Physician-patient Communication Research Articles

Physicians’ perceptions of patient participation in the myocardial infarction pathway

Myocardial infarction is an acute, frightening and life-threatening condition for patients who are affected. They need plain and simple information about the disease and the treatment, yet patient participation might be challenging in acute situations. Previous studies have shown that patient participation leads to improved patient satisfaction, cooperation with healthcare professionals and better management of the disease. Physicians have a key role in facilitating patient participation in the healthcare services. This study explores physicians’ perceptions of patient participation in the myocardial infarction pathway. In 2018 we interviewed nine experienced physicians in Norway working in different phases of the pathway. Hermeneutics was chosen as the underpinning analytical framework. Four themes illustrated patient participation in the myocardial infarction pathway. Paternalism characterised the acute phase. During hospitalisation the physicians perceived a lack of continuity in physician–patient communication. In the discharge phase, the physicians focused on strengthening health literacy. In the rehabilitation phase, dialogue and shared decision making was central to achieving treatment adherence. We found variations in the level of patient participation along the different phases of the myocardial infarction pathway. Strengthening continuity to ensure patient participation and collaboration between healthcare professionals is essential. The physicians proposed introducing checklists for patient information to enhance interprofessional collaboration and strengthen patient participation.

Impact of Patient and Physician Disconnect on Satisfaction with Treatment for Atopic Dermatitis in Japan.

Atopic dermatitis (AD) is an inflammatory disease causing severe skin itching. Data on patient-physician disconnect on treatment satisfaction in patients with AD in Japan are limited. We investigated patient-physician disconnect on treatment satisfaction in AD and if it influences treatment patterns, clinical characteristics, and patient-reported outcomes (PROs). Data were drawn from the Adelphi AD Disease Specific Programme (DSP), a real-world, point-in-time survey of physicians and patients with AD conducted in Japan from April to July 2019. Patients and physicians were grouped according to level of treatment satisfaction ("extremely satisfied" to "extremely dissatisfied"); with any level of dissatisfaction recorded as "less than satisfied." Data were collected on treatment patterns, clinical characteristics, and PROs including the Dermatology Life Quality Index (DLQI), Patient-Oriented Eczema Measure (POEM), EQ-5D-3L questionnaire, and Work Productivity and Activity Impairment (WPAI) questionnaire. Data were provided by 184 patients with AD and 56 physicians; 72.8% of patient-physician pairs reported a fair (kappa coefficient: 0.40) level of agreement on treatment satisfaction, 51.6% of patient-physician pairs were both satisfied, and 21.2% were both less than satisfied. Satisfied physicians prescribed a mean 1.2 fewer treatments than dissatisfied physicians (p < 0.05). Cases where both physician and patient were less than satisfied or where patients were less satisfied than their physicians reported the worst PROs, DLQI (both less than satisfied: mean 10.7 versus patient less satisfied than physician: 10.6 versus overall: 7.9), POEM (19.5 versus 17.3 versus 17.0), EQ-5D-3L (0.82 versus 0.81 versus 0.87) (all, p < 0.05). Work impairment was highest when both patient and physician were less than satisfied (p < 0.05). Physicians cited treatment efficacy and patients cited efficacy and usability as main reasons for dissatisfaction. Overall, 12.0% of patients were less satisfied with their AD treatment than the physician, demonstrating some of the worst PROs, suggesting unmet need that could be improved by better patient-physician communication.

Effective communication and shared decision making: Theoretical approach from the doctor-patient relationship approach

Introduction: shared decision making is understood as a communicational model in which health personnel collaborate with the patient or caregiver in making optimal health decisions, encouraging patients, family members and physicians to evaluate clinical information and compare risk-benefit in order to select the most appropriate treatment option.Objective: to characterize shared decision making as a model of patient-physician communication.Development: the method has gained acceptance among the medical community in recent years; despite having an approach in line with current medicine due to benefits such as a decrease in medical errors, being associated with a better overall quality of decisions and less decisional conflict, its use is controversial due to weaknesses such as lack of practical guidelines for its use, lack of training for the parties involved, lack of time and applicability due to the patient's characteristics. Shared decision support tools provide information about the options and potentially expected outcomes for a person's health status, and are different from traditional educational materials. Conclusions: shared decision making emerges as a method of patient-physician communication centered on the participation of the patient in his or her medical therapy and is credited with reducing decisional uncertainty. The scientific evidence is insufficient to recommend its use over traditional methods, although its application has gained acceptance among the international community in recent years.

