Patient-provider Communication Research Articles

Strategies to optimise the health equity impact of digital pain self-reporting tools: a series of multi-stakeholder focus groups

Abstract Background There are avoidable differences (i.e., inequities) in the prevalence and distribution of chronic pain across diverse populations, as well as in access to and outcomes of pain management services. Digital pain self-reporting tools have the potential to reduce or exacerbate these inequities. This study aimed to better understand how to optimise the health equity impact of digital pain self-reporting tools on people who are experiencing (or are at risk of) digital pain inequities. Methods This was a qualitative study, guided by the Health Equity Impact Assessment tool—digital health supplement (HEIA-DH). We conducted three scoping focus groups with multiple stakeholders to identify the potential impacts of digital pain self-reporting tools and strategies to manage these impacts. Each group focused on one priority group experiencing digital pain inequities, including older adults, ethnic minorities, and people living in socio-economically deprived areas. A fourth consensus focus group was organised to discuss and select impact management strategies. Focus groups were audio-recorded, transcribed verbatim, and analysed using a framework approach. We derived codes, grouped them under four pre-defined categories from the HEIA-DH, and illustrated them with participants’ quotes. Results A total of fifteen people living with musculoskeletal pain conditions and thirteen professionals took part. Participants described how digital pain self-reports can have a positive health equity impact by better capturing pain fluctuations and enriching patient-provider communication, which in turn can enhance clinical decisions and self-management practices. Conversely, participants identified that incorrect interpretation of pain reports, lack of knowledge of pain terminologies, and digital (e.g., no access to technology) and social (e.g., gender stereotyping) exclusions may negatively impact on people’s health equity. The participants identified 32 strategies, of which 20 were selected as being likely to mitigate these negative health equity impacts. Example strategies included, e.g., option to customise self-reporting tools in line with users’ personal preferences, or resources to better explain how self-reported pain data will be used to build trust. Conclusion Linked to people’s personal and social characteristics, there are equity-based considerations for developing accessible digital pain self-reporting tools, as well as resources and skills to enable the adoption and use of these tools among priority groups. Future research should focus on implementing these equity-based considerations or strategies identified by our study and monitoring their impact on the health equity of people living with chronic pain.

Talk2Care: Facilitating Asynchronous Patient-Provider Communication with Large-Language-Model

Despite the plethora of telehealth applications to assist home-based older adults and healthcare providers, basic messaging and phone calls are still the most common communication methods, which suffer from limited availability, information loss, and process inefficiencies. One promising solution to facilitate patient-provider communication is to leverage large language models (LLMs) with their powerful natural conversation and summarization capability. However, there is a limited understanding of LLMs' role during the communication. We first conducted two interview studies with both older adults (N=10) and healthcare providers (N=9) to understand their needs and opportunities for LLMs in patient-provider asynchronous communication. Based on the insights, we built an LLM-powered communication system, Talk2Care, and designed interactive components for both groups: (1) For older adults, we leveraged the convenience and accessibility of voice assistants (VAs) and built an LLM-powered conversational interface for effective information collection. (2) For health providers, we built an LLM-based dashboard to summarize and present important health information based on older adults' conversations with the VA. We further conducted two user studies with older adults and providers to evaluate the usability of the system. The results showed that Talk2Care could facilitate the communication process, enrich the health information collected from older adults, and considerably save providers' efforts and time. We envision our work as an initial exploration of LLMs' capability in the intersection of healthcare and interpersonal communication.

CommSense: A Wearable Sensing Computational Framework for Evaluating Patient-Clinician Interactions

Quality patient-provider communication is critical to improve clinical care and patient outcomes. While progress has been made with communication skills training for clinicians, significant gaps exist in how to best monitor, measure, and evaluate the implementation of communication skills in the actual clinical setting. Advancements in ubiquitous technology and natural language processing make it possible to realize more objective, real-time assessment of clinical interactions and in turn provide more timely feedback to clinicians about their communication effectiveness. In this paper, we propose CommSense, a computational sensing framework that combines smartwatch audio and transcripts with natural language processing methods to measure selected "best-practice'' communication metrics captured by wearable devices in the context of palliative care interactions, including understanding, empathy, presence, emotion, and clarity. We conducted a pilot study involving N=40 clinician participants, to test the technical feasibility and acceptability of CommSense in a simulated clinical setting. Our findings demonstrate that CommSense effectively captures most communication metrics and is well-received by both practicing clinicians and student trainees. Our study also highlights the potential for digital technology to enhance communication skills training for healthcare providers and students, ultimately resulting in more equitable delivery of healthcare and accessible, lower cost tools for training with the potential to improve patient outcomes.

