Physician Behavior Research Articles

A Physician's Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

It is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming support among physicians to screen for patient-level social needs, but only a minority of clinicians actually do so. The authors explored potential associations between physician beliefs about health disparities and behaviors to screen and address social needs among patients. The authors used 2016 data from the American Medical Association Physician Masterfile database to identify a purposeful sample of U.S. physicians (n = 1,002); data obtained in 2017 were analyzed. Chi-squared tests of proportions and binomial regression analyses were employed to investigate associations between the belief that it is a physician's responsibility to address health disparities and perceptions of physician behaviors to screen for and address social needs, accounting for physician, clinical practice, and patient characteristics. Of 188 respondents, respondents who felt that physicians have a responsibility to address health disparities were more likely than their peers (who did not feel that physicians have such a responsibility) to report that a physician on their health care team would screen for social needs that were psychosocial (e.g., safety, social support) (45.5% vs 29.6%, P = .03) and material (e.g., food, housing) (33.0% vs 13.6%, P < .0001). They were also more likely to report that a physician on their health care team would address both psychosocial needs (48.1% vs 30.9%, P = .02) and material needs (21.4% vs 9.9%, P = .04). With the exception of screening for psychosocial needs, these associations persisted in adjusted models. Engaging physicians to screen for and address social needs should couple efforts to expand infrastructure with educational efforts about professionalism and health disparities, especially underlying drivers such as structural racism and the social determinants of health.

Assessing patient experience of the tenets of osteopathic medicine.

Previous studies document that both osteopathic physicians and third-party observers identify an approach tothe patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit. The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians. More than 2000 patients at four outpatient clinicfacilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and whowere not pregnant were included in theanalysis. Survey results for 1,330 patient-physician encounters wereanalyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets ofosteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables. Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), andamong those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) wereincluded. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (β=0.332, p=0.00, se=0.052) and Satisfaction with the visit (β=0.209, p=0.01, se=0.081) only when the physician was a DO. Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with thevisit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.

Fertility Preservation Knowledge, Attitudes, and Self-Reported Behaviors of Resident Physicians.

Purpose: Fertility preservation (FP) and family building are important considerations for quality survivorship for young cancer patients. Resident physicians across all specialties encounter reproductive-aged cancer patients. The purpose of this study was to assess resident physicians' attitudes and awareness about FP with the goal to identify specific educational gaps to direct future training. Methods: The Institutional Review Board (IRB)-approved anonymous online survey was sent to resident physicians across specialties at three separate academic-affiliated campuses in one state. The survey consisted of three sections: awareness about FP options and knowledge about referral placement, attitudes and comfort levels discussing FP, and practices regarding FP. Data were collected in Qualtrics and analyzed by resident specialty, age, level of training, and gender. Statistical analyses were conducted with Prism. Results: Obstetrics and gynecology residents and fellows were significantly more aware of FP options in cancer patients than their counterparts in other specialties. Postgraduate year (PGY 3) residents and beyond were more aware of at least one male and one female FP option compared with PGY 1 and 2 residents. Of importance, we found that the majority of resident physicians are aware of FP options and the referral process, but they are uncomfortable discussing these techniques with their patients. Conclusion: To provide better education for patients, focus should be on outpatient educational activities for both the health care provider and the patient to facilitate conversation about FP.

The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting

ABSTRACT Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.

