Poor Physician-patient Communication Research Articles

Abstract B136: Health related social needs of people with cancer underrepresented in clinical trials: Early experience of the Cancer Research Equity and Advocacy through Engagement Initiative (CREATE) clinical trial patient navigation program

Abstract Background: Black and African Americans (AA) remain severely underrepresented in therapeutic oncology clinical trials (TOCTs) and have the highest cancer mortality rates compared to all other groups. Racially biased clinical trial offers, poor physician-patient communication, and social determinants of health largely contribute to these racial inequities. The UNC Lineberger CREATE Clinical Trial Patient Navigation (CTPN) program was established to advance racial equity in TOCT participation. The CTPN program entails clinical trial education, facilitating communication between patients and their medical/research team, identifying barriers to clinical trial participation and connecting patients to resources to address those barriers. Here we describe the health-related social needs and referrals made to address those needs. Methods: The CTPN program employed a targeted proactive approach to reach patients with a new cancer diagnosis who self-identified as Black/African American (AA) or were insured by Medicaid. The patient navigator used the electronic medical record (EMR) to review the oncologist's schedule to identify patients meeting the above criteria. Identified patients received a letter in the mail describing the CTPN program and were offered an in-person clinic visit and/or telephone call with the patient navigator. During these encounters, the patient navigator assessed clinical trial barriers including health-related social needs and made referrals to resources to help address these needs. The CTPN program was initially launched in the thoracic oncology clinic but later became available for direct referrals from all oncology groups. Results: In the first 18 months of the CTPN program, there were 292 patient encounters among183 unique patients who received navigation services. Most patients (83%) were identified through the EMR, 79% identify as Black or AA, 64% have Medicaid. Patients had a diagnosis of lung (62%), head and neck (18%), gynecological (9%), and breast (2%) cancers. Clinical trial related barriers and health-related social needs included lack of clinical trial knowledge (68%), housing (9%), transportation (26%), financial support (18%), and family/caregiver support (14%). CTPN program materials were provided to address clinical trial informational needs (78%), and referrals were made to assist with emotional (13%), logistical (20%), and financial (21%) needs. On average, 2 referrals were made per patient encounter. Conclusion: CTPN can engage Black/AA patients with cancer using a proactive EMR approach to identify patients and may help address health-related social needs to facilitate cancer care and potential clinical trial participation. Future work will evaluate the impact of CTPN on enrollment of Black/AAs in therapeutic cancer clinical trials. Citation Format: Ashley Rankin Collins, Hayley N. Morris, Lauren N. Matthews, Omar N. Buenaventura Gomez, Marjory Charlot. Health related social needs of people with cancer underrepresented in clinical trials: Early experience of the Cancer Research Equity and Advocacy through Engagement Initiative (CREATE) clinical trial patient navigation program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B136.

Living with axial spondyloarthritis: a cross-sectional survey of patient knowledge and perceptions

