Physician Communication Research Articles

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.

Patient- versus clinician-reported symptoms in the POLARIX study.

12100 Background: The safety profiles of novel agents are mainly based on clinician-reported adverse events (AEs) from clinical trials. Patient-reported outcomes (PROs) may better represent the treatment burden experienced by patients (pts) compared with clinician-reported AEs. Using data from POLARIX, a double-blind, placebo-controlled, randomized Phase 3 international study (NCT03274492), we previously presented PRO and clinician-reported data showing similar rates of neuropathy (Trněný et al. 2022). Here, we evaluate the reporting of other common symptoms using PRO and clinician-reported data in POLARIX. Methods: POLARIX methods were previously described (Tilly et al. 2022); this analysis included all pts with PRO data. PRO and clinician-reported data described the incidence and severity of fatigue, constipation, diarrhea, nausea, and vomiting. Clinician-reported severity grading was based on the NCI Common Terminology Criteria for Adverse Events (NCI-CTCAE) v4.0. PROs were collected using the European Organisation Research and Treatment of Cancer Quality of Life-Core 30 questionnaire (EORTC QLQ-C30), which was administered to pts at clinic visits on Day 1 of Cycles 1 (baseline), 2, 3, and 5, and end of treatment (EOT). PRO severity scores included ‘A little’, ‘Quite a bit’, and ‘Very much’. Results: Overall, 825 pts were evaluable. From baseline to EOT, PROs showed a higher incidence of symptoms compared with clinicians for fatigue (98% vs 27%), constipation (68% vs 29%), diarrhea (56% vs 26%), nausea (58% vs 40%), and vomiting (24% vs 15%). PRO severity scores of ‘Quite a bit’ or ‘Very much’ were reported in 33% of pts for fatigue, 29% for constipation, 17% for diarrhea, 19% for nausea, and 7% for vomiting. Clinicians reported Grade ≥2 symptoms in 11% of pts for fatigue, 11% for constipation, 11% for diarrhea, 14% for nausea, and 6% for vomiting. Conclusions: In POLARIX, pts reported a higher incidence and severity of symptoms compared with clinicians. Although distinct scales were used, the differences in symptom rates reported by pts and clinicians were clinically meaningful. These data may have implications for symptom management, including physician evaluation and communication of symptom expectations for pts. Reporting of symptoms by PROs should be incorporated into clinical trials as an adjunct to standard AE reporting to better characterize the patient experience. Clinical trial information: NCT03274492 . [Table: see text]

The Impact of Words: Multisource Feedback Provides Students With a Deeper Understanding and Reflection on Goals of Care Discussions.

Background: Physician communication during goals of care (GOC) discussions impact experiences for patients and families at end-of-life (EOL). Simulation allows training in a safe environment where feedback from simulated patients (SP), clinicians, and self-reflection can be incorporated. Objectives: To determine if multisource feedback from SP scenarios enriches feedback provided to trainees. Design: Fourth-medical students participated in two SP GOC discussions during an advanced care planning (ACP) curriculum. Students received feedback from SPs and faculty and completed a video review with self-reflection. Setting and Subjects: Forty-seven fourth-year medical students at the University of Cincinnati College of Medicine participated in the curriculum from 2019-2021. Measurements: An inductive thematic analysis of the narrative data was performed examining all sources of feedback from the SP sessions. Results: Six themes emerged from the feedback: the warning shot: words to say and why it helps; acknowledging emotion: verbal vs non-verbal responses; organization: necessity of a clear path; body language: adding to and distracting from the conversation; terminology to avoid: what jargon encompasses and how it impacts patients; and silence: perceived importance by everyone. SP feedback focused on the personal emotional impact of a student's word choice and body language. Faculty feedback focused on specific learning points through examples from the conversation and expanded to hypothetical scenarios. Student self-reflection after video review allowed students to see challenges that they did not notice while immersed in the encounter. Conclusion: Multisource feedback from simulated GOC discussions provides unique insights for students to guide their development in leading difficult conversations.

The process and outcomes of chronic low back pain treatment provided by osteopathic and allopathic physicians: a retrospective cohort study.

