Patient-Doctor Relationship Questionnaire Research Articles

Brief acceptance and commitment therapy for children and adolescents with type 1 diabetes.

Children and adolescents with diabetes face challenges that can significantly impact their quality of life. Investigating psychological interventions for stress management can equip them with the skills needed to cope with type 1 diabetes. This study investigated the impact of a brief Acceptance and Commitment Therapy (ACT) intervention on stress management, diabetes acceptance, psychological flexibility, and patient-doctor relationships among this population. A total of 55 children, and adolescents from Romania participated in a four-session ACT intervention for type 1 diabetes. The evaluation instruments used were the Perceived Stress Scale for Children (PSS-C), Acceptance and Action Diabetes Questionnaire (AADQ), Children's Psychological Flexibility Questionnaire (CPFQ), and Patient-Doctor Relationship Questionnaire (PDRQ-9). The participants (mean age = 14.14, SD = 2.26; 67% girls) reported lower stress levels, increased acceptance of diabetes, and greater psychological flexibility after the intervention. Additionally, the patient-doctor relationship was enhanced, potentially improving patient adherence to treatment. Positive qualitative feedback mirrored previous ACT research in the paediatric population, highlighting the beneficial role of experiential activities and metaphors when working with this target group. This study adds to the growing body of evidence supporting the effectiveness of ACT in enhancing healthy coping strategies among children and adolescents with chronic illnesses.

Perceived attitudes toward LGBTQ + physicians among individuals with psychiatric illness in the religiously diverse Southern Region of Thailand: a multihospital-based survey

ObjectivesThis study purposed to analyze perceived attitudes toward LGBTQ + physicians and related factors among individuals with psychiatric illnesses in southern Thailand.Materials and methodsFrom May to July 2023, a cross-sectional study was conducted at four psychiatric outpatient clinics in Southern Thailand. The questionnaires utilized were: 1) a demographic information questionnaire, 2) a questionnaire regarding attitudes toward LGBTQ + physicians, 3) a questionnaire evaluating individuals’ attitudes toward LGBTQ + physicians while receiving medical attention, and 4) a patient-doctor relationship questionnaire. All data were analyzed using descriptive statistics, and the factors associated with perceived attitudes toward LGBTQ + physicians were analyzed using the Wilcoxon rank sum test, the Kruskal–Wallis test, and linear regressions. The analyses were conducted using the R Foundation for Statistical Computing software, version 4.3.1. Statistical significance was defined as a p-value of less than 0.05.ResultsAmong our 542 participants, the mean age was 36.3 ± 14.1 years. The majority were female (64.6%), Buddhist (62.4%), and diagnosed with depression (46.3%). Approximately three-quarters showed a good doctor-patient relationship (74.0%). The median (IQR) score of the perceived attitudes toward LGBTQ + physicians was 75 (66, 88). Predominantly, the LGBTQ + physicians were perceived as normal (76.3%) and being a viable part of society (88.7%). Moreover, our participants disagreed with the view that being an LGBTQ + physician was a sin (70.6%) or immoral (68.2%). They felt comfortable during history taking (79.0%), physical examination not involving private parts of the body (72.5%), and management for both medical (78.4%) and psychiatric conditions (81.4%) at the hands of LGBTQ + physicians. However, they reported feeling uncomfortable during history taking involving private matters (6.3%) and the physical examination of private parts (16.4%). Older age, absence of LGBTQ + close relatives/friends, and being a Muslim were associated with lower scores of perceived attitudes toward LGBTQ + physicians. Conversely, a higher level of education and a reported mismatch between the patient’s sex and gender were associated with higher scores.ConclusionsMost participants reported positive perceived attitudes toward LGBTQ + physicians. However, some age groups and adherents of Islam showed lower perceived attitude scores and reported feeling uncomfortable receiving medical treatment from LGBTQ + physicians. On the one hand, LGBTQ + physicians have cause to be concerned about this point; on the other hand, finding appropriate approaches to promote positive attitudes toward LGBTQ + physicians among these groups of people remains a necessity.

