Physician Communication Research Articles

Patterns of disruptions: Complexities of discursive-embodied triggers and resilience responses of individuals with autoimmune diseases

ABSTRACT Individuals with autoimmune diseases face a multiplicity of adverse disruptions throughout their lives that can span physical, emotional, social, and financial contexts. We employed the communication theory of resilience as a theoretical framework to explore how individuals with an autoimmune disease construct the connections between triggers and communicative resilience responses within their narratives. Utilizing abductive analysis, we identified four overarching trigger patterns: (1) linear, (2) cyclical, (3) compounding, and (4) branching. In examining the triggers and health journeys of individuals with autoimmune diseases, we can practically aid physician communication approaches for patients with complex symptomologies, diagnostic journeys, and trigger patterns.

Virtual reality evidence on the impact of physicians' open versus defensive communication on patients.

Using virtual reality (VR) in an experimental setting, we analyse how communicating more openly about a medical incident influences patients' feelings and behavioural intentions. Using VR headsets, participants were immersed in an actual hospital room where they were told by a physician that a medical incident had occurred. In a given scenario, half of the participants were confronted by a physician who communicated openly about the medical incident, while the other half were confronted with the exact same scenario except that the physician employed a very defensive communication strategy. The employed technology allowed us to keep everything else in the environment constant. Participants exposed to open disclosure were significantly more likely to take further steps (such as contacting a lawyer to discuss options and filing a complaint against the hospital) and express more feelings of blame against the physician. At the same time, these participants rated the physician's communication skills and general impression more highly than those who were confronted with a defensive physician. Nevertheless, communicating openly about the medical incident does not affect trust in the physician and his competence, perceived incident severity and likelihood of changing physician and filing suit.

Communication with physicians and family about breast Cancer recurrence

ObjectiveAdequate physician-patient communication about cancer recurrence is vital to quality of life and to informed decision-making related to survivorship care. The current study was guided by a cognitive-affective framework to examine communication with family and physicians about breast cancer recurrence risk. MethodsA survey of recently-diagnosed, early-stage breast cancer patients in Appalachia investigated physician-patient and familial communication about breast cancer recurrence risk. ResultsOver 30% of participants reported not talking to family or physicians about breast cancer recurrence risk. Younger patients reported more conversations, and speaking with physicians was associated with greater perception risk factors associated with recurrence risk. Greater worry about recurrence was associated with more communication with family and plans to talk to family, physicians, and friends about recurrence risk in the future. ConclusionAdditional supports for patients and physicians are needed to improve understanding of breast cancer recurrence risk and risk factors for recurrence. InnovationFamily communication about breast cancer recurrence risk is understudied. The combination of physician and family communication adds novelty to our analysis.

Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study.

Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Communication strategies used by medical physicians when delivering bad news at the Maputo Central Hospital, Mozambique: a cross-sectional study

BackgroundPhysicians’ communication with patients and their families is important during both the disease diagnosis and prognosis stages and through the follow-up process. Effective physician communication improves patients’ quality of life and satisfaction with care and helps reduce suffering for those newly diagnosed with advanced progressive illnesses. This study aims to identify the communication strategies physicians use in the transition to palliative care and how these professionals perceive their academic and clinical preparation concerning this task.MethodsA cross-sectional and quantitative study. Physicians providing palliative care at the Maputo Central Hospital, Mozambique, were invited to complete a 17-question questionnaire. This questionnaire was based on a Brazilian adaptation of the Setting-Perception-Invitation-Knowledge-Emotions-Strategy (SPIKES) tool, the P-A-C-I-E-N-T-E protocol, with additional questions regarding socio-demographic details and the integration of “communication of bad news” into hospital training.ResultsOf the 121 participants, 62 (51.2%) were male, and 110 (90.9%) were general practitioners, with a median age of 36 years old. They had worked in clinical practice for a median of 8 years and in their current department for three years. The majority of the participants considered that they have an acceptable or good level of bad news communication skills and believed that they do it in a clear and empathic way, paying attention to the patient’s requests and doubts; however, most were not aware of the existing tools to assist them in this task and suggested that delivering bad news ought to be integrated into the undergraduate medical course and included in hospital training.ConclusionsThis study adds to our understanding of physicians’ strategies when communicating bad news in the context of palliative care at one Mozambique hospital. As palliative care is not fully implemented in Mozambique, it is important to use protocols suitable to the country’s healthcare level to improve how doctors deal with patients and their family members.

