Physician Communication Research Articles

Turn that frown upside down: implementation of a visual cue improves communication during emergency department to inpatient hand-offs

When a patient is admitted to the hospital from the emergency department (ED), the ED clinician passes on relevant clinical information to the admitting team to transition care, a process...

A novel method for evaluating physician communication: A pilot study testing the feasibility of parent-assisted audio recordings via Zoom.

Quality of physician consultations are best assessed via direct observation, but require intensive in-clinic research staffing. To evaluate physician consultation quality remotely, we pilot tested the feasibility of parents using their personal mobile phones to facilitate audio recordings of pediatric visits. Across four academic pediatric primary care clinics, we invited all physicians with a patient panel (n=20). For participating physicians, we identified scheduled patients from medical records. We invited parents to participate via text message and phone calls. During their adolescent's appointment, parents used their mobile phone to connect to Zoom for remote research staff to audio record. In Spring 2021, five of 20 (25%) physicians participated. During a nine-week period, we invited parents of all 54 patients seen by participating physicians of which 15 (28%) completed adult consent and adolescent assent and 10 (19%) participated. For 9 recordings, at least 45% of the conversation was audible. It was feasible and acceptable to directly observe physician consultations virtually with Zoom, although participation rates and potentially audio quality were lower. Patients used their cellular phone calling features to connect to Zoom where research staff audio-recorded their physician consultation to evaluate communication quality.

Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals

BackgroundCervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer.MethodologyA qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data.ResultsOverall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment.ConclusionsThe women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.

Knowledge of Saudi Patients with Autoimmune Diseases about Hydroxychloroquine Toxicity: The Role of Physician-Patient Communication.

This cross-sectional internet-based questionnaire aimed to assess the knowledge and experience of autoimmune disease patients in Saudi Arabia of the ocular effects of hydroxychloroquine (HCQ). Among the 245 respondents, discontinuation of the drug was linked to its ocular toxicity in approximately 7.3%. Most patients had taken HCQ for a period longer than five years, exceeding a dose of 5 mg/Kg. A lack of education and physician communication about medication toxicity was reported by approximately 40.8% of the participants. Despite the knowledge about HCQ retinopathy, the drug is prescribed to autoimmune disease patients at an inappropriate dosage. Knowledge obtained from physicians' communication may improve the health outcomes of chronically ill patients. Rheumatologists and ophthalmologists should work together to recognize patients at risk of hydroxychloroquine toxicity and ensure they receive proper education and adhere to periodic follow-up.

The War in Ukraine: How Should Physicians and Health Physicists Communicate Radiation-related Cancer Risks to the Public?

The War in Ukraine: How Should Physicians and Health Physicists Communicate Radiation-related Cancer Risks to the Public?

Prudence in end-of-life decision making: A virtue-based analysis of physician communication with patients and surrogates

Despite significant improvements in end-of-life care over several decades, belated hospice referrals and hospital staffing patterns make challenging end-of-life conversations between strangers unsurprising, especially when the interaction is time-sensitive. Understanding how physicians perform under these circumstances is relevant to patient quality and medical education. This study is a secondary analysis of transcripts from a simulation that placed 88 intensivists, hospitalists, and ED physicians in the setting of responding to a nurse's call to evaluate a floor patient for impending respiratory collapse. A philosophical account of prudence guided the analytical approach and was operationalized through behavior-based and exemplar-based qualitative coding strategies. Exemplary performances and specific behaviors were then compared with preferred outcomes. Results indicate that exemplary performance correlated with a cluster of 3 behaviors that predicted the desired outcomes, but did not determine them: (1) directly affirming the likelihood that the patient will die in the near term; (2) explicitly soliciting the patient's preferences for care; and (3) asking what other family and friends should be involved. The current study implies that educational initiatives aimed at improving end-of-life conversations should expose clinicians both to technical competencies and to the virtues required to employ these competencies well.

Heartache or Bellyache? Epigastric Pain, Communication Skills, and Implicit Bias: Can We Uncover an Association in the Simulation Lab?