P02 Surgeon's narcissism, hostility, stress and meaning in life

Abstract Introduction Disruptive physician behaviour can affect patients’ safety. If surgical trainees throughout higher education experience disruptive behaviour, impaired work-life may follow. Therefore, we studied if surgeons were prone to disruptive behaviour in form of narcissism (N), hostility, perceived stress and the presence of meaning in life. Methods General surgeons in UK National Health Service from 2 hospitals participated with 3 level of training: senior house officer (SHO), specialist registrars (SPR) and consultants (CONS). Participants completed 52 VAS-formed questions plus demographics. Modified questionnaires were used for assessments of ‘Hostility’, ‘Narcissism’, Meaning in life, Quality of work-life and bullying. Results Altogether 33% of surgeons displayed narcissism and 22% could exhibit disruptive behaviour. By MANOVA significant differences between low, medium and high N groups was revealed in hostility (p&amp;lt;.01), perceived stress (p=.001), presence of meaning in life (p&amp;lt;.05). Regression analyses explained hostility both by N-scale (p=.000) and ‘being bullied during training’(p=.009) but negatively by ‘presence of meaning in life’(p=.004). Surgeons’ perceived stress was explained both by N-scale (p=.000) followed by ‘seeing others bullied during training (p=.000) and negatively by ‘working extra days beyond schedule’ (p=.007). Presence of meaning in life was explained mostly by ‘(eu)stress’ (p= .000) but negatively both by ‘doing extra work beyond schedule’ (p= .016) and hostility (p= .003). Conclusion Surgeons may exhibit disruptive behaviour in a challenging situation. Being bullied during surgical training predicted hostility. Seeing others being bullied during surgical training predicted stress. Eustress explained best surgeons’ experience of presence of meaning in life.

Preventing the overdiagnosis of chest sepsis in children: A quality improvement project.

Respiratory infections in children are one of the most common causes of hospital attendances and a common cause of sepsis. Most of these infections turn out to be viral in nature. However, the overuse of antibiotics is common and with increasing problems with antimicrobial resistance, changes to antibiotic prescribing practices need to be implemented urgently. To test our hypothesis that a significant number of children and young people are diagnosed with and treated for 'chest sepsis' unnecessarily by evaluating adherence to British Thoracic Society and National Institute of Clinical Excellence sepsis guidelines, and to implement measures to prevent overdiagnosis. A baseline audit undertaken, stratified patient risk as per NICE sepsis guidelines. Data were analysed to assess adherence to these guidelines following presentation of possible lower respiratory tract infection. Questionnaires were sent to Paediatric doctors in local hospitals and focus groups were held to qualitatively evaluate the barriers and facilitators to preventing overdiagnosis. These informed implemented measures. The baseline audit showed 61% of children under two, who are more likely to have a viral chest infection were treated with intravenous antibiotics. Seventy-seven percentof children had blood tests and 88% had chest X-rays (CXRs) which are not routinely recommended. A total of 71% with a normal CXRhad been treated with intravenous antibiotics. Barriers to preventing overdiagnosis included the over-sensitivity of the sepsis tool, anxiety and drug prescribing habits. Facilitators included visual cues and team work. Implemented changes including a revised sepsis pathway and raising awareness led to some positive changes. However, upon re-auditing there was no significant change in the number of children being overdiagnosed. Initial audit results supported our hypothesis that children were being overdiagnosed, over-investigated and over-treated. Despite multimodal interventions aimed at understanding the drivers underpinning these issues, the re-audit results mirrored the baseline audit despite a transient improvement following our campaign to raise awareness and further work to change physician behaviour is required.

Evaluation of Conflict of Interest in Consulting Fee Payments in Plastic Surgery and Related Specialties.

The Physician Payments Sunshine Act was enacted to increase transparency regarding physician and industry financial interests. Consulting fee payments constitute a large proportion of these financial relationships. The authors hypothesized that there are discrepancies among industry-derived consulting payments to medical and surgical specialties. The purpose of this study was to evaluate the distribution of consulting fee payments to plastic surgery and related specialties. This cross-sectional study used the publicly available Centers for Medicare & Medicaid Services Open Payments Program database for 2018. Consulting fee payments to physicians practicing in dermatology, internal medicine, neurosurgery, orthopedic surgery, otolaryngology, and plastic surgery were isolated and analyzed to identify discrepancies in consulting payments among these specialties and within plastic surgery. A total of $250,518,240 was paid in consulting fees to specialties analyzed, with the largest average payment made to orthopedic surgeons and neurosurgeons. Nearly half of physicians were paid at least $5000 for consulting fees in 2018. Most payments were not associated with contextual information. Among U.S. plastic surgeons, 4.2% held financial relationships with corporations and were likely to be paid more when consulting for small companies. Consulting payments make up a large proportion of payments included in the Open Payments Database. Although sex, state, company type, and sole proprietorship did not correlate with higher pay, plastic surgeons who consulted for small companies were paid more per payment than those working for large companies. Future studies are warranted to determine whether these industry financial relationships impact physician behavior.