Racial Disparities in Patient-Provider Communication During Telehealth Visits Versus Face-to-face Visits Among Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer: Cross-sectional Analysis.

Telehealth visits increase patients' access to care and are often rated as "just as good" as face-to-face visits by oncology patients. Telehealth visits have become increasingly more common in the care of patients with cancer since the advent of the COVID-19 pandemic. Asians and Pacific Islanders are two of the fastest growing racial groups in the United States, but there are few studies assessing patient satisfaction with telemedicine among these two racial groups. Our objective was to compare satisfaction with communication during telehealth visits versus face-to-face visits among oncology patients, with a specific focus on Asian patients and Native Hawaiian and other Pacific Islander (NHOPI) patients. We surveyed a racially diverse group of patients who were treated at community cancer centers in Hawaii and had recently experienced a face-to-face visit or telehealth visit. Questions for assessing satisfaction with patient-physician communication were adapted from a previously published study of cancer survivors. Variables that impact communication, including age, sex, household income, education level, and cancer type and stage, were captured. Multivariable logistic models for patient satisfaction were created, with adjustments for sociodemographic factors. Participants who attended a face-to-face visit reported higher levels of satisfaction in all communication measures than those reported by participants who underwent a telehealth encounter. The univariate analysis revealed lower levels of satisfaction during telehealth visits among Asian participants and NHOPI participants compared to those among White participants for all measures of communication (eg, when asked to what degree "[y]our physician listened carefully to you"). Asian patients and NHOPI patients were significantly less likely than White patients to strongly agree with the statement (P<.004 and P<.007, respectively). Racial differences in satisfaction with communication persisted in the multivariate analysis even after adjusting for sociodemographic factors. There were no significant racial differences in communication during face-to-face visits. Asian patients and NHOPI patients were significantly less content with patient-physician communication during telehealth visits when compared to White patients. This difference among racial groups was not seen in face-to-face visits. The observation that telehealth increases racial disparities in health care satisfaction should prompt further exploration.

Medical Students’ Self-Assessment of Communication Skills During COVID-19 Pandemic at Tabriz University of Medical Sciences

Background. In addition to patient satisfaction and treatment compliance by patients, appropriate physician-patient communication leads to development of a relationship between physicians and patients based on trust. The purpose of this study was self-assessment of medical interns and stagers of Tabriz University of Medical Sciences in communicating with the patients during COVID-19 pandemic. Methods. The population of this cross-sectional study included all medical stagers and interns at Tabriz University of Medical Sciences, Iran from November to December, 2020. The research tool was a standard questionnaire of Interpersonal Communication Skills Scale developed by Vakili et al. to assess interpersonal communication skills. After the online questionnaires were filled by the students, we calculated and compared the mean score of self-assessment of communication skills for the medical stagers and interns. Additionally, we compared the mean scores of students’ self-assessment in term of educational level, gender, wards and on duty hours during a week. Results. In this study, a total of 152 medical stagers and interns participated. More than half of the participants were female (55.92%). The mean self-assessment score of the participants was 93.83±9.78. The mean self-assessment score of medical stagers and interns was 93.15±8.13 and 94.51±12.26, respectively. There was no statistically significant difference in self-assessment score of patient communication based on educational level and ward (surgical and non-surgical), but the mean score of self-assessment was significantly higher in females (P=0.044). Conclusion. Most medical interns and stagers had an average self-assessment score regarding patient communication during COVID-19 pandemic. So, appropriate training can improve medical students’ communication skills. However, the communication skills required for medical students may vary depending on whether they are dealing with a pandemic or non-pandemic situation.

EPH39 Association Between Patient-Physician Communication and Perceived Mental Health Status Among United States Adults With Cancer

EPH39 Association Between Patient-Physician Communication and Perceived Mental Health Status Among United States Adults With Cancer

Sexual and urinary function in prostate cancer clinical studies and the Europa Uomo Patient Reported Outcome Study: does it match?

