Patient-healthcare Provider Relationship Research Articles

Trust in the health-care provider-patient relationship: a systematic mapping review of the evidence base

Trust is important for patients and may be used as an indicator and potential 'marker' for how patients evaluate the quality of health care. The review aimed to classify the current evidence base on trust in the patient-provider relationship in order to identify strengths and weaknesses and to point towards areas for future research. Nine electronic databases were searched from 2004 onwards using text and subject heading keywords relating to 'trust' and 'health care' and 'relationships'. Abstracts were identified for empirical studies carried out in health-care settings that explicitly examined trust or reported trust-related findings as a secondary outcome. Data extraction Two review authors assessed the relevance of abstracts and extracted data relating to year published, country of study, clinical speciality, and participants. Five hundred and ninety-six abstracts were included. Most reported on patients' trust in providers; were carried out in the USA; collected data in family care or oncology/palliative care settings; used questionnaires and interviews and elicited patients' perspectives. Only one study explicitly set out to examine providers' trust in patients and <5% of included studies reported on providers' trust in patients. Providers' trust in patients remains a neglected area on the trust research agenda. Empirical studies examining the factors that influence providers' trust in patients and how this might affect the quality of care and patient health-related behaviours are urgently needed to readdress this imbalance. Further exploration of this area using observational methods is recommended.

Knowledge, Attitudes, and Awareness of Croatian Dentists Concerning Patients’ Confidentiality and Privacy

Confidentiality and privacy have always been a vital part of the health care provider-patient relationship. The aim of this study was to identify and analyze the knowledge, attitudes, and awareness of dentists in Croatia concerning patients' confidentiality and privacy and to determine the degree to which they were protecting patients' confidentiality and privacy in everyday practice. Survey data were collected from seventy of the approximately 4,000 dentists in Croatia who had been randomly selected using the registry of the Croatian Chamber of Dental Medicine. Our strategy for data collection included visits to the dental offices and clinics. The data showed that dentists displayed a lack of awareness and had a poor attitude toward respecting patients' rights to confidentiality and privacy. This study indicated the need to educate dentists about their responsibilities and legal obligations.

Who will be the Patient Advocate on a Multidisciplinary Team?

Who among us has not experienced a potentially hazardous event or error in care when we, our family, or friends have been hospitalized? Errors can be readily recognized and corrected, but the occasions of suboptimal care that may arise from inadequate patient–health care provider (HCP) relationships are less obvious. An HCP disregarding a patient’s input or the patient failing to seek more information are examples of situations leading to suboptimal care resulting from impaired patient–HCP relationships. These situations where treatment regimens do not match patient abilities or preferences result in inadequate care and potential increased costs. Patients who are also medical professionals are more likely to recognize errors in care and intervene than are laypersons. What happens to non-informed patients? What problems might be prevented or efficiencies gained, if these individuals were better informed and supported to participate in their own care?

The effects of a multimodal training program on burnout syndrome in gynecologic oncology nurses and on the multidisciplinary psychosocial care of gynecologic cancer patients: An Italian experience

In cancer care, the burden of psycho-emotional elements involved on the patient-healthcare provider relationship cannot be ignored. The aim of this work is to have an impact on the level of burnout experienced by European Institute of Oncology (IEO) gynecologic oncology nurses (N = 14) and on quality of multidisciplinary team work. We designed a 12 session multimodal training program consisting of a 1.5 hour theoretical lesson on a specific issue related to gynecologic cancer patient care, 20 minute projection of a short film, and 1.75 hours of role-playing exercises and experiential exchanges. The Link Burnout Questionnaire (Santinello, 2007) was administered before and after the completion of the intervention. We also monitored the number of patients referred to the Psycho-oncology Service as an indicator of the efficacy of the multidisciplinary approach. After the completion of the program, the general level of burnout significantly diminished (p = 0.02); in particular, a significant decrease was observed in the "personal inefficacy" subscale (p = 0.01). The number of patients referred to the Psycho-oncology Service increased by 50%. Nurses are in the first line of those seeing patients through the entire course of the disease. For this reason, they are at a particularly high risk of developing work-related distress. Structured training programs can be a valid answer to work-related distress, and feeling part of a multidisciplinary team helps in providing patients with better psychosocial care.