Osteopathic physicians are trained to treat patients with musculoskeletal symptoms, to treat somatic dysfunction with osteopathic manipulative treatment (OMT), and to avoid unnecessarily prescribing drugs such as opioids. It is also generally believed that osteopathic physicians provide a unique patient-centered approach to medical care that involves effective communication and empathy. Such training and characteristics of osteopathic medical care (OMC) may enhance clinical outcomes among patients with chronic pain. The objectives of this study were to measure and compare the process and longitudinal outcomes of chronic low back pain (CLBP) treatment provided by osteopathic and allopathic physicians and to identify mediators of the treatment effects of OMC. This retrospective cohort study was conducted utilizing adult participants with CLBP within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from April 2016 through December 2022. Participants having an osteopathic or allopathic physician for at least 1month prior to registry enrollment were included and followed at quarterly intervals for up to 12months. Physician communication and physician empathy were measured at registry enrollment. Opioid prescribing and effectiveness and safety outcomes were measured at registry enrollment and for up to 12months and were analyzed with generalized estimating equations to compare participants treated by osteopathic vs. allopathic physicians. Multiple mediator models, including physician communication, physician empathy, opioid prescribing, and OMT, with covariate adjustments, were utilized to identify mediators of OMC treatment effects. A total of 1,079 participants and 4,779 registry encounters were studied. The mean (SD) age of participants at enrollment was 52.9 (13.2) years, 796 (73.8 %) were female, and 167 (15.5 %) reported having an osteopathic physician. The mean physician communication score for osteopathic physicians was 71.2 (95 % CI, 67.6-74.7) vs. 66.2 (95 % CI, 64.8-67.7) for allopathic physicians (p=0.01). The respective mean scores for physician empathy were 41.6 (95 % CI, 39.9-43.2) vs. 38.3 (95 % CI, 37.6-39.1) (p<0.001). There was no significant difference in opioid prescribing for low back pain between osteopathic and allopathic physicians. Although participants treated by osteopathic physicians reported less severe nausea and vomiting as adverse events potentially attributable to opioids in a multivariable model, neither result was clinically relevant. OMC was associated with statistically significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and health-related quality of life (HRQOL) over 12months. Physician empathy was a significant mediator of OMC treatment effects in each of the three outcome domains; however, physician communication, opioid prescribing, and OMT were not mediators. The study findings indicate that osteopathic physicians provide a patient-centered approach to CLBP treatment, particularly involving empathy, that yields significant and clinically relevant outcomes pertaining to low back pain intensity, physical function, and HRQOL over 12months of follow-up.

Patient-Physician Communication and Perception of Treatment Goals in Rheumatoid Arthritis: An Online Survey of Patients and Physicians.

To evaluate patient-physician communication and patients' understanding of treatment goals in rheumatoid arthritis (RA). A cross-sectional online survey of patients with RA and physicians treating RA was conducted between 16 and 30 June 2021. Participants were asked to rate the importance of 17 goals on a 6-point Likert scale, and mean scores were compared between patients and physicians by the Wilcoxon rank sum test. Patients' satisfaction with physician communication and their understanding of treatment goals were also assessed. The responses of 502 patients and 216 physicians were analyzed. The most common patient age group was 50-59years (28.5%), and the mean disease duration was 10.3years. Physicians had a mean of 19.2years of treatment experience and were treating a mean of 44.3 patients. Among the 17 goals assessed, patients placed significantly more importance on drug tapering or discontinuation as short-term goals (3-6months) and on performing basic activities of daily living, being able to engage in daily tasks, achieving and maintaining remission, maintaining better laboratory values, and drug tapering or discontinuation as long-term goals (5-10years; all adjusted p < 0.05). Patient treatment satisfaction was significantly associated with disease activity, a feeling of treatment effectiveness, satisfaction with physician communication, and agreement with physician goals. Differences exist among patients with RA and physicians treating RA regarding the importance of short- and long-term treatment goals. Good patient-physician communication appears to be important for improving patient satisfaction. University Hospital Medical Information Network identifier: UMIN000044463.