Clinical competence, communication ability and adherence to choosing wisely recommendations for lipid reducing drug use in older adults

BackgroundAlthough lipid-lowering drugs are not recommended for primary prevention in patients 75+, prevalence of use is high and there is unexplained variation in prescribing between physicians. The objective of this study was to determine if physician communication ability and clinical competence are associated with prescribing lipid-lowering drugs for primary and secondary prevention.MethodsWe used a cohort of 4,501 international medical graduates, 161,214 U.S. Medicare patients with hyperlipidemia (primary prevention) and 49,780 patients with a history of cardiovascular disease (secondary prevention) not treated with lipid-lowering therapy who were seen by study physicians in ambulatory care. Clinical competence and communication ability were measured by the ECFMG clinical assessment examination. Physician citizenship, age, gender, specialty and patient characteristics were also measured. The outcome was an incident prescription of lipid-lowering drug, evaluated using multivariable GEE logistic regression models for primary and secondary prevention for patients 75+ and 65-74.ResultsPatients 75+ were less likely than those 65-74 to receive lipid-lowering drugs for primary (OR 0.62, 95% CI 0.59-0.66) and secondary (OR 0.70, 95% CI 0.63-0.78) prevention. For every 20% increase in clinical competence score, the odds of prescribing therapy for primary prevention to patients 75+ increased by 24% (95% CI 1.02-1.5). Communication ability had the opposite effect, reducing the odds of prescribing for primary prevention by 11% per 20% score increase (95% CI 0.8-0.99) for both age groups. Physicians who were citizens of countries with higher proportions of Hispanic (South/Central America) or Asian (Asia/Oceania) people were more likely to prescribe treatment for primary prevention, and internal medicine specialists were more likely to treat for secondary prevention than primary care physicians.ConclusionClinical competence, communication ability and physician citizenship are associated with lipid-lowering drug prescribing for primary prevention in patients aged 75+.

Abstract 15344: LVAD Recipients and Caregivers Understanding of Associated Complications

Introduction: Shared decision-making centers around accurate patient understanding of risk-benefits associated with a therapy. This study evaluates (i) patient and caregiver estimated risks for LVAD complications and (ii) describes how patients and caregivers rationalize estimated risks. Methods: We conducted a qualitative study using semi-structured interviews with 18 LVAD recipients and 9 caregivers between 1/13/2023 - 6/4/2023. Interviews were transcribed and coded, with themes identified using rapid qualitative analysis. Results: Included patients had a median age (range) of 60.5 (28-83) years, 12 (67%) were men, 12 (67%) were White and 10 (56%) received their LVAD as destination therapy (DT). Participating caregivers included 8 (89%) women supporting 5 (56%) DT LVAD recipients. Using the Penn Columbia Risk Score, 22% of the participants were high risk, 33% moderate risk, and 44% were low risk for mortality. When asked about patient physician communication participants ranked their interactions highly. Of all LVAD risks, both patients and caregivers demonstrated good understanding of risks of stroke and heart failure hospitalization after LVAD (89% and 72% respectively). However, both patients and caregivers described poor understanding of risks of GI bleeding and LVAD associated infections (63% patients and 25% caregivers for GI bleeding and 55% patients and 37% caregivers for infection). We identified three themes explaining how patients and caregivers rationalized under-estimation of LVAD risks (i) lack of awareness (ii) survivor bias (iii) minimization. Exemplary quotes highlighting these themes are provided in the Table below. Conclusion: Our qualitative study highlights the poor understanding patients have with regards to LVAD complications. This highlights the need to improve LVAD recipient and caregiver education on associated risks.