Barriers to diabetes control from Syrian women's perspectives

Diabetes constitutes a major public health problem and is a leading cause of morbidity and mortality. The purpose of this study was to explore the barriers to diabetes control of middle-aged Syrian women with type 2 diabetes. A qualitative approach was adopted using conventional content analysis of semi-structured interviews carried out with 12 women with type 2 diabetes in the diabetic center in Lattakia (Syria) between March 2010 and December 2010. The participants were recruited by the purposeful sampling method. Three main themes emerged from the data analysis: (i) a poor patient-healthcare provider relationship; (ii) inadequate education; (iii) and psychosocial problems. The first theme had two subthemes: (i) relationship with doctors; and (ii) relationship with nurses. The second theme was without subthemes. The third theme consisted of six subthemes: (i) work and family responsibilities; (ii) motherhood role; (iii) lack of social support; (iv) anxiety; (v) depression; and (vi) low self-efficacy. The findings support that effective relationships can be enhanced through active listening and by opening a free channel for the flow of ideas and information between patients and healthcare providers. Additionally, providers have an important role to play in learning to identify and manage the psychosocial problems that arise in living with diabetes, so that their patients can be supported in overcoming barriers to managing their diabetes more effectively.

Using Diabetes Therapy Management Software to Support Behavior Change—A Case-based Approach

The management of diabetes is complex and requires a team approach for optimal outcomes. This team is comprised of the patient, numerous healthcare providers, and various technologies to elicit the behavioral changes needed in the ongoing care of the disease. This paper uses a case-based approach to demonstrate the patient–healthcare provider relationship and the use of various technologies when managing diabetes. The use of diabetes therapy management software demonstrates enhanced patient–healthcare provider communication, provides data showing that behavioral changes can improve outcomes, and allows the patient to enact positive self-management practices.

Adherence to oral endocrine treatments in women with breast cancer: can it be improved?

There is a perception that women on oral endocrine treatments for oestrogen receptor-positive breast cancer will be adherent to these medicines, as they are facing a serious life-threatening disease, and the oral endocrine treatments are effective, easy to use and generally well tolerated. This is not in fact the case, and this is the basis of the first half of this review. The second half is of whether the changes/interventions to 'improve' adherence do actually increase adherence to the oral endocrine medicines. The review shows that better outcomes are achieved with good adherence to endocrine treatments in breast cancer. The rates of adherence to endocrine treatments range between 15 and 50%, and are influenced by a large number of factors (e.g. adverse effects, lack of belief in treatment, psychological problems and poor patient-health care provider relationship). Interventions to minimise the adverse effects have been used in an attempt to improve the adherence to the endocrine treatment therapies, but it is not known whether these do actually improve adherence. Similar, it has been assumed that interventions by health professionals (doctors, nurses and pharmacists) will improve the adherence, but this has not been tested. In conclusion, in women with breast cancer, we know there is a problem with adherence. There are also many approaches and suggestions about how to improve adherence to the oral endocrine treatments, but none of these approaches/suggestions have been scientifically tested, and they need to be.

Older men&amp;rsquo;s satisfaction (or dissatisfaction) with health care delivery in St Catherine, Jamaica

Older men’s satisfaction (or dissatisfaction) with health care delivery in St Catherine, Jamaica Paul A Bourne1, Chloe Morris1, Christopher AD Charles2, Maureen D Kerr-Campbell3, Denise Eldemire-Shearer11Department of Community Health and Psychiatry and 2King Graduate School, Monroe College, Bronx, and Center for Victim Support, Harlem Hospital Center, New York; 3Systems Development Unit, Main Library, Faculty of Humanities and Education, The University of the West Indies, Mona, JamaicaAbstract: Patient satisfaction and quality of life are becoming increasingly important among the more traditional clinical outcomes in the monitoring and evaluation of health care delivery. This study explored patient’s self-rated health and patient satisfaction with health care ­providers, and examined whether health care providers are a barrier to patient care. The sample consisted of 2000 men aged 55 years and older in the parish of St Catherine, Jamaica. A 132-item ­questionnaire was used to collect the data. Descriptive statistics was used to provide information about their satisfaction with the health care system. Seventy-four percent of the sample indicated good self-rated health status (excellent, 19.0%). Forty-seven percent of the sample had sought advice from a health care provider in the last 12 months; 14.1% understood the advice of the clinician, community health aide (19.9%), pharmacist (15.4%), nurse (2.1%) and nurse aide (4.6%). The respondents indicated that community health aides contributed more to improving their health (43.4%) when compared with nurses (34.8%), clinicians (17.5%), and herbalists (3.7%). Furthermore, 31.7% indicated that their medical doctors were hospitable and 4.2% were knowledgeable. Negative self-rated health, perceived lack of knowledge among doctors, lack of understanding of advice from health care providers, are just some of the factors associated with dissatisfaction of patients with chronic conditions. These findings provide a framework and foundation from which further studies on effective intervention aimed at improving the health care provider-patient relationship and service can be conducted.Keywords: satisfaction, men, patient satisfaction, health care provider