Experiences with diagnostic delay among underserved racial and ethnic patients: a systematic review of the qualitative literature

ObjectiveDiagnostic delay is a pervasive patient safety problem that disproportionately affects historically underserved populations. We aim to systematically examine and synthesise published qualitative studies on patient experiences with diagnostic delay...

A qualitative exploration of the client-provider relationship and its role in discussing sexual health and HIV among African American women in the US South

ObjectiveSexually transmitted infections (STIs), including HIV, are a key contributor to psychological and physical morbidity across the United States (US). African American (AA) women are disproportionately impacted by STIs, particularly in the Deep South of the US. Strong patient-provider communication can help to increase client understanding of STI prevention and treatment options. This study aimed to explore factors influencing effective patient-provider relationships and communication around STIs (including HIV) and sexual health broadly, which will ultimately inform the refinement of a patient-provider communication tool for discussing PrEP as an HIV prevention method. MethodsAs part of a larger study focused on PrEP implementation, in-depth, semi-structured qualitative interviews were conducted among cisgender AA women who are PrEP-eligible, both with and without PrEP experience, as well as providers from three federally qualified health centers (FQHCs) and HIV service agencies in Alabama. Data were analyzed using content analysis. ResultsA total of 41 participants enrolled, including 21 clients (n = 6 PrEP experienced; n = 15 PrEP naïve) and 20 providers. Qualitative data were organized across the following domains: meaning of health and sexual health, factors influencing the client-provider relationship, and factors influencing sexual health discussions among clients and providers. Key factors influencing client-provider relationships were organized at client, provider, and clinic levels. Factors impacting sexual health discussions between clients and providers were organized at client, provider, and structural levels. ConclusionThese interviews identified key determinants of effective client-provider communication pertaining to sexual health among cisgender AA women in the US South who were receiving care at FQHCs and HIV service organizations. Individual, provider, and clinic-level factors were identified that have implications for designing sexual health interventions for cisgender AA women.

Patient experiences of cancer genetic testing by non-genetics providers in the surgical setting.

As indications for hereditary cancer genetic testing (GT) for patients with breast cancer (BC) expand, breast surgery teams offer GT to newly diagnosed patients to inform surgical plans. There is, however, limited data on the experiences of patients undergoing cancer GT by non-genetic providers. This study used in-depth interviews with 21 women recently diagnosed with BC at a large academic health system to capture their experiences. Post-positivist codebook thematic analysis was used to identify major themes from the interviews. Participants reported an overall positive experience of this GT process, stating that they prefer GT at an existing appointment shortly after their diagnosis, even though they described the conversation as brief. Many participants indicated thinking about or desiring GT before the offer was made. Interestingly, most participants did not see surgical decision-making as the main reason for GT and were instead motivated by concern for relatives and to have complete information. Interview data indicated areas for improvement in patient-provider communication, and most participants agreed that additional reference information on GT in the form of written or video materials would be helpful. Offering GT at an initial breast surgery appointment is acceptable and desired by patients with a new BC diagnosis and should be considered as a way to increase access to GT for these patients. However, additional information for patients is needed to close gaps in communication and provide a trustworthy reference following a busy medical appointment.

Exploring Perspectives on HIV Vulnerability Communication among Transgender and Gender Diverse Patients and Primary Care Providers.