Diagnosis and effective treatment of axial spondyloarthritis (AxSpA) are often delayed due to inadequate awareness and poor patient-physician communication. Some AxSpA patients fail to maintain an active lifestyle by exercising regularly, further worsening their disease management. The evolving concept of patient-centred care necessitates better understanding of patient awareness and their needs. We aimed to survey AxSpA patients to reflect on healthcare planning and management perspectives. Our self-administered questionnaire focused on perceptions of AxSpA diagnosis and management, particularly exploring issues of physical activity and active lifestyle. Satisfaction with AxSpA medical care and its accessibility, diagnostic delays, patient-physician communication, and support for disease management were also explored. This offline survey was arranged at the Department of Rheumatology, Immunology, and Internal Medicine of Jagiellonian University Medical College and Krakow University Hospital. We surveyed patients with AxSpA attending outpatient clinics between December 1st, 2023 and April 22nd, 2024. The questionnaire included questions on types of physical activities, barriers to exercising, satisfaction with medical care, patient-physician interactions, diagnostic delays, and use of teleconsultations. A total of 117 patients with AxSpA were enrolled (mean age 41.62 years). The majority (n = 93, 79.5%) were employed. There was a male predominance (69, 59%). The average diagnostic delay was 5.5 years. Notably, 104 (88.9%) responders perceived physical activity as a factor influencing their disease course. However, only 32 (27.35%) managed to exercise regularly (≥ 30 min, 2–3 times a week). The majority (70, 59.83%) were irregularly engaged in some form of physical activity, with 15 (12.8%) not exercising at all, and nearly half (48%) reported at least one barrier to maintaining a physically active lifestyle. Pain (32, 27.35%), fatigue (27, 23.08%), lack of motivation (17, 14.53%), and lack of time (12, 10.26%) were noted as barriers to exercising. The respondents preferred to exercise at home. The survey identified critical areas where patient dissatisfaction or uncertainty were notably prevalent: 38 (32.5%) were uncertain and 35 (30%) were dissatisfied with rehabilitation access. For spa therapy, 63 (53.85%) reported uncertainty and 23 (19.7%) expressed dissatisfaction. Only 48 (41%) were treated by a rehabilitation specialist last year. Only 23% of AxSpA patients took part in teleconsultations last year, and 65% preferred in-person visits. While AxSpA patients recognize the importance of physical activity, significant barriers exist to engaging them regularly in exercising. Addressing these barriers through personalized, motivational, and educational strategies could improve patient outcomes. Improving patient satisfaction with healthcare services, particularly in areas of rehabilitation and physician-patient communication, is crucial for improving the overall care of AxSpA patients.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

ObjectivesIn middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.MethodsData were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians’ communication skills on healthcare quality and patient satisfaction.ResultsThe findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians’ knowledge and other factors, demonstrated positive associations between physicians’ communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.ConclusionThis study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

Perception, attitudes, knowledge of using complementary and alternative medicine for cancer patients among healthcare professionals: A mixed-methods systematic review.

With the rapid increase in the prevalence of cancer worldwide, the utilization of complementary and alternative medicine (CAM) has increased among cancer patients. This review aimed to understand the perception, attitudes, and knowledge of healthcare professionals toward using CAM for cancer patients. A mixed-methods systematic review was undertaken in four databases. Inclusion criteria were primary studies reporting perception, attitudes, and knowledge of healthcare professionals for using CAM for cancer patients were eligible. A mixed-methods convergent synthesis was carried out, and the findings were subjected to a GRADE-CERQual assessment of confidence. Forty-two studies were chosen. The majority of the studies were quantitative and had less than 100 participants. Most publications were from European countries, and oncology was the highest among the specialties. The review found the following themes: feasibility of having negative adverse effects, low expectations of using CAM among HCPs, potential positive effects of using CAM, specific CAM training may be helpful, no concrete regulations to promote CAM practice, and poor physician-patient communication. Nurses had more positive views than other professions; oncologists were concerned regarding herb-drug interactions; integration of CAM into the healthcare system was favorable; HCPs felt the need to participate in specific CAM training; and HCPs agreed that CAM education should be provided more regularly. Future studies should explore the studies views of cancer patients and details of in-depth evidence of CAM in oncology settings.

Impact of Social Isolation, Physician-Patient Communication, and Self-perception on the Mental Health of Patients With Cancer and Cancer Survivors: National Survey Analysis.