When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review.

Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.

Communication Experiences of Caregivers Using a Language Other Than English on Inpatient Services.

Individuals who prefer to communicate about health care in a language other than English (LOE) experience poorer quality medical care and challenges when communicating with health care providers. The objective of this study was to elucidate how caregivers who prefer an LOE perceive communication with their physicians on an inpatient general pediatrics service. Caregivers of patients admitted to the general pediatrics service at our urban freestanding children's hospital whose preferred language for medical care was Spanish, Arabic, Brazilian Portuguese, or Mandarin were eligible for this qualitative study. Semistructured interviews using video interpreter services were conducted to explore the participants' experiences communicating with their physicians. Interview transcripts were analyzed using conventional content analysis. We interviewed 15 participants representing 7 countries of origin and 4 non-English languages: Spanish, Arabic, Brazilian Portuguese, and Mandarin. Three main domains emerged, including: (1) use of interpreter services, (2) overall communication experience with physician providers, and (3) suggestions for improvement in physician communication. Salient themes included early identification of the need for an interpreter is essential and physicians' use of body language in combination with an interpreter enhances successful communication. This project fills a gap in existing literature by describing the perspectives of caregivers who prefer an LOE, including those speaking languages other than Spanish, because they communicate with inpatient pediatricians. In addition to ensuring appropriate use of interpreter services, physicians can focus on using plain language and gestures during encounters, helping to facilitate communication and provide culturally competent care for this population.

Preoperative Pain Control Discussion With EMR Documentation Prompt to Guide Opioid Prescriptions for Laparoscopic Sterilization Surgery [ID: 1377197

INTRODUCTION: Our objective was to evaluate whether implementing a standardized patient–physician counseling and documentation process about pain and opioid use after laparoscopic bilateral salpingectomy (LSC BS) decreased opioid prescribing. METHODS: In this study, we evaluated a quality improvement project aimed at decreasing opioid overprescribing and promoting patient–physician conversations and documentation surrounding pain control after surgery. An electronic medical record (EMR) standardized smart phrase was implemented in the Resident GYN Specialty Clinic at the Obstetrics and Gynecology Care Center in order to standardize patient–physician counseling and documentation about postoperative pain, opioid use, storage, and disposal, providing written and verbal education at the time of preoperative and postoperative appointments for Lap BS. We collected EMR data from patients who had a LSC BS preintervention (January 2019 to December 9, 2020) and postimplementation (March 2021 to October 2022). To have 90% power to detect a 25% reduction in morphine milligram equivalents (MMEs) from preimplementation to postimplementation, we needed 78 patients per group. RESULTS: A total of 78 patients met inclusion criteria for both groups. Patients postintervention were prescribed significantly fewer opioids (58.3 versus 31.35 MME, P&lt;.001, or 7.8 versus 4.2 oxycodone 5 mg tablets) compared to patients preintervention. Significant differences were also seen in secondary outcomes with increased documentation of discussion surrounding the addictive properties of opioids and expected pain postoperatively postintervention compared to preintervention. CONCLUSION: Implementation of physician education combined with EMR prompts decreased the amount of opioids prescribed and increased documentation of patient–physician communication about safe opioid use and pain control.

Dermatologists Communication Skills and Performance From Point of View of Patients.

Effective communication is an important issue in patient-doctor interaction which is even more important regarding chronic disorders which need a strong relationship between patient and clinician for better compliance and optimal control disease. This study was aimed to develop the best cultural adapted Persian version of the 28-item Calgary- Cambridge Observation Guide (CCOG) questionnaire. In this descriptive-analytic study, data collected from 400 patients attending the outpatient dermatology clinics of 3 major hospitals in Tehran using the modified Persian version of CCOG questionnaire, both before and after being visited by dermatologists. The difference of CCG scores for all of questions, except for questions number 1,16 and 22, was statistically significant. The highest score, both before and after visiting, attained by question regarding being respectful. The lowest scores for necessary behavior and the adequate amount of execution were related to questions number 3 (Introducing self) and 4 (Introducing role), respectively. Age and educational level of patients were significantly correlated with their expectations regarding communication skills of clinician. This study showed the acceptable validity of modified Persian version of CCOG-24 item questionnaire. Our findings also demonstrated that there was a significant difference between what patients expected from a dermatologist and the manner they actually were treated regarding physician communication skills.