Transgender and gender diverse (TGD) individuals represent a population with a heavy burden of HIV. Multi-level stigma encountered by TGD individuals can create significant barriers to discussing topics related to HIV prevention; however, research on communication between TGD patients and primary care providers (PCPs) about HIV vulnerability and prevention remains limited. This study used in-depth qualitative interviews with 25 TGD patients and 15 PCPs conducted in 2022 to explore perspectives on HIV vulnerability communication during primary care encounters. Overall, 14 of the TGD patients were nonbinary, genderqueer, or another gender identity; all but two participants identified as a sexual minority. The majority of PCPs (n = 11) were physicians. The range of years practicing medicine was between two and 39years. Thematic analysis was used to organize codes and establish themes. Three broad themes regarding factors that facilitate communication regarding HIV vulnerability were identified: (1) focusing on behaviors over identities, (2) conveying impartiality, and (3) acknowledging individuality among TGD patients. Findings corroborate earlier research that identified strengths in providers refraining from behavior-based assumptions tied to a patient's gender identity and sexual orientation and conveying impartial and nonjudgmental attitudes when discussing behaviors that can increase HIV vulnerability. Additionally, these findings underscore the significance of recognizing that, within the TGD community, all persons have unique circumstances, preferences, and needs. Future work should continue to explore the dynamics of HIV vulnerability and prevention discussions, especially among TGD individuals from diverse backgrounds and regions, to identify strategies for strengthening patient-provider communication and reducing vulnerability to HIV.

Factors Affecting U.S. Adults’ Comfort Level in Sharing Social Needs Information with Healthcare Providers

ObjectiveThis study examines various factors affecting U.S. adults’ comfort level in sharing information about their social needs with healthcare providers. MethodsWe used data from the 2022 Health Information National Trends Survey (cycle 6), a nationally representative survey of U.S. adults (n=6,252). The outcome variables were participants’ comfort level in sharing information about three social needs (food insecurity, transportation difficulties, and housing instability). Data were analyzed using weighted bivariate and multivariable logistic regression models. ResultsParticipants who faced discrimination when getting medical care based on race/ethnicity were more likely to be uncomfortable in sharing information about food insecurity, housing instability, and transportation difficulties. Those who trusted the healthcare system “a lot” were less likely to be uncomfortable in sharing information about food insecurity and transportation difficulties. Patient-Centered Communication (PCC) and social isolation scores significantly affected participants’ comfort level in sharing information about social needs. ConclusionVarious factors such as trust, discrimination, social isolation, and PCC were found to be significantly affecting US adults’ comfort level in sharing information about social needs. Practice implicationsHealthcare systems and policymakers should focus on developing approaches and strategies to enhance trust, reduce discrimination, improve patient-provider communication, and create supportive social environments.

Talking About Incarceration History: Engaging Patients and Healthcare Providers in Communication.

Incarcerated individuals in carceral facilities demonstrate an elevated prevalence of chronic disease conditions which are likely to persist post-release. Healthcare providers may not be trained on how exposure to incarceration may influence patient health outcomes and patient-provider communication. To examine the self-perceived preparedness of healthcare providers to interview patients regarding history of incarceration and the potential related health consequences. This cross-sectional study consisted of a web-based self-administered questionnaire distributed via email to a random sample of healthcare providers in the Department of Medicine at Brigham and Women's Hospital. In total, 400 healthcare providers were invited to participate; 114 respondents completed the survey, of which 26% were medical doctors (n=30), 41% were physician assistants (n=47), and 32% were nurse practitioners (n=37). Understanding healthcare provider training in caring for formerly incarcerated patients, current treatment practices and confidence caring for patients who have experienced incarceration, and implications for clinical care. Of 114 respondents, 73% reported that they currently care for formerly incarcerated patients. However, only 8% received specialized training for the care of formerly incarcerated patients. While most respondents did not ask their patients about prior history of incarceration (81%), when asked about comfortability in doing so, 60% reported low levels of comfort. Most providers (77%) reported high agreement that incarceration impacted health, with 54% reporting that it led to significant healthcare access barriers, but 64% reported low confidence levels in addressing the needs of formerly incarcerated patients. Healthcare workers recognized incarceration as a detrimental health exposure. However, providers reported low levels of confidence in understanding and addressing the unique needs of patients who experienced incarceration. Findings support the need for further training regarding how to address the needs of formerly incarcerated patients, which would support efforts towards achieving equitable healthcare.

Hispanic Breast Cancer Survivors Share Their Perceptions About Endocrine Blocking Therapy Adherence

Breast cancer is the leading cause of cancer-related mortality among Hispanic women in the U.S., despite a lower incidence compared to non-Hispanic White women. Hispanic women often face unique socio-economic and cultural barriers that impact timely diagnosis, treatment, and survival outcomes. Hormone receptor-positive breast cancer is prevalent in this population, with endocrine blocking therapy (EBT) recommended as a standard treatment. However, Hispanic breast cancer survivors exhibit higher rates of EBT non-adherence, influenced by factors such as side effects, medication access, and patient-provider communication. This study investigates the perceptions of Hispanic breast cancer survivors on EBT use and identifies factors contributing to adherence challenges, aiming to address disparities and improve outcomes.