Cancer is perceived as a life-threatening, fear-inducing, and stigmatized disease. Most patients with cancer and cancer survivors commonly experience social isolation, negative self-perception, and psychological distress. The heavy toll that cancer takes on patients continues even after treatment. It is common for many patients with cancer to feel uncertain about their future. Some undergo anxiety, loneliness, and fear of getting cancer again. This study examined the impact of social isolation, self-perception, and physician-patient communication on the mental health of patients with cancer and cancer survivors. The study also explored the impact of social isolation and physician-patient communication on self-perception. This retrospective study used restricted data from the 2021 Health Information National Trends Survey (HINTS), which collected data from January 11, 2021, to August 20, 2021. We used the partial least squares structural equation modeling (PLS-SEM) method for data analysis. We checked for quadratic effects among all the paths connecting social isolation, poor physician-patient communication, mental health (measured using the 4-item Patient Health Questionnaire [PHQ-4]), and negative self-perception. The model was controlled for confounding factors such as respondents' annual income, education level, and age. Bias-corrected and accelerated (BCA) bootstrap methods were used to estimate nonparametric CIs. Statistical significance was tested at 95% CI (2-tailed). We also conducted a multigroup analysis in which we created 2 groups. Group A consisted of newly diagnosed patients with cancer who were undergoing cancer treatment during the survey or had received cancer treatment within the last 12 months (receipt of cancer treatment during the COVID-19 pandemic). Group B consisted of respondents who had received cancer treatment between 5 and 10 years previously (receipt of cancer treatment before the COVID-19 pandemic). The analysis indicated that social isolation had a quadratic effect on mental health, with higher levels of social isolation associated with worse mental health outcomes up to a certain point. Self-perception positively affected mental health, with higher self-perception associated with better mental health outcomes. In addition, physician-patient communication significantly indirectly affected mental health via self-perception. The findings of this study provide important insights into the factors that affect the mental health of patients with cancer. Our results suggest that social isolation, negative self-perception, and communication with care providers are significantly related to mental health in patients with cancer.

Abstract P571: Investigating Factors Relevant to Understanding the Hispanic Health Paradox in Patients After Cardiac Arrest

Introduction: The growing Hispanic community faces disproportionate hardship due to lower financial capital and educational opportunity. The Hispanic health paradox refers to the finding that Hispanics tend to have better cardiovascular outcomes than non-Hispanics, despite facing greater hardships and more cardiovascular risk factors. Behavioral (e.g., sleep) and psychological (e.g., optimism) factors predict recovery after acute coronary syndrome events, but less is known about how these factors differ by ethnicity after cardiac arrest (CA). We tested demographic, psychological, behavioral, and recovery factors that may underlie the Hispanic health paradox among CA survivors. Hypothesis: We hypothesized that Hispanic vs. non-Hispanic cardiac arrest survivors would have lower income and education but would not differ in behavioral, psychological, and recovery factors. Methods: An observational cohort study, Psychological predictors of recovery after an Acute Cardiac Event (PACE) , enrolled 68 neurologically intact CA survivors admitted to NewYork-Presbyterian Hospital. At hospital discharge, self-reported demographic, psychological, behavioral, and recovery variables were assessed. Independent-samples t-tests of Hispanic vs. non-Hispanic CA survivors were conducted comparing income, education, posttraumatic stress symptoms, depression, negative affect, cardiac anxiety, optimism, positive affect, social support, sleep, physical activity, independent activities of daily living, and self-maintenance. Results: As hypothesized, Hispanic vs. non-Hispanic participants had lower income, Mann Whitney U = 99.00, z = -3.46, p &lt; .01, and lower education, Mann Whitney U = 336.00, z = -2.65, p = .01. Unexpectedly, Hispanic patients reported greater cardiac anxiety M = 39.60, SD = 16.70) than non-Hispanic patients ( M = 30.29, SD = 11.67), t (66) = -2.722, p = .008. No other tested factors were significant, all p s ≥ .419. Conclusions: Cardiac anxiety is the only tested variable that differed by ethnicity. While Hispanic ethnicity may be protective for certain aspects of cardiovascular health, the present findings indicate that Hispanic CA survivors experience higher psychological distress, which itself is a known risk factor for poor health behaviors. Future research should assess potential drivers of cardiac anxiety (e.g., mistrust of healthcare system, poor patient-physician communication). Future intervention research should target heart-related fear during CA recovery.

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.

Racial disparities in Black men with prostate cancer: A literature review.