Purpose: Implicit bias contributes to health disparities through physician communication behaviors. 1 Research in clinical encounters suggests certain nonverbal and verbal communication is associated with racial implicit bias. 2 To date, there are no published simulations that can be used for teaching or assessment purposes in implicit bias recognition and management (IBRM). We developed a high-fidelity simulation 3 and adapted existing checklists and global rating scales to include communication behaviors known to be associated with racial implicit bias. 2 Approach: This case involved a 52-year-old man presenting to the urgent care center with nausea, vomiting, and epigastric pain. Epigastric pain was chosen as the clinical presentation given the demonstrated racial disparities in acute coronary syndrome (ACS). 4 Cognitive stressors included time constraints, clinical ambiguity (epigastric pain, a normal EKG, asymptomatic on exam), and an interruption from a standardized nurse. We have complete data for N = 15 physician volunteers (PV) over 3 pilots. We pursued an exploratory approach investigating the associations between racial implicit bias as measured on race and race-compliance implicit association tests (IAT) and communication skills of internal/family medicine PVs. We explored the associations between IATs and communication skills of internal/family medicine PV as rated by a highly trained SP and monitor. For each communication domain and subdomain, the mean score was computed comparing the scores on SPs that were Black vs White. Communication checklist items were rated on a 3-point scale, while the entrustment items were rated on a 4-point scale. A mean score was then computed for reach domain and subdomain, and linear regression was conducted with race of the SP and race of the Physician (model 1) as independent variables, followed by race IAT (model 2). Correlation analysis was also conducted to determine if significant relationship existed between the domain/subdomain scores and IAT scores. Outcomes: Mean IAT scores for PVs were in the neutral range. A total of 11 Black SPs/monitors and 9 White SPs/monitors rated physician skills. A significant negative relationship was found between “Elicits all patient’s concerns” item from information gathering with race IAT (r = −0.68, P = .01) and compliance IAT (r = −0.72, r = 0.02). A significant main effect was found on PV race and overall mean global entrustment scores (P = .01), with non-Black physicians receiving a higher score (m = 2.43, SD = 0.35) than Black physicians (m = 1.82, SD = 0.48) when race IAT was not included (model 1). When race IAT was included, no significant differences were found. No other significant differences were found in the other competencies. Significance: We developed a high-fidelity simulation and accompanying checklists and global rating scales that were able to elicit variability in communication skills scores among practicing PVs. A significant difference was found between the Black and non-Black physicians in their overall global entrustment scores when race IAT was not controlled for. When we controlled for race IAT scores (implicit bias impact), differences were no longer present suggesting the impact of implicit bias can be measured through the use of this case and global entrustment measures rather than communication competencies. This study suggests the use of high-fidelity simulations over vignettes may be better in understanding the impact of implicit bias in the patient experience. Medical educators implementing curricula in IBRM infrequently provide learners opportunities for skill development and practice, or assessment of those skills. 5 Our simulation provides a model for skill development in IBRM as it relates to ACS. In addition, given the racial disparities treatment decisions in ACS, this simulation is timely and relevant both for its assessment of communication behaviors associated with IBRM and for its clinical content. Next steps include finalizing simulations with community member input, revisions as informed by data analysis, and assessing medical decision making.

Association between Patient-Provider Communication and Self-Perceived Mental Health in US Adults with Cancer: Real-World Evidence through Medical Expenditure Panel Survey.

Using real-world data, this retrospective cross-sectional study aimed to analyze the association between patient–physician communication and self-reported mental health from cancer patients using publicly available 2019 Medical Expenditure Panel Survey (MEPS) household component data. Four adjusted logistic regression models were conducted to analyze the association between patient–physician communication and self-perceived mental health among United States adult cancer patients, with each model assessing different aspects of patient–physician communication: being respected (respect), being listened to (listen), spending enough time (time), and being explained (explain). The main finding from this study was that only the time model showed a statistical significance, where patients who reported that their physician always spent enough time perceived their mental health as good. Other covariates that showed statistical significance with self-perceived mental health in cancer patients included age, income level, physical limitation, and limitation from pain. In conclusion, there were generally no statistically significant associations between patient–physician communication and mental health among cancer patients.

Variation in Patient-Reported Decision-Making Roles in the Last Year of Life among Patients with Metastatic Cancer: A Longitudinal Study.

