Audiologist-patient communication profiles in hearing rehabilitation appointments

ObjectiveTo profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients’ decisions to pursue hearing aids.MethodsSixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted.ResultsTwo distinct audiologist-patient communication profiles were identified during both the history taking phase (46 = biopsychosocial profile, 15 = psychosocial profile) and diagnosis and management planning phase (45 = expanded biomedical profile, 11 = narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients’ decisions to pursue hearing aids.ConclusionInitial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction.Practice implicationsFindings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients.     

The nature of informational continuity of care in general practice

Background

The availability of patient information to practitioners forms the basis of informational continuity of care. Changes in family practice that now encourage multiphysician clinics have meant that informational continuity of care has become crucial because it is likely that a patient will not continuously see the same doctor. Therefore a review of the nature of informational continuity is useful.

Aim

To answer the question ‘How is informational continuity developed in general practice?’.

Design of study

A rigorous systematic review of relevant electronic databases.

Method

Databases were searched for articles answering the research question. Articles focused on family medicine and informational continuity of care were included. Data from reviewed articles were independently extracted and reviewed by two researchers. Conceptual and evidence-based articles were included.

Results

Initially, 193 articles were obtained from all five bibliographic databases; 57 were retained following title and abstract review. Of these, 34 articles were included in the final systematic review. Results show that informational continuity of care is developed using paper/electronic records and remembered information collectively, through a series of doctor–patient consultations over time. Obstacles to its development are practitioners not recording patient information and patients not disclosing important details.

Conclusion

These findings have implications for newer styles of primary care that may have a negative impact in the successful management of chronic illnesses in particular.     

Development and validation of the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication

ObjectiveThe purpose of this study was to develop and analyze the psychometric properties of an instrument that could analyze the communication of nursing professionals in nurse-patient therapeutic communication.MethodsA literature review and a panel of experts were used (N = 10) to develop the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication. The final version of the questionnaire was composed of 49 items and applied to a convenience sample of 370 nurses.ResultsThe construct validity was assessed by an exploratory factor analysis (EFA) and the reliability using Cronbach’s Alpha. Three dimensions were identified that determine therapeutic communication: professional, contextual and/or situational and patient. The Cronbach’s α total coefficient was 0.90, ranging from 0.71 to 0.81 for the dimensions.ConclusionThe questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication represents a valid and reliable questionnaire to measure nurses’ communication with patients in the clinical setting.Implications for practiceThe use of the questionnaire enables the analysis of elements that interfere with effective communication. This can assist in developing interventions to improve nurses’ therapeutic communication with patients.     

Evaluating relationships between lung cancer stigma,anxiety, and depressive symptoms and the absence of empathic opportunities presented during routine clinical consultations

ObjectiveEmpathic communication in clinical consultations is mutually constructed, with patients first presenting empathic opportunities (statements communicating emotions, challenges, or progress) to which clinicians can respond. We hypothesized that lung cancer patients who did not present empathic opportunities during routine consultations would report higher stigma, anxiety, and depressive symptoms than patients who presented at least one.MethodsAudio-recorded consultations between lung cancer patients (N = 56) and clinicians were analyzed to identify empathic opportunities. Participants completed questionnaires measuring sociodemographic and psychosocial characteristics.ResultsTwenty-one consultations (38 %) did not contain empathic opportunities. Unexpectedly, there was a significant interaction between presenting empathic opportunities and patients’ race on disclosure-related stigma (i.e., discomfort discussing one’s cancer; F = 4.49, p = .041) and anxiety (F = 8.03, p = .007). Among racial minority patients (self-identifying as Black/African-American, Asian/Pacific Islander, or other race), those who did not present empathic opportunities reported higher stigma than those who presented at least one (t=-5.47, p = .038), but this difference was not observed among white patients (t = 0.38, p = .789). Additional statistically significant findings emerged for anxiety.ConclusionDisclosure-related stigma and anxiety may explain why some patients present empathic opportunities whereas others do not.Practice implicationsClinicians should intentionally elicit empathic opportunities and encourage open communication with patients (particularly from diverse racial backgrounds).     