Black men are disproportionately affected by prostate cancer (PCa), with earlier presentation, more aggressive disease, and higher mortality rates versus White men. Furthermore, Black men have less access to PCa treatment and experience longer delays between diagnosis and treatment. In this review, the authors discuss the factors contributing to racial disparities and present solutions to improve access to care and increase clinical trial participation among Black men with PCa. Racial disparities observed among Black men with PCa are multifaceted, evolving from institutional racism. Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on PCa and treatment options, fear of PCa diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time, and cancer debt, play an important role in racial disparities observed in PCa treatment and outcomes. Racial diversity is often lacking in genomic and precision medicine studies. Black men are largely underrepresented in key phase 3 PCa trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams, and bias of health care providers to recommend clinical research. The authors propose solutions to address these factors that include educating clinicians and institutions on the barriers Black men experience, increasing the diversity of health care providers and clinical research teams, and empowering Black men to be involved in their treatment, which are keys to creating equity for Black men with PCa. LAY SUMMARY: Prostate cancer negatively affects Black men more than men of other races. The history of segregation and mistreatment in the health care system may contribute to mistrust among Black men. Outcomes are worse for Black men because they are less likely to be screened or to receive treatment for prostate cancer. Black men also are unlikely to participate in clinical research, making it difficult for investigators to understand how Black men are affected by prostate cancer. Suggestions for addressing these differences include teaching physicians and nurses about the issues Black men experience getting treatment and improving how Black men get information on prostate cancer.

Continuous Subcutaneous Insulin Infusion Therapy Resulting in Improved Glycemic Control in Patient With Low Health Literacy

Introduction: According to White et al., health literacy is defined as ‘the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions. Nearly 36 percent of adults in the United State have low health literacy. Low health literacy not only affects the individual and the communities but also puts a lot of burden on healthcare resulting in high healthcare costs. It has adversely influenced diabetes care due to lack of use of preventive services, poor physician-patient communication, poor comprehension of medical instructions, and errors in medication dosing, and timing. Continuous subcutaneous insulin infusion (CSII), also known as insulin pump therapy, and continuous glucose monitors (CGM) are commonly indicated in patients with inadequate glycemic control, high glucose variability, unpredictable hypoglycemia, patients with an erratic schedule or varied work shifts. We present a case of uncontrolled diabetes mellitus in a patient with low health literacy, with significant improvement in glycemic control after starting CSII with CGM.Case: A 59-year-old female with a 13-year history of Latent Autoimmune Diabetes in Adults, on Insulin and Semaglutide, presented for evaluation in the clinic. She was struggling with insulin dosing and blood glucose control with multiple hospital admissions for hypo- and hyperglycemia. Her home blood glucose levels ranged from 92 to 536 mg/dl. Her HbA1C was between 12 and 18% in the past years. She had developed microvascular complications like diabetic nephropathy, neuropathy, and had a cerebrovascular accident in the past. Her current insulin dose was Glargine 50 units daily at nighttime and Lispro 25 units with each meal. Her most recent HbA1c was 14.5. She was not compliant with diet and has difficulty exercising due to residual weakness from CVA. The patient was struggling with insulin injection with errors in the dosing and timing of insulin due to difficulty in understanding medical instructions. Considering all the struggles and uncontrolled diabetes, CSII with CGM was initiated, with a simple protocol for her, one-click, or two clicks depending on the meal size. Within two months there was a significant improvement in her glycemic control. Her recent HbA1C was 9.5%.Conclusion: CSII can be considered as a viable treatment option in patients with low health literacy with uncontrolled diabetes mellitus like in our patient.

