Patient-centered Care Practices Research Articles

Navigating the integration of technology in physiotherapy: A balanced approach

The integration of technology in physiotherapy practices holds immense promise for advancing patient care and outcomes. Yet, the swift evolution of technological solutions necessitates a cautious and discerning approach from physiotherapists. This article explores the complexities surrounding technology adoption in physiotherapy, emphasizing thorough evaluation, critical analysis, and context-driven implementation. By acknowledging the limitations and constraints inherent in various technological advancements, physiotherapists can effectively harness their potential while prioritizing patient-centered care and evidence-based practice. Such an approach ensures that technology serves as a tool to augment clinical decision-making and therapeutic interventions, rather than overshadowing the fundamental principles of personalized care and holistic rehabilitation. As technology continues to reshape the landscape of physiotherapy, a balanced integration strategy that values both innovation and patient well-being remains paramount for optimizing outcomes and fostering sustainable healthcare practices.

Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression.

We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.

Adult Development and Associated Health Risks.

Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care. Knowing the prominent issues, stressors, and risks at each stage of development is important in understanding patients. This knowledge can help customize medical advice to patients regarding obesity, disability, sleep, substance use, relationships, and age-related declines. This paper summarizes an updated view of adult development and discusses its relevance to health risks and patient-centered care practices at different stages.

Exploring healthcare barriers and satisfaction levels among deaf individuals in Ecuador: A video-based survey approach

BackgroundApproximately 80% of Deaf individuals live in low- and middle-income countries, where health systems often overlook their specific needs. This communication gap can result in misdiagnosis and inappropriate treatment, impacting their overall satisfaction with healthcare services. ObjectivesThis study aims to uncover barriers to healthcare access and preferences among the Deaf population in Ecuador, and the role of communication barriers in shaping satisfaction levels with healthcare services. MethodsThe study gathered data from 386 participants through online surveys, focusing on demographic characteristics, healthcare experiences, communication methods, and levels of satisfaction. Descriptive statistics and association analyses were employed to analyze the data. ResultsThe study reveals that nearly all participants possessed an officially recognized disability (95.9%) and 53.9% reported hereditary deafness. Ecuadorian sign language was predominant (60.9%). Communication barriers were evident, with 65.0% having trouble understanding medical instructions, and 66.6% identifying a deficiency of tools for Deaf individuals in healthcare settings. Satisfaction levels were associated with the presence of interpreters during medical care, with 46.6% expressing a preference for interpreters over other communication methods. Additionally, private healthcare facilities were perceived as providing better services, despite being less frequently accessed (38.9%). Dissatisfaction was evident, particularly in aspects of communication and physician courtesy. ConclusionsThis study underscores the importance of tailoring healthcare services to address the unique needs of the Deaf population. Communication barriers emerged as a central obstacle, necessitating the inclusion of sign language interpreters and improvement of resources. The study's implications extend to healthcare equity in developing nations, emphasizing the significance of patient-centered care and inclusive healthcare practices.

Perspectives and Experiences of Healthcare Professionals Involved in a Community Nurse-Delivered Shared Care Model Intervention Designed to Support Outpatients Receiving Chemotherapy: A Qualitative Study Using Interviews

Background. Chemotherapy can cause a range of side effects including nausea, vomiting, diarrhea, and infection, which can have a significant impact on an individual’s quality of life. Survival outcomes can be impacted when side effects are poorly managed, leading to failure to complete the defined dose of treatment. Objective. This study presents clinicians’ experiences with a shared care model involving home-based community nurse (CN) support to improve side-effect management of individuals receiving chemotherapy as an outpatient. Methods. A qualitative study was conducted with CNs, cancer nurses, medical oncologists, and a general practitioner involved in the CN intervention delivered as part of a randomized controlled trial (RCT) aimed at reducing unplanned presentations to hospital of cancer patients receiving outpatient chemotherapy. Semistructured individual and focus group interviews were conducted. Key themes were identified using thematic analysis. Findings. Twenty-three healthcare professionals were interviewed. Three themes were identified: (1) being able to enhance patient-centered care and clinical practice during chemotherapy; (2) importance of effective communication and collaborative relationships between different care settings; and (3) ways to adapt the intervention for implementation in routine clinical practice. Participants reported that it was feasible for CNs to care for this patient group, and their home visits enabled preemptive symptom management. Suggestions to improve and modify the intervention to implement this care model within existing clinical care included a flexible approach, such as a blended delivery with face-to-face visits and telephone calls; a risk- or needs-based approach to prioritize patient groups more likely to benefit from the intervention; and sharing of electronic medical records for more effective collaboration and communication. Conclusions. A CN-delivered shared care model provided a feasible approach to the provision of individualized support for outpatients receiving chemotherapy. This study suggests ways to adapt this care model into existing clinical workflow and structures. This trial is registered with ACTRN12614001113640.