We aimed to quantify the difference in patient reported outcome (PRO) data between clinical studies and the (patient initiated) EUPROMS study for sexual functioning and urinary incontinence after radical prostatectomy (RP) and external beam radiotherapy (RT). Europa Uomo, the patient organization of men with prostate cancer (PCa) in Europe, initiated the EUPROMS study. Data involved 1101 men with PCa treated with RP and 304 patients treated with RT. In a literature search we identified investigator-initiated studies which matched EUPROMS characteristics. The observed scores in the literature were compared to the scores calculated using the EUPROMS-models. Data from EUPROMS was used to develop four regression models for men treated with RP and RT. The time between diagnosis and questionnaire completion was estimated to be 3/4 years for men after RP, and 5 for RT. Eight studies were identified which reported PRO data using the EPIC with comparable follow-up. Large heterogeneity was observed in reported literature. For sexual function, the difference in calculated and observed scores is at most 24 points (range 3-24 points) and differences between studies were less evident; for urinary incontinence, the difference between calculated and observed scores is at most 15 points (range 1.5-15) (4 scores above the MID) and previous studies underreported the actual effect compared to the current study. Previous clinical investigator studies underreported the actual effect for urinary incontinence compared to the EUPROMS study. Clinicians should be aware of a potential underestimation of the reported PRO in the patient-physician communication.

Examining how physician factors influence patient satisfaction during clinical consultations about cancer prognosis and pain.

Patient-physician communication affects cancer patients' satisfaction, health outcomes, and reimbursement for physician services. Our objective is to use machine learning to comprehensively examine the association between patient satisfaction and physician factors in clinical consultations about cancer prognosis and pain. We used data from audio-recorded, transcribed communications between physicians and standardized patients (SPs). We analyzed the data using logistic regression (LR) and random forests (RF). The LR models suggested that lower patient satisfaction was associated with more in-depth prognosis discussion; and higher patient satisfaction was associated with a greater extent of shared decision making, patient being black, and doctor being young. Conversely, the RF models suggested the opposite association with the same set of variables. Somewhat contradicting results from distinct machine learning models suggested possible confounding factors (hidden variables) in prognosis discussion, shared decision-making, and doctor age, on the modeling of patient satisfaction. Practitioners should not make inferences with one single data-modeling method and enlarge the study cohort to help deal with population heterogeneity. Comparing diverse machine learning models (both parametric and non-parametric types) and carefully applying variable selection methods prior to regression modeling, can enrich the examination of physician factors in characterizing patient-physician communication outcomes.

The use of 3D digital anatomy model improves the communication with patients presenting with prostate disease: The first experience in Senegal.

We hypothesized that the use of an interactive 3D digital anatomy model can improve the quality of communication with patients about prostate disease. A 3D digital anatomy model of the prostate was created from an MRI scan, according to McNeal's zonal anatomy classification. During urological consultation, the physician presented the digital model on a computer and used it to explain the disease and available management options. The experience of patients and physicians was recorded in questionnaires. The main findings were as follows: 308 patients and 47 physicians participated in the study. In the patient group, 96.8% reported an improved level of understanding of prostate disease and 90.6% reported an improved ability to ask questions during consultation. Among the physicians, 91.5% reported improved communication skills and 100% reported an improved ability to obtain patient consent for subsequent treatment. At the same time, 76.6% of physicians noted that using the computer model lengthened the consultation. This exploratory study found that the use of a 3D digital anatomy model in urology consultations was received overwhelmingly favorably by both patients and physicians, and it was perceived to improve the quality of communication between patient and physician. A randomized study is needed to confirm the preliminary findings and further quantify the improvements in the quality of patient-physician communication.

Assessment Briefs

Assessment Briefs

Digital Narratives of Living With Lupus: Lived Experiences and Meanings for Latin American and Latino Patients and Their Families.

Systemic lupus erythematosus (SLE) disproportionately affects Latin American and Latino populations, with worse outcomes compared to nonminority populations. Understanding patients' views is critical to provide culturally competent care. The objective of this research is to analyze lived experiences with SLE from comments made by Latin American and Latino patients, and their relatives and friends, on the public Facebook group "Hablemos de Lupus" (in English: "Let's Talk about Lupus"). Deidentified narratives posted as a reaction to the most popular resources shared by the page were extracted using the Facepager application. We conducted a thematic analysis under an interpretative medical anthropology framework. Five core themes were demonstrated by social media comments: lived experiences with lupus, religious/spiritual thoughts, metaphors, heredity, and experiences of family and friends. Being diagnosed with lupus is perceived as a life-changing event. The fluctuating course of the disease causes uncertainty, and the perception of invisibility within the patient's social circle generates feelings of being misunderstood. Faith and spiritual thoughts are coping strategies. Patients use metaphors about the disease's meaning and their lived experiences (the purple butterfly, not belonging, bellicose metaphors) to communicate with others. Relatives and friends are impacted by their loved one's distress. Patients perceive lupus as an unpredictable illness and use metaphors to foster empathy and communicate their experiences to others. Religion is as important as medical treatment to cope with the disease, and the experience of having lupus extends to family and friends. Findings can be used to improve physician-patient communication and lupus education campaigns in the Latin American and Latino population.