Role Preference Characteristics in Persons With Asthma

Asthma self-management requires the patient and health care provider to work together. Understanding what role asthma patients prefer may improve adherence to the prescribed treatment plan and improve clinical outcomes. Role preference is how a patient prefers to participate in the decision making with their health care provider. There are 3 role preferences: passive, collaborative, and active. The objective of this study was to describe role preference characteristics in persons with asthma. The study sample consisted of 225 patients with asthma. Data collection included demographic and clinical characteristics. Patients were categorized into passive, collaborative, and active role groups using the Control Preferences Scale. Noninferential and inferential statistics were used to describe and explore the sample. Most demographic and clinical characteristics were not significantly different among the 3 role preference groups, except for education and environmental irritant exposures. Education level was significantly different in the sample, with lower education associated with passive role preference. Environmental irritant exposure was significantly different between collaborative and active role preference groups, suggesting active role preference patients are exposed to more environmental irritants. Asthma patient role preferences tend not to have the same associations that patients with other chronic diseases have. Age, gender, ethnicity, income, disease severity, and previous hospital admissions were not associated with passive role preference. However, highest level of education and environmental irritant exposures did vary by role preference. Health care providers should try to tailor the patient–health care provider relationship around the patient’s education level. Furthermore, health care providers should recognize how role preference may influence a patient’s willingness to employ environmental control measures.

Adherence to Disease-Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis

This paper synthesizes findings from available research about medication adherence to disease-modifying antirheumatic drugs (DMARDs) in the population with rheumatoid arthritis (RA). This review of literature included 35 articles. Medication adherence to DMARDs ranged from 30% to 107%. Adherence rates of more than 100% indicated that patients took more than the prescribed amount of medication. There were no consistent risk factors for nonadherence to DMARD prescriptions identified, but some evidence was provided for self-efficacy, patient-healthcare provider relationships, social support, patient beliefs about medications, and age as factors affecting medication adherence. Support for educational interventions focused on medication adherence was equivocal. Further research is necessary to develop a comprehensive, theoretically based understanding of medication adherence in RA patients.

Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

ObjectiveTo evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines.MethodsTwenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?'ResultsMost GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles.ConclusionQualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers’ perspective

Breast cancer and cervical cancer are major contributors to morbidity and mortality among Vietnamese Canadian women. Vietnamese women are at risk because of their low participation rate in cancer-preventative screening programmes. Drawing from the results of a larger qualitative study, this paper reports factors that influence Vietnamese women's participation in breast and cervical cancer screening from the healthcare providers' perspectives. The women participants' perspective was reported elsewhere. Semistructured interviews were conducted with six healthcare providers. Analysis of these interviews reveals several challenges which healthcare providers encountered in their clinical practice. These include the physicians' cultural awareness about the private body, patient's low socioeconomic status, the healthcare provider-patient relationship, and limited institutional support. This is the first Canadian study to identify the healthcare providers' perspective on giving breast and cervical cancer preventive care to the Vietnamese immigrant women. The insight gained from these healthcare providers' experiences are valuable and might be helpful to healthcare professionals caring for immigrant women of similar ethno-cultural backgrounds. Recommendations for the promotion of breast cancer and cervical cancer screening among Vietnamese women include: (i) effort should be made to recruit Vietnamese-speaking female healthcare professionals for breast and cervical health-promotion programmes; (ii) reduce woman-physicians hierarchical relationship and foster effective doctor-patient communication; (iii) healthcare providers must be aware of their own cultural beliefs, values and attitudes that they bring to their practice; and (iv) more institutional support and resources should be given to both Vietnamese Canadian women and their healthcare providers.