We investigated the variation in patient-reported decision-making roles in the past year of life among patients with metastatic solid cancer and the associations of these roles with patient quality of life and perceived quality of care. We used the last year of life data of 393 deceased patients from a prospective cohort study. Patients reported their decision-making roles, quality of life (emotional well-being, spiritual well-being, and psychological distress) and perceived quality of care (care coordination and physician communication) every 3 months until death. We used mixed effects linear regressions to investigate the associations of decision-making roles with patients' quality of life and perceived quality of care. The most reported roles, on average, were patient-led (37.9%) and joint (23.4%; with physicians and/or family caregivers) decision making, followed by no patient involvement (14.8%), physician/family-led (12.9%), and patient alone (11.0%) decision making. Patient level of involvement in decision making decreased slightly as death approached (P < 0.05). Compared with no patient involvement, joint decision making was associated with better emotional well-being (β [95% confidence interval] = 1.02 [0.24, 1.81]), better spiritual well-being (1.48 [0.01, 2.95]), lower psychological distress (-1.99 (-3.21, -0.77]), higher perceived quality of care coordination (5.04 [1.24, 8.85]), and physician communication (5.43 [1.27, 9.59]). Patient-led decision making was associated with better spiritual well-being (1.69 [0.24, 3.14]) and higher perceived quality of care coordination (6.87 [3.17, 10.58]) and physician communication (6.21 [2.15, 10.27]). Joint and patient-led decision-making styles were reported by 61% of the patients and were associated with better quality of life and quality of care. A decrease in the level of patient involvement over time indicates reliance on family and physicians as death approached. Among patients with metastatic cancer, the level of patient involvement in decision making decreased slightly as death approached.Joint decision making of patients with their physicians and/or family caregivers and patient-led decision making were associated with better quality of life and perceived quality of care.Patients with metastatic cancer should be encouraged to be involved in decision making together with their physicians and/or family caregivers to potentially improve their end-of-life experience.

PACCT: An intervention to improve communication quality and clinical trial invitations for Black and White men with prostate cancer.

101 Background: Cancer clinical trial enrollment rates are low, with Black individuals especially underrepresented. We tested Partnering Around Cancer Clinical Trials (PACCT), a multi-level intervention designed to improve patient-physician communication and increase trial invitations among Black and White men with prostate cancer. This study reports only on PACCT Phase 1, the patient-focused intervention, because data collection for PACCT Phase 2, the physician-focused intervention, was halted by the COVID-19 pandemic. Methods: Black and White men with prostate cancer and their physicians were invited to participate. Patients were tracked &lt;two years for trial eligibility, with eligible patients randomized to usual care or intervention. Intervention patients received a brochure that included text promoting patient-physician partnerships and a trials-focused Question Prompt List to encourage them to participate actively in clinic visits, such as by asking questions or stating concerns. Patient-physician visits with eligible patients were video-recorded. After the visits, communication (i.e., patient active participation and physician patient-centered communication) was assessed via patient self-report and observer ratings of video-recordings. Medical chart abstractions determined trial invitations. Univariable logistic mixed-effects models nesting patients within physicians tested intervention effects by race on communication and trial invitation. Results: Among 199 participants (91 Black; 108 White), 22% (n = 44; 20 Black, 24 White) became eligible for a trial and received the intervention (n = 19) or usual care (n = 25). Regarding communication, Black intervention patients reported participating more actively than those in usual care (difference = 0.41, 95% CI -0.27-1.08), while White intervention patients reported participating less actively than those in usual care (difference = -0.34, 95% CI -0.72-0.05). No differences in observer ratings of active participation or self-report or observer ratings of physician communication were found. Regarding trial invitations, findings were nonsignificant, but showed more intervention patients (74%) than usual care patients (60%) received invitations (logOR = 1.97, 95% CI -0.30 to 4.24), with Black intervention patients having higher odds of receiving invitations (80%) than White intervention patients (67%) (logOR = 3.84, 95% CI -0.92 to 8.59 vs. logOR = -0.14, 95% CI -4.61 to 4.50). Conclusions: Few patients (22%, n = 44) were eligible for a trial during PACCT Phase 1. Despite this small sample, the PACCT intervention showed promise in increasing the level of active participation among Black patients and in increasing clinical trial invitations for Black and White patients. Future research should test this intervention in a larger sample and in combination with the physician-focused intervention. Clinical trial information: NCT02906241.