Racial/ethnic differences in prognosis communication during initial inpatient palliative care consultations among people with advanced cancer

ObjectiveWe examined whether conversations involving Black or Latino patients with advanced cancer differ in the presence or characteristics of prognosis communication.MethodsWe audio-recorded initial consultations between 54 palliative care clinicians and 231 hospitalized people with advanced cancer. We coded for the presence and characteristics of prognosis communication. We examined whether the presence or characteristics of prognosis communication differed by patients' self-reported race/ethnicity.ResultsIn 231 consultations, 75.7% contained prognosis communication. Prognosis communication was less than half as likely to occur during conversations with Black or Latino patients (N = 48) compared to others. Among consultations in which prognosis was addressed, those involving Black or Latino patients were more than 8 times less likely to contain optimistically cued prognoses compared to others.ConclusionPrognosis communication occurred less frequently for Black and Latino patients and included fewer optimistic cues than conversations with other patients. More work is needed to better understand these observed patterns of prognosis communication that vary by race and ethnicity.Practice implicationsGrowing evidence supports prognosis communication being important for end-of-life decision-making and disproportionately rare among non-White populations. Therefore, our findings identify a potentially salient target for clinical interventions that are focused on ameliorating disparities in end-of-life care.     

Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: An observational study

ObjectiveThis observational study explores advanced practice nurses’ (APN) performance in secondary prevention and self-management support in patients with cardiovascular disease.MethodsReal-life consultations in three outpatient clinics were recorded on audio and analysed. First, discussed (sub)categories were determined using five categories of self-management: symptom management, treatment, biomedical cardiovascular risk factors, psychosocial consequences, and lifestyle changes. Second, the extent in which motivational interviewing aspects were applied was determined using the Behaviour Change Counselling Index (BECCI).ResultsIn total, 49 consultations performed by five female APNs were analysed. Physical topics were discussed in 98% and psychological subthemes in 41% of the consultations. Although not all components of motivational interviewing were applied, talking about current behaviour and behaviours that should change were discussed, and information was provided. Especially setting targets and exchanging ideas on how to reach behavioural goals were applied to a small extent.ConclusionWell-trained APNs in the current study do not carry out motivational interviewing in a structural and complete manner according to BECCI and do not discuss all self-management categories.Practice implicationsPsychological topics should be more integrated in providing self-management support by APNs and the application of motivational interviewing should be enhanced by regularly and repeated training.     

Self-management support activities in primary care: A qualitative study to compare provision across common health problems

ObjectiveTo explore the views of primary care teams about the provision of self-management support to patients with common health problems.MethodsSemi-structured interviews were conducted with twenty-one members of the primary care team from thirteen general practices. Interviews were transcribed verbatim, and analysed using the ‘Framework’ approach.ResultsThree categories and six sub-categories illustrating different self-management support activities across common health problems were identified from the analysis of interviews, and contributed to one major theme and one cross-cutting theme. Referral and signposting were frequently used to facilitate patient engagement with external services and resources. Practitioners faced some challenges in balancing medical management and psychosocial support and motivating patients to engage with self-management.ConclusionsPrimary care teams described providing a wide range of self-management support activities, but the pattern of use varied for different types of health problem. These patterns may have been influenced, in part, by general practices focusing upon achieving financially incentivised quality improvement goals.Practice implicationsTo improve self-management support, practitioners need a digital repository of services/resources, motivational interviewing skills, an understanding of the optimum duration and pattern of consultations, and incentivised targets that match a biopsychosocial model of care.     

Barriers and facilitators for an effective palliative care communication with older people: A systematic review

ObjectivesThe present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people.MethodsThe review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool.ResultsTwenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people.ConclusionPalliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication.Practice implicationsFacilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging.     

The effects of nurse-led health coaching on health-related quality of life and clinical health outcomes among frequent attenders: A quasi-experimental study

ObjectiveTo evaluate the effects of the nurse-led health coaching on health-related quality of life and clinical health outcomes among frequent attenders in primary healthcare.MethodsA quasi-experimental study design. A total of 110 patients were enrolled in the study. The experimental group (n = 52) received nurse-led health coaching and the control group (n = 58) received the usual care at primary health care centres in Finland. The data were collected before the intervention and 12 months via a questionnaire of health-related quality of life and clinical health outcomes as measured by health-coaching nurses.ResultsThis study found frequent attenders have low health-related quality of life. The nurse-led health coaching showed no differences in health-related quality of life between the experimental and control groups. However, the nurse-led health coaching had statistically significant effects on the blood pressure and health-related quality of life among the experimental participants, especially in emotional role limitation and energy.ConclusionsThis study suggests that nurse-led health coaching may lead to an improvement in the health-related quality of life and blood pressure among frequent attenders.Practice ImplicationsThe health-coaching sessions with own health-coaching nurses and action plans support the frequent attenders´ health promotion goals and implementation.     