The Impact of the Covid-19 Pandemic on Physicians in Turkey Towards Informed Consent

Background: The study aimed to figure out whether, how, and why the COVID-19 pandemic has changed physicians’ attitudes toward informed consent in Turkey. Materials and Methods: An online questionnaire was distributed to physicians through the snowball sampling method and 528 physicians treating COVID-19 patients turned in the questionnaire. Findings: Most of the physicians (n= 317) indicated that the COVID-19 pandemic has influenced their attitudes on informed consent, while 39.96% of them (n= 211) stated that the pandemic did not change their behaviors on informing patients and/or families. An overwhelming majority of the physicians (n= 259) emphasized the impact of the higher mortality rate of the disease, the lack of standard treatment for the disease, and the higher demand from patients and families for information on providing patients and/or families with more information. On the other hand, 18.30% (n= 58) of the physicians admitted that the pandemic has caused them to disclose less information because of the lack of time to provide information, the need for urgent treatment, and the lack of information regarding the risks, benefits, and outcomes of applied treatments. Conclusion: COVID-19 pandemic affected the majority of the physicians attitudes and behaviors toward informed consent.

Evaluation of Family Physician's Knowledge, Attitudes and Behaviors towards Post-COVID-19 Pulmonary Rehabilitation

Objective: This study was to evaluate the knowledge, attitude, and behaviors of family physicians working during the pandemic in terms of pulmonary rehabilitation for post-COVID patients, and to raise awareness of any deficiencies. Material and Methods: This descriptive study was conducted on family physicians working in the city centre of Kahramanmaraş during the COVID-19 pandemic. A 21-item questionnaire was created by scanning the relevant literature information to be applied to the participants. SPSS 22.0 statistical program was used to evaluate the data. P&lt;0.05 was considered significant. Results: Those who use correct resources showed statistically significant differences in the responses to certain issues (p&lt;0.05). These include pulmonary rehabilitation for post-COVID patients, the state of need (p=0.030), an increase in muscle strength and endurance (p=0.05), improvement in the quality of life (p=0.018), regular exercise and breathing being just as important as muscle training (p=0.043), rehabilitation of patients at the hospital (p=0.006), explanation of the necessity of rehabilitation to patients (p=0.000), recommendation of rehabilitation programs (p=0.023), suggestion of appropriate visual materials for the situation (p=0.037), and the benefit of follow-up for patients included in the program (p=0.000). Conclusion: There is a lack of knowledge, attitude and behaviour of family physicians about the pulmonary rehabilitation of post-COVID patients. Accordingly, it causes problems in treatment referral and follow-up regarding pulmonary rehabilitation.

Information needs, sources and seeking behaviour of physicians and residents during clinical decision-making and patient care process: A qualitative study

The aim of the present study was to investigate the information needs of physicians and residents during the clinical decision-making. The research has been performed with phenomenological approach and using semi-structured interview based on critical incident technique with 28 physicians and residents of the educational health care centers of Birjand city South Khorasan province, Iran. The results showed that the information needs of physicians and residents were mostly related to diseases, diagnosis, prescription, treatment, disease follow-up, learning and self-updating, education and research. The information sources utilized were categorized into three main themes of human sources, electronic sources and print sources. The barriers against their information seeking were personal, organizational, technological, skill related, nature of information seeking, and barriers related to information sources. The present study provides a clear picture of the information needs, the information resources and the barriers to finding information for physicians and residents, therefore, the results of the present study can help medical libraries to improve their collection of resources and services to support the information needs of physicians and residents. It also paves the way for designers of information systems in creating systems that suit the needs of physicians in every stage of clinical decision-making and helps libraries in solving the challenges of finding information for physicians.