CT-448 Academic Center Outreach to Community Practices Increases Transplant Referrals and Possibly Reduces Racial Disparities

Racial disparities are evident in transplant utilization rates. Outcomes improve for multiple myeloma (MM) with an autologous stem cell transplant (autoSCT) but despite the guidelines, African Americans (AA) receive fewer autoSCT when compared to whites (W). Multiple single-institution studies have confirmed that rates of autoSCT for MM in AA are similar to W when patients are referred for evaluation. Lower referral to a transplant center may contribute to these disparities. Emphasis on physician communication to facilitate an improved referral network represents an intervention to overcome this disparity. We reviewed our center data to assess the impact of outreach on transplant referrals and impact on race. We reviewed transplants (both autoSCT and alloSCT) performed at Augusta University between fiscal years 2015 to 2021. Patients were divided into two cohorts (cohort A: FY2014-17 and cohort B: FY2019-21) based on initiation of physician outreach by our program. FY2018 was used in our analysis for a year of outreach which included visiting practices within catchment area. In addition, two outreach clinics were established in collaboration with large community practice sites. Statistics are descriptive. 389 transplants analyzed included patients age >18 years with 52% males and 45% age ≥ 61 years. Cohort B had a significant increase with 266 vs 123 in cohort A, a 116% increase. There was increased median distance travelled to our center from 15.2 to 52.3 miles. Considering 15 miles as our urban area, >60% of transplants in cohort B were from outside our area. The increase in median distance travelled was found in both autoSCT and alloSCT (15.2 vs 40.3 and 15.2 vs 79.3, respectively). More significantly, cohort B had a 147% increase in AA compared to 96% in W. The distance travelled to our center was higher for W but also increased for AA at 15.4 vs 69.3 and 15.2 vs 34.8 miles, respectively. Of note, review of regional transplant center data suggests the increased volume at our center is not related to redistribution between programs across GA and SC. Our model confirms that academic outreach increases transplant referrals. The increase includes patients of minority thus may be an effective model to reduce healthcare disparities.

Understanding Perceived Barriers to Colposcopy Follow-Up Among Underserved Women at an Urban Teaching Hospital: A Qualitative Study.

Loss to follow-up after abnormal cervical cancer screening disproportionately impacts underserved populations. Our objective was to identify perceived barriers to follow-up after abnormal Pap smear among underserved women. Women with abnormal Pap smear presenting for colposcopy at an urban teaching hospital were asked to participate in qualitative interviews. A topic guide was developed to assess knowledge about cervical cancer screening and perceived barriers to follow-up. A demographic survey was completed and interviews were recorded and transcribed. Responses were coded and placed into a framework: intrapersonal, interpersonal, and community barriers. Major themes and subthemes were identified. Demographic data were reported descriptively. Of 24 women enrolled, 18 (75%) completed full interviews. Median age was 38 years (range = 21-64). Participants were racially diverse: 10 (56%) Hispanic, 7 (39%) non-Hispanic White, 1 (5.5%) non-Hispanic Black, and 1 (5.5%) Asian, and all had public insurance. Seven (39%) presented for their 1st colposcopy visit and 11 (61%) had previous visits. Seventeen (94%) had a positive human papillomavirus test and 7 (39%) had atypical squamous cells of undetermined significance. The most common themes identified were related to knowledge gaps, including lack of understanding of Pap smears/human papillomavirus and cervical cancer risk factors. Most participants were satisfied with provider communication but dissatisfied with communication with the office, like scheduling appointments. Despite positive patient perception of physician communication, knowledge was most commonly identified as a barrier to colposcopy follow-up. Implementing a web-based intervention addressing knowledge gaps may improve abnormal cervical cancer screening follow-up among this population.

Association of Pneumococcal and Influenza Vaccination With Patient-Physician Communication in Older Adults: A Nationwide Cross-sectional Study From the JAGES 2016.

BackgroundIncreasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient–physician communication and whether this variable was associated with increased odds of vaccination.MethodsWe used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination.ResultsAmong the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians’ listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients’ questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination.ConclusionThe results suggest that promotion of having a family physician, better patient–physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.

Abstract P009: Feasibility And Acceptability Of A Digitally-Based Blood Pressure Self-monitoring Program That Promotes Hypertension Self-management And Health Education Among Low-income Patients.

