Clinician-patient Relationship Research Articles

Experiences and perspectives of adults on using opioids for pain management in the postoperative period: A scoping review.

Opioids play an important role in peri-operative pain management. However, opioid use is challenging for healthcare practitioners and patients because of concerns related to opioid crises, addiction and side effects. This review aimed to identify and synthesise the existing evidence related to adults' experiences of opioid use in postoperative pain management. Systematic scoping review of qualitative studies. Inductive content analysis and the Theoretical Domains Framework (TDF) were applied to analyse and report the findings and to identify unexplored gaps in the literature. Ovid MEDLINE, PsycInfo, Embase, CINAHL (EBSCO), Cochrane Library and Google Scholar. All qualitative and mixed-method studies, in English, that not only used a qualitative approach that explored adults' opinions or concerns about opioids and/or opioid reduction, and adults' experience related to opioid use for postoperative pain control, including satisfaction, but also aspects of overall quality of a person's life (physical, mental and social well being). Ten studies were included; nine were qualitative ( n = 9) and one used mixed methods. The studies were primarily conducted in Europe and North America. Concerns about opioid dependence, adverse effects, stigmatisation, gender roles, trust and shared decision-making between clinicians and patients appeared repeatedly throughout the studies. The TDF analysis showed that many peri-operative factors formed people's perceptions and experiences of opioids, driven by the following eight domains: Knowledge, Emotion, Beliefs about consequences, Beliefs about capabilities, Self-confidence, Environmental Context and Resources, Social influences and Decision Processes/Goals. Adults have diverse pain management goals, which can be categorised as proactive and positive goals, such as individualised pain management care, as well as avoidance goals, aimed at sidestepping issues such as addiction and opioid-related side effects. It is desirable to understand the complexity of adults' experiences of pain management especially with opioid use and to support adults in achieving their pain management goals by implementing an individualised approach, effective communication and patient-clinician relationships. However, there is a dearth of studies that examine patients' experiences of postoperative opioid use and their involvement in opioid usage decision-making. A summary is provided regarding adults' experiences of peri-operative opioid use, which may inform future researchers, healthcare providers and guideline development by considering these factors when improving patient care and experiences.

Italian Association of Hospital Cardiologists position paper-obesity in adults: a clinical primer.

Obesity is a chronic and relapsing disease characterized by the interaction between individual predispositions and an obesogenic environment. Recent advances in understanding the mechanisms of energetic homoeostasis paved the way to more effective therapeutic approaches compared with traditional treatments. Since obesity is a complex disease, it necessitates a multi-disciplinary approach whose implementation remains challenging. Nonetheless, emerging pharmacological interventions appear promising. Currently, therapeutic success is discreet in the short term but often fails to maintain long-term weight loss due to a high likelihood of weight regain. Cardiologists play a key role in managing patients with obesity, yet often lack familiarity with its comprehensive management. The aim of this document is to summarize knowledge to consolidate essential knowledge for clinicians to effectively treat patients living with obesity. The paper emphasizes the pivotal role of a strong patient-clinician relationship in navigating successful treatment. We analyse the criteria commonly used to diagnose obesity and point out the strengths and limitations of different criteria. Furthermore, we discuss the role of obesiologists and the contributions of cardiologists. In addition, we detail key components of effective therapeutic strategies, including educational aspects and pharmacological options.

Oncology patients' willingness to report their medication safety concerns from home: a qualitative study.