Using of opioids for chronic pain: Controversies, guidelines, research needs

Using of opioids for chronic pain: Controversies, guidelines, research needs First in a series of five articles, Norm Buckley and Jason Busse explore the trials and tribulations associated with using opioids for chronic pain, particularly in Canada. The prescription of opioids for chronic pain is both clinically controversial and a highly politicized arena. Although rigorously developed clinical practice guidelines, when followed, can improve patient care, a number of other issues affect the behaviour of physicians, other healthcare providers and agencies responsible for access to treatment. This is the first of five editorials that will be published over the next year that will review the use of opioids for chronic noncancer pain, with a particular focus on Canada.

Knowledge, Attitudes and Behaviors regarding Tick-Borne Encephalitis Vaccination and Prevention of Tick-Borne Diseases among Primary Care Physicians in Bavaria and Baden-Wuerttemberg, Germany, May-September 2022.

In 2020, a record number of tick-borne encephalitis (TBE) cases was reported in major endemic areas in Germany, i.e., the southern federal states of Baden-Wuerttemberg and Bavaria. Most cases were unvaccinated. Other tick-borne diseases (TBDs), including Lyme borreliosis and tularemia, are rising, too. Thus, strategies are needed to increase TBE vaccination uptake in risk areas and promote education on TBD prevention. Primary care physicians are key providers of both vaccinations and TBD education. The TBD-Prevention (TBD-Prev) study aimed to investigate the knowledge, attitudes and behaviors of primary care physicians in Baden-Wuerttemberg and Bavaria with regard to TBE vaccination and prevention of TBDs and to derive strategies for increasing vaccination rates and improving knowledge about TBE and other TBDs in the population and among primary care physicians. We invited all primary care physicians (N = 14,046) in both states to participate by mail. Using standardized, self-administered questionnaires, available both on paper and online, we asked physicians anonymously about their knowledge, attitudes and behaviors with respect to TBE vaccination and TBD prevention and their need for further information/educational materials. A total of 2321 physicians participated between May and September 2022 (response rate 17%), of whom 1222 (53%) worked in Baden-Wuerttemberg and 1067 (46%) in Bavaria. Among the participating physicians, 56% were male, 71% were >50 years and 51% worked in an individual practice. Furthermore, 91% were aware of the German national vaccination guidelines, and 98% perceived their knowledge of the risks and benefits of vaccination as adequate. A total of 97% offer TBE vaccinations, 67% provide vaccination counselling during initial consultations with new patients and 64% actively remind patients about due vaccinations. In addition, 24% expressed a need for further information materials, mainly traditional, analogue media such as flyers (82%) and posters (50%), and named timeliness, quality assurance, easy comprehensibility and independence from the pharmaceutical industry as the most important characteristics of such materials. Almost all participating physicians reported offering TBE vaccinations and feeling well-informed about TBE vaccination and TBDs. However, active offering of vaccinations and education could be further improved, and additional, low-threshold information materials are needed. Based on these results, we will develop and provide various materials on TBE vaccination and TBDs, in particular flyers and posters, for use by physicians during consultations.

Commercializing Personal Health Information: A Critical Qualitative Content Analysis of Documents Describing Proprietary Primary Care Databases in Canada.

