf University (AGU). The collaborative module comprises: an interactive medical physics WebCT virtual learning environment that provides students with shared workspaces for coordinating and recording their collaboration in scientific inquiry; inside and outside field visits carried out collaboratively by each subgroup and the tutor. Medical physics diagnostic and application dialogue (learning problems) and Web-based materials are designed to match and enrich the module. The individual and group assessments given to students guide their learning process, and help them to scientifically report and evaluate their collaboration inquiry experiences. The main aim of this work was to redesign the medical physics module at the AGU and contribute in shifting the learning process from a teacher-center to a learner-center activities and support learner-learner interaction, learner-content interaction, and learner-tutor interaction to a degree that facilitate deep learning and fulfill satisfaction with learning. The results indicate that collaborative learning enabled the participants to communicate easily with their teachers (resource people, tutors and professors) and their peers searching for answers for themselves. In addition, the participants were able to assess their own expertise, resulting in the enhancement of knowledge, skills, attitudes and satisfaction with learning. Concerning achievement in medical physics; data analysis results revealed no significance differences related to treatment type (collaboration, no collaboration) or the gender of the experimental group participant`s (male, female). A remarkable result was that participants who were taught through collaborative approach scored significantly more gain in achievement (M = 15.1289, SD = 16.84061) than the control group that did not use collaborative approach (M = 6.1225, SD= 21.26310), t(290) = -4.023, p &lt; .05. i.e. collaborative approach for teaching medical physics prove its strength in empowering subjects gain development in achievement. Further research on more courses is needed to cross validate the study findings and generalize the results. Attached an appendix titled “X-Ray and Medical Diagnostic Dialogue”.

Family presence in routine medical visits: a meta-analytical review.

Older adults are commonly accompanied to routine physician visits, primarily by adult children and spouses. This is the first review of studies investigating the dynamics and consequences of patient accompaniment. Two types of evidence were examined: (1) observational studies of audio and/or videotaped medical visits, and (2) surveys of patients, families, or health care providers that ascertained experiences, expectations, and preferences for family companion presence and behaviors in routine medical visits. Meta-analytic techniques were used to summarize the evidence describing attributes of unaccompanied and accompanied patients and their companions, medical visit processes, and patient outcomes. The weighted mean rate of patient accompaniment to routine adult medical visits was 37.6% in 13 contributing studies. Accompanied patients were significantly older and more likely to be female, less educated, and in worse physical and mental health than unaccompanied patients. Companions were on average 63 years of age, predominantly female (79.4%), and spouses (54.7%) or adult children (32.2%) of patients. Accompanied patient visits were significantly longer, but verbal contribution to medical dialog was comparable when accompanied patients and their family companion were compared with unaccompanied patients. When a companion was present, health care providers engaged in more biomedical information giving. Given the diversity of outcomes, pooled estimates could not be calculated: of 5 contributing studies 0 were unfavorable, 3 inconclusive, and 2 favorable for accompanied relative to unaccompanied patients. Study findings suggest potential practical benefits from more systematic recognition and integration of companions in health care delivery processes. We propose a conceptual framework to relate family companion presence and behaviors during physician visits to the quality of interpersonal health care processes, patient self management and health care.

Slicing it thin: New methods for brief sampling analysis using RIAS-coded medical dialogue

Objective To explore the relationship between one-minute slices and full-session interaction and the predictive validity of the slices to ratings of affect and rapport. Methods Third-year medical students ( n = 253) were videotaped during an OSCE. All interaction was coded using the Roter Interaction Analysis System (RIAS) and samples were drawn at minutes 1, 5, and 9 and extracted from the coded database. The slices were related in multivariate analysis to full-session interaction, corrected for slice content, and correlated with affect ratings of participants and independently rated judgments of rapport. Results One-minute slices explained 33% of full-session variance in student interaction and 30% of variance in standardized patient interaction. Slices were significantly correlated with affective ratings of participants and independent judgments of rapport in a similar pattern as full-session interaction analysis. Conclusions One-minute slices of interaction can provide a meaningful degree of insight into OSCE session communication with both concurrent and predictive validity to ratings of session affect and rapport. Practice implications Evidence of concurrent and predictive validity further supports use of this approach as a research tool that provides an efficient means of analyzing processes of care, examining variation in communication throughout a visit and predicting visit outcomes.

Patient-provider communication differs for black compared to white HIV-infected patients.

Poor patient-provider interactions may play a role in explaining racial disparities in the quality and outcomes of HIV care in the United States. We analyzed 354 patient-provider encounters coded with the Roter Interaction Analysis System across four HIV care sites in the United States to explore possible racial differences in patient-provider communication. Providers were more verbally dominant in conversations with black as compared to white patients. This was largely due to black patients' talking less than white patients. There was no association between race and other measures of communication. Black and white patients rated their providers' communication similarly. Efforts to more effectively engage patients in the medical dialogue may lead to improved patient-provider relationships, self-management, and outcomes among black people living with HIV/AIDS.

Oral literacy demand of prenatal genetic counseling dialogue: Predictors of learning

Objective To assess the relationship between the oral literacy demand of genetic counseling sessions and the ability of low literate subjects to learn genetics-related information. Methods Ninety-six simulated genetic counseling sessions were videotaped and shown to 312 subjects recruited to imagine themselves as the session's client. Study measures included oral literacy demand, operationalized as: (1) use of key genetics terms; (2) informational context; (3) general language complexity; and (4) structural characteristics of dialogue interactivity. The study outcome was learning of genetics-related information. Results Subjects with restricted literacy (below 8th grade level) learned more when viewing sessions with greater dialogue interactivity and more personally contextualized information. Subjects with adequate literacy skills, however, tended to learn less in low literacy demand sessions. Conclusion The oral literacy demand of medical dialogue represents a learning obstacle to low literate subjects. However, this may not be the case for those with greater literacy skills who can understand the complex language and process the dense informational load of high demand sessions. Practice implications In order to meet the educational needs of all patients, clinicians must attend to both the informativeness and the oral literacy demand of their communication.

Munchausen by mommy.

Munchausen's Syndrome by Proxy is hard to diagnose and treat. The patient harms a defenseless person who is in his care, usually a baby or a child, in order to receive the attention the parent requires. Such a parent makes his child ill, introduces his body to various dangers, and with much concern and sacrifice brings him in for medical treatment, accompanying it all patiently, lovingly and anxiously. All the while, the caregiver is making sure to sabotage the healing and cause further harm. This syndrome is a challenge to family physicians, internists and pediatricians, since only the continuity of care of these families may reveal the dangerous syndrome and prevent its harmful outcomes. In this case report, Sarah, the loving mother of Joy, continuously damages her daughter's health and exposes her to the dangers of sophisticated medical interventions. Only careful inspection by the medical teams, dialogue and co-operation can bring to an end the harmful behavior of Joy's mother.