“I didn’t know you were such a good cook”: Photos as a tool for primary care clinician-patient communication

ObjectivesTo examine audio-recorded primary care interactions with patient-initiated photo sharing around food and diet choices.MethodsData were 13 audio recordings of primary care visits with English-, Chinese-, or Spanish-speaking patients 60+ with two or more chronic conditions. Patients and clinicians completed pre-intervention surveys and some training on photo-taking / photo-sharing discussion. Data were analyzed using discourse analysis.ResultsPhoto-based communication interactions lasted 3:34?28:37 min and averaged one-third of the visit. Clinicians and patients both initiated the photo-based talk and transition to other topics occurred smoothly. In eight of 13 interactions, the photo-based communication task was raised, but conversation did not occur at that moment. When discussed, the photos raised opportunities to talk about patient’s decision-making which led to dietary suggestions including clinical nutrition suggestions and referrals to other specialty clinics.ConclusionPhoto-based communication in primary care can be used to promote patient activation and facilitate collaborative decision making that accounts for the patients’ lived experiences and lifeworld.Practice implicationsBy setting the agenda early, clinicians or patients can designate the photo-sharing as a relevant part of the visit. Photos may be most relevant as part of the problem presentation, diagnosis, or treatment recommendation sections of the visit.     

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

BackgroundDespite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented.ObjectiveTo explore nurses’ experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation.MethodsThis investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.ResultsThree themes and nine sub-themes emerged: (1) “Choice as facilitator for shared understanding and engagement in patients’ own care,” with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) “enhancing the patients’ strengths,” with two sub-themes: releasing patient's internal strengths and confirming “normalcy” for the patient; and (3) “new challenges for the nurse,” with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges.ConclusionsFindings suggest that, from nurses’ perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses’ professional roles and created dilemmas such as nurses’ ambivalence regarding patients’ levels of disclosure of sensitive issues and the nurses’ ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.     

Barriers and facilitators to shared decision-making in neonatal medicine: A systematic review and thematic synthesis of parental perceptions

ObjectivesSystematically review parental perceptions of shared decision-making (SDM) in neonatology, identifying barriers and facilitators to implementation.MethodsElectronic database (Medline, PsycINFO, CINAHL and Scopus) and follow-up searches were conducted to identify qualitative studies. Data were extracted, thematically analysed and synthesised.ResultsSearches yielded 2445 papers, of which 25 were included. Thematic analysis identified six key themes. Key barriers included emotional crises experienced in the NICU setting, lack of medical information provided to parents to inform decision-making, inadequate communication of information, poor relationships with caregivers, lack of continuity in care, and perceived power imbalances between HCPs and parents. Key facilitators included clear, honest and compassionate communication of medical information, caring and empathetic caregivers, continuity in care, and tailored approaches that reflected parent’s desired level of involvement.ConclusionThe highly specialised environment, and the emotional crises experienced by parents impact significantly on their perceived capacity to engage in surrogate decision-making.Practice ImplicationsComplex and multi-factorial interventions that address the training needs of HCPs, and the emotional, informational and decision support needs of parents are needed. SDM skills training, improved information delivery, and integrated emotional and decisional support could help parents to become more involved in SDM for their infant.     

Emotional and informational patient cues: The impact of nurses’ responses on recall

Objective

To investigate older cancer patients’ informational and emotional cues, how nurses respond to these cues and the effect of cues and responses on patients’ information recall.

Methods

105 cancer patients (aged ≥65 years) completed a recall questionnaire after an educational session preceding chemotherapy treatment. Recall was checked against the actual communication in videorecordings of the consultations. Patients’ emotional and informational cues and subsequent responses by the nurse were rated using an adaptation of the Medical Interview Aural Rating Scale (MIARS).

Results

Patients gave more informational than emotional cues. The most frequent response to emotional cues was distancing followed by acknowledgement. Nurses gave appropriate information in response to the majority of informational cues. Patients’ expression of emotional or informational cues did not influence recall; neither did nurses’ responses to informational cues. Responses to emotional cues did affect recall. The more nurses responded by giving ‘minimal’ encouragements (e.g. ‘Hmmm’), the more patients recalled, while distancing responses (e.g. switching focus) were associated with lower recall scores.

Conclusion

Responding to patients’ emotions is likely to impact information recall.

Practice implications

These results highlight the importance of addressing patients’ expressions of emotions in the context of patient education, as it enhances information recall.     