Commercial data brokers have amassed large collections of primary care patient data in proprietary databases. Our study objective was to critically analyze how entities involved in the collection and use of these records construct the value of these proprietary databases. We also discuss the implications of the collection and use of these databases. We conducted a critical qualitative content analysis using publicly available documents describing the creation and use of proprietary databases containing Canadian primary care patient data. We identified relevant commercial data brokers, as well as entities involved in collecting data or in using data from these databases. We sampled documents associated with these entities that described any aspect of the collection, processing, and use of the proprietary databases. We extracted data from each document using a structured data tool. We conducted an interpretive thematic content analysis by inductively coding documents and the extracted data. We analyzed 25 documents produced between 2013 and 2021. These documents were largely directed at the pharmaceutical industry, as well as shareholders, academics, and governments. The documents constructed the value of the proprietary databases by describing extensive, intimate, detailed patient-level data holdings. They provided examples of how the databases could be used by pharmaceutical companies for regulatory approval, marketing and understanding physician behaviour. The documents constructed the value of these data more broadly by claiming to improve health for patients, while also addressing risks to privacy. Some documents referred to the trade-offs between patient privacy and data utility, which suggests these considerations may be in tension. Documents in our analysis positioned the proprietary databases as socially legitimate and valuable, particularly to pharmaceutical companies. The databases, however, may pose risks to patient privacy and contribute to problematic drug promotion. Solutions include expanding public data repositories with appropriate governance and external regulatory oversight.

149 A Mixed Methods Analysis of Disparities in the Management of Low-Risk Febrile Infants

OBJECTIVES/GOALS: Febrile infants are a model population for exploring communication, implicit bias, and health disparities in the pediatric emergency department. Using mixed methods, we performed an in-depth analysis of disparities and physician-parent communication, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We performed a multicenter cross-sectional study of febrile infants with low-risk for invasive bacterial infection evaluated between 2018-19 across 32 institutions. We performed logistic regression to assess the association between 1) race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic [H], Other Race and/or Ethnicity [O]) and 2) limited English proficiency (LEP) with the standard of care, discharge without lumbar puncture and without antibiotics. We concurrently performed in-depth semi-structured interviews with physicians to explore physician–parent communication and implicit bias in the management decisions for febrile infants. RESULTS/ANTICIPATED RESULTS: Of 3629 low-risk febrile infants, 74.2% received standard of care. NHB, compared to NHW, infants were more likely to receive standard of care (aOR 1.3 [95% CI 1.0-1.7]; aOR H: 1.1 [95% CI 0.9-1.4]; aOR O: 1.0 [95%CI 0.8-1.4]). There was no association between LEP and standard of care (aOR 0.8 [0.61–1.1]). When accounting for documented use of professional interpretation, families with LEP without documented professional interpretation were less likely than families without LEP to receive standard of care (aOR 0.6 [95% CI 0.4–0.9]). Thematic analysis of 13 physician interviews is expected to elucidate aspects of the physician-parent interaction that influence management decisions. DISCUSSION/SIGNIFICANCE: Infant race, ethnicity, and use of professional interpretation, are associated with the management of low-risk febrile infants. Physician behaviors that are influenced by the physician-parent interaction may represent modifiable targets for future interventions to promote health equity.

Physicians’ views on optimal use and payment system for telemedicine: a qualitative study

BackgroundTelemedicine is already in use in daily practice, but appropriate reimbursement and physician payment is falling behind in many countries. One reason is the limited availability of research on the matter. This research therefore examined physicians’ views on the optimal use and payment modalities for telemedicine.MethodsSixty-one semi-structured interviews were conducted with physicians from 19 medical disciplines. Interviews were encoded using thematic analysis.ResultsTelephone and video televisits tend not to be used as a first patient contact, except for triage of patients in urgency situations. Several minimum required modalities for the payment system of televisits and telemonitoring were identified. For televisits these were: (i) remuneration of both telephone- and videovisits to increase healthcare equity, (ii) little or no differentiation between videovisit and in-person visit fee to make videovisits financially attractive and sustainable for physicians, (iii) differentiation of televisit fee per medical discipline, and (iv) quality requirements such as mandatory reporting in the patient’s medical file. The identified minimum required modalities for telemonitoring were: (i) an alternative payment scheme than fee-for-service, (ii) remunerating not only physicians but also other involved health professionals, (iii) designating and remunerating a coordinator, and (iv) distinguishing sporadic vs. continuously follow-up.ConclusionsThis research investigated the telemedicine usage behavior of physicians. Moreover, several minimum required modalities were identified for a physician-supported payment system of telemedicine, as these innovations necessitate challenging and innovation of the healthcare payment systems as well.