Oncology patients often struggle to manage their medications and related adverse events during transitions of care. They are expected to take an active role in self-monitoring and timely reporting of their medication safety events or concerns to clinicians. The purpose of this study was to explore the factors influencing oncology patients' willingness to report adverse events or concerns related to their medication after their transitions back home. A qualitative interview study was conducted with adult patients with breast, prostate, lung, or colorectal cancer who experienced care transitions within the previous year. A semi-structured interview guide was developed to understand patients' perceptions of reporting mediation-related safety events or concerns from home. All interviews were conducted via phone calls, recorded, and transcribed for thematic data analysis. A total of 41 individuals participated in the interviews. Three main themes and six subthemes emerged, including patients' perceived relationship with clinicians (the quality of communication and trust in clinicians), perceived severity of adverse medication events (perceived severe vs. non-severe events), and patient activation in self-management (self-efficacy in self-management and engagement in monitoring health outcomes). The patient-clinician relationship significantly affects patients' reporting behaviors, which can potentially interact with other factors, including the severity of adverse events. It is important to engage oncology patients in medication safety self-reporting from home by enhancing health communication, understanding patients' perceptions of severe events, and promoting patient activation. By addressing these efforts, healthcare providers should adopt a more patient-centered approach to enhance the overall quality and safety of oncological care.

The Legal Landscape for Opioid Treatment Agreements.

Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids' risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in which the law permits flexibility for clinicians and health care institutions to adopt best practices. We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions' requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts' reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician-patient relationships and patient care within the bounds of relevant legal requirements and risks.

Exploring Trust in Pregnancy Care Clinicians Among Latine Patients in Spanish and English: A Qualitative Study [ID 2683628

INTRODUCTION: Trust between patients and clinicians is critical for better experiences and outcomes, yet there is no consensus on how trust is defined and measured in pregnancy care. We aimed to explore how patients define trust in clinicians; facilitators and barriers to building trust; and how trust may be eroded and rebuilt over time. METHODS: A bilingual, multicultural team led this qualitative focus group study. The semistructured discussion guide included definitions of trust based on a literature review, how trust is built, when trust is lost, external factors that influence the patient–clinician relationship, previous pregnancy experiences, and sources of trustworthy information during pregnancy. The discussions were audiorecorded and transcribed in the language in which they were held. We performed thematic content analysis on transcripts using both deductive and inductive approaches in each language. Codes were organized and synthesized according to emerging themes. The IRB approved this study. RESULTS: We held eight focus groups of Hispanic/Latine pregnant and postpartum patients; five were held in Spanish and three in English with a total of 35 participants. We identified five constructs of trust: communication, comfort, caring, competency, and accompaniment (“acompañamiento”). Facilitators of trust were warm interpersonal dynamics, continuity with clinician and care team, rapid direct communication with clinician, and language concordance. Barriers of trust were inadequate or inaccurate information, rotating clinicians, cold interpersonal dynamics, and language discordance. There were few differences between Spanish and English groups. CONCLUSION: Patient perspectives about building trust with clinicians are critical for improving the quality of patient–clinician relationships, especially when language barriers exist.

Instagram and clear aligner therapy: A content analysis of patient perspectives

BackgroundThe popularity of clear aligner treatment (CAT) has been on the rise. Improving treatment satisfaction with CAT requires an in-depth understanding of the patient's perspectives. Nowadays, patients use social media to share authentic treatment experiences. This study aimed to explore the content of CAT-related Instagram posts before, during, and after CAT. Materials and methodsThis study used mixed quantitative and qualitative methods. A social media monitoring software, AwarioTM, was used to collect Instagram CAT-related posts over 4 weeks and categorize them as positive, negative, and neutral ones. Three investigators manually reviewed this categorization. The sentiments of posts before, during, and after treatment were compared using Chi-square tests. Qualitative analysis of post content was carried out to extract themes relevant to patient experiences. ResultsA total of 2015 posts were included in the analysis, including posts before (n=422), during (n=1503), and after (n=90) CAT. The majority of posts (90%) before CAT were positive in sentiment analysis. In contrast, there were more negative than positive posts during CAT (54.8% and 45.2% respectively). Among notable sources of negative sentiments there were pain, unfavorable esthetic appearance of attachments, and sleep difficulties. While 60% of post-treatment posts contained positive sentiments about treatment outcomes and the patient-clinician relationship, 40% were negative and focused on the length of treatment being longer than expected. ConclusionsHigh expectations among the public are prevalent before using CAT. Discrepant negative sentiments are revealed during treatment due to pain, attachments, sleep difficulties, and other factors. Patients reflect negatively on the treatment duration after the treatment is concluded. Clinicians should focus on these patient perceptions when counseling them before and during CAT.