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study.

Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician's ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient's quality of care. This exploratory qualitative study was conducted at the largest academic medical center in Pakistan. Purposive sampling was used to approach participants from surgery, medicine, obstetrics and gynecology, pediatrics and family medicine. Faculty, fellows and residents working in these departments and medical students in their fourth and fifth years of undergraduate education with prior experience of at least one month in these specialties during their clinical rotations were included. Focus group discussions (FGDs) lasting 45-60 minutes were conducted with each cohort of healthcare professionals separately, using a semi-structured interview guide. Sixty participants (19 males and 41 females, mean age: 32.9, SD: 10.9) took part in the study. Thematic analysis revealed five major themes. Four themes focused on residents' biases and patient disparities hindering patient-resident communication: (1) patient-resident gender discordance (2) ethnicity and language barriers, (3) differing social class of the patient, and (4) challenging patient-resident interactions (patients resistant to treatment, exceedingly inquisitive and those with multiple attendants, etc.). The fifth theme identified the need for a communication skills curriculum in postgraduate medical education. Opposite gender and discordant socioeconomic/cultural backgrounds of patients pose a challenge to effective patient-physician communication. Self-identification and awareness of residents' biases when interacting with patients can ensure their active elimination and improve their communication skills. Integrating these components in a standardized curriculum within postgraduate programs can enable resident-physicians to provide the same level of care and communicate more efficiently with patients of all backgrounds.

A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure.

Among patients with heart failure (HF), we examined 1) the evolution of patient involvement in decision making over 2 y, 2) the association of patient characteristics with decision-making roles, and 3) the association of decision-making roles with distress, spiritual well-being, and quality of physician communication. We administered the survey every 4 mo over 24 mo to patients with New York Heart Association class 3/4 symptoms recruited from inpatient clinics. The decision-making roles were categorized as no patient involvement, physician/family-led, joint (with family and/or physicians), patient-led, or patient-alone decision making. The associations between patient characteristics and decision-making roles were assessed using a mixed-effects ordered logistic regression, whereas those between patient outcomes and decision-making roles were investigated using mixed-effects linear regressions. Of the 557 patients invited, 251 participated in the study. The most common roles in decision making at baseline assessment were "no involvement" (27.53%) and "patient-alone decision making" (25.10%). The proportions of different decision-making roles did not change over 2 y (P = 0.37). Older age (odds ratio [OR] = 0.97; P = 0.003) and being married (OR = 0.63; P = 0.035) were associated with lower involvement in decision making. Chinese ethnicity (OR = 1.91; P = 0.003), higher education (OR = 1.87; P = 0.003), awareness of terminal condition (OR = 2.00; P < 0.001), and adequate self-care confidence (OR = 1.74; P < 0.001) were associated with greater involvement. Compared with no patient involvement, joint (β = -0.58; P = 0.026) and patient-led (β = -0.59; P = 0.014) decision making were associated with lower distress, while family/physician-led (β = 4.37; P = 0.001), joint (β = 3.86; P < 0.001), patient-led (β = 3.46; P < 0.001), and patient-alone (β = 3.99; P < 0.001) decision making were associated with better spiritual well-being. A substantial proportion of patients was not involved in decision making. Patients should be encouraged to participate in decision making since it is associated with lower distress and better spiritual well-being. The level of involvement in medical decision making did not change over time among patients with heart failure. A substantial proportion of patients were not involved in decision making throughout the 24-mo study period.Patients' involvement in decision making varied by age, ethnicity, education level, marital status, awareness of the terminal condition, and confidence in self-care.Compared with no patient involvement in decision making, joint and patient-led decision making were associated with lower distress, and any level of patient involvement in decision making was associated with better spiritual well-being.