Living with chronic illness: A phenomenological study of the health effects of the patient–provider relationship

To understand the patient-healthcare provider (HCP) relationship from the lived experience of women with chronic disease and determine how this relationship affects women's health. Narrative accounts of 25 women's relationships with HCPs in repeated group and individual interviews were audio-taped and transcribed verbatim. Interpretive phenomenology was used to explore the data using three interconnected modes of paradigm cases, exemplars, and themes. Women with chronic disease believed their health was significantly affected by their relationships with HCPs. They experienced a greater sense of well-being and security in connected relationships and had more confidence and motivation to manage their illness. This research suggests that for women with chronic disease, relationships with HCPs that are connected, and characterized by partnership, and personableness result in the women feeling better in many dimensions. The context of today's healthcare system often pushes the nurse practitioner (NP) to provide care more attuned to medical issues, leaving little time for the development of connected relationships. In spite of this pressure, NPs need to strive to develop relationships with patients that are intersubjective/connected.

Balancing Ethical Principles in Emergency Medicine Research

This paper attempts to provide a broader view into the ethical issues surrounding the field of emergency medicine (EM) research. It starts from defining bioethically relevant features of EM and presents this field in the context of different models of health care provider-patient relationship. The paper also provides a short overview of the "post-Nuremberg" evolution of the main international research ethics guidelines relevant to EM research which demonstrates a tendency of liberalization of research on incapable persons. This tendency culminates with the exceptions to informed consent for EM research which is supposed to be balanced by other research ethics principles, especially a careful rationing of risks and benefits. This finally brings us towards a critical analysis of the minimal risk standard which is one of the main fundamental safeguards in EM research.

Patient Satisfaction With Treatment for Chronic Pain

Patient satisfaction with treatment has been extensively researched in a variety of medical patients. However, satisfaction with treatment of chronic pain has received considerably less attention. The present study sought to identify the predictors of patient satisfaction with treatment of chronic pain. In addition, the relationship between patient satisfaction and compliance with treatment recommendations was explored. One hundred eighty patients (84 men and 96 women) seeking treatment of chronic pain at University of Florida pain clinics were recruited for this telephone follow-up study. Satisfaction ratings were generally high, with ratings of satisfaction with care significantly higher (t179=9.58, P<0.001) than ratings of satisfaction with improvement. Aspects of the patient-provider interaction, pain relief, and anxiety at treatment onset predicted satisfaction with care. These same variables, with the exception of anxiety, also predicted satisfaction with improvement. Those patients who were more satisfied with their improvement were also more compliant with treatment recommendations, and this relationship was stronger for health care provider-rated compliance. Results suggest the importance of distinguishing between satisfaction with care and satisfaction with improvement in assessments. Satisfaction with treatment of chronic pain is not merely a matter of pain relief. To increase the probability of treatment success and satisfaction, attention to the interpersonal aspects of the health care provider-patient relationship appear critical. Explanations for satisfaction's stronger relationship to health care provider-rated compliance were discussed.

Measurement, correlates, and health outcomes of medication adherence among seniors.

To provide a comprehensive review of the literature on the measurement, correlates, and health outcomes of medication adherence among community-dwelling older adults. Searches of MEDLINE, PubMed, and International Pharmaceutical Abstracts databases for English-language literature (1966-December 2002) were conducted using one or more of the following terms: elderly, adherence/nonadherence, compliance/noncompliance, medication/drug, methodology/measurement, and hospitalization. From the above search, studies of medication adherence in community-dwelling seniors were selected for review along with relevant publications from the reference lists of articles identified in the initial database search. Although several methods are available for the assessment of adherence, accurate measurement continues to be difficult. The available evidence suggests that polypharmacy and poor patient-healthcare provider relationships (including the use of multiple providers) may be major determinants of nonadherence among older persons, with the impact of most sociodemographic factors being negligible. There is little consensus regarding other determinants of nonadherence. Relatively few high-quality investigations have examined the associations between nonadherence and subsequent health outcomes. Available data provide some support for increased health risks with nonadherence. However, interventions to improve adherence have seldom demonstrated positive effects on health outcomes. There are few empirical data to support a simple systematic descriptor of the nonadherent patient. The inconsistencies across studies may be attributable, in part, to the inherent difficulties involved in the measurement of a behavioral risk factor such as nonadherence. Future research in this area would be strengthened by incorporation of detailed assessments of patient-reported reasons for nonadherence, the appropriateness of drug regimens, and the effect of nonadherence on health outcomes.

Excellence in oncologic care: passion, priority, and performance.