Abstract PS9-43: Impact of educational workshops on patient-provider communication among Spanish-speaking metastatic breast cancer survivors and their caregivers: Results from the frankly speaking about cancer: Cáncer de seno métastatico evidence-based educational workshops

Abstract Background: Latina metastatic breast cancer survivors, in particular those of low socioeconomic status, often receive unsatisfactory medical care and experience poor physician-patient communication and relationships.1 Patient education about metastatic breast cancer can improve communication between Latina survivors and caregivers and their health care team.2 This analysis explores participants’ experiences gained from Cancer Support Community’s national evidence-based educational program, Frankly Speaking about Cancer: Cáncer de seno metástatico (Metastatic Breast Cancer). Methods: Frankly Speaking about Cancer (FSAC): Metastatic Breast Cancer is a comprehensive psychosocial educational program that provides information about current treatments, side effect management, and social and emotional challenges of an advanced breast cancer diagnosis. FSAC: Metastatic Breast Cancer was originally created in English and was then translated into Spanish to make the program more accessible to Spanish-speaking metastatic breast cancer survivors and caregivers in the US. 75 participants from 22 workshops across the country between 2018 and 2020 completed program evaluation surveys in Spanish and provided self-reported data on factors including pre- and post-workshop knowledge and intentions for patient-provider communication. Descriptive analyses and pre-and post-workshop comparisons were conducted to assess workshop outcomes. Results: Most workshop participants were metastatic breast cancer patients/survivors (n=46); the remainder served in the caregiving capacity and included spouses/partners (n=19) and family members (n=10). The average age of participants was 61 years old (s.d.= 24.14 years). Among those with metastatic breast cancer, more than half (54%) received the diagnosis within the last two years; and only 29% reported being moderately to highly involved in their treatment decisions. 76% of respondents reported experiencing emotional distress due to their/their loved one’s cancer. Pre- and post-survey results show a significant gain in reported knowledge about metastatic breast cancer (χ²= 13.4, p &amp;lt;.05). Caregivers of Latina metastatic breast cancer survivors also demonstrated a significant gain from pre- to post-workshop in knowledge about metastatic breast cancer treatment options, confidence to participate in treatment decision-making with their health care team, and confidence in asking questions about side effects of metastatic breast cancer and its treatment. As a final point, 68% of cancer patients/survivors and 72% of caregivers reported that because of the workshops, they felt better prepared to emotionally cope with their metastatic breast cancer experience. Discussion: Our findings indicate that educational workshops in Spanish can play a role in enhancing Latina patients’ self-perceived knowledge about metastatic breast cancer and empowering patients and caregivers to become active participants in their treatment decisions. These results underscore the importance of providing culturally specific educational resources to support patients and caregivers in their interactions with their health care team and advance breast health equity among Latinas. Citation Format: Claire Saxton, Maria B. Gonzalo, Richa Ruwala, Kirstin Fearnley, Alyssa Jaisle. Impact of educational workshops on patient-provider communication among Spanish-speaking metastatic breast cancer survivors and their caregivers: Results from the frankly speaking about cancer: Cáncer de seno métastatico evidence-based educational workshops [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-43.

246 An analysis of qualitative themes in yelp reviews of maternal fetal medicine (MFM) practices

To identify qualitative themes distinguishing poorly-rated practices from highly-rated practices offering MFM care. We conducted an IRB-exempt, qualitative analysis of the publically-accessible online review platform Yelp. MFM practices were analyzed in over 30 highly-populated U.S. cities; reviews were only included on practices with 5+ total reviews. Reviews were coded for 14 qualitative themes grouped into either provider-specific or practice-specific areas with both positive and negative variations. Analysis was performed on the frequency of these themes as a function of 1- to 5-star rating. A total of 1008 reviews were analyzed, with 69% being private practices, defined as not associated with an academic teaching center. The average star rating was 3.34 with 50% being 5-star practices and 32% being 1-star practices. The 5-star practices were three times more likely to be private than academic and most often included positive physician-related themes. Conversely, 1-star practices were much more likely to include negative practice-related themes (Table 1). The most common cited reasons for a 1-star rating included negative staff interactions, poor patient-physician communication, and long wait times (Table 2). Provider-related themes are more important in forming a positive patient experience, while practice-related themes are more likely to worsen patient satisfaction. The aggregation of online reviews may allow physicians to identify areas of practice management that can be enhanced to improve satisfaction measures, an increasingly important aspect of health care quality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Patients Fail to Disclose Their Symptoms During A Visit to Their Primary Care Physician