A-092 Trends in Laboratory Communications Utilized in the Implementation of the Race-Free CKD-EPI 2021 Estimated Glomerular Filtration Rate (eGFR) Equation

Abstract Background The National Kidney Foundation (NKF) established a Laboratory Engagement Working Group (WG) that issued strategies for implementing the race-free CKD-EPI 2021 eGFR equation following the recommendation from the National Kidney Foundation/American Society for Nephrology Joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases. These guidelines covered four areas of implementation including communication, assay selection, programming, and reporting. Regarding communication, the NKF-WG recommendations identified six categories of stakeholders that should be included in communications: physicians and advance practitioners, pharmacists, clinical researchers, patients, patient advocates, and dietitians and nutritionists. This research evaluated the alignment of laboratory communications and inclusion of specific stakeholders during implementation of the CKD-EPI 2021 equation with recommendations from the NKF Laboratory Engagement Working Group. Additionally, the research sought to identify if concerns of racial bias associated with previous equations were communicated to stakeholders. Methods An anonymous, web-based, cross-sectional survey of laboratory directors in the United States was conducted from November 1st through November 29th, 2022. The call for participants was distributed widely to the membership of the American Society for Clinical Laboratory Science (ASCLS) and the American Association for Clinical Chemistry (AACC). Participants were asked to denote if they had implemented the CKD-EPI 2021 equation, to identify communication methods utilized during implementation, and to identify key stakeholders included in communications. Participants were also asked to indicate if communications included information regarding concerns of racial bias associated with previous eGFR equations. Results In total, there were 34 survey participants, with 32 completed submissions. Participants represented 19 states, with 5 states having 2 or more participants. Of the completed submissions, 87.5% (n = 28) of respondents reported implementing the CKD-EPI 2021 equation. Of those respondents, 100% reported issuing communications to physicians and advance practitioners. 71.4% (n = 20) of respondents reported issuing communication to pharmacists, 32.1% (n = 7) included clinical researchers, and 14.3% (n = 4) included dieticians and nutritionists. The most common method of communication directed to the patient care teams was through an official laboratory memo 82.1% (n = 23), followed by direct email 64.8% (n = 18). Notably, only 10.7% (n = 3) of respondents reported issuing communication to patients, however 25.0% (n = 7) of respondents stated that the equation change was noted in the patient’s medical record upon receiving an eGFR value calculated using the updated equation. Of the participants who implemented the equation change, 64.8% (n = 18) reported addressing concerns of racial bias with previous equations in communications with physicians and advanced providers. 42.8% (n = 12) included this information in communications with pharmacists, and only 10.7% (n = 3) reported sharing this information with patients. Conclusion A majority of participating laboratories did not include patients as stakeholders in communications during CKD-EPI 2021 implementation, highlighting a lack of alignment with NKF-WG recommendations. Further, and in contrast to physician communications, a majority of laboratories declined to include information regarding potential racial bias associated with previous eGFR equations in their patient communications.

Experiences and expectations of physician communication: A focus group discussion with Indian patients with type 2 diabetes mellitus.

This pilot study aimed to: (a) understand the experiences of Indian patients with type 2 diabetes mellitus and their expectations of their physicians during a medical consultation, (b) serve as a preliminary study to inform the development of a larger project exploring and improving patients' communication experiences, and (c) assess whether the pilot study findings indicate the viability of using the Relationship: Establishment, Development, and Engagement model of communication as the conceptual framework for the larger project. Using convenience sampling, 11 patients participated in a focus group discussion. Conventional content analysis was used. Two themes were generated: (a) A plethora of negative feelings: experiences of the physician's verbal and nonverbal communication styles, and (b) 'I know what I want': Expectations of communication by patients from their physician. The medical encounter with the physician elicited a range of negative experiences and clear expectations from the patients with type 2 diabetes mellitus. This pilot points to the need for (a) a mixed methods approach to comprehensively examine the communication needs of patients with type 2 diabetes mellitus from their physician, (b) understand physicians' communication practices, and (c) using these findings, culturally adapt and test the Relationship: Establishment, Development, and Engagement to improve physicians' communication skills in India.