PATIENTS’ PERSPECTIVE OF PATIENT-CENTRED CARE IN SELECTED HEALTH FACILITIES IN SOUTHERN GHANA

This research assessed patients’ perspective of factors associated with patient-centred care in selected health facilities in the Volta Region of southern Ghana. A descriptive hospital-based cross-sectional survey design was used where a structured questionnaire was administered to 403 patient participants. Regression analysis was conducted and the results reported in proportions, frequencies and odds ratios. The level of patient-centred care practice among patients in the selected health facilities was 56.8%. Patient-centred care was influenced by age (aOR=1.13; CI:1.02-1.25), educational status (aOR=0.02; CI:0.001-0.63), road network (aOR=0.09; CI:0.02-0.63) and cultural barriers (aOR=15.22; CI:1.65-139.99). Individual patient and community system factors including cultural beliefs have the potential of influencing patient-centred care satisfaction with the quality of care delivery in health facilities. Thus, there is a need for the government to address the problem of deplorable road networks in the communities.

Perceptions and Current Practices in Patient-Centered Care: A Qualitative Study of Ryan White HIV Providers in South Florida.

Background: Patient-centered care (PCC) improves HIV adherence and retention, though lack of consensus on its conceptualization and understanding how it is interpreted has hindered implementation. Methods: We recruited 20 HIV providers at Ryan White Programs in FL for in-depth interviews. Thematic analysis identified core consistencies pertaining to: 1) provider perceptions, 2) current practices promoting PCC. Results: Provider perceptions of PCC emerged under four domains: 1) holistic, 2) individualized care, 3) respect for comfort and security, and 4) patient engagement and partnership. PCC practices occurred at multiple levels: 1) individual psychosocial and logistical support, 2) interpersonal support within patient-provider relationships through respectful communication and active engagement, and 3) institutional practices including feedback mechanisms, service integration, patient convenience, and diverse staffing. Conclusions: Our findings highlight the central tenets of PCC as respectful, holistic, individualized, and engaging care. We offer an HIV-adapted framework of PCC as a multilevel construct to guide future intervention.

Philosophical Analysis of Pragmatic Nursing Inquiry

The paper discusses the role of pragmatism and critical thinking integration within nursing practices as viewed from a philosophical angle in relation to paradigms, beliefs, and ways to solve problems. This study focuses on scrutinizing knowledge claims, querying presuppositions, and evaluating implications as this form the basis for the developing idea about pragmatic nursing inquiry. An empirical validation is proposed to establish the significance of pragmatic nursing inquiry in fostering teamwork, patient-centered care, and evidence-based practice. The study tests quantitative and qualitative theories toward providing excellent patient care, quality education, and improving theory advancement. This paper develops a framework for transforming the way nurses practice through pragmatism and critical thinking.

Video review of family medicine resident clinical encounters: a tool for building emotional intelligence.

Video Review (VR) is a well established educational tool for developing the practice of patient-centered care in family medicine residents. There are a number of behaviorally-based checklists that can be use in both live observation as well as VR of clinical encounters to identify and promote behaviors associated with patient-centered care, most of which also overlap with behaviors associated with Emotional Intelligence (EI). We propose a VR that is structured less on a seek-and-find of clinician behaviors and more as a self-reflective exercise of how the clinician presents in the room alongside how they were feeling during that encounter. We believe that this exercise promotes the first two skills of EI (self-awareness and self-management) and then provides a foundation on which to build the second pair of skills (social awareness and relationship management). This perspective paper offers guidance, including stepwise instruction, on how to facilitate such a VR curriculum.