The Role of Emotional Intelligence on the Patient's Quality of Care in Jordanian Healthcare Providers

Background: Emotional intelligence (EI) has emerged as a crucial factor in various professional domains, including healthcare. Understanding the impact of healthcare providers' emotional intelligence on patients' healthcare quality is essential for optimizing patient outcomes and satisfaction. Result: improved emotional intelligence in healthcare practitioners will be linked to improved patient satisfaction ratings and more effective patient-provider communication, which are indicators of the perceived quality of care. Conclusion: The findings of this study highlight the significant role of emotional intelligence in shaping patients' healthcare experiences and outcomes. Healthcare organizations should prioritize the development of emotional intelligence skills among healthcare providers through training and professional development initiatives.

Assessing the use of activity trackers in clinical practice: a survey of cardiac rehabilitation clinicians from Australia, Brazil, and Canada

Abstract Background The use of wearable activity trackers has been found to significantly improve health profile and cardiorespiratory fitness, as well as to reinforce positive health behaviours in patients participating in cardiac rehabilitation (CR) programs. However, clinicians’ perceptions of activity trackers and their use in clinical practice have not been widely explored. Purpose To describe perceptions, attitudes, and behaviours of CR clinicians towards the use and usefulness of activity trackers in CR programs, and identify barriers and enablers associated with their personal and clinical use. Methods Descriptive cross-sectional survey. Data were collected using Research Electronic Data Capture (REDCap) from April to December 2023. Clinicians working in CR programs were recruited in each country via social media, email and digital flyers, group chats and author networks. A purpose-built 44-item digital survey comprising four sections was constructed: (1) socio-demographic details, (2) personal and professional use of activity trackers, (3) perspectives on the use of activity trackers for CR, and (4) perceptions of factors affecting the use of activity trackers in CR. Results In total, 199 clinicians from Australia (n=44), Brazil (n=102) and Canada (n=53) responded to the survey. Most were women (74%), physiotherapists (37%), working at a metropolitan hospital (55%), with a median age of 35 years (range 22-71). The majority found activity trackers helpful for patients with goal setting and monitoring exercise (89%) and promoting patient engagement and autonomy beyond structured, supervised CR (75%). Activity trackers were also perceived to be useful in engaging patients in their own health (94%), improving patient-provider communication (73%), boosting patient adherence with directed exercise (87%), and improving patient’s understanding of their own health conditions (79%). Furthermore, activity trackers were perceived to enable a more personalised care (69%), increase accessibility to CR (45%) and be time- and cost-effective for CR programs (49%). Sixty percent were motivated to use activity trackers and 69% recommended the use of trackers to their patients. On the other hand, the use of activity trackers was reported to be related to dependence (44%) and excessive obsession of one’s own health (55%); 50% reported a lack of relevant policies on activity trackers for clinical use in their respective institutions and limited funding for purchasing activity trackers by health services (78%). Only 30% reported that there was support from leadership and/or peers for the use of activity trackers. Conclusion In general, clinicians held positive attitudes towards the use of activity trackers in CR. However, a lack of relevant policies, funding and support from leadership are important barriers to the adoption and use of activity trackers in CR programs. Development of guidelines for the use of activity trackers in clinical practice is warranted.

Looking beyond the eyes of the patient: The importance of effective communication in the treatment of age-related macular degeneration.

Patients with exudative and nonexudative age-related macular degeneration (AMD) can experience physical, mental, social, administrative or financial burden that are associated with the treatment of this progressive chronic disease. The role of healthcare providers in supporting patients who experience high treatment burden can be important, especially when it comes to effective communication. Despite previous research underlining the need to improve patient-provider communication in AMD care, patient experiences with communication, and how these are related to perceived treatment burden, remain underexplored. A survey was distributed among Dutch patients with AMD, which contained questions on several aspects of communication with the patient's ophthalmologist, such as the Quality Of communication Through the patients' Eyes (QUOTE-COMM, including task-, affect- and therapy-oriented communication) questionnaire. Patients were primarily enlisted through a patient association. A total of 162 patients completed the questionnaire, of which 133 provided fully completed responses. While patients reported positive experiences with affect-oriented communication of their ophthalmologist, they rated task- and therapy-oriented communication as below their expectations. Most patients wished to receive (additional) information on AMD-related costs (71%), future perspectives (71%) and coping with negative emotions pertaining to the disease (68%). Both lower experience scores on task- and affect-oriented communication and lower self-efficacy were associated with higher administrative burden and mental burden among patients. Our study shows that current communication, information provision and decision-making do not fully meet patients' needs and preferences. Enhancing patient-provider communication seems important, as effective dialogue is likely to diminish patients' perceived treatment burden.