Factors Affecting Glaucoma Medication Adherence and Interventions to Improve Adherence: A Narrative Review.

Glaucoma is a leading cause of vision loss. First line therapy for primary open angle glaucoma (POAG) are topical ocular hypotensive drops. Patient adherence with topical therapy for glaucoma is a significant challenge with a reported adherence of 60%. The purpose of this review is to discuss factors associated with glaucoma adherence (including demographic factors, cost, patient education, health beliefs, treatment burden and regimen, and physical limitations) and to explore potential interventions to improve medication adherence. Articles included in this review were found by searching PubMed and Google Scholar using the key words "Glaucoma Treatment Adherence" and "Glaucoma Treatment Compliance." Data from this review demonstrates that higher medication cost, lower patient education/literacy levels, and being of African and Hispanic descent are associated with lower medication adherence rates. The data is inconclusive on whether medication regimen complexity lowers patient medication adherence rates. Interventions that have successfully improved medication adherence rates for minority patients have focused on building trust and addressing fears and false beliefs. For cost, explicit physician communication to patients regarding medication cost is important and can help the physician determine any patient concerns about cost. Outside the USA, adherence has been improved through adherence-contingent rebate systems and government subsidies. Most interventions that aim to increase adherence target patient education and literacy with the following interventions demonstrating efficacy: written instructions targeting glaucoma-specific health literacy, literacy level appropriate glaucoma education videos, and interactive and personalized educational programs. More clinic infrastructure and programs that utilize patient reminder tools and patient educators could help physicians and patients in support of these personalized action plans.

Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis

ObjectiveUptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients’ conceptualisation of RA treatment to inform interventions improving TTT...

The Associations Between Physician-Patient Communication and Adjustment Outcomes of Patients and Physicians: A Systematic Review and Meta-Analysis of Correlations

ABSTRACT Physician-Patient communication (PPC) has been linked to patient adjustment outcomes. However, conflicting results have been reported and previous systematic reviews showed some methodological weaknesses. It has also been suggested that PPC is related to physicians’ own adjustment outcomes. This systematic review aims to explore and synthesize the associations between PPC and both patient and physician adjustment outcomes. A systematic search was conducted primarily in five databases and 11.488 non-duplicated articles were identified. Forty-five studies met the eligibility criteria and data extraction was performed for sample characteristics, PPC measurement, adjustment outcomes under examination and main outcomes. The observed results showed that the majority of the included studies were cross-sectional, assessed PPC by proxy-report and reported an overall positive association with patients’ adjustment outcomes. None of the studies examined the association between PPC and physicians’ adjustment outcomes. Thirty-three studies were meta-analyzed and showed a positive and significant association between PPC and patients’ adjustment outcomes (r = .16). Due to the small number of studies included in the meta-analysis, the heterogeneity was high. Subgroup analysis could not identify sources for heterogeneity. Research on the associations between PPC and physicians’ own adjustment outcomes is warranted. Future studies should be rigorous in defining clear PPC definitions, directionality of communication processes, and study design.

Nasal oxytocin administration does not influence eye gaze or perceived relationship of male volunteers with physicians in a simulated online consultation: a randomized, placebo-controlled trial.

The patient-physician relationship is a critical determinant of patient health outcomes. Verbal and non-verbal communication, such as eye gaze, are vital aspects of this bond. Neurobiological studies indicate that oxytocin may serve as a link between increased eye gaze and social bonding. Therefore, oxytocin signaling could serve as a key factor influencing eye gaze as well as the patient-physician relationship. We aimed to test the effects of oxytocin on gaze to the eyes of the physician and the patient-physician relationship by conducting a randomized placebo-controlled crossover trial in healthy volunteers with intranasally administered oxytocin (with a previously effective single dose of 24 IU, EudraCT number 2018-004081-34). The eye gaze of 68 male volunteers was studied using eye tracking during a simulated video call consultation with a physician, who provided information about vaccination against the human papillomavirus. Relationship outcomes, including trust, satisfaction, and perceived physician communication style, were measured using questionnaires and corrected for possible confounds (social anxiety and attachment orientation). Additional secondary outcome measures for the effect of oxytocin were recall of information and pupil diameter and exploratory outcomes included mood and anxiety measures. Oxytocin did not affect the eye-tracking parameters of volunteers' gaze toward the eyes of the physician. Moreover, oxytocin did not affect the parameters of bonding between volunteers and the physician nor other secondary and exploratory outcomes in this setting. Bayesian hypothesis testing provided evidence for the absence of effects. These results contradict the notion that oxytocin affects eye gaze patterns or bonding.

Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study.

According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mmHg and +3.31 (SE 0.71) mmHg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.

Patients preferences for communication during video consultations

Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations MethodsWe conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred Results417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician’s statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). ConclusionOur results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician’s statements. Practice implicationsGiven the increasing use of video consultations, video communication “best practices”should be systematically addressed in physician training

Poster 387: Are Our Actions Matching Our Words? A Systematic Review of the Literature Surrounding Diversity in Orthopaedic Surgery and Other Surgical Specialties

Objectives: Physician ethnic and gender diversity is known to be inextricably linked to patient outcomes, access to care and healthcare literacy in underrepresented patients. Despite this knowledge, the ethnic and gender disparities prevalent amongst physicians continue to contribute to inequalities in the American healthcare system. Recent data has demonstrated that surgeons, with orthopaedic surgeons in particular, are amongst the least diverse group of physicians. There has been an increased emphasis on promoting surgeon diversity as well as an increased emphasis on publishing literature regarding diversity. Through a systematic review of the literature regarding diversity throughout all surgical subspecialties, this study aims to determine whether this recent increased awareness has correlated to an increase in the number of publications on the matter. This study also aims to quantify the literary contributions of each surgical subspecialty and correlate this with each subspecialties respective demographic profile to identify areas that can be improved in order to continue to promote diversity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to query articles from PubMed, Embase, Web of Science and the Cumulative Index to Nursing and Allied Health Literature through April 1st, 2022. The search used a combination of keywords for the constructs of surgical subspecialties, residency training and diversity. The Rayyan Intelligent Systematic Review program was then utilized by three independent reviewers to screen articles. Broad inclusion criteria was utilized to include articles that discussed either ethnic or gender diversity as it pertained to any surgical subspecialty. Articles that only discussed diversity in non-surgical medical fields or articles that only discussed diversity related to religion, age, or sexual orientation were excluded. Articles were then categorized by surgical subspecialty, type of diversity discussed (gender, ethnic or both) and level of training. Results: The query resulted in 1429 total articles from 4 database searches. 408 duplicate articles were found and removed. Of the remaining 1021 articles screened, 701 were excluded with the remainder of the 320 studies included in the review (Figure 1). Orthopaedic surgery was the subspecialty with the highest number of publications regarding ethnic or gender diversity (n=73), followed by general surgery (n=56) (Figure 2). A majority of articles focused solely on gender diversity (n=144) with fewer articles focusing solely on ethnic diversity (n=39). A total of 137 articles analyzed both ethnic and gender diversity. Figure 3 illustrates the number of studies about diversity published by year dating back to 1998. A total of 109 studies regarding surgical diversity were published in 2021 compared to just 22 studies during a 10 year period from 1998 to 2007 (Figure 3). Two articles were published prior to 1998 and 17 articles have been published in 2022 prior to April 1st, 2022. A total of 221 reports discussed ethnic or gender diversity at the resident level, 41 studies at the fellow level and only 20 studies at the student level. Conclusions: The importance of promoting diversity in surgeons cannot be overstated. Improved patient satisfaction, better patient outcomes, greater access to healthcare and more transparent patient- physician communication are but a few of the tangible benefits of having a diverse workforce. Orthopaedic surgery is the surgical subspecialty with the most publications regarding diversity amongst surgeons. While orthopaedic surgery should be commended for this, it remains one of the least ethnically and gender diverse surgical subspecialties. This review highlights the need for orthopaedic surgeons to continue to promote diversity at all training levels. Furthermore, as the recent emphasis on promoting diversity has led to a rapid increase in published studies in recent years, close attention should be paid to how the ethnic and gender landscape of the surgical workforce changes over the coming years. There were more than ten times the number of articles discussing diversity at the resident level compared to at the medical student level. Should gender and ethnic diversity remain stagnant, surgeons may need to place increased emphasis on targeting a younger demographic and continue to implement more grassroots programs that promote ethnic and gender diversity.