Attachment styles and healthcare utilization: exploring the role of the patient-doctor relationship

BackgroundWith the purpose of improving healthcare, past research has examined the link between healthcare utilization and attachment. It is suggested that an individual’s attachment style influences both the quality of their patient-physician relationship and healthcare utilization patterns. Nevertheless, most studies concentrate on the individual aspect, overlooking the dyadic dimension; specifically, the investigation of how insecure attachment relates to health behavior within patient-physician relationships. This gap leaves the role of the patient-doctor relationship in this process unclear. Therefore, to elucidate this complex interplay, we hypothesized that the correlation between attachment and healthcare utilization is mediated by the quality of the patient-physician-relationship.MethodParticipant selection was based on electoral districts, a random-route procedure, and the Kish selection grid. The participants were visited by a trained interviewer who collected psychometric and sociodemographic information. Participants answered the Experiences in Close Relationships-Revised questionnaire (ECR-RD8) and the Patient-Doctor Relationship Questionnaire (PDRQ-9). Additionally, participants were asked about their healthcare utilization. The final sample consisted of N = 2.275 participants.ResultsIn average the participants reported consulting their primary health care practitioner M(SD) = 4.44 (4.76) times in the past 12 months. Generally, the participants rated the quality of the relationship with their primary health care practitioner close to “totally appropriate” (M = 4.12 ± .69). The degree of insecure attachment manifested towards the lower extremity of the scale. The total effect of the mediation analyses was significant. Regardless, the indirect effect indicated a trend result with minimal effect sizes.ConclusionThe findings of the current study bridged the gap between attachment styles and healthcare utilization. Nonetheless, our results suggested insufficient support for the mediating role of the primary care physician in the relationship between attachment style and healthcare utilization. Considering the characteristics of the sample, this outcome may not apply in a clinical context. However, further research is needed to shed light in the revealed trends and indicate implications.

Perceived attitudes toward LGBTQ+ physicians among Thai patients with psychiatric disorder: A multiregional cross-sectional study.

This study aims to examine attitudes toward LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and more) physicians among Thai psychiatric patients and to identify associated factors across three regions of Thailand. A cross-sectional survey was conducted from June to August 2023 in Central, Northern, and Southern Thailand. The Attitudes Toward LGBTQ+ Physician Questionnaire and a patient-doctor relationship questionnaire were utilized. Data analysis involved descriptive statistics and linear regression. The study included 543 participants with a median age of 37 years (IQR 26-52), predominantly female (68.9%) and Buddhist (78.1%). The median score for perceived attitudes toward LGBTQ+ physicians was 86 (IQR 73.0-95.5), with significant regional variations. Most participants perceived LGBTQ+ physicians as normal (85.5%) and integral to society (94.5%). A significant portion disagreed with the idea that being an LGBTQ+ physician was sinful (85.3%) or immoral (84.0%). However, 20.3% expressed discomfort with the possibility of LGBTQ+ physicians conducting private physical examinations. Lower perceived attitudes were associated with older age and being Muslim. Conversely, higher education, female gender, having LGBTQ+ connections, and a reported gender non-conformity showed a correlation with more positive attitudes. Thai psychiatric patients generally hold positive attitudes toward LGBTQ+ physicians, though demographic factors influence these attitudes. There needs to be a particular focus on improving attitudes regarding conducting private physical examinations to maximize patient comfort and trust.

Correlation between consultation time and patient´s satisfaction in primary care

It is important to understand how consultation time relates to patient satisfaction, as these two variables have not been extensively studied together. To determine the correlation between consultation time and patient satisfaction in primary care settings in Mexico. Cross-sectional, observational, and analytical study that included patients over 18 years old. Time was measured using a stopwatch, and satisfaction was assessed using the Patient Doctor Relationship Questionnaire (PDRQ-9). The correlation between both variables was analyzed using the Spearman test, and multiple linear regression was employed to associate satisfaction with the consultation. A total of 115 participants were included. The average consultation duration was 12.1 minutes, and 74% of patients reported that the consultation time was adequate. A weak positive correlation (p < 0.001, r = 0.38) was found between actual consultation time and satisfaction. Multiple linear regression demonstrated that for every minute increase in consultation time, level of satisfaction increased in 0.04 units (p = 0.001, CI95%: 0.016-0.063). Most patients reported satisfaction with the duration of their medical consultation, and longer consultation times were associated with higher satisfaction levels.

Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine.

Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.