Romantic partner involvement during oncology consultations: A narrative review of qualitative and quantitative studies

ObjectiveTo review the currently available research into romantic partner involvement during oncology consultations.MethodsStudies were identified via database searches plus hand-searching. A narrative review was performed using the principles of Thematic, and Framework syntheses. The search strategy was performed according to the principles of PRISMA.ResultsFrom 631 results, 18 studies were included. The findings indicate that romantic partners are most valued by patients when they provide emotional, practical, and informational support. It is also indicated that psychosocial and sexual concerns are rarely discussed. Couples’ self-reported satisfaction with consultations appear related to the extent of romantic partner involvement, the roles that they enacted, and the extent to which psychosocial and sexual concerns were addressed.ConclusionThis review indicates that romantic partner involvement during clinical consultations enhances the couple’s experience. However, there are methodological limitations to this body of research, which are discussed in this review.Practice implicationsResearch to date has yet to offer an exploration of the social practices and conversational actions relating to romantic partner involvement during triadic oncology consultations. Future studies that draw upon recordings of these consultations, using methods capable of analysing situated social practices can address this gap.     

Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services

ObjectiveLittle is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations.MethodsSemi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15–25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics.ResultsApart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP’s individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP’s cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together.ConclusionBy adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management.Practice implicationsUsing a structured conversation model combined with a tool to encourage YP’s agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.     

A partnership-oriented and culturally-sensitive communication style of doctors can impact the health outcomes of patients with chronic illnesses in Indonesia

ObjectivesA partnership-oriented communication style is globally recommended for medical practice. A culturally-sensitive doctor-patient communication guideline is also needed for Southeast Asia. The ‘Greet-Invite-Discuss’ guideline was established and tested with primary care doctors and their patients in Indonesia.MethodsIn this mixed-methods study, doctors were trained according to the ‘Greet-Invite-Discuss’ guideline, while patients received standard treatment. Two groups of fifteen doctors were assigned to have consultations with 45 patients with hypertension or 51 patients with type-2 diabetes mellitus. Doctors’ self-assessment and patients’ perceptions and their clinical outcomes were longitudinally measured. Six focus group discussions were conducted to explore doctors’ and patients’ experiences.ResultsDoctors’ self-assessments and patients’ perceptions of doctors’ communication skills increased significantly (p < 0.05). Moreover, patients’ blood pressure or fasting blood glucose levels decreased significantly (p < 0.05), except the two-hour blood glucose levels (NS). Qualitatively, doctors demonstrated more partnership and culturally-sensitive communication, and patients expressed more satisfaction, increased comprehension and self-management, of their chronic illnesses.ConclusionsThe ‘Greet-Invite-Discuss’ guideline was useful for primary care doctors for a more partnership-oriented and culturally-sensitive communication with patients in chronic care management.Practice implicationsUsing a partnership-oriented and culturally-sensitive communication guideline, doctors can improve their communication skills with their patients towards optimum health outcomes.     

Do gender-dyads have different communication patterns? A comparative study in Western-European general practices

From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1). whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2). if so, whether these differences continue to exist when controlling for patient, GP and consultation characteristics. Doctor-patient communication was assessed in six Western-European countries by coding video taped consultations of 190 GPs and 2812 patients. Cluster analysis revealed three communication patterns: a biomedical, a biopsychosocial and a psychosocial pattern. Across countries, communication patterns of the female/female dyad differed from that of the other gender-dyads. Differences in communication patterns between countries could especially be explained by differences in consultations of male doctors, irrespective of the patients' gender. It is important to take into consideration differences between gender-dyads and between countries when studying gender effects on communication across countries or when comparing studies performed in different countries.     

Patient centred care in infertility health care: Direct and indirect associations with wellbeing during treatment

ObjectiveTo investigate whether different dimensions of patient centred care (PCC) were directly associated with wellbeing or indirectly, via lower concerns about medical procedures and/or increased tolerability of treatment.MethodsCross-sectional study with 322 women and 111 men undergoing fertility diagnosis or treatment recruited online and in clinical setting. Participants completed questionnaires that assess PCC (PCQ-Infertility), individual (BSI Anxiety and Depression subscales) and relational wellbeing (FertiQoL Relational Domain), treatment concerns (CART Procedural Concerns scale) and tolerability (FertiQoL Tolerability Domain) and they filled a socio-demographic and fertility data file.ResultsAll dimensions of PCC were positively associated with better wellbeing except for organization of care. Information provision and continuity of care were indirectly associated with better individual wellbeing, the first via lower treatment concerns and the second via higher treatment tolerability. Competence, accessibility, continuity and communication were indirectly associated with better relational wellbeing via higher treatment tolerability.ConclusionsPatient centred care promotes wellbeing during treatment. PCC is directly associated to wellbeing but also indirectly. The mode of action of the different PCC dimensions on wellbeing varies.Practical implicationsTo promote patients’ wellbeing during treatment clinics should provide treatment related information and allow patients to establish a stable clinical relationship with a trustworthy and competent physician.