OA33 Factors associated with systemic lupus erythematosus patient concordance to medication: does nurse initiated therapy make a difference?

Abstract Background/Aims Medication non-concordance in systemic lupus erythematosus (SLE) is associated with a higher risk of flares, hospitalisations and mortality. Patient non-concordance involves a complex interplay of both patient and physician factors including communication, the nature and severity of disease, treatment and the clinician-patient relationship. We hypothesise that patients starting medication initiated by a specialist nurse would achieve better rates of medication concordance. Methods A retrospective analysis of patients attending the tertiary lupus clinic at King’s College Hospital was undertaken. Inclusion criteria included patients with a diagnosis of lupus being initiated on conventional DMARD therapy (mycophenolate, methotrexate or azathioprine) who had their medication prescribed and dispensed by the hospital pharmacy. Those starting biologics or receiving medication via shared care agreements were excluded. Patients were defined as concordant if they renewed all 3-monthly prescriptions over a 12 month period. Demographics, disease activity, employment status and ethnicity were recorded. We sought to assess differences in concordance between those initiated by nurse specialists vs doctors, and between those given written vs online information about the drug. Statistical analyses was performed using t-tests and Chi square. Results 45 patients were included in the analysis. The median age was 41.52 ± 12.04 years old with 86.9% females. 65% of patients were of black ethnicity, 56.5% of patients were employed and the median SLEDAI-2K score was 6 (6,8). 65% of patients were on mycophenolate, 26% on azathioprine and 6.5% on methotrexate. Concordance is summarised in the attached Table. In total, 64% (29/45) were concordant with medications over 12 months. All patients initiated by a nurse were concordant for the full 12 months, compared to only 6% (1/17) if initiated by a doctor. Interestingly, concordance was significantly higher if patients were given an online link to an information leaflet compared to when a paper leaflet was provided. Conclusion These findings suggest that patients with SLE who are initiated on DMARD therapy by a nurse specialist are markedly more likely to be concordant at 12 months when compared with those initiated by doctors, emphasising the vital role of nurse specialists in the care of patients with SLE. Disclosure R. Salerno: None. S. Ali: None. F. Dell’Accio: None. H. Lapham: None. J. Dobson: None. P. Gordon: None. C. Wincup: None.

Social media analysis of the nature of shared online content for orthodontic functional appliances: An observational study

Abstract Introduction: Increased smartphone accessibility has enhanced the speed and diversity of the dissemination of data, ideas, and thoughts. Notably, patients often turn to social media platforms to gather information on treatment options, share personal experiences, offer opinions, and choose the best health-care providers. Social media has been employed to distribute health information. Aims: This study aimed to analyze the content regarding orthodontic functional appliances posted on various social media platforms. Materials and Methods: The study analyzed content posted in August 2020 on four social media sites, namely, Instagram, YouTube, Twitter, and Reddit, focusing on terms related to orthodontic functional appliances. Data from the first 100 posts per keyword were collected and then recorded and coded in spreadsheets. Descriptive and statistical analyses were performed to elucidate the nature of the posted content. Results and Discussion: A total of 1204 posts were included in the study. Of these, 29.8.2% were photos and 51.8% were videos. Majority of the posts (65.3%) were about information sharing and uploaded by doctors (51.2%). The type of malocclusion was described as Class II in 18.4% of the posts but not specified in 72.8%. The overall usefulness of the posts was low. Posts of photos, posts on Instagram, and posts by doctors were found to be more significantly useful (P < 0.001). Conclusion: Patients, doctors, and academics extensively use social media platforms to disseminate orthodontic information. However, more useful posts on orthodontic functional appliances should be uploaded, including those on treatment effectiveness, patient experience, and patient–clinician relationships, which have been widely disregarded.