Using the Candidacy Framework to understand individual, interpersonal, and system level factors driving inequities in women with breast cancer: a cross-sectional study

BackgroundPersistent inequities in breast cancer outcomes exist. Understanding women’s experiences along the care pathway is the first step to finding solutions to tackle these inequities.MethodsSecondary data analysis of the 2017/2018 English National Cancer Patient Experience Survey (n = 25,408) using logistic regression to explore inequities in care experience by sociodemographic factors (age, ethnicity, socioeconomic position, sexual orientation) across 59 survey questions. We used the Candidacy Framework to interpret and organise our findings.ResultsCompared to older (65–74) and White British women, young (35-44, OR = 0.55 [0.44, 0.69]), Asian (OR = 0.52 [0.41, 0.67]), Black (OR = 0.67 [0.46, 0.97]) and White Other (OR = 0.63 [0.49, 0.81]) women were more likely to rate their overall care experience less positively, respectively. Similar findings were observed along all domains of the cancer pathway. Through a candidacy lens, we identified multilevel factors related to this variation including prolonged help-seeking behaviours (individual), poor patient-provider communication (interpersonal), and variation in access to healthcare professionals and resources (system level).ConclusionMultilevel factors influence inequities in the experience of care along the breast cancer pathway for young women and women from minoritised groups. Interventions are necessary to ensure cancer care systems are responsive to women’s health needs and provide equity of care to all patients.

A 360-degree evaluation of the professionalism and communication skills of technologists working in the radiology department of a public sector tertiary care hospital in Karachi, Pakistan

BackgroundRadiologic technologists (RTs) are at the forefront of radiology departments and require optimal skills to demonstrate professionalism and effective provider–patient communication. Hence, the objective of this study was to determine the reliability of 360-degree evaluation as a feedback tool to improve competencies in this crucial workforce.MethodsA planned 360-degree evaluation was conducted using a 10-item tool to evaluate communication skills and professionalism among radiological technologists working at Dow University Hospital, Karachi. In total, 311 evaluations of fifteen radiological technologists were conducted while performing various diagnostic radiology procedures at the radiology department of Dow University Hospital. The data were analysed using SPSS version 26 to compute the evaluation scores and the reliability of 360-degree evaluation.ResultsA total of 311 RT-patient interactions were recorded over 48 days, with scores from all three raters. The evaluation tool was found to have good internal consistency for patients, faculty, and RT, with Cronbach’s alpha values of 0.89, 087, and 0.74, respectively. The study found an intraclass correlation of 0.66 (95% CI; 0.58–0.72), showing moderate reliability of the 360-degree evaluation across different raters.ConclusionWe conclude that 360-degree evaluation is a valid and reliable tool for determining the professionalism and communication skills of radiologic technologists and should be incorporated into training programs for formative and summative assessments. However, large-scale multicenter studies are crucial for generalizing these findings and incorporating 360 evaluations in radiological technologist training programs for formative and summative assessments.

Feasibility, Preference, and Impact of a Rapid Multiplexed Point-of-Care Digital Innovation (AideSmart!) to Expedite Screening of Sexually Transmitted Blood-Borne Infections in At-Risk Populations in Canada: Cross-Sectional Study.