Patient-physician communication is Associate in Nursing integral a part of clinical observe. once done well, such communication produces a therapeutic result for the patient, as has been valid in controlled studies. Formal coaching programs are created to reinforce and live specific communication skills. several of those efforts, however, specialise in medical faculties and early postgraduate years and, therefore, stay isolated in educational settings. Thus, the communication skills of the busy medical practitioner typically stay poorly developed, and also the want for established physicians to become higher communicators continues. during this article, the authors concisely review the why and the way of effective patient-physician communication. they start by reviewing current information on the advantages of effective communication within the clinical context of physicians caring for patients. The authors then supply specific steering on the way to attain effective communication within the patient-physician relationship. However, there's very little empirical proof relating to the role of patients in distinguishing and preventing medical damage[1]. For hospitalized patients, the technical complexness of treatment and also the acute nature of their sicknesses undermine their ability to acknowledge issues. In ambulant patients, many studies document poor understanding of treatment recommendations or medication regimens[2].Two recent reports address patients’ ability to spot medication-related errors and injuries in medical care. within the ambulant Quality Improvement Project, eighteen of patients in eleven medical care practices according a tangle because of medications within the previous year, however solely three-dimensional of patients’ charts recorded this finding.11 A limitation of the study was the dearth of certification by physicians of patient-reported medication symptoms. The goal of the current study was to know the medication-related symptoms old by members of this patient cohort yet because the contribution of poor patient-physician communication to ADEs. we have a tendency to theorized that if patients and physicians communicated additional effectively concerning medication-related symptoms, then the intensity or period of symptoms can be quenched. Specifically, we have a tendency to wanted to answer the subsequent questions: (1) What square measure the frequency, type, and severity of patient-identified medication symptoms? (2) however typically do clinicians accept as true with patients’ attribution of symptoms to their medications? (3) What factors square measure related to patients’ choices to inform physicians concerning symptoms? (4) What factors square measure related to physicians’ choices to handle patient-reported medication symptoms?

Assessment of Asthma Control and Quality of Life among Asthmatic Patients Attending Armed Forces Referral and Teaching Hospital, Addis Ababa, Ethiopia.

Background The primary goal of asthma management is to achieve good asthma control. However, poor patient-physician communication, unavailability of appropriate medications, and lack of long-term goals have made asthma control difficult in developing countries. Poor assessment of asthma control and quality of life is a major cause of suboptimal asthma treatment worldwide, and information regarding this issue is scanty in developing countries like Ethiopia. This study thus attempted to assess the level of asthma control and quality of life in asthmatic patients attending Armed Forces Referral and Teaching Hospital. Methods A cross-sectional study comprising 184 physician-diagnosed asthmatic patients was conducted using interview, chart review, and prescription assessment. Asthma control was assessed using Asthma Control Test, while asthma quality of life was assessed using Mini-Asthma Quality of Life Questionnaire (mini-AQLQ). Spearman's rank correlation analysis was performed to understand the relationship between mean mini-AQLQ score and asthma control. Receiver operating characteristic curve analysis was performed to establish cut-off values for mini-AQLQ. Results Asthma was uncontrolled in 67.9% subjects. There was a strong correlation between asthma control and quality of life (rs = 0.772; P < 0.01). A cut-off value for the quality of life was established at 4.97. Majority of the patients were taking two or three antiasthmatic drugs. Oral tablet and inhaler short-acting beta agonists (SABA) were the frequently combined drugs. Uncontrolled asthma was associated with middle-aged adults (adjusted odds ratio (AOR) = 6.31; 95% CI: 2.06, 19.3; P = 0.001), male gender (AOR = 0.38; 95% CI: 0.15, 0.98; P = 0.044), married (AOR = 0.24; 95% CI: 0.08, 0.78; P = 0.017), comorbidities (AOR = 0.23; 95% CI: 0.09, 0.61; P = 0.003), and oral SABA use (AOR = 0.22; 95% CI: 0.09, 0.59; P = 0.003). Male gender (AOR = 0.36; 95% CI: 0.16, 0.84; P = 0.018), intermittent asthma (AOR = 0.18; 95% CI: 0.04, 0.86; P = 0.032), use of oral corticosteroids (AOR = 0.22; 95% CI: 0.06, 0.73; P = 0.013), and SABA (AOR = 0.39; 95% CI: 0.17, 0.89; P = 0.026) were found to have a significant association with poor asthma-related quality of life. Conclusion The findings collectively indicate asthma remains poorly controlled in a large proportion of asthma patients in the study setting. Moreover, quality of life appears to be directly related to asthma control. Healthcare providers should therefore focus on asthma education with an integrated treatment plan to improve asthma control and quality of life.

Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study.

Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy.Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM).Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p < 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p < 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C.Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model.

Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies.

Adherence to asthma medications is generally poor and undermines clinical outcomes. Poor adherence is characterized by underuse of inhaled corticosteroids (ICS), often accompanied by over-reliance on short-acting β2-agonists for symptom relief. To identify drivers of poor medication adherence, a targeted literature search was performed in MEDLINE and EMBASE for articles presenting qualitative data evaluating medication adherence in asthma patients (≥12 years old), published from January 1, 2012 to February 26, 2018. A thematic analysis of 21 relevant articles revealed several key themes driving poor medication adherence, including asthma-specific drivers and more general drivers common to chronic diseases. Due to the episodic nature of asthma, many patients felt that their daily life was not substantially impacted; consequently, many harbored doubts about the accuracy of their diagnosis or were in denial about the impact of the disease and, in turn, the need for long-term treatment. This was further compounded by poor patient-physician communication, which contributed to suboptimal knowledge about asthma medications, including lack of understanding of the distinction between maintenance and reliever inhalers, suboptimal inhaler technique, and concerns about ICS side effects. Other drivers of poor medication adherence included the high cost of asthma medication, general forgetfulness, and embarrassment over inhaler use in public. Overall, patients’ perceived lack of need for asthma medications and medication concerns, in part due to suboptimal knowledge and poor patient-physician communication, emerged as key drivers of poor medication adherence. Optimal asthma care and management should therefore target these barriers through effective patient- and physician-centered strategies.

WHY HEARING STATUS MATTERS IN DELIVERY OF VALUE BASED HEALTH CARE

Hearing loss (HL) is a major public health issue with two-thirds of adults age 70+ years in the US having clinically-significant HL. As society ages, the number of persons with HL is increasing. HL is independently associated with accelerated cognitive decline, poorer physical functioning and is a risk factor for falls. It results in higher healthcare costs, poor physician-patient communication, and may contribute to suboptimal medical outcome due to communication errors and associated poor adherence to treatment recommendations. As healthcare provision shifts to value-based care, effective communication assumes greater import. We propose that systematic screening in healthcare settings can identify individuals whose HL may threaten delivery of care. We will discuss options for screening individuals with multi-morbidity and offer cost effective solutions for optimizing hearing status in persons with HL. Case studies will highlight how optimizing hearing status can reduce listening effort, fatigue and expedite throughput in busy clinic settings.

Prevalence of Self-Reported Hypertension in Deaf Adults Who Use American Sign Language.

In the United States, roughly one-third of adults have hypertension; another third have prehypertension. The prevalence of hypertension in deaf American Sign Language (ASL) users is unknown. We address this gap through a descriptive study for the prevalence of hypertension in the American Deaf community and discuss future directions to address this issue. Self-reported data for 1,388 ASL using deaf adults were compared with a secondary data of 2,830 English-speaking hearing adults. Frequency and percentages were used to describe the prevalence of hypertension in the deaf community. Age-weighted analysis was used to compare unmodifiable risk factors and hypertension rate between deaf and hearing adults. Deaf and hearing samples' hypertension rates for gender and age were similar. Significant group differences between deaf and hearing samples emerged across race. Compared with the hearing controls, our deaf sample demonstrated a significantly decreased risk for hypertension with a prevalence of 37% (compared with 45% in the hearing sample). Although the hypertension rate for gender and age was similar across deaf and hearing samples, between-group disparities exist for race. The lower rate of hypertension in our deaf sample is likely a consequence of underdiagnoses due to lower health literacy and poor patient-physician communication. Furthermore, deaf black Americans' lower rates compared with hearing black Americans may be due to poor patient-physician communication, not having regular providers or social stressors. It is recommended that modifiable risk factors and social determinants be investigated to determine their effect on hypertension within the deaf community.