Mediating role of physician's empathy between physician's communication and patient's satisfaction

Mediating role of physician's empathy between physician's communication and patient's satisfaction

Differences in survivorship care experiences among older breast cancer survivors by clinical cancer characteristics, race/ethnicity, and socioeconomic factors: A SEER-CAHPS study.

To determine if disparities exist in survivorship care experiences among older breast cancer survivors by breast cancer characteristics, race/ethnicity, and socioeconomic factors. A total of 19,017 female breast cancer survivors (≥ 65 at post-diagnosis survey) contributed data via SEER-CAHPS data linkage (2000-2019). Analyses included overall and stratified multivariable linear regression to estimate beta (β) coefficients and standard errors (SE) to identify relationships between clinical cancer characteristics and survivorship care experiences. Minority survivors were mostly non-Hispanic (NH)-Black (8.1%) or NH-Asian (6.5%). Survivors were 76.3years (SD = 7.14) at CAHPS survey and were 6.10years (SD = 3.51) post-diagnosis on average. Survivors with regional breast cancer vs. localized at diagnosis (β = 1.00, SE = 0.46, p = 0.03) or treated with chemotherapy vs. no chemotherapy/unknown (β = 1.05, SE = 0.48, p = 0.03) reported higher mean scores for Getting Needed Care. Results were similar for Overall Care Ratings (β = 0.87, SE = 0.38, p = 0.02) among women treated with chemotherapy. Conversely, women diagnosed with distant breast cancer vs. localized reported lower mean scores for Physician Communication (β = -1.94, SE = 0.92, p = 0.03). Race/ethnicity, education, and area-level poverty significantly modified several associations between stage, estrogen receptor status, treatments, and various CAHPS outcomes. These study findings can be used to inform survivorship care providers treating women diagnosed with more advanced stage and aggressive disease. The disparities we observed among minority groups and by socioeconomic status should be further evaluated in future research as these interactions could impact long-term outcomes, including survival.

A qualitative analysis of female patient perspectives on physician communication regarding sexual dysfunction associated with pelvic radiotherapy.

Sexual dysfunction is a known side effect of pelvic radiotherapy, resulting from a complex intersection of physiologic and psychosocial factors. Maintaining sexual function is relevant to long-term quality of life and is an important aspect of survivorship. Many female patients report being insufficiently informed before treatment about the potential sexual side effects of radiation therapy. To elucidate how radiation oncologists communicate sexual function side effects with their female patients and how discussing sexual side effects of cancer treatment can positively affect patient-physician rapport. Semistructured interviews in English and Spanish were conducted with 20 female participants who received pelvic radiation as part of their cancer treatment. Patients responded to advertisements or were referred by physicians. All interviews were conducted virtually between June and October 2021. Thematic analysis was conducted with NVivo. Patients also completed an online demographics survey in REDCap. We found 4 primary themes addressing patient perspectives on patient-physician communication of sexual dysfunction and how it affected the cancer care experience. Theme 1: This may be expected, but I didn't expect it! The participants who were not properly informed about sexual side effects felt blindsided and embarrassed about their symptoms. Theme 2: I do not feel like a woman anymore . . . The psychological impact included lower self-esteem and no longer feeling sexy nor like a woman. Theme 3: Fine, I'll deal with this myself! Patients turned to the internet rather than their doctors for answers once they began experiencing symptoms, and they found information, normalization, and community online. Theme 4: Ask me about my sex life and find out if sex is a priority for me. Participants emphasized that their radiation oncologist should take a sexual history early to monitor sexual dysfunction and to identify individual patient priorities surrounding sex posttreatment. This evidence provides a guide to patient-physician communication that may help to mitigate the impacts of radiotherapy on female sexual function as well as the negative impact that the absence of communication about sexual dysfunction may have on patient-physician trust. While this project did have a small sample size, there is considerable diversity in race, education level, and age, with interviews conducted in Spanish and English. Overall these findings provide physicians with important information about the unmet information needs of patients and their preferences for how to help them feel more prepared and less distressed when sexual dysfunction occurs.