The Cultural Formulation Interview as a clinical tool in the assessment of eating disorders: a pilot study.

The Cultural Formulation Interview (CFI) in the DSM-5 is a person-centered instrument for systematically appraising the impact of sociocultural factors in psychiatric assessment. The CFI has been shown to be feasible, acceptable, and useful in various clinical contexts. However, to this date there is only one published report describing the use of the CFI with patients with eating disorders. To explore the potential benefits and challenges of utilizing the CFI in the assessment of eating disorders. As an addendum to an ongoing qualitative study about barriers to treatment for eating disorders for individuals with a migration background in Sweden, we utilized the CFI in the assessment of adult patients (n=8) in specialist eating disorder treatment. Interview data were analyzed employing a thematic analysis framework. Participants provided feedback using a standard form for evaluation of the CFI. Certain CFI questions proved especially meaningful in this context. In response to the CFI question about patient explanatory models, previously unrecognized ideas about causation emerged. These included perfectionism-a known risk factor for eating disorders-based on immigrant parents' career expectations and experiences of strict family control over life choices. In response to the CFI questions on cultural identity and its impact, the participants provided rich descriptions including important themes such as religion, racism, and ambiguities associated with being a second-generation immigrant. The final CFI question, eliciting concern about the patient-clinician relationship, revealed numerous examples of prejudice and unfamiliarity with migrant groups among healthcare providers. The CFI can be useful in the assessment of patients with eating disorders and should be further explored as a standard tool in specialist eating disorder services.

Perspective of Health Care Professionals and Cancer Survivors on the Usage of Technology in Consultations.

This study explored the integration of technology in healthcare consultations between healthcare professionals (HCPs) and cancer survivors. The research aimed to understand how technological tools influence the dynamics and environment of cancer survivor rehabilitation consultations. The study used Actor-Network Theory (ANT) to analyze the effects of new technological actors in consultations and Invisible Work Theory to uncover hidden workflows associated with technology implementation. The study combined observations and in-depth interviews with HCPs and cancer survivors conducted in March to May 2022, and a follow-up group interview in November 2023. The study revealed that technology's presence notably impacts the relationship between HCPs and cancer survivors, with HCPs expressing concerns that technology disrupts the consultation and challenges the relation. Over time, HCPs gradually began to use laptops during consultations to varying degrees, although the resistance to fully embracing technology persisted. This resistance is attributed to perceived pressure from management and a mismatch with established practices. The findings address the challenges in digital literacy and confidence among HCPs to facilitate the effective incorporation of technology and enhance the patient-clinician relationship. This research contributes to a deeper understanding of the interplay between digital health tools and patient-clinician relationships, highlighting the complexities and opportunities in digitizing healthcare consultations.

Fostering relational autonomy in end-of-life care: a procedural approach and three-dimensional decision-making model

Respect for patient autonomy is paramount in resolving ethical tensions in end-of-life care. The concept of relational autonomy has contributed to this debate; however, scholars often use this concept in...

Multidisciplinary teams and social science: a patient perspective.

Multidisciplinary teams (MDTs) are common in colorectal cancer and have been deemed important when providing care. Yet they take place outside of the patient, often with little consideration of the patient's views, goals and desires. In this paper specific examples from a patient perspective are integrated with the social science literature to provide an overview of areas of disconnect between MDT recommendations and the individual patient. The reasons for these disconnects are explored, including how MDTs relate to dyadic patient-clinician relationships, weak incorporation of patient-oriented outcomes in MDTs, poor integration of nonmedical patient information and the patient perspective and the impact of team dynamics and cognitive decision biases. Consideration of these issues should facilitate higher-quality MDT recommendations that are also more acceptable to patients.

The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic

BackgroundThe clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as “Working Alliance,” which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients’ care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients’ perspective to inform evidence-based practice.MethodsParticipants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance.ResultsThe findings highlight that an early working alliance entails the gradual development of patients’ confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients’ expectations, the trainee chiropractors’ qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance.ConclusionsEstablishing an early trainee chiropractor-patient working alliance involves a process of building patients’ confidence in the trainee chiropractors’ expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients’ perceptions of trainee chiropractors’ qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors’ explanations.