Poor concordance between reason for consultation and parental expectations in behavioral referrals

Abstract BACKGROUND Behavioural conditions such as Attention-deficit/hyperactivity disorder (ADHD) are present in up to 5% of children across the world. This is a common reason for referral from primary care to paediatricians. When a primary care provider refers a patient to a specialist, they often create a set of expectations in the patient. These expectations may have a strong effect on the patient relationship with the specialist. It has been shown that parental expectations can influence prescribing practices in paediatrics. Low socioeconomic status, a risk factor for behavioural conditions is also a risk factor for poor physician-patient communication. If patient expectations set up in primary care are not reflected in the referral question sent to the paediatrician, this may hinder paediatrician-patient communication and impact care. OBJECTIVES The primary objective of this project was to determine the level of concordance between physician referrals and parent expectations in the consultant paediatrician’s office. A secondary objective was to examine demographic and socio-economic trends within this population. DESIGN/METHODS A clinic nurse conducted almost 500 pre-appointment intake interviews of guardians in children with a referral related to a behavioural concern and asked them their expectations for the consultation. The referral question and parental expectations were categorized by question of behavioural diagnosis, learning difficulties, medical complaint or unknown. Chi sqaured analysis was performed to measure concordance. RESULTS Among this population, 70.4% were male, with 54% coming from single parent families. Chi-square analysis indicated a small-moderate level of concordance on issues relating to attention, behaviour and academics, (59.9%, p&lt;0.001; 57.3%, p&lt;0.001; 62.6%, p=0.001), and high concordance but low correlation for social and medical issues (80.1%, p=0.002, 91.6%, p=0.06). CONCLUSION This study demonstrates how we could improve our patient-centered approach by being clear in what is being offered by paediatric consultation. When primary care providers consult paediatrics for behavior referrals there should be clear commnication of the concern at hand and management of the expectations for the visit with the family. This will improve efficiency and lessen dealys or barriers to access to care allowing approriate triage of referrals and patient satisfaction.

Secondary prevention patterns in persons with pre-existing coronary artery disease: Are we getting it right?

Background:Cardiovascular diseases are the main cause of death globally. Individuals with evidence of coronary artery disease are at increased risk of further cardiovascular events. However, with good secondary prevention, which consists broadly of lifestyle changes, medical therapy and revascularisation, this risk can be reduced. The true extent of secondary prevention in individuals who are re-admitted with a myocardial infarction in such a high-risk cohort has never been explored in Malaysia.Methods:We performed a retrospective, observational study in a tertiary hospital in 100 individuals with previously diagnosed coronary artery disease admitted with a myocardial infarction from August 2016 to February 2017.Results:Twenty-nine per cent of patients were still smoking; 15% and 47% were not taking antiplatelet or beta-blocker therapy, respectively. A further 45% and 20% of patients were not on any renin–angiotensin–aldosterone inhibition or lipid-lowering therapy, respectively.Conclusion:In our high-risk cohort, secondary prevention practices were sub-optimal. Poor physician–patient communication was frequently listed as a major factor. Simple strategies taken at various levels of care should be implemented and audited to improve these practices.

Strategies for Acing the Fundamentals and Mitigating Legal and Ethical Consequences of Poor Physician-Patient Communication.

This article explores how the absence of effective verbal and nonverbal communication in the physician-patient encounter can lead to poor outcomes for patients and physicians alike. The article discusses legal and ethical topics physicians should consider during a medical encounter and provides educational and practical suggestions for improving effective communication between physicians and their patients.