Abstract 749: The impact of multimorbidity on the relationship between breast cancer tumor characteristics and survivorship care experiences among older women: A SEER-CAHPS analysis

Abstract Our study examined the associations between breast cancer tumor characteristics and self-reported survivorship care experiences stratified by multimorbidity among older female breast cancer survivors in the United States. Utilizing the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and the Centers for Medicare and Medicaid Services’ Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data linkage from 2000-2019. Breast cancer (BC) survivors (N=19,017) were aged ≥65 years at CAHPS survey who completed a survey after diagnosis of primary site invasive BC. Adjusted multivariable linear regression models were used to estimate beta (β) and standard error (SE) coefficients of the relationships between tumor characteristics (extent of disease: localized, regional, distant; estrogen receptor [ER] status: ER+, ER-, missing/unknown) and several CAHPS composite and rating outcomes, overall and stratified by multimorbidity (BC only, 2-5 chronic conditions, ≥6 chronic conditions). Women were on average 76.3 years (SD=7.14) of age at survey and 4.65 years (SD=3.51) since BC diagnosis. Most survivors were non-Hispanic white (78.1%), had ≥6 chronic conditions (38.1%), were diagnosed with localized BC (80.5%) and/or ER+ tumors (56.9%). Survivors with regional BC at diagnosis reported significantly higher mean scores on Getting Needed Care (β=1.00, SE=0.46, p=0.03), and with distant BC reported significantly lower mean scores on Physician Communication (β=-1.92, SE=0.92, p=0.03) compared to those with localized BC. When stratified by multimorbidity, survivors with distant stage compared to localized, and with 2-5 chronic conditions reported significantly higher mean scores for Getting Needed Care (β=3.85, SE=1.96, p=0.04), while this association was inverse and not statistically significant (β=-2.72, SE=1.87, p=0.14) among survivors with BC only (p-interaction=0.01). While the overall associations between ER status and the CAHPS outcomes were not statistically significant, we observed significant statistical interactions by multimorbidity for the following association: among survivors with BC only, survivors with ER- tumors reported lower Health Plan Ratings (β=-1.89, SE=0.73, p=0.009) compared to survivors with ER+ tumors, while this association was positive however, marginally statistically significant (β=1.63, SE=0.86, p=0.05) among survivors with ≥6 conditions (p-interaction=0.002). BC survivors who are diagnosed with advanced stage and aggressive tumor phenotypes, such as ER- BC, experience different survivorship care experiences when they are also managing multiple chronic conditions. Remarkably, our results demonstrate that women with distant stage breast cancer and multimorbidity reported higher score on getting the care they need. Citation Format: Kate E. Dibble, Zhengyi Deng, Avonne E. Connor. The impact of multimorbidity on the relationship between breast cancer tumor characteristics and survivorship care experiences among older women: A SEER-CAHPS analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 749.

Understanding online ratings of joint arthroplasty surgeons: A national cross-sectional analysis

BackgroundPatient reviews provide an important referral source for physicians and an opportunity to improve practice performance. This study's objective was to characterize the online reviews of hip and knee arthroplasty surgeons published by three of the industry's leading platforms. MethodsA random sample of 1000 hip and knee arthroplasty surgeons across all 50 US states (10 hip and 10 knee surgeons per state) was generated using Google Search. A total of 7842 online reviews posted for those surgeons on Healthgrades, Vitals, and Google were analyzed. A range of surgeons, affiliated hospitals, and reviewer attributes was compared to identify significant predictors of patient satisfaction. ResultsThe study cohort had 98.1% male surgeons with a mean age of 53.55 ± 8.94 years and mean experience of 26.43 ± 9.21 years. Younger age (p < 0.001), shorter years of experience (p < 0.001), and arthroplasty fellowship training (p < 0.001) were associated with more positive ratings. Reviewer anonymity, observed in 30.93% of all reviews, tended to correlate with more negative ratings (p < 0.001). Overall, 86.93% of patient remarks were positive, and only 74.81% of remarks centered on physician attributes. The five leading components of patient satisfaction were perceptions of physician competence (34.81%, p < 0.001), bedside manner (23.83%, p = 0.002), and communication (16.17%, p = 0.94); interactions with physician extenders (14.75%, p < 0.001); and wait time (2.73%, p < 0.001). ConclusionWhile most ratings of hip and knee arthroplasty surgeons were positive, more than a quarter of reviews were either not directly related to the individual surgeons or were submitted anonymously. Caution is advised regarding overreliance on patient experience surveys as predictors of physician performance.