Athletic Training Student Core Competency Professional Behavior Implementation Between Immersive and Non-immersive Clinical Experiences: A Report From the Association for Athletic Training Education (AATE) Research Network

Context The Commission on Accreditation of Athletic Training Education requires athletic training programs to emphasize the use of professional behaviors that are associated with 6 core competencies, 5 of which were measured in this study: patient-centered care, interprofessional education and collaborative practice (IPECP), evidence-based practice (EBP), health information technology (HIT), and quality improvement (QI). The purpose of this study was to examine the association between clinical experience type and student implementation of behaviors associated with the core competencies. Design Multisite, panel design. Setting Twelve professional athletic training programs (7 graduate, 5 undergraduate). Patients or Other Participants A total of 338 athletic training students logged patient encounters for 1 academic year in the E*Value system. Main Outcome Measure(s) Students reported clinical experience type (immersive versus nonimmersive) and implementation of behaviors associated with core competencies. Counts of professional behaviors were calculated, and differences in behavior implementation between immersive (ICEs) and non-immersive (N-ICEs) clinical experiences were assessed using a generalized estimating-equations approach for patient-centered care, IPECP, EBP, HIT, and QI behaviors (P &amp;lt; .05). Results Students implemented more behaviors associated with IPECP (P = .002), EBP (P = .002), and HIT (P = .042) during ICEs than N-ICEs. Students implemented the QI behavior more often during N-ICEs than during ICEs (P = .001). Patient-centered care behavior did not differ between clinical experience types. Conclusions Immersive clinical experiences facilitate increased implementation of behaviors associated with EBP, IPECP, and HIT, while N-ICEs offered increased opportunities for QI behaviors. Program administrators should consider placement of ICEs and N-ICEs in the curriculum that align with students’ capability to perform core competency behaviors. Preceptors of both ICEs and N-ICEs should be encouraged to provide students with opportunities to implement all core competencies during their clinical experience.

Patient-centered care and geriatric knowledge translation among healthcare providers in Vietnam: translation and validation of the patient-centered care measure

BackgroundPeople are living longer, and the majority of aging people reside in low- and middle-income countries (LMICs). However, inappropriate healthcare contributes to health disparities between populations of aging people and leads to care dependency and social isolation. Tools to assess and evaluate the effectiveness of quality improvement interventions for geriatric care in LMICs are limited. The aim of this study was to provide a validated and culturally relevant instrument to assess patient-centered care in Vietnam, where the population of aging people is growing rapidly.MethodsThe Patient-Centered Care (PCC) measure was translated from English to Vietnamese using forward-backward method. The PCC measure grouped activities into sub-domains of holistic, collaborative, and responsive care. A bilingual expert panel rated the cross-cultural relevance and translation equivalence of the instrument. We calculated Content Validity Indexing (CVI) scores at both the item (I-CVI) and scale (S-CVI/Ave) levels to evaluate the relevance of the Vietnamese PCC (VPCC) measure to geriatric care in the Vietnamese context. We piloted the translated instrument VPCC measure with 112 healthcare providers in Hanoi, Vietnam. Multiple logistic regression models were specified to test the a priori null hypothesis that geriatric knowledge is not different among healthcare providers with perception of high implementation compared with low implementation of PCC measures.ResultsOn the item level, all 20 questions had excellent validity ratings. The VPCC had excellent content validity (S-CVI/Ave of 0.96) and translation equivalence (TS- CVI/Ave of 0.94). In the pilot study, the highest-rated PCC elements were the holistic provision of information and collaborative care, while the lowest-rated elements were the holistic attendance to patients’ needs and responsive care. Attention to the psychosocial needs of aging people and poor coordination of care within and beyond the health system were the lowest-rated PCC activities. After controlling for healthcare provider characteristics, the odds of the perception of high implementation of collaborative care were increased by 21% for each increase in geriatric knowledge score. We fail to reject the null hypotheses for holistic care, responsive care and PCC.ConclusionThe VPCC is a validated instrument that may be utilized to systemically evaluate the practice of patient-centered geriatric care in Vietnam.

Patients' Perception of Patient-Centered Care and Associated Factors Among Patients Admitted in Private and Public Hospitals: A Comparative Cross-Sectional Study.