Introduction: According to evidence-based clinical guidelines, adults with hypertension should self-monitor their blood pressure regularly. We developed a remote patient monitoring (RPM) program that supports self-monitoring and promotes improved self-management among low-income patients. Hypothesis: We hypothesized that the program would have high feasibility and acceptability among patients with varying digital health literacy and at least 50% of patients would utilize their monitor at a rate required for reimbursement of the cost of the device (16 days of measurements in any 30-day period). Methods: Between 01/2022 and 05/2022, we deployed cellularly connected monitors to patients with hypertension at Family Health Centers of San Diego. Program elements included training on measurement, behavior change, SMS reminders, and physician communication. Data was monitored via a RPM platform provided by Withings. Participants completed a baseline and follow-up survey on digital health literacy and usability. We used descriptive statistics to quantify the utilization of the monitors over time and evaluate usability. Results: Patients who received blood pressure monitors (N=177) had a mean (SD) age of 55 (12.0) years and 57.6% (102 out of 177) were female. Most patients were Hispanic (71.8%, 127 out 177), spoke Spanish (62.7%, 111 out 177), and owned a smartphone (79.7%, 141 out 177). However, only 63.3% (112 out 177) had access to internet or Wi-Fi at home. The mean (SD) SBP was 136.45 mm Hg (20.5) and the mean (SD) DBP was 83.85 mm Hg (13.9). Only 20.9% (37 out of 177) of patients were able to comply with the measurement rate that would result in device cost reimbursement. This did not differ by levels of digital health literacy; with 86.2% (50 out of 58) participants having said they would recommend the monitor to others and 74.1% (43 out of 58) having said they would like to continue using the monitor in the future. Conclusion: Providing a simple and low-cost method to monitor blood pressure was feasible and acceptable to patients. However, relatively few patients were able to use the monitors at a rate that would result in device cost reimbursement. While RPM programs show promise, plans for sustaining costs among low-income patients need to be further evaluated.

Association of Self-reported Primary Care Physician Tolerance for Uncertainty With Variations in Resource Use and Patient Experience

Inappropriate variations in clinical practice are a known cause of poor quality and safety, with variations often associated with nonclinical factors, such as individual differences in cognitive processing. The differential response of physicians to uncertainty may explain some of the variations in resource use and patient experience. To examine the association of physician tolerance for uncertainty with variations in resource use and patient experience. This survey study linked physician survey data (May to June 2019), patient experience survey data (January 2016 to December 2019), and billing data (January 2019 to December 2019) among primary care physicians (PCPs) at Massachusetts General Hospital with at least 10 visits in 2019. The statistical analysis was performed in 2021. The analysis examined associations of PCP tolerance for uncertainty with the tendency to order diagnostic tests, the frequency of outpatient visits, hospital admissions, emergency department visits, and patient experience data (focused on physician communication and overall rating). A 2-stage hierarchical framework was used to account for clustering of patients under PCPs. Binary outcomes were modeled using a hierarchical logistic model, and count outcomes were modeled using hierarchical Poisson or negative binomial models. The analysis was adjusted for patient demographic variables (age, sex, and race and ethnicity), socioeconomic factors (payer and neighborhood income), and clinical comorbidities. Of 217 included physicians, 137 (63.1%) were women, and 174 (80.2%) were adult PCPs. A total of 62 physicians (28.6%) reported low tolerance, 59 (27.2%) reported medium tolerance, and 96 (44.2%) reported high tolerance for uncertainty. Physicians with a low tolerance for uncertainty were less likely to order complete blood cell counts (odds ratio [OR], 0.66; 95% CI, 0.50-0.88), thyroid tests (OR, 0.67; 95% CI, 0.52-0.88), a basic metabolic profile (OR, 0.78; 95% CI, 0.60-1.00), and liver function tests (OR, 0.72; 95% CI, 0.53-0.99) than physicians with a high tolerance for uncertainty. Physicians who reported higher tolerance for uncertainty were more likely to receive higher patient experience scores for listening to patients carefully (OR, 0.65; 95% CI, 0.50-0.83) and higher overall ratings (OR, 0.80; 95% CI, 0.66-0.98) than physicians with medium tolerance. Conversely, no association was found between physician tolerance for uncertainty and patient outpatient visits, hospital admissions, or emergency department visits. In clinical practice, identifying and effectively managing inappropriate variations and improving patient experience have proven to be difficult, despite increased attention to these issues. This study supports the hypothesis that physicians' tolerance for uncertainty is associated with differences in resource use and patient experience. Whether enhancing physicians' tolerance for uncertainty could help reduce unwarranted practice variations, improve quality and patient safety, and improve patient's experience remains to be established.