Physician Perceptions of Performance Feedback and Impact on Personal Well-Being: A Qualitative Exploration of Patient Satisfaction Feedback in Neurology.

To understand neurologists' experiences and perspectives on patient satisfaction feedback and its impact on personal well-being and behavior. From May to June 2021, the researchers conducted 19 semistructured interviews with neurologists from a large academic medical center. Clinical Performance Feedback Intervention Theory informed a combined inductive and deductive thematic analysis of the qualitative data, which focused on perceptions of current feedback practices, its impact on physician behavior, and recommendations for improvement. Participants tended to be female (n = 12/19, 63.2%), aged 30-39 (n = 8/19, 42.1%), white (n = 9/19, 47.4%), and were 10+ years into clinical practice (n = 18/19, 94.7%). Physicians were receptive to feedback overall, but perceptions varied by feedback type. Physicians preferred informal feedback (delivered unprompted directly by patients), given its tendency toward actionability. They disliked formal feedback (derived from anonymous surveys) due to low actionability, bias and validity issues, lack of contextual considerations, delivery through public reports, and links to financial incentives. Nearly all physicians reported formal feedback programs had the potential to negatively affect well-being and were not beneficial to their practice; a few reported adjusting their clinical practice to improve patient satisfaction performance. Five recommendations to improve patient satisfaction feedback programs emerged: Align on feedback intent, acknowledge survey limitations during program administration, increase actionability of feedback through specificity and control, support direct patient-physician feedback and problem resolution, and support empathetic integration of feedback. Understanding physician perceptions of current approaches to patient satisfaction feedback offers the opportunity to shape subsequent collection and distribution methods to improve physician performance and optimize professional fulfillment.

Pharmacovigilance System in Georgia: A Study of Awareness, Behavior and Attitudes of Physicians and Pharmacists

Pharmacovigilance System in Georgia: A Study of Awareness, Behavior and Attitudes of Physicians and Pharmacists

Factors affecting patient satisfaction in the emergency department

Aim: The aim of the present study was to investigate patient satisfaction level and affecting factors in the Emergency Department of Ondokuz Mayıs University Hospital, and to contribute to improvements planned to be performed in the future in this regard. Methods: This study was carried out between 01/01/2018 and 03/30/2018 using the revised version of the questionnaire that was used in the study conducted in 2008 in the Emergency Department of Ondokuz Mayıs University Hospital. In the revised version, the questionnaire was applied to both outpatients and inpatients. Results: A total of 18,034 patients applied to the Emergency Department of Ondokuz Mayıs University Hospital during the study period and 284 of whom were followed-up as in patients in the emergency observation unit. The study was carried out with 565 randomly selected patients meeting the inclusion criteria. Of these patients, 187 (33.10%) were treated in the emergency observation unit and 378 (66, 90%) were treated in the emergency outpatient clinic. The rate of the patients who stated that they were satisfied with the service they received was 80.4% (304) in those receiving treatment in the emergency outpatient clinic while 88.2% (1165) in those receiving treatment in the emergency observation unit. Conclusion: Behaviors of nurses and physicians as well as their care and interventions were determined to be the most influential factors on patient satisfaction. In addition, it was revealed that there was a negative correlation between satisfaction and patient education level, where as a positive correlation between satisfaction and patient age and inpatient follow-up.

