Inpatient Understanding of Their Care Team and Receipt of Mixed Messages: a Two-Site Cross-Sectional Study.

BACKGROUND: Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding. OBJECTIVE: We aimed to assess inpatients' understanding of their care and their perceived receipt of mixed messages, as well as the associated patient, care team, and hospitalization characteristics. DESIGN: We administered a 30-item survey to inpatients between February 2020 and November 2021 and incorporated other hospitalization data from patients' health records. PARTICIPANTS: Randomly selected inpatients at two urban academic hospitals in the USA who were (1) admitted to general medicine services and (2) on or past the third day of their hospitalization. MAIN MEASURES: Outcome measures include (1) knowledge of main doctor and (2) frequency of mixed messages. Potential predictors included mean notes per day, number of consultants involved in the patient's care, number of unit transfers, number of attending physicians, length of stay, age, sex, insurance type, and primary race. KEY RESULTS: A total of 172 patients participated in our survey. Most patients were unaware of their main doctor, an issue related to more daily interactions with care team members. Twenty-three percent of patients reported receiving mixed messages at least sometimes, most often between doctors on the primary team and consulting doctors. However, the likelihood of receiving mixed messages decreased with more daily interactions with care team members. CONCLUSIONS: Patients were often unaware of their main doctor, and almost a quarter perceived receiving mixed messages about their care. Future research should examine patients' understanding of different aspects of their care, and the nature of interactions that might improve clarity around who's in charge while simultaneously reducing the receipt of mixed messages.

Mixed Messages: I. The Consequences of Communicating Negative Statements Within Emotional Support Messages to Cancer Patients.

BACKGROUND: Not all emotional support messages consist purely of positive statements. Some emotional support messages received by cancer patients simultaneously communicate statements of caring but also negative statements, such as criticisms of patients' actions. OBJECTIVE: This study tests if a negative statement occurring within an emotional support message affects cancer patients' perceptions of the effectiveness of the entire emotional support message as well as the perceived competence of the supporter communicating the emotional support message. METHODS: Cancer patients watched video recordings of emotional support messages and subsequently provided ratings on message effectiveness and supporter competence. Some emotional support messages included negative statements, whereas other messages did not. RESULTS: Messages that included a negative statement were rated lower on message effectiveness than messages without negative statements. Cancer patients rated supporters communicating messages with a negative statement as having significantly less competence than those who did not communicate a negative statement. CONCLUSION: A single negative statement occurring within an emotional support message may result in cancer patients viewing the emotional support as less effective and the supporter as less competent.