With the need to expedite the detection of multiple sexually transmitted blood-borne infections (STBBIs), there is an increased demand for digital innovations and tests that improve the efficiency of point-of-care testing in outreach community settings. Multiplexed testing is being offered to at-risk populations by frontline health care professionals. With this in mind, we evaluated AideSmart! (for health aides or health care workers), an integrated app and platform solution that enables multiplexed STBBI screening at the point of care, for feasibility, preference, accuracy, and impact. With AideSmart!, we provided trained health care workers with the ability to perform rapid multiplexed tests; offer STBBI pre- or posttest counseling; maintain quality assurance of testing; facilitate linkages to care; and enhance health care provider-patient communication, data documentation, and patient engagement through the multiplexed STBBI screening and linkage process. We evaluated the performance of multiplexed tests. In a cross-sectional study conducted during the COVID-19 pandemic, we recruited at-risk populations in Canada from community-based organizations in Montreal, Quebec, and Saint John, New Brunswick, with unknown serostatus for HIV, hepatitis C virus (HCV), and syphilis. Following orientation and pretest counseling with AideSmart!, we performed multiplexed tests, simultaneously screening for HIV, HCV, and syphilis, using 2 rapid investigational multiplexed tests (Chembio for HIV and syphilis and MedMira for HIV, HCV, and syphilis) followed by confirmatory testing from local and national laboratories. Of the 401 participants, all (100%) accepted the AideSmart! multiplexed strategy: 59.4% (148/249) preferred multiplexed rapid tests over laboratory tests, and 56.6% (141/249) preferred receiving same-day test results. Rapid test results were obtained in 15 minutes (vs laboratory tests at 4-24 days). A total of 29 new infections (n=27, 93% HCV; n=1, 3% syphilis; and n=1, 3% HIV) were identified and treated within a week. Feasibility of the strategy (completion of testing and linkages to care) was at 76.1% (305/401). Health care professionals provided positive feedback and emphasized the importance of knowing one's negative or positive serostatus, especially during a pandemic. Multiplexed rapid tests' specificity (against laboratory reference standards) exceeded 98% (98.7%-100%) for all pathogens and devices. An electronic reader, used by the Chembio rapid test, enhanced sensitivity (HIV: 100%, 95% CI 79.4%-100%; syphilis: 86.8%, 95% CI 71.9%-95.6% [Chembio] vs HIV: 100%, 95% CI 78.2%-100%; HCV: 90.3%, 95% CI 80.1%-96.4%; and syphilis: 57.9%, 95% CI 40.8%-73.7% [MedMira]). The AideSmart! digital multiplexed rapid screening strategy for health care workers facilitated STBBI testing for multiple STBBIs and arranged for pre- or posttest counseling and rapid linkages with high feasibility and acceptability. Electronic readers enhanced the diagnostic performance of multiplexed biomarker tests. This study generated data in support of digital multiplexed strategies in digitally enabled settings for at-risk populations nationally and worldwide.

Plan of Care Visits: Implementation During Hospitalization and Association With 30-Day Readmissions in a Large, Integrated Health Care System.

Plan of Care of Visits (POCV), including the patient, nurse, and hospital provider were implemented across an integrated health system to improve provider-patient communication during hospitalization and patient outcomes. To assess POCV adoption after implementation, patient characteristics assosites were classified as teachsites were classified as teachsites were classified as teachsites were classified as ciated with POCV completion, and association of POCV with 30-day readmissions. This retrospective cohort study utilized electronic medical record (EMR) data of 237,430 adult patients discharged to home from 11 hospitals from January 2020 to December 2022. POCV completion was a discrete EMR variable. POCV adoption was estimated monthly by hospital as proportion of patients with at least 1 POCV during hospitalization, with variation among hospitals measured using the Variance Partition Coefficient (VPC). Multivariable logistic regressions assessed factors associated with POCV completion and POCV association with 30-day readmission. POCV adoption increased from 69% to 94% (2020-2022) and varied by 50% across hospitals (VPC 0.50, 95% CI: 0.29-0.70). Odds of a discharge-day POCV were lower among older patients (≥65 vs. 18-34y, OR 0.81, CI: 0.79-0.83), and higher among female (OR 1.06; CI: 1.04-1.07), Asian (vs. White, OR 1.13; CI: 1.06-1.21), Hispanic (OR 1.09; CI: 1.05-1.13), and surgical patients (vs. medical, OR 1.33; CI: 1.30-1.35). Patients completing discharge-day POCV had lower 30-day readmission odds (2022 OR 0.76, CI: 0.73-0.79). Patients with POCV on ≥75% of hospital days had similar readmission odds trends. POCV implementation was successful, and POCV completion was associated with fewer 30-day readmissions. Future work should focus on increasing POCV adoption while reducing hospital variation.

Patient motivation: A concept analysis.