Behavior of general physicians about lung cancer screening in a French region hosting a pilot study

IntroductionLung cancer is the leading cause of cancer-related death in France and has a 5-year survival rate of 20%. Recent prospective randomized controlled trials revealed that lung cancer-specific mortality decreased in patients who underwent screening using low-dose chest computed tomography (low-dose CT). The DEP KP80 pilot study conducted in 2016 showed that an organized lung cancer screening campaign involving general practitioners was feasible. Material and methodWe conducted a descriptive observational study of screening practices by sending a self-reported questionnaire to 1013 general practitioners practicing in the Hauts-de-France region.Our study's primary aim was to investigate the knowledge and practices of general practitioners in the Hauts-de-France region of France regarding lung cancer screening using low-dose CT. The secondary endpoint was to compare practices between general practitioners in the Somme department who had experience of experimental screening and their colleagues in the rest of the region. ResultsThe response rate was 18.8% (190 completed questionnaires). Even though 69.5% of the physicians were unaware of the potential benefits of organized low-dose CT screening for lung cancer, 76% proposed screening tests for individual patients. Despite its proven ineffectiveness, chest radiography was still the most widely recommended screening modality. Half of the physicians stated that they had already prescribed chest CT to screen for lung cancer. Additionally, only 36.3% proposed chest CT screening for patients aged over 50 years with a history of more than 30 pack-years. The physicians working in the Somme department (61% had participated in the DEP KP80 pilot study) were more aware of low-dose CT as a screening modality, and offered it significantly more than their colleagues in the other departments (61.1% vs 13.4% p<0.01). All the physicians were in favor of an organized screening program. ConclusionMore than a third of general practitioners in the Hauts-de-France region offered for lung cancer screening using chest CT, although only 18% specified low-dose CT. Before an organized screening program can be set up, good practice guidelines must be made available about lung cancer screening.

Perceived guideline clarity impacts guideline-concordant care for breast cancer screening in women age 40–49

BackgroundCanadian and US Task Forces recommend against routine mammography screening for women age 40–49 at average breast cancer risk as harms outweigh benefits. Both suggest individualized decisions based on the relative value women place on potential screening benefits and harms. Population-based data reveal variation in primary care professionals (PCPs) mammography rates in this age group after adjusting for sociodemographic factors, highlighting the need to explore PCP screening perspectives and how this informs clinical behaviours. Results from this study will inform interventions that can improve guideline concordant breast screening for this age group.MethodsQualitative semi-structured interviews were performed with PCPs in Ontario, Canada. Interviews were structured using the theoretical domains framework (TDF) to explore determinants of breast cancer screening best-practice behaviours: (1) risk assessment; (2) discussion regarding benefits and harms; and (3) referral for screening.AnalysisInterviews were transcribed and analyzed iteratively until saturation. Transcripts were coded deductively by behaviour and TDF domain. Data that did not fit within a TDF code were coded inductively. The research team met repeatedly to identify potential themes that influenced or were important consequences of the screening behaviours. The themes were tested against further data, disconfirming cases, and different PCP demographics.ResultsEighteen physicians were interviewed. The theme of perceived guideline clarity (a lack of clarity on guideline-concordant practices) influenced all behaviours and moderated the extent to which the risk assessment and discussion occurred. Many were unaware of how risk-assessment factored into the guidelines and/or did not perceive that a shared-care discussion was guideline-concordant. Deferral to patient preference (screening referral without a complete discussion of benefits and harms) occurred when the PCPs had low knowledge regarding harms and/or if they experienced regret (TDF domain: emotion) resulting from prior clinical experiences. Older providers described patient’s influence impacting their decisions and physicians trained outside Canada, practicing in higher-resourced areas, and female physicians described being influenced by beliefs about consequences of benefits of screening.ConclusionPerceived guideline clarity is an important driver of physician behaviour. Improving guideline concordant care should start by clarifying the guideline itself. Thereafter, targeted strategies include building skills in identifying and overcoming emotional factors and communication skills important for evidence-based screening discussions.