Clinicians in academic medicine appreciate the paramount importance of science. Academic institutions achieve national ranking primarily based on grant funding and science. The true power of discovery is translation of science to better medical care and enhancement of society as a whole. That said, the fundamental patient–health care provider relationship was, is, and will remain the heart and soul of the American health care system. This relationship must prevail to fully realize scientific discovery. Those who push the frontiers of science are noble. Those who work tirelessly in service to their patients, who go the extra mile, are special. Bringing the “noble” and “special” together makes for an unbeatable team. In broad terms, optimal patient care requires excellence in 3 key areas: (1) personal qualities, (2) awareness of patient needs and desires, and (3) a well-functioning clinical delivery system.

Enhancing Patient Advocacy and Social Ethics

Clinical bioethics has focused largely on individual clinical case dilemmas. Less attention has been given to the everyday ethics of being good healthcare practitioners, physicians, nurses, social workers, respiratory therapists, and physical therapists. Rapid scientific and technical advances push for public and professional ethical concerns focused on science and technology. Consequently, scientific protocols and technologies receive more attention in ethical discourse than everyday ethical comportment and relationships between patients and healthcare providers. Yet, technical and scientific aspects of practice would be ineffective without good patient-healthcare provider relationships. Many ethicists are calling for broader concerns to be addressed in professional ethics. Meeting patients and their families and recognizing their concerns about healthcare comprise the everyday ethical comportment of the practitioner. Patients and families, while encouraged to become empowered and take more responsibility for their health, are often vulnerable due to lack of knowledge of healthcare or due to crisis and reduced capacities. Therefore, patients rely on healthcare workers to have a fiduciary relationship with them. 1,2 That is, ethically and legally, healthcare workers are expected to act in the best interests of patients. This requires that commercial or research interests, or any other sources of conflict of interest, not triumph over a patient’s best interests. Being faithful to a patient’s best interests also requires advocacy for patients and their families in complex healthcare settings. Bioethics needs to focus on more than clinical case dilemmas and ethical issues at the individual level. Advocacy for good everyday ethical comportment, and social ethics and public pol

Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients

Focus groups were conducted with HIV-infected, monolingual Spanish-speaking patients (N=81) taking antiretrovirals in order to: (1) determine what barriers impede medication adherence; (2) determine what strategies facilitate adherence; and (3) investigate the health care provider-patient relationship and whether it impacts adherence. Both quantitative and qualitative information was gathered. Participants were prescribed an average of 11 pills per day (M=11.4, SD=7.0, range=1-30). Only 32% of participants were consistently adherent when self-report of medication taking (yesterday, the day before yesterday, and last Saturday) was compared to prescribed regimen. The most frequently reported strategies were: learning more about the medications (77%), accepting the need to take them (75%) and refilling prescriptions early or on time (70%). Barriers most often reported were: feeling depressed or overwhelmed (21%), simply forgetting (19%) and sleeping through a dose (17%). From the qualitative data, four main issues emerged: patient characteristics, the health care professional-patient relationship, language and cultural barriers within the health care system, and the medication regimen. Among this Latino sample, having someone to live for was extremely important in terms of patient adherence. Language barriers were reported, and the use of translators was not always seen as a sufficient remedy. Differences between monolingual Spanish-speaking patients' and English-speaking patients' strategies and barriers are discussed.

Introduction: Special Issue on Health Care and Business Ethics

Health care has been a hot topic within the United States for over a decade. Despite the many changes that have taken place, health care—and more specifically, versions of what have been termed “managed care”—continues to be a subject of intense debate and ongoing change. Whether the discussion is about access to care, quality of services, costs of care, or strains in the health care provider-patient relationship, a wide variety of stakeholders (e.g., patients, health care providers, health care organizations) have expressed frustration with the health care system. One of the central rallying cries behind the debate about health care is concern about the influence of “business” on health care. This special issue emerges out of the recognition that health care remains in flux, that health care continues to be a controversial subject among a wide array of stakeholders, and that the influence of business on health care is a key underlying source of tension.Part of this debate has to do with what constitutes a just health care system. On the one hand, people in our society want to have access to high-quality care. More specifically, they want to be able to utilize the latest technology, care that is available when they need it (especially in crisis), a highly skilled care provider they can trust and develop a relationship with, and to not have to wait to gain access. On the other hand, people want a health care system they can afford. They want a health care system that is efficient, that offers reasonably priced services, and that doesn’t unduly strain the financial resources of families or the state.