Com-On Questionnaire: Development and validation of a questionnaire for evaluating communication skills of oncologists.

The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view. A first draft of the questionnaire was compiled based on skills reflecting good physician-patient communication identified in the literature. The questionnaire was critically revised by experts to ensure the validity of its contents. The revised questionnaire was completed by a sample of 153 cancer patients. The questionnaire was developed in German and later translated into English. After analysis using classical test theory and an exploratory factor analysis, four different factors could be extracted. These factors were labelled setting, patient-centeredness, empathy and consulting competencies. Unsuitable items were eliminated within the analysis. All remaining items hold an appropriate degree of selectivity, item difficulty and reliability/consistency. A novel questionnaire for evaluating communication skills of physicians was developed. It contains 36 items and is named 'Com-On Questionnaire: Questionnaire for the Evaluation of Physician's Communication Skills in Oncology'. The questionnaire is suitable for measuring both the strengths and deficits within the physician-patient communication in oncology from the patients' perspective.

Physician and Surgeon Communication Assessed via the Pathology Requisition in a Regional Laboratory Over Ten Years.

BackgroundIneffective communication between healthcare providers is a known risk factor for adverse events.ObjectiveThe aim of this study was to retrospectively assess the communication with pathology via an analysis of the information provided on the pathology requisitions over ten years.MethodsAll in-house surgical specimens and all non-gynecologic cytopathology specimens accessioned from 2011 to 2020 were retrieved at a regional laboratory. Cases with any clinical information were deemed to have a clinical history present (CHP). CHP was tabulated by submitting physicians/surgeons (SPS), hospital site, year, and tissue group.ResultsThe study period contained 554,817 relevant pathology reports, of which 553,966 could be extracted. The overall CHP rate was 74% and varied from 76% to 67% over the study period. SPSes submitting ≥200 cases (n=314) had a mean/median/standard deviation/max/min CHP rate of 81%/92%/23%/100%/5%. The CHP varied between four hospital sites, from 53% to 97%. CHP varied from 61% to 99% by tissue group.ConclusionsCHP is associated with several factors and appears to depend on the hospital culture, specialty, and individual physician/surgeon. The pathology requisition is a way to measure and track the communication that is clinically relevant. Improving communication with pathologists/the pathology department will likely require process changes and mandates. Hospital and laboratory accreditation bodies should consider effective communication with pathology a marker of quality and an accreditation issue.

Communication skills utilized by physicians in the pediatric outpatient setting

BackgroundEffective communication has been shown to increase patient satisfaction. The objective of this study was to describe communication strategies employed by physicians, and determine if physician communication strategies affect caregiver perception of quality or satisfaction with physician communication in a pediatric ambulatory setting.MethodsThis observational study was conducted at the Children’s Hospital of Philadelphia and consisted of video recordings of visits that were reviewed by research assistants for physician utilized communication strategies. Caregivers completed surveys on their preferred physician communication qualities, perception of communication quality, and satisfaction with communication. Correlation was performed between types of communication strategy and caregiver satisfaction with communication or perceived quality of communication. T-tests were run to see if there was a significant difference in patient perceived communication and satisfaction scores based on the communication strategies utilized during visits.ResultsThere were five universally used communication strategies across the 84 clinic visits recorded, including: eye contact, good posture, speaking concisely, providing thorough explanations, and providing summary of next steps. The average number of communication strategies used was 15.95 (σ = 1.50) with physicians using at least 16 of the 18 communication strategies in 62% of the clinic visits. There was no correlation between the number of communication strategies physicians utilized and either the caregiver perception of communication quality score (CPCQ) or communication satisfaction (CS) score. Caregivers who preferred an authoritative approach but perceived a collaborative approach reported lower average CPCQ and CS scores compared to caregivers who had their communication expectations met.DiscussionThere are numerous tools designed to help the physician facilitate an effective working relationship with the patient. In our study, the universally used verbal communication strategies are generally recognized as components of an effective communication repertoire. Another part of effective communication is meeting communication expectations with the CS scores suggesting that caregivers felt their communication needs were being met. Dedicating clinical time to understanding this need may help improve the overall clinical experience.ConclusionPhysicians utilize many of the suggested communication strategies to help facilitate an effective clinical encounter. Further studies on caregiver communication requirements and meeting caregiver communication expectations are needed.