Perpetuation of defunctioning stoma: risk factors and countermeasures

Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage after rectal cancer surgery. It is of concern that about 1 in 5 defunctioning stomas will not be restored, that is, becoming permanent. And that is usually beyond expectation by physicians and patients, which deserves enough attention. The causes are complex, including anastomotic complications, tumor progression, perioperative death, poor anal function and patient willingness. Possible risk factors include symptomatic anastomotic leakage, age, tumor location, neoadjuvant therapy, anal function, TNM stage, ASA score, hospital factors, etc. Those factors may occur in various stages of patient referral such as before neoadjuvant therapy, prior to surgery, intra or post-operative period, and follow-up. Adequate physician-patient communication and shared decision-making, comprehensive tumor and patient function assessment, rational treatment strategy, careful manipulation during operation and good quality control, and meticulous perioperative management are important steps to reduce the permanent stoma. When shared decision-making, patients' needs should be fully considered while unnecessary expectations of anal preservation should be avoided. The risk of perpetuation of defunctioning stoma should be fully informed. Safe operation, especially anastomosis, is the key to avoid permanent stoma. And attention should be paid to the early detection and intervention of postoperative anastomotic stenosis.

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.

The "Nationaler Kompetenzbasierter Lernzielkatalog Medizin NKLM2.0"-Implications for medical education in ophthalmology

The Masterplan Medicine 2020 has been passed by German authorities in 2017 and will be the basis for future developments in teaching and medical education in Germany. The "Nationaler Kompetenzbasierter Lernzielkatalog" NKLM as alearning target index will be the substructure in terms of its content. The NKLM2.0 has been finalized in 2021. The basic concept of skill-related learning will replace the pure teaching of medical facts. Physician-patient communication will be acentral issue. The structure of the NKLM2.0 is presented and the main topics for teaching in ophthalmology are discussed. The main chapters of the NKLM2.0 that are directly related to topics in ophthalmology are chapterV medical conditions, chapterVI diseases, chapterVII comprehensive learning targets and chapter VIII comprehensive competences. New teaching standards in ophthalmology need to include the topics and learning targets of the NKLM2.0, as the NKLM will be legally binding in the future. It should be the basis but not exclusively, to improve educational standards in ophthalmology.

Optimal training in communication model (OPTiCOM): A programmatic roadmap

ObjectivesTeaching primary care residents patient communication skills is essential, complex, and impeded by barriers. We find no models guiding faculty how to train residents in the workplace that integrate necessary system components, the science of physician-patient communication training and competency-based medical education. The aim of this project is to create such a model. MethodsWe created OPTiCOM using four steps: (1) communication educator interviews, analysis and theme development; (2) initial model construction; (3) model refinement using expert feedback; (4) structured literature review to validate, refine and finalize the model. ResultsOur model contains ten interdependent building blocks organized into four developmental tiers. The Foundational value tier has one building block Naming relationship as a core value. The Expertize and resources tier includes four building blocks addressing: Curricular expertize, Curricular content, Leadership, and Time. The four building blocks in the Application and development tier are Observation form, Faculty development, Technology, and Formative assessment. The Language and culture tier identifies the final building block, Culture promoting continuous improvement in teaching communication. ConclusionsOPTiCOM organizes ten interdependent systems building blocks to maximize and sustain resident learning of communication skills.Practice ImplicationsResidency faculty can use OPTiCOM for self-assessment, program creation and revision.

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.

DESIGN AND EVALUATION OF PSYCHOMETRIC ATTRIBUTES OF THE "PHYSICIANS' ATTITUDES TOWARD ESTABLISHING PERSONAL AND FRIENDLY COMMUNICATION WITH PATIENTS" SCALE

The physician-patient communication is one of the most important forms of communication in the health system. If this communication loses its moral aspects for different reasons, it will lead to mistrust. Therefore, this research was conducted to design and evaluate the psychometric attributes of the "Physicians' attitudes toward establishing personal and friendly communication with patients" scale. The present methodological research was conducted in three phases. In the first phase, conventional content analysis was used. In the second phase, the terms of the questionnaire were developed using the results of the qualitative part. In the third stage, the psychometric attributes of the questionnaire were determined using face validity, content, and reliability of internal consistency and stability. The score of all items of the questionnaire using the effective item selection method was more than 1.5. The CVR of 15 items was more than 0.62 and the CVI of all items was higher than 0.79. Cronbach's alpha of 0.749 was obtained to measure the internal consistency of the questionnaire using SPSS-v24 software. The used questionnaire has appropriate internal validity and reliability. Based on the results, there was no comprehensive and unified attitude towards establishing personal and friendly relations between a physician and a patient among experts.