Factors predicting medication adherence among Omani patients with chronic diseases through a multicenter cross-sectional study

Management of chronic diseases is complex and requires a long-term commitment to therapeutic medications. However, medication adherence is suboptimal. There is limited understanding of factors predicting medication adherence in chronic diseases in Oman. This study aimed to examine predictors of medication adherence (i.e. patient clinical and demographic data, patient-physician relationship, health literacy, social support) among Omani patients with chronic diseases. This study used a cross-sectional correlation design. Data were collected from 800 participants using convenience sampling between December 2019 and April 2020. Arabic versions of the Brief Health Literacy Screening tool, Multidimensional Scale of Perceived Social Support, Patient-Doctor Relationship Questionnaire, and Adherence in Chronic Disease Scale were used to measure study variables. Descriptive statistics, independent t tests, one-way ANOVA, Pearson correlations, and multivariate linear regression were used for analysis. The study found that factors such as the patient-physician relationship, social support, disease duration, employment status, and medication frequency significantly predicted medication adherence. Medication adherence was higher among those who were unemployed, had a better patient-physician relationship, and greater social support. However, medication adherence was lower with longer disease duration and higher daily medication frequency. Additionally, medication adherence was positively associated with perceived social support and the patient-physician relationship, but not with health literacy. In conclusion, the study reveals that patient characteristics, social support, and patient-physician relationships are key factors in predicting medication adherence in patients with chronic diseases in the Middle East. It emphasizes the importance of improving these aspects, considering factors like employment status, disease duration, and medication frequency, and enhancing healthcare provider-patient relationships and social support systems to boost adherence.

Knowledge and attitudes on medication adherence and residual symptoms in individuals with depression: a survey at a University Hospital

BackgroundDepression is a common disease and the relapse of depression can cause functional impairment. Good medication adherence and relapse prevention should be targeted to achieve normal functioning. This study aimed to evaluate the levels of knowledge, attitude toward depression, and medication adherence among individuals with depression.MethodsA cross-sectional study surveyed Thai individuals with depression at the psychiatric outpatient clinic of Songklanagarind Hospital; from April to August 2022. The questionnaires inquired about:1) demographic information, 2) knowledge and attitude toward depression questionnaire, 3) the medication adherence scale in Thais (MAST), 4) the Patient Health Questionnaire-9 (PHQ-9), 5) the stigma questionnaire, 6) a patient-doctor relationship questionnaire (PDRQ-9), and 7) the Revised Thai Multidimensional Scale of Perceived Social Support (rMSPSS). All data were analyzed using descriptive statistics. Chi-square or Fisher’s exact test, and Wilcoxon rank sum test were used.ResultsOf all 264 participants, the majority of them were female (78.4%). The overall mean age was 42.3 ± 18.3 years. Most participants had good knowledge and a positive attitude regarding any relationship problems, childhood trauma or bad memories, or having a chemical imbalance in the brain as one of the main causes that result in depression (86.4, 82.6, 77.3%, respectively). They disagreed with common stereotypical assumptions towards individuals with depression. Most of them had good medication adherence (97.0%), low or no level of stigma (92.5%), high perceived social support from family (64.4%), and good doctor-patient relationships (82.2%). Due to most participants reporting having good medication adherence, then an attempt to indicate the factors associated with medication adherence could not be established in this study. This study found that individuals reporting residual symptoms of depression had higher levels of knowledge and perceived stigma, but lower levels of family support compared to those without residual symptoms.ConclusionMost participants reported good knowledge and a positive attitude toward depression. They exhibited good medication adherence, a low level of stigma, and a high level of social support. This study revealed a correlation between the presence of residual symptoms of depression and increased levels of knowledge, perceived stigma, and reduced family support.

The effect of using internet hospitals on the physician-patient relationship: Patient perspective

BackgroundInternet hospitals are rapidly developing in China. Despite many studies regarding internet hospitals, there has been little further research that evaluates the impact of using internet hospitals on the physician-patient relationship during outpatient visits. MethodsWe developed a questionnaire based on the patient-doctor relationship questionnaire (PDRQ-9) to survey the physician-patient relationship. A sample of 505 patients who sought medical services from offline physical or internet hospitals was selected by convenience sampling. Multiple linear regression analysis was performed to determine whether the use of internet hospitals during outpatient visits was associated with the physician-patient relationship. ResultsInternet hospital users gave significantly lower scores than nonusers in total physician-patient relationship scores (P =.01) and in the 5 items of “My physician helps me” (P <.001), “I trust my physician” (P =.001), “My physician understands me” (P =.002), “My physician and I agree on the nature of my medical symptoms” (P =.01), and “I can talk to (communicate with) my physician freely” (P =.005). Multiple linear regression results showed that the use of internet hospitals during outpatient visits influenced the physician-patient relationship. And after controlling for other patient characteristics, the use of internet hospitals decreased the physician-patient relationship scores by 11.9%. ConclusionsOur findings suggest that the current use of internet hospitals could not significantly enhance the physician-patient relationship during outpatient visits. Therefore, we should work on improving physicians’ online communication skills and strengthening the level of trust between physicians and their patients. Policymakers should also pay close attention to the gap of the physician-patient relationship between internet hospitals and offline physical hospitals.