The provision of patient-centered care is challenging around the globe, including in Ethiopia. There is a scarcity of information on this issue. Therefore, this study aimed to assess patients' perceptions of patient-centered care and associated factors among patients admitted to public and private hospitals in Bahir Dar city. A facility-based comparative cross-sectional study was conducted from May 8-June 15, 2022. Using a multistage sampling approach, the study participants were selected. An interviewer was used to collect the data. Bi-variable and multivariable logistic regressions were used to analyze the data. Statistical significance was declared using a p value< 0.05. Overall, 53.7% of patients reported poor patient-centered care. And it was higher among public hospitals (66.3%) than private hospitals (40.3%). Length of stay (AOR = 4.2; 95% CI [1.1, 15.3] and AOR = 4.3; 95% CI [1.4, 13]), intimacy with providers (AOR = 2.4; 95% CI [1.2, 4.6] and AOR = 3.9; 95% CI [1.1-9.6]), privacy during care (AOR = 4.2; 95% CI [1.93, 8.9]and AOR=3.3;95% CI: [1.5-7]), easy access to service (AOR=2.76;95% CI [1.33, 5.74] and AOR=3.8;95% CI [1.15, 12.7]) were associated with patient-centered care in public and private hospitals respectively. Awareness of the disease (AOR = 2.3; 95% CI [1.12, 4.8]), information on plans of care (AOR = 4.6; 95% CI [1.9, 10]), and being involved in decisions (AOR = 2.7; 95% CI [1.28, 5.9]) were associated factors in private hospitals. The following factors were associated with the practice of patient-centered care only in public hospitals: residence (AOR = 2.9; 95% CI [1.4, 5.5]), medication information (AOR = 2.88; 95% CI [1.34, 6.2]), and external appearance of hospital (AOR = 2.27; 95% CI [1.04, 4.97]). This study showed that the practice of patient-centered care in public hospitals was poor compared to that in private hospitals. Hence, hospitals should train their staff regarding a culture of patient-centered care in order to deliver high-quality and safer care.

Patient-centered care in the Middle East and North African region: a systematic literature review

BackgroundThe need for patient centered care (PCC) and its subsequent implementation has gained policy maker attention worldwide. Despite the evidence showing the benefits and the challenges associated with practicing PCC in western countries there has been no comprehensive review of the literature on PCC practice in the Middle East and North African (MENA) region, yet there is good reason to think that the practices of PCC in these regions would be different.ObjectivesThis paper summarizes the existing research on the practice of PCC in the MENA region and uses this analysis to consider the key elements of a PCC definition based on MENA cultural contexts.MethodsFive electronic databases were searched (EMBASE, Cochrane, Medline, CINAHL and Scopus) using the search terms: patient OR person OR client OR consumer AND centered OR centred AND care. The MENA countries included were Bahrain, Iran, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Israel, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Algeria, Egypt, Libya, Morocco, Tunisia, Djibouti, Pakistan, Sudan, and Turkey. Identified papers were imported to Covidence where they were independently reviewed against the inclusion criteria by two authors. The following data were extracted for each paper: author, year, location (i.e., country), objectives, methodology, study population, and results as they related to patient centred care.ResultThe electronic search identified 3582 potentially relevant studies. Fifty articles met the inclusion criteria. Across all papers five themes were identified: 1) patient centered care principles; 2) patient and physician perceptions of PCC; 3) facilitators of PCC; 4) implementation and impact of PCC; and 5) barriers to PCC.ConclusionThe preliminary findings suggest that the concept of PCC is practiced and supported to a limited extent in the MENA region, and that the implementation of PCC might be impacted by the cultural contexts of the region. Our review therefore highlights the importance of establishing patient-centered care definitions that clearly incorporate cultural practices in the MENA region. The elements and impact of culture in the MENA region should be investigated in future research.

The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey.

Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.