Interest and Utility of MC1R Testing for Melanoma Risk in Dermatology Patients with a History of Nonmelanoma Skin Cancer.

Public access to genetic information is increasing, and community dermatologists may progressively encounter patients interested in genetic testing for melanoma risk. Clarifying potential utility will help plan for this inevitability. We determined interest and uptake of genetic risk feedback based on melanocortin receptor gene (MC1R) variants, immediate (two weeks) responses to risk feedback, and test utility at three months in patients (age ≥ 18, with a history of nonmelanoma skin cancer). Participants (N = 50) completed a baseline survey and were invited to consider MC1R testing via the study website. Testing interest and uptake were assessed through registration of test decision, request of a saliva test kit, and kit return (all yes/no). Immediate responses to risk feedback included feedback-relevant thoughts, emotions, communication, and information seeking after result receipt; test utility outcomes included family and physician communication and information seeking. Results indicated good retention at both time points (76%; 74%). Half (48%) logged onto the study website, and of these, most (92%) chose testing and (95%) returned a saliva sample. After two weeks, most (94%) had read all the risk feedback information and distress was low (M = 8.81, 7–28, SD = 2.23). Many (69%) had talked with their family about the results. By three months, most had spoken with family (92%) and physicians (80%) about skin cancer risk. Physician communication was higher (70%) in those tested versus those not tested (40%, p = 0.02). The substantial interest and promising outcomes associated with MC1R genetic testing in dermatology patients inform intervention strategies to enhance benefits and minimize risks of skin cancer genetic testing.

Strengthening Parent – Physician Communication: A Mixed Methods Study on Attuned Communication Training for Pediatric Residents

Problem : High-quality communication improves patient satisfaction and clinical outcomes, yet formal communication training in residency is often minimal. Many studies on empathic communication show mixed results and are often hindered and skewed by brief study lengths, insufficiently and ambiguously defined concepts, and limited methods for objective measurements. Intervention : The FAN Curriculum is a unique communication curriculum, based on the conceptual frameworks of patient-centered communication, reflective practice, mindfulness, and attunement using the Facilitating Attuned Interactions (FAN) model. The first part of the FAN Curriculum was delivered as a 3-hour interactive workshop involving didactics, group discussion, and role play with pediatric residents. Residents then completed weekly self-reflections, a follow-up one-hour training to reinforce concepts, and five monthly mentor sessions, all emphasizing reflective practice. Context : This longitudinal, mixed-methods study examined the effects of the FAN Curriculum on residents’ empathy levels and ability to communicate with parents in the clinical setting. The study was conducted at two urban, academic, medium-sized pediatric residency programs in Chicago between October 2016 and November 2017. First- and second-year pediatric residents whose continuity clinic site was located at their home institution participated. Residents received training in the use of the FAN Communication Tool using a delayed-start crossover study design. Impact : At five time points, residents and parents completed instruments validated for measuring physician empathy and mindfulness. Post-study interviews were conducted for one institution’s residents and mentors and were evaluated using open and focused coding. Participants (n = 23) demonstrated a high degree of use of the FAN Communication Tool six months post-training and a significant rise in self-reported comfort with four of five FAN core processes. One parent-completed survey (Consultation and Relational Empathy, CARE) showed a statistically significant rise of 3.26% in resident relational empathy and collaboration after training (p = 0.02). In qualitative analysis of interviews, residents and mentors found the FAN Communication Tool beneficial, making clinic visits more efficient and collaborative. Both groups noted improvement in the residents’ relationship-building skills; residents were able to use enhanced communication skills to better approach challenging encounters and work through parent concerns. Lessons Learned : Family-centered communication training can improve physician-perceived empathy and mindfulness. Effective communication for pediatric residents incorporates an empathic approach, and introduction to this formal curriculum supported their growth in connecting and engaging with children and parents. The FAN Curriculum may provide a useful method for improving resident communication skills with a positive impact on pediatricians’ collaboration with patients and families.