Willingness to take less medication for type 2 diabetes among older patients: The Diabetes & Aging Study.

To examine the willingness of older patients to take less diabetes medication (de-intensify) and to identify characteristics associated with willingness to de-intensify treatment. Survey conducted in 2019 in an age-stratified, random sample of older (65-100 years) adults with diabetes on glucose-lowering medications in the Kaiser Permanente Northern California Diabetes Registry. We classified survey responses to the question: "I would be willing to take less medication for my diabetes" as willing, neutral, or unwilling to de-intensify. Willingness to de-intensify treatment was examined by several clinical characteristics, including American Diabetes Association (ADA) health status categories used for individualizing glycemic targets. Analyses were weighted to account for over-sampling of older individuals. A total of 1337 older adults on glucose-lowering medication(s) were included (age 74.2 ± 6.0 years, 44% female, 54.4% non-Hispanic white). The proportions of participants willing, neutral, or unwilling to take less medication were 51.2%, 27.3%, and 21.5%, respectively. Proportions of willing to take less medication varied by age (65-74 years: 54.2% vs. 85+ years: 38.5%) and duration of diabetes (0-4 years: 61.0% vs. 15+ years: 44.2%), both p < 0.001. Patients on 1-2 medications were more willing to take less medication(s) compared with patients on 10+ medications (62.1% vs. 46.6%, p = 0.03). Similar proportions of willingness to take less medications were seen across ADA health status, and HbA1c. Willingness to take less medication(s) was similar across survey responses to questions about patient-clinician relationships. Clinical guidelines suggest considering treatment de-intensification in older patients with longer duration of diabetes, yet patients with these characteristics are less likely to be willing to take less medication(s).

Tackling Guideline Non-concordance: Primary Care Barriers to Incorporating Life Expectancy into Lung Cancer Screening Decision-Making-A Qualitative Study.

Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. Qualitative study based on semi-structured telephone interviews. Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS.

Older Adult and Primary Care Practitioner Perspectives on Using, Prescribing, and Deprescribing Opioids for Chronic Pain

Guidelines recommend deprescribing opioids in older adults due to risk of adverse effects, yet little is known about patient-clinician opioid deprescribing conversations. To understand the experiences of older adults and primary care practitioners (PCPs) with using opioids for chronic pain and discussing opioid deprescribing. This qualitative study conducted semistructured individual qualitative interviews with 18 PCPs and 29 adults 65 years or older prescribed opioids between September 15, 2022, and April 26, 2023, at a Boston-based academic medical center. The PCPs were asked about their experiences prescribing and deprescribing opioids to older adults. Patients were asked about their experiences using and discussing opioid medications with PCPs. Shared and conflicting themes between patients and PCPs regarding perceptions of opioid prescribing and barriers to deprescribing. In total, 18 PCPs (12 [67%] younger that 50 years; 10 [56%] female; and 14 [78%] based at an academic practice) and 29 patients (mean [SD] age, 72 [5] years; 19 [66%] female) participated. Participants conveyed that conversations between PCPs and patients on opioid use for chronic pain were typically challenging and that conversations regarding opioid risks and deprescribing were uncommon. Three common themes related to experiences with opioids for chronic pain emerged in both patient and PCP interviews: opioids were used as a last resort, opioids were used to improve function and quality of life, and trust was vital in a clinician-patient relationship. Patients and PCPs expressed conflicting views on risks of opioids, with patients focusing on addiction and PCPs focusing on adverse drug events. Both groups felt deprescribing conversations were often unsuccessful but had conflicting views on barriers to successful conversations. Patients felt deprescribing was often unnecessary unless an adverse event occurred, and many patients had prior negative experiences tapering. The PCPs described gaps in knowledge on how to taper, a lack of clinical access to monitor patients during tapering, and concerns about patient resistance. In this qualitative study, PCPs and older adults receiving long-term opioid therapy viewed the use of opioids as a beneficial last resort for treating chronic pain but expressed dissonant views on the risks associated with opioids, which made deprescribing conversations challenging. Interventions, such as conversation aids, are needed to support collaborative discussion about deprescribing opioids.