Healthcare Experiences Are Associated with Colorectal Cancer Mortality but only for Specific Racial Groups: a SEER-CAHPS Study

BackgroundThe objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality.MethodsWe conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute’s SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group.ResultsOf the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding “getting all needed prescriptions” and the lowest score for “getting care quickly.” In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = − 4.34, B = − 4.32, B = − 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = − 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003).ConclusionOur research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients’ perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes.

#6055 PATIENT REPORTED OUTCOMES AMONG DIALYSIS POPULATION IN STATE OF QATAR

Abstract Background Patients with (ESKD) undergoing dialysis, experience large burden of the disease and suffer variable symptoms that impact their health-related quality of life (HRQL). However, their symptoms are often under-recognized and under treated by their health care providers because they depend on objective measures such as physical examination and lab results. These examinations mostly don't reflect patients’ symptoms and the impact on health-related quality of life. Therefore, standardized subjective measures are important for symptoms screening and may improve symptom detection and treatment. Patient-Reported Outcome Measures (PROMs) are example of these measures and it capture patients’ symptom burden, level of functioning, and HRQL. PROMs can be used to evaluate and monitor aspects of patients’ health that may otherwise be overlooked, inform care planning, and facilitate the introduction of treatments. Aims To capture patients perceptions of their health and to address the HRQL symptoms in haemodialysis,to capture patients perception of their health and address the HRQL symptoms in chronic haemodialysis patients. To find the tools for follow up those HRQL symptoms. To encourage and promote patients patriation in care plan. Method Sample of 94 haemodialysis patients were included. We used two validated questionnaires to assess patients reported outcome (IPOS &amp; EQ-5D) because there is no single instrument has established itself as the gold standard for measuring patient status. The (IPOS) captures symptoms such as, diarrhea, changes in skin color, restlessness, difficulty to sleep,itching,poor mobility, drowsiness, mouth sore, constipation, poor appetite,vomiting,nausea,weakness and renal scale. The (EQ-5D) is a standardized measure of health-related quality of life from five dimensions (Mobility, self-care, usual activities, pain, depression and anxiety). Results Majority of participants in this survey were male (n = 56; 60%). Middle eastern (67%), between the age of 19 to 77 (Mean = 53; STD =14). In the IPOS 50% of the patients reported the presence of symptoms such as difficulty of sleeping, itching, poor mobility, and general weakness. However, the severity of these symptoms varied from zero severity to overwhelming, 16% of patients were bothered by severe difficulties to sleep and poor mobility,15% had severe lack of energy,13% severe shortness of breath and 11% reported poor appetite. Pain was reported by 44% of patients out of which 33% expressed it as slight to moderate and 11% reported severe pain. The EQ-5D revealed that 47% have problem in walking, 41% of patients found to have difficulties in performing their usual activities, 27% of patients expressed feelings of depression and anxiety (22% mild to moderate and 5% severe).In addition 17% reported difficulties to perform self-care activities such as washing and dressing themselves. Conclusion Patients reported outcome is an important approach that captures patients’ perspectives of health and disease. PROM could result in improvement of health care delivery because it is a way to evaluate health care interventions effectiveness in a reliable and acceptable way that value patient's feedback. clinicians can utilize treatment aids to manage symptoms. Treatment aids are actionable assessment and treatment resources developed by expert clinicians and patient partners for the management of certain symptoms using these aids will help in tailoring patients therapy to improve outcome. And patients physician communication and improve quality performance.