Psychometric properties of the GP-Patient Relationship Questionnaire as an instrument for quality improvement in Germany

IntroductionSince the patient-doctor relationship (PDR) plays a crucial role in patient primary health care and management, the evaluation of the PDR from both, the patients’ and primary care physicians’, perspectives is an important approach to improve the quality of primary care. However, although there are a variety of questionnaires surveying the patients’ view of the PDR, only few consider the physicians’ perspective. The purpose of this study was to develop a questionnaire that adds the physicians’ perspective to an existing PDR instrument and thus enables a mutual assessment of the relationship. MethodsThis study was embedded in a German project aiming at enhancing the adherence in patients with hypertension. Patients and primary care physicians were asked to complete a questionnaire concerning their PDR. The Patient-Doctor Relationship Questionnaire (PDRQ-9) was used to assess the patients’ perspective. For the physicians, the PDRQ-9 items were adapted to the physicians’ perspective resulting in the GP-Patient Relationship Questionnaire (GPPR). The Helping Alliance Questionnaire (HAQ) was used for external validation. ResultsA total of 60 physician questionnaires and 50 matched pairs of questionnaires from physicians and patients were included in the analyses. Within the analysis, notable deviations were found for one item, nevertheless the calculated Cronbach’s α of 0.89 showed a high internal consistency of the 9-item questionnaire. External validation showed a high correlation of the GPPR with the HAQ, confirming the good psychometric properties demonstrated for the overall instrument. DiscussionOverall, this initial validation study revealed good psychometric properties of the GPPR. A retest will be performed in the course of the overall project to confirm the reliability of the newly developed questionnaire. ConclusionA new questionnaire to assess the physicians’ perspectives on the PDR was successfully developed to improve adherence-dependent processes of quality improving in primary care.

Doctors' and Patients' Perceptions of Impacts of Doctors' Communication and Empathy Skills on Doctor-Patient Relationships During COVID-19.

BackgroundDuring the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor–patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors’ communication and empathy skills on DPRs during the COVID-19 pandemic.ObjectiveTo examine the perceptions of doctors and patients on how doctors’ communication skills and empathy skills influence DPRs during COVID-19.Main MeasuresDoctors’ and patients’ perceptions of doctors’ communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients.ResultsA total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors’ empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors’ communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors’ empathy had a greater mediating effect than their communication.ConclusionsDuring COVID-19, there were both similarities and differences between Chinese doctors’ and patients’ views on how doctors’ communication and empathy skills influenced DPRs. The greater effect of doctors’ empathy skills suggests that both doctors and patients attach more importance to doctors’ empathy in doctor–patient interactions. The bi-directional effect on patient outcomes suggests that both doctors’ communication and empathy skills are important to patients’ perceptions of DPRs.

Hastanın Hasta Merkezlilik Algısı Ölçeği Türkçe Geçerlik Güvenilirlik Çalışması

Background: Patient-centeredness is one of the components of high-quality care and accepted as one of the core competencies of family medicine. The positive effect of patient-centered care on health outcomes reveals itself mainly through the patient's perception of patient-centeredness, which can be measured by the Patient Perception of Patient-Centeredness (PPPC) scale. Aims: To evaluate Turkish validity and reliability of the 18-item 'patient perception of patient-centeredness' scale (PPPC-R) developed by Stewart et al. Study Design: Methodological study. Methods: The translation of the scale was performed by three researchers with the help of 10 family medicine academicians as well as the main developers of the original scale. The Turkish form of the scale, along with the Patient-Physician Relationship summary dimension of the Primary Care Assessment Scale (PCAS) and the Patient-Doctor Relationship Questionnaire (PDRQ), was applied to 339 primary care patients. Results: The original 3-factor model of the revised Patient Perception of Patient-Centeredness (PPPC-R) questionnaire was tested with a Confirmatory Factor Analysis (CFA) to determine if the factor structure of the PPPC-R cross-validates in a Turkish patient population. The fit indices regarding the three-dimensional structure of PPPC-R are within the good or acceptable limits. The standardized factor loadings of the PPPC-R scale items ranged from 0.52 to 0.81 and t values were significant. Cronbach alpha of the scale was 0.903. With respect to criterion, the validity scale showed a negative correlation with both PCAS and PDRQ as expected. Conclusion: The three-dimensional structure of the scale was confirmed with CFA. During this verification, one item did not work and the factor load was considered to be low and removed from the scale. Turkish version of PPPC-R is a scale that can be used to evaluate patients' perception of patient-centeredness.