Hospital information system-based pharmacovigilance for elderly patients: practices and results.

To evaluate the effect of a pharmacovigilance system on potentially inappropriate medication prescriptions for elderly patients. The retrospective study was conducted at Shaanxi Provincial People's Hospital, China, after approval from the ethics review committee, and comprised data from May 2020 to April 2021, and comprised prescriptions related to elderly patients aged at least 65 years. Number of medication risk assessment entries, number of intervened medical orders on outpatients and inpatients number of medical order prompts, and number of physician communication with prescription-checking pharmacists were noted. Potential drug interaction rate was compared between pre- implementation from May to October 2020 and post-implementation from November 2020 to April 2021. Besides, the usage of sedatives and hypnotics and potentially inappropriate medication was noted for the period from January to June 2021 to evaluate the sustained effect of pharmacovigilance system. Data was analysed using SPSS 19. A total of 118 drugs were involved in the 3911 entries of outpatient prescription warnings, of which 19 drugs accounted for 3156 (80%). Besides, a total of 113 drugs were involved in the 3999 entries of inpatient prescription warnings, of which 19 drugs accounted for 3199 (80%) The overall prevalence of potentially inappropriate medication related to sedatives and hypnotics decreased post-intervention as warning percentage was 16.1% in January and 6.7% in June among outpatients. On inpatients, the warning percentage was 30.6% in January and 6.1% in June. The pharmacovigilance system could reduce potentially inappropriate medication and provide deeper technical support for the safety of medical behaviour and individualised treatment of patients.

O.3.5 - Physician communication about pain during end-of-shift handoffs: Presenter(s): Stephen Henry, University of California Davis, United States

O.3.5 - Physician communication about pain during end-of-shift handoffs: Presenter(s): Stephen Henry, University of California Davis, United States

Patient Satisfaction With Medical Care for Chronic Low Back Pain: A Pain Research Registry Study.

The process and outcomes of delivering medical care for chronic low back pain might affect patient satisfaction. We aimed to determine the associations of process and outcomes with patient satisfaction. We conducted a cross-sectional study of patient satisfaction among adult participants with chronic low back pain in a national pain research registry using self-reported measures of physician communication, physician empathy, current physician opioid prescribing for low back pain, and outcomes pertaining to pain intensity, physical function, and health-related quality of life. We used simple and multiple linear regression models to measure factors associated with patient satisfaction, including a subgroup of participants having both chronic low back pain and the same treating physician for >5 years. Among 1,352 participants, only physician empathy (standardized β, 0.638; 95% CI, 0.588-0.688; t = 25.14; P < .001) and physician communication (standardized β, 0.182; 95% CI, 0.133-0.232; t = 7.22; P < .001) were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy (standardized β, 0.633; 95% CI, 0.529-0.737; t = 11.95; P < .001) and physician communication (standardized β, 0.208; 95% CI, 0.105-0.311; t = 3.96; P < .001) remained associated with patient satisfaction in the multivariable analysis. Process measures, notably physician empathy and physician communication, were strongly associated with patient satisfaction with medical care for chronic low back pain. Our findings support the view that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.