Special Report: Measurement-Based Care—Using Data to Augment Psychotherapy

Special Report: Measurement-Based Care—Using Data to Augment Psychotherapy

Dilemmas in patient-clinician communication about do-it-yourself hormone therapy: A qualitative study

Many transgender and gender diverse (trans) people use hormone therapy for gender-affirmation. Some trans people obtain hormone therapy without prescriptions from clinicians—a practice called “do-it-yourself hormone therapy” (DIY HT). When patients using DIY HT seek formal medical care, patient-clinician communication challenges arise. In an effort to explore these challenges and improve patient-clinician communication, we conducted qualitative interviews with 20 U.S.-based trans people who had practiced DIY HT. We performed a thematic analysis guided by Goldsmith's Normative Rhetorical Theory. We generated two themes regarding the dilemmas patients face when (not) communicating about DIY HT with clinicians. First, I want a clinician who is a partner, not a gatekeeper, describes patients' difficulties partnering with clinicians who often create barriers to accessing hormone therapy. Second, I (don't) want to be honest, describes a tension patients reported; patients desired honest communication with clinicians, but feared that disclosing DIY HT use would cause them to be stigmatized and labeled ‘non-compliant.’ We also developed two themes regarding trans patients' recommendations for clinicians. First, create respectful and inclusive clinic spaces, suggests that clinicians can demonstrate respect for trans identities by displaying pride flags, and asking for patients' pronouns and name they go by on intake forms. Second, share decision-making with patients, suggests that clinicians can build alliances with trans patients by communicating their desire to openly discuss, assess, and mutually agree upon hormone treatment plans. We offer strategies for how clinicians can practice patient-centered care and build partnerships with trans patients when communicating about hormone therapy.

Alignment of patient-centredness definitions with real-life patient and clinician experiences: A qualitative study.

Patient-centred care (PCC) has come to the forefront for many institutions, funding agenciesand clinicians, and is integrated into care. Does a disconnect in understanding still exist between patients, healthcare organizationsand clinicians in what PCC means and how outstanding issues might be addressed? We conducted interviews and focus groups with self-reported chronic care patients and clinicians providing care to these patients exploring PCC experiences, expectationsand practices. These data were initially analysed using inductive thematic analysis. This paper reports on the findings of a secondary analysis examining the alignment between patients and clinicians on five key predetermined dimensions of PCC. Eighteen patients participated, representing a range of chronic conditions. Thirty-eight clinicians participated. One thousand and three hundred patient and 1800 clinician codes were identified and grouped into 5 main topics with 140 unique themes (patients) and 9 main topics with 54 unique themes (clinicians). A total of 166 quotes (patient = 93, clinician = 73) were identified for this PCC definition alignment analysis. Partial or complete alignment of patient and clinician perspectives was seen on most dimensions. Key disconnects were observed in patient involvement, patient empowermentand clinician-patient communication. Only 18% of patients reported experiencing patient-centred communication, whereas 57% of clinicians reported using patient-focused communication approaches. Overall, study patients and clinicians endorse that many PCC elements occur. This study highlights key differences between patients and clinicians, suggesting persistent challenges. Clinician participants relayed their PCC approaches of informing and educating patients; however, patients often perceive these approaches as didactic, role-diminishingand noncollaborative. Collaborative approaches, such as shared decision-making,hold promise to bridge persistent PCC gaps and should be integrated into medical education programmes. This project was conceived and executed with a co-design approach wherein patients with chronic conditions who are trained in research (i.e., see descriptions of Patient and Community Engagement Research in the text) were involved in all stages of the research project alongside other researchers on the project team. Healthcare providers were involved as participants and as principal investigators in the project.

Patients’ and Caregivers’ Experiences With Atopic Dermatitis–Related Burden, Medical Care, and Treatments in 8 Countries