PERCEPTION OF PATIENTS REGARDING HUMANIZATION IN MEDICAL CARE

Objective: To evaluate patients’ perception of humanization in medical care, regarding the integrality of the attendance and comparing the humanization of physicians from the FTC clinic with those from outside the FTC clinic. Methods: This was a descriptive, quantitative and cross-sectional study that was carried out with patients in the FTC Clinic – Ogunjá - Salvador /BA from December 2018 to May 2019. Data were obtained through the Patient-doctor relationship questionnaire (PDRQ-9). Results: The questionnaire was applied in 100 patients with mean age of 47.7 ± 14.1 years, the majority of them being female (70%). Regarding the statement related to the help provided by physicians, 42 (84%) patients who were already treated at the FTC clinic consider it as totally appropriate, in contrast only 26 (52%) patients who were never attended at the FTC clinic, consider the statement totally appropriate. Regarding the extent to which physicians are expansive and communicable, 50 (100%) patients who have already been seen at the FTC clinic consider this statement to be at least appropriate, while 16 (32%) participants from the other group judge as at most appropriate. Regarding the affirmative about the ease of access to the physician, the greatest discrepancy occurred in the presente study, when 49 (98%) patients who were already treatedat the FTC clinic declare this statement as atleast appropriate, where as 25 (50% %) patients who have never beenseenat the FTC clinic, judge as atmost appropriate. Conclusion: The physicians of the FTC clinic were better evalutated by their patients when compared too ther physicians in seven of the nine characteristics surveyed, which may berelated to the off erof the curriculum componente of humanism in the curriculum ofthe UNIFTC medical course, which comes contributing to the integrality of the doctor-patient relationship in the FTC clinic.

Does de-implementation of low value care impact the patient-clinician relationship? A mixed methods study.

Context: In the U.S., provision of LVC is prevalent (up to 20% of total health services), costly ($350 billion annually), and associated with patient harm. Concern about a negative impact on the patient-clinician relationship has been cited by primary care clinicians as a barrier to reducing LVC. Study Design: Mixed-methods study. Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading one of three vignettes about a clinician declining to provide a requested LVC service (antibiotics for sinusitis, screening EKG, or screening vitamin D test) or a comparison vignette. A different sample of participants was asked to imagine that their own clinician did not order requested antibiotics or screening EKG and then to respond to structured interview questions about satisfaction and trust. Setting: Primary care patients of a southwest Virginia health system. Population: Adults (n= 232 questionnaire/n= 24 interview). Outcome Measures: Participant demographics data, PDRQ-9 score for each vignette (higher score = greater relationship integrity), and thematic analysis of interview responses. Results: Among questionnaire participants, a lower PDRQ-9 score was associated with the vignette about not providing LVC vitamin D screening (31.2) compared with antibiotics (38.9), EKG screening (37.5), and the comparison vignette (36.4) (p<0.05). There was a statistically significant, but weak, correlation between education and PDRQ-9 score (r=0.2, p<0.01). More than half of interviewees believed that their satisfaction and trust would not be negatively impacted by not receiving the LVC service, citing the strength of their relationship with their clinician and faith in their guidance. Some even felt that not providing the service would increase their satisfaction and trust. Participants who believed their satisfaction and trust may be impacted seemed to recognize the complexity of the scenario, discussing medical necessity, potential harm, insurance, and the option to go elsewhere (ex: urgent care or a new doctor). However, most emphasized that negative impacts could be mitigated if the clinician listened to them, spent time with them, and offered understandable advice. Conclusions: Findings emphasize prioritization of the patient-clinician relationship in LVC de-implementation interventions and suggest minimal impact of such interventions on the patient-clinician relationship. Evidence of service-specific differences was observed.

Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

BackgroundThe importance of reducing low-value care (LVC) is increasingly recognized, but the impact of de-implementation on the patient-clinician relationship is not well understood. This mixed-methods study explored the impact of LVC de-implementation on the patient-clinician relationship.MethodsAdult primary care patients from a large Virginia health system volunteered to participate in a survey (n = 232) or interview (n = 24). Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading a vignette about a clinician declining to provide a low-value service: antibiotics for acute sinusitis (LVC-antibiotics); screening EKG (LVC-EKG); screening vitamin D test (LVC-vitamin D); or an alternate vignette about a high-value service, and imagining that their own primary care clinician had acted in the same manner. A different sample of participants was asked to imagine that their own primary care clinician did not order LVC-antibiotics or LVC-EKG and then respond to semi-structured interview questions. Outcomes data included participant demographics, PDRQ-9 scores (higher score = greater relationship integrity), and content analysis of transcribed interviews. Differences in PDRQ-9 scores were analyzed using one-way ANOVA. Data were integrated for analysis and interpretation.ResultsAlthough participants generally agreed with the vignette narrative (not providing LVC), many demonstrated difficulty comprehending the broad concept of LVC and potential harms. The topic triggered memories of negative experiences with healthcare (typically poor-quality care, not necessarily LVC). The most common recommendation for reducing LVC was for patients to take greater responsibility for their own health. Most participants believed that their relationship with their clinician would not be negatively impacted by denial of LVC because they trusted their clinician’s guidance. Participants emphasized that trusted clinicians are those who listen to them, spend time with them, and offer understandable advice. Some felt that not providing LVC would actually increase their trust in their clinician. Similar PDRQ-9 scores were observed for LVC-antibiotics (38.9), LVC-EKG (37.5), and the alternate vignette (36.4), but LVC-vitamin D was associated with a significantly lower score (31.2) (p < 0.05).ConclusionsIn this vignette-based study, we observed minimal impact of LVC de-implementation on the patient-clinician relationship, although service-specific differences surfaced. Further situation-based research is needed to confirm study findings.

Factors Associated With the Quality of the Patient-Doctor Relationship: A Cross-Sectional Study of Ambulatory Mexican Patients With Rheumatic Diseases.

BackgroundThe patient-doctor relationship (PDR) is a complex phenomenon with strong cultural determinants, which impacts health-related outcomes and, accordingly, does have ethical implications. The study objective was to describe the PDR from medical encounters between 600 Mexican outpatients with rheumatic diseases and their attending rheumatologists, and to identify factors associated with a good PDR.MethodsA cross-sectional study was performed. Patients completed the PDRQ-9 (Patient-Doctor Relationship Questionnaire, 9 items), the HAQ-DI (Health Assessment Questionnaire Disability Index), the Short-Form 36 items (SF-36), a pain–visual analog scale, and the Ideal Patient Autonomy Scale. Relevant sociodemographic, disease-related, and treatment-related variables were obtained. Patients assigned a PDRQ-9 score to each patient-doctor encounter. Regression analysis was used to identify factors associated with a good PDR, which was defined based on a cutoff point established using the borderline performance method.ResultsPatients were primarily middle-aged female subjects (86%), with substantial disease duration (median, 11.1 years), without disability (HAQ-DI within reference range, 55.3%), and with deteriorated quality of life (SF-36 out of reference range, 73.7%–78.6%). Among them, 36.5% had systemic lupus erythematosus and 31.8% had rheumatoid arthritis. There were 422 patients (70.3%) with a good PDR and 523 medical encounters (87.2%) involved certified rheumatologists.Patient paternalistic ideal of autonomy (odds ratio [OR], 3.029; 95% confidence interval [CI], 1.793–5.113), SF-36 score (OR, 1.014; 95% CI, 1.003–1.025), female sex (OR, 0.460; 95% CI, 0.233–0.010), and being certified rheumatologist (OR, 1.526; 95% CI, 1.059–2.200) were associated with a good PDR.ConclusionsPatient-related factors and the degree of experience of the attending physician impact the quality of the PDR, in Mexican outpatients with rheumatic diseases.