Investigating Patients' Continuance Intention Toward Conversational Agents in Outpatient Departments: Cross-sectional Field Survey.

Conversational agents (CAs) have been developed in outpatient departments to improve physician-patient communication efficiency. As end users, patients' continuance intention is essential for the sustainable development of CAs. The aim of this study was to facilitate the successful usage of CAs by identifying key factors influencing patients' continuance intention and proposing corresponding managerial implications. This study proposed an extended expectation-confirmation model and empirically tested the model via a cross-sectional field survey. The questionnaire included demographic characteristics, multiple-item scales, and an optional open-ended question on patients' specific expectations for CAs. Partial least squares structural equation modeling was applied to assess the model and hypotheses. The qualitative data were analyzed via thematic analysis. A total of 172 completed questionaries were received, with a 100% (172/172) response rate. The proposed model explained 75.5% of the variance in continuance intention. Both satisfaction (β=.68; P<.001) and perceived usefulness (β=.221; P=.004) were significant predictors of continuance intention. Patients' extent of confirmation significantly and positively affected both perceived usefulness (β=.817; P<.001) and satisfaction (β=.61; P<.001). Contrary to expectations, perceived ease of use had no significant impact on perceived usefulness (β=.048; P=.37), satisfaction (β=-.004; P=.63), and continuance intention (β=.026; P=.91). The following three themes were extracted from the 74 answers to the open-ended question: personalized interaction, effective utilization, and clear illustrations. This study identified key factors influencing patients' continuance intention toward CAs. Satisfaction and perceived usefulness were significant predictors of continuance intention (P<.001 and P<.004, respectively) and were significantly affected by patients' extent of confirmation (P<.001 and P<.001, respectively). Developing a better understanding of patients' continuance intention can help administrators figure out how to facilitate the effective implementation of CAs. Efforts should be made toward improving the aspects that patients reasonably expect CAs to have, which include personalized interactions, effective utilization, and clear illustrations.

Dupuytren contracture: using qualitative data to inform a conceptual framework for shared decision-making.

Multiple treatment options are available to patients with Dupuytren contracture, making shared decision-making complex. Our rigorous qualitative analysis sought to understand patient perceptions of shared decision-making in Dupuytren contracture treatment and create a conceptual framework to optimize patient-physician communication. We interviewed 30 patients with Dupuytren contracture to learn about their experience with treatment selection. The following themes were integral to shared decision-making for Dupuytren contracture treatment: discussing disease progression and treatment initiation, presenting all available treatment options, assessing patients' pre-existing biases towards treatment, patient values and preferences for treatment trade-offs, treatment risks and benefits, physician recommendation and active patient participation. This model can optimize communication about treatment options and expectations for relevant outcomes including, recovery time, contracture recurrence, complications, and treatment-related expenses.Level of evidence: V.

Identification of Clinical Risk Factors Affecting Patient-Physician Communication

IntroductionPatient satisfaction is an important indicator of quality in health care and is linked to clinical outcomes, patient retention, and professional satisfaction. Patients admitted to the hospital from the emergency department may not understand their diagnosis, reason for admission or plan of care, which can adversely impact their hospital experience. We aim to identify risk factors that contribute to poor patient-physician communication and to assess the effects of raising awareness of these issues to hospital providers. MethodsFrom November 2020 to April 2021, patients admitted to the surgical floor were surveyed within 24 h of admission. Relevant data were extracted through retrospective chart review. Residents and attendings were debriefed regarding the improving communication. Surveys answered before and after the brief intervention were compared. ResultsOne hundred thirty one patients who were admitted to the surgical floor were surveyed. Nineteen did not know their diagnoses (14.5%), 29 could not explain their diagnoses (22.1%), and 28 did not know their treatment plans (21.4%). A total of 38 (29.0%) patients answered “no” to at least one question. Trauma patients (P = 0.034), patients with pain score >4 at time of admission (P = 0.038), age >65 y (P = 0.047), and patients with >3 comorbidities were more likely to answer “no” to at least one of the questions. Postintervention, a 10% reduction in number of patients answering “no” was observed. ConclusionsTrauma patients, patients with poor pain control, the elderly, and those with multiple comorbidities are more likely to experience poor patient-physician communication. Raising awareness of the importance of this matter resulted in an improvement in communication.