Previous studies have documented the high patient and caregiver burden associated with atopic dermatitis (AD). Less is known about the factors-especially those related to treatment options and the delivery of medical care-that may relate to burden and unmet needs among patients and their caregivers. Our primary aim was to characterize and compare health-related quality of life, long-term control of symptoms, satisfaction with treatments, the financial burden, and the prevalence of patient-centered care among adult and pediatric patients with AD in 8 developed nations. We developed a 53-item anonymous online survey for adult patients and caregivers of children with AD (N= 3171; self-reported disease severity: 8.2% clear, 33.2% mild, 41.1% moderate, 17.6% severe). The survey included questions across 7 domains selected by a steering committee of 11 patient organizations that advocate for patients with AD in the 8 countries. We used validated instruments when available including the 5-level EuroQol five-dimensional questionnaire and the Atopic Dermatitis Control Tool. The survey was offered in 5 languages and promoted through social media and other communication channels of the patient organizations. The health-related quality-of-life scores for adult patients with AD (driven by 2 domains: pain/discomfort and anxiety/depression) were worse than those reported for asthma and type 2 diabetes in previous studies (0.72; 95% CI, 0.65-0.78). Patients and caregivers reported substantial financial impacts even in countries with government-funded health care systems, though the greatest impact was in the United States. In all countries, adults reported better control of symptoms than children, but neither group nor any nationality reported adequate control on average (rescaled mean, 57.5; 95% CI, 56.1-58.9), and control correlated negatively with disease severity. Similarly, satisfaction with treatments, which was moderate across countries on average, was much lower for respondents with more severe disease symptoms (F(3,3165)= 5.5; P < .001). Patients who saw a specialist (a dermatologist or an allergist) instead of a general practitioner for AD care indicated better long-term control of symptoms (by 4 points on average on the 100-point scale; 95% CI, 2.6-5.4; P < .001). Finally, self-management training and shared decision making were uncommonly reported by patients in all countries except by respondents from the United States, but both were associated with better long-term control of symptoms and higher satisfaction. The burden of AD, evaluated as health-related quality-of-life detriments, financial impacts, and uncontrolled symptoms, is significant and highest for patients with more severe atopic dermatitis who report greater challenges in achieving symptom resolution with existing treatments and approaches to care. The better outcomes associated with respondents who saw specialists suggest that patients, especially those with more severe AD, might benefit from medical care that is guided by providers with more in-depth knowledge of this complex condition. Finally, wider use of patient-centered care practices (specifically, self-management training and shared decision making) could improve outcomes and boost satisfaction with treatments for AD, though more research on this topic is warranted.

Training for the future: Introducing foundational skills necessary to promote patient-centered care practice in medical physics graduate programs.

Current medical physics graduate training in the United States seldom explicitly includes education on foundational skills necessary to produce Patient-Centered Care (PCC)-focused healthcare providers. Such abilities include effective communication, critical reflection, and ethical decision-making. In this article, we present examples of curricula used to purposefully introduce these skills into graduate training to fill this gap. Presented didactic activities include an introduction to patient communication, ethics in medical physics, and a primer in health disparities for medical physicists. Although development of new curricula is resource-intensive when left to individual programs, we here propose resource-sharing and interprofessional collaboration to overcome these barriers.

"Provider discretionary power practices to support implementation of patient-centered HIV care in Lusaka, Zambia".

Traditional patient-provider relationships privilege the providers, as they possess the formal authority and clinical knowledge applied to address illness, but providers also have discretion over how they exercise their power to influence patients' services, benefits, and sanctions. In this study, we assessed providers' exercise of discretionary power in implementing patient-centered care (PCC) practices in Lusaka, Zambia. HIV clinical encounters between patients on antiretroviral therapy (ART) and providers across 24 public health facilities in Lusaka Province were audio recorded and transcribed verbatim. Using qualitative content analysis, we identified practices of discretionary power (DP) employed in the implementation of PCC and instances of withholding DP. A codebook of DP practices was inductively and iteratively developed. We compared outcomes across provider cadres and within sites over time. We captured 194 patient-provider interactions at 24 study sites involving 11 Medical Officers, 58 Clinical Officers and 10 Nurses between August 2019 to May 2021. Median interaction length was 7.5 min. In a hierarchy where providers dominate patients and interactions are rapid, some providers invited patients to ask questions and responded at length with information that could increase patient understanding and agency. Others used inclusive language, welcomed patients, conducted introductions, and apologized for delayed services, narrowing the hierarchical distance between patient and provider, and facilitating recognition of the patient as a partner in care. Although less common, providers shared their decision-making powers, allowing patients to choose appointment dates and influence regimens. They also facilitated resource access, including access to services and providers outside of scheduled appointment times. Application of DP was not universal and missed opportunities were identified. Supporting providers to recognize their power and intentionally share it is both inherent to the practice of PCC (e.g., making a patient a partner), and a way to implement improved patient support. More research is needed to understand the application of DP practices in improving the patient-centeredness of care in non-ART settings.