Doctor-patient relationship improved during COVID-19 pandemic, but weakness remains

ObjectiveTo assess the quality of the doctor-patient relationship (DPR) in China and possible influencing factors during the COVID-19 period from the patient’s perspective.MethodsAn online survey was carried out nationwide from March 12, 2020 to March 30, 2020 in China via a convenience sampling strategy. Patients who met the inclusion criteria were invited to complete a questionnaire regarding the quality of DPR, including sociodemographic information, the Patient-Doctor Relationship Questionnaire (PDRQ-9), and influencing factors for DPR during the pandemic.ResultsA total of 1903 patients were included. Our result showed that participants had a higher PDRQ-9 score during the COVID-19 pandemic (4.18 ± 0.51) than that before the COVID-19 pandemic (3.86 ± 0.67). Importance-performance analysis (IPA) revealed that doctor-patient communication, patient satisfaction, consultation time, doctor’s attitude, and medical knowledge were specific aspects that needed to be prioritized to improve the DPR. Multiple linear regression analysis suggested that positive media reports, telemedicine, and national policies had a significantly positive effect on the DPR during the pandemic (P < 0.05).ConclusionIn general, the DPR had been improved during the COVID-19 pandemic. Our research found the key points that needed to be prioritized to improve the DPR during the pandemic, which may provide effective suggestions for building a harmonious DPR in the future.

Experiences of Trans and Non-Binary Patients during Medical Transitioning and Associations with the Patient-Physician Relationship in Austria

Abstract Background Trans and non-binary (TNB) patients confront various issues in the healthcare system and with healthcare workers (HCWs) tasked with navigating complex systems to achieve optimal outcomes. The most time intensive and intimate contact TNB patients have is typically with physicians making the physician-patient relationship instrumental. This study aimed to explore the experiences of patient-physician relationship in TNB patients in Austria in order to identify caveats for future interventions. Methods We conducted an exploratory cross-sectional study using an online questionnaire consisting of 86 items including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9) distributed between June and October 2020 through various organizations working with TNB people. Austrian residents older than 18 who self-identified as TNB and were undergoing or finished medical transitioning were included. Descriptive statistics and linear regression models were applied. Results From a total of 91 participants, 58.3% identified as trans, 70.3% were assigned female at birth, and 87.7% were on hormone replacement therapy. Most (58.1%) perceived physicians as the most problematic HCWs, and 60.5% reported having never or rarely been taken seriously in healthcare settings. Linear regression model showed that PDRQ-9 score was associated with a diagnosis of a mental illness (beta=3.88, 95%CI 0.24 - 7.51), quality of life (beta=0.66, 95%CI 0.43 - 0.90), never being taken seriously (beta=11.69, 95%CI 2.91 - 20.47) and being misgendered (beta=-7.64, 95%CI -14.88 - -0.41) by HCWs. Conclusions TNB patients in Austria reported negative experiences in the healthcare system, mostly with physicians that often did not take their gender identity seriously or used inappropriate language. Future interventions should focus on increasing transgender care competencies across various components of medical education.

The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust.

A trusting physician-patient relationship is an essential component of high-quality care. To explore the relationship between the physician-patient relationship, physician empathy, and patient trust. Cross-sectional survey. A total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys. Physician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed. There were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician's benevolence and competence, and the physician-patient relationship (r = 0.49-0.75, P < 0.01 for all). Patients' evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician's benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15-0.21) and that the mediation effect of patient trust in physician's benevolence was significant (β = 0.24, 95% CI: 0.20-0.28), though the mediation effect of patient trust in physician's competence was not (β = 0.01, 95% CI: -0.02 to 0.02). Patients' perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician's benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients.

Design and Initial Validation of a Humanistic Care Evaluation Tool.

ObjectiveThis study aimed at developing and validating a humanistic care tool in Anhui province that could be used across Chinese public hospitals, and to reflect the humanistic care from patients’ perspective.ParticipantsA cross-sectional survey was conducted in three public hospitals of Anhui Province, China by adopting simple random sampling, which included 312 outpatients and 323 inpatients.MethodsThe dimensions of the tool were set according to “Further Improve Medical Service Action Plan” in China and Patient-Doctor Relationship Questionnaire. Cronbach’s alpha values were calculated and used to evaluate the reliability of this tool. Construct validity was tested by the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The associations between characteristics and humanistic care were analyzed by binary logistic regression.ResultsThese initial findings showed that about two-thirds of the respondents experienced humanistic care. Both the reliability and construct validity of the humanistic care evaluation tool were suitable Social aspects (location and yearly income), treatment style and having a regular doctor were significantly associated with better humanistic care (all P<0.05).ConclusionThe humanistic care tool can directly reflect the humanistic care from patients’ perspective, and can be popularized and applied across Chinese public hospitals. These findings have important implications to further improve medical service in Chinese public hospitals.