Enablers and barriers to a quaternary prevention approach: a qualitative study of field experts

ObjectiveThere is a growing concern about the sustainability of healthcare and the impacts of ‘overuse’ on patients and systems. Quaternary prevention (P4), a concept promoting the protection of patients from...

A Pharmacist-Led Process to Monitor Discrepant Urine Drug Screen Results.

A urine drug screen (UDS) is a common risk-mitigation strategy tool for prescribing controlled substances, particularly opioids. Due to their complexity, UDS results can be misinterpreted and thereby have profound impacts on the patient-clinician relationship. From 2021 to 2022, a clinical dashboard to review potentially discrepant UDS results-based on a comparison of the results to the patient's medication list-was made available by the Veterans Health Administration. This quality improvement project implemented a process for weekly clinical pharmacist reviews of the UDS dashboard. Significant discrepant UDS results were reviewed in depth. From June 2022 through September 2022, 700 UDSs were performed and 60 patients had significant discrepancies that warranted in-depth review. Pharmacist interventions during the review included 39 collaborations with medication prescribers to discuss follow up (65%), 25 queries to a prescription drug monitoring program (42%), and 9 confirmatory UDS on the original sample (15%). In-depth reviews were required for about 4 patients weekly, with a mean length of 14 minutes. A pharmacist-led process to monitor discrepant UDS results led to opportunities for collaboration with prescribers and positively impacted confirmatory testing at a rural veterans affairs health system.

Managing stigma together: Relationality in the wound clinic

Our paper contributes to studies of stigma and dirty work by asking ‘how can workers and clients of dirty work manage stigma together?’ With the purpose of appreciating the worker/client relational dynamics in an organisation characterised by stigma, we conducted an ethnography in a wound healing clinic where clinicians do the dirty work of caring for patients with socially stigmatising wounds. To guide and subsequently interpret our ethnographic observations, we developed an original theoretical framework informed both by realist social theory and by extant studies of how people cope with dirty work through techniques of refocusing, reformulating and recalibrating stigma. Our findings point at three types of patient-clinician relationships: of familiality, scripted compliance and obstruction. For each type of relationship, we trace the conditions of possibility (theorised as a relational configuration) and the plausible effects (theorised as relational goods and evils) on patients’ and clinicians’ capacity to cope with stigma together. Overall, we find that the types of relations threaded by workers and clients over time can be a powerful resource (or obstacle) for managing stigma together. Our paper points to future avenues for research on the materiality of social relations and on the significance of the broader sociological context in which specific relationships are threaded between relational subjects.

AI-Enhanced Healthcare: Not a new Paradigm for Informed Consent.

With the increasing prevalence of artificial intelligence (AI) and other digital technologies in healthcare, the ethical debate surrounding their adoption is becoming more prominent. Here I consider the issue of gaining informed patient consent to AI-enhanced care from the vantage point of the United Kingdom's National Health Service setting. I build my discussion around two claims from the World Health Organization: that healthcare services should not be denied to individuals who refuse AI-enhanced care and that there is no precedence to seeking patient consent to AI-enhanced care. I discus U.K. law relating to patient consent and the General Data Protection Regulation to show that current standards relating to patient consent are adequate for AI-enhanced care. I then suggest that in the future it may not be possible to guarantee patient access to non-AI-enhanced healthcare, in a similar way to how we do not offer patients manual alternatives to automated healthcare processes. Throughout my discussion I focus on the issues of patient choice and veracity in the patient-clinician relationship. Finally, I suggest that the best way to protect patients from potential harms associated with the introduction of AI to patient care is not via an overly burdensome patient consent process but via evaluation and regulation of AI technologies.