Patient motivation is crucial in maintaining health-improving activities and helping patients recover from illnesses. Despite extensive research on patient motivation, this concept has not been clearly defined and remains ambiguous. The latest analysis of patient motivation was over two decades ago, thus necessitating the need to reexamine it in more updated literature. This study aims to explore the concept of patient motivation. The eight-step approach of Walker and Avant was used: concept selection, determining analysis aim, identifying concept use, defining attributes, model case identification, borderline and contrary case identification, antecedents and consequences identification, and empirical referent identification. Five databases, CINAHL, Cochrane, Medline, PubMed, ProQuest, and ScienceDirect, were searched for published works between 2014 and 2024 using the keywords "patient" and "motivation." The identified attributes of patient motivation are a psychological drive, a desire to adopt healthy behaviors, and goal-directed action. Antecedents of patient motivation are self-efficacy, provider-patient communication, and social support. Patient motivation leads to consequences, including healthier lifestyles and greater adherence and compliance. The present concept analysis draws upon current literature to suggest the antecedents, attributes, and consequences of patient motivation. Nurses can promote healthier lifestyles and greater adherence and compliance among patients by employing techniques to raise self-efficacy and provide social support while enhancing patient-centered interactions.

The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness.

Chronic pain and problematic substance use are prevalent among Veterans with homeless experience (VHE) and may contribute to a challenging primary care experience. To examine the association of chronic pain and problematic substance use with unfavorable primary care experiences among VHE and to explore the association of pain treatment utilization and unfavorable care experiences in VHE with chronic pain. We surveyed VHE (n = 3039) engaged in homeless-tailored primary care at 29 Veterans Affairs Medical Centers (VAMCs). We assessed unfavorable primary care experiences with four validated Primary Care Quality-Homeless (PCQ-H) scales: multivariable logistic regressions explored associations between unfavorable care experiences for VHE with chronic pain and problematic substance use, chronic pain alone, problematic substance use alone, or neither. We then examined the association between receipt of pain treatments and unfavorable experiences among VHE with chronic pain. Last, we identified PCQ-H items that had the greatest difference in unfavorable response rates between VHE with and without chronic pain. The prevalence of unfavorable primary care experience was higher on all four scales for patients reporting chronic pain (with or without problematic substance use) (all p < 0.001), but not for problematic substance use alone, compared to VHE with neither pain nor problematic substance use. In analyses limited to VHE with chronic pain, those on long-term opioids were less likely to report an unfavorable experience (OR = 0.49, 95%CI 0.34-0.69). Receipt of occupational therapy was associated with lower odds of reporting an unfavorable experience (OR = 0.83, 95%CI 0707-0.98). PCQ-H items related to trust, relationships, and provider communication had the greatest differences in dissatisfaction ratings (all p < 0.001). Chronic pain is associated with unfavorable primary care experiences among VHE, potentially contributing to poor care outcomes. Strategies are needed to enhance patient-provider trust and communication and increase VHE's access to effective pain treatments.

Motivators of and barriers to in-person health care and video telehealth utilization among older Black adults: a qualitative study

ABSTRACT Objective Older Black adults continue to experience heightened rates of chronic illness and poor health outcomes. Further, older Black adults must navigate interlocking systems of oppression (e.g. racism, ageism, ableism, and classism etc.) that impact their healthcare utilization. Telehealth has emerged as a common health care modality, which presents unique concerns for aging populations. Design The present study explored the motivators of and barriers to in-person healthcare and video telehealth use among a sample of predominantly lower-income, older Black adults. The researchers collaborated with community scientists to recruit, facilitate focus groups and provide technological support for participants. Sixteen virtual focus groups were conducted (n = 147) with older Black adults aged 55–84 years. The researchers utilized a thematic analysis approach to identify twelve distinct themes. Results Participants identified the following as motivators to using in-person health care: improved patient-provider relationships, increased community support, and more culturally sensitive resources. Limited accessibility, discrimination and resulting distrust, and poor patient-provider communication were identified as barriers to in-person health care use. E-health literacy and accessibility both emerged as motivators of and barriers to using telehealth, while disinterest in telehealth and impersonal patient-provider relationships were noted as additional barriers. Conclusion These findings provide key implications for reducing the burden of health care inequity for older Black adults. Future implementation research should use equity-focused frameworks such as the patient-centered culturally sensitive health care (PC-CSHC) model. Additionally, collaboration with the community is necessary to create and implement the necessary culturally sensitive health interventions.