Viswanathan Chosen APA’s Next President-Elect

Back to table of contents Previous article Next article APA & MeetingsFull AccessViswanathan Chosen APA’s Next President-ElectCatherine BrownCatherine BrownSearch for more papers by this authorPublished Online:24 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.65AbstractAPA’s next president-elect is a nationally known researcher and clinician and has worked tirelessly on such issues as access to care, social justice, empowerment of minorities and women, physician wellness, positive psychiatry, and environmental psychiatry. He has held numerous leadership positions at APA and other organizations.APA’s voting members have elected Ramaswamy Viswanathan, M.D., Dr.Med.Sc., of Brooklyn, N.Y., as APA’s next president-elect. He ran against Robert L. Trestman, Ph.D., M.D., of Roanoke, Va.Ramaswamy Viswanathan, M.D., Dr.Med.Sc. (left), will become president-elect of APA at the end of APA’s Annual Meeting in May, when Petros Levounis, M.D., M.A., becomes president.Viswanathan is professor, interim chair of psychiatry, director of the consultation-liaison psychiatry and fellowship, and co-chair of the Faculty Wellness Committee at SUNY Downstate Health Sciences University. His research has been in physician communication, ethics, innovations in psychotherapy and pharmacotherapy, treatment adherence in gynecologic cancers, children’s sickle cell disease, HIV, and substance use.Viswanathan has held numerous leadership positions within APA and other national organizations. He currently serves as the Brooklyn Psychiatric Society representative in the APA Assembly and is chair of the Committee on Consultation-Liaison Psychiatry for the Group for the Advancement of Psychiatry.“I am honored that my colleagues in psychiatry have elected me to the APA presidency,” said Viswanathan. “I look forward to working together to further develop and expand our workforce and to keeping up our momentum on research and development of cutting-edge psychopharmacologic, neuro-interventional, and psychotherapeutic treatment and preventive approaches. We will also work together to advance physician wellness, reduce practice burdens, advocate for our patients and our profession, address inequities in health care, and promote appreciation of diversity and inclusion.”“Congratulations to Dr. Viswanathan and the other candidates on their election,” said APA President Rebecca Brendel, M.D., J.D. “I look forward to working with him and all the newly elected APA leaders to advance psychiatric practice and APA’s leadership role in increasing access to care and improving the quality of mental health care.”APA CEO and Medical Director Saul Levin, M.D., M.P.A., echoed those sentiments. “APA members and the profession of psychiatry will be well served by Dr. Viswanathan’s leadership and commitment. I want to congratulate Dr. Viswanathan and all the newly elected APA leaders.”The race for secretary, which has a two-year term, was up for election this cycle. Gabrielle L. Shapiro, M.D., of New York City defeated Jenny L. Boyer, M.D., Ph.D., J.D., of Norman, Okla., and C. Freeman, M.D., M.B.A., of Marina Del Rey, Calif.In the race for minority/underrepresented representative trustee, Kamalika Roy, M.D., M.C.R., of Seattle emerged the winner. Her opponent was Dora-Linda Wang, M.D., of New York City. The term for minority/underrepresented representative trustee is two years.Two of APA’s seven geographic Areas voted for their trustee in this cycle. Area trustees hold three-year terms. In the race for Area 2 trustee, Kenneth B. Ashley, M.D., of New York City defeated Glenn A. Martin, M.D., of Forest Hills, N.Y. The winner of the Area 5 trustee race was Heather Hauck, M.D. She defeated Sudhakar Madakasira, M.D., of Flowood, Miss.The winner of the race for resident-fellow member (RFM) trustee-elect was Sarah El Halabi, M.D., M.S., a psychiatry resident at Westchester Medical Center in New York. She defeated Sarah A. Friedrich, D.O., M.B.A., M.S., chief resident at Jefferson Health’s Albert Einstein Medical Center in Philadelphia, and Sarin Pakhdikian, D.O., a psychiatry resident at the Kirk Kerkorian School of Medicine at the University of Nevada. El Halabi will serve for a year in the RFM trustee-elect position and then rotate into the RFM trustee position.Election results were approved by the Tellers Committee in February, but the results are not official until the Board of Trustees reviews them at its meeting this month. All of the winning candidates will assume their positions on the Board at the close of APA’s Annual Meeting in May. ■ResourcesComplete results, including vote counts for each race ISSUES NewArchived