Patient-resident physician communication - a qualitative study to assess the current state, challenges and possible solutions.

BACKGROUND: Patients perceive effective patient-doctor communication as an important metric when evaluating their satisfaction with health systems. Hence, optimal patient-physician communication is fundamental for quality healthcare. High-income countries (HICs) have extensively studied patient-resident communication. However, there is a dearth of similar studies in low- and middle-income countries (LMICs). Therefore, we aimed to explore the current state of and barriers to practicing good patient-resident communication and explore possible solutions to mitigate these challenges at one of the largest Academic Medical Centers in an LMIC. METHODS: This study employed an exploratory qualitative study design and was conducted at the Aga Khan University Hospital in Pakistan. Through purposive maximum variation sampling, 60 healthcare workers from diverse cohorts, including attendings, fellows, residents, and medical students, participated in eight focus group discussions. RESULTS: We identified three key themes from the data: Status-quo of residents' communication skills and learning (Poor verbal and non-verbal communication, inadequate training programs, and variable sources of learning), Barriers to effective communication (Institutional barriers such as lack of designated counselling spaces, lack of resident insight regarding effective communication and deficits in intra-team communication), and the need for developing a communication skills curriculum (Design, implementation and scaling to other cohorts of healthcare workers). CONCLUSIONS: Findings from this study show that multifaceted factors are responsible for inadequate patient resident-physician communication, highlighting the need for and importance of developing a formal communication skills training curriculum for residents. These insights can be used to create standardized training for equipping residents with adequate skills for effectively communicating with patients which can improve healthcare service delivery and patient outcomes.

Race Dialogues and Potential Application in Clinical Environments: A Scoping Review.

BACKGROUND: Race dialogues, conversations about race and racism among individuals holding different racial identities, have been proposed as one component of addressing racism in medicine and improving the experience of racially minoritized patients. Drawing on work from several fields, we aimed to assess the scope of the literature on race dialogues and to describe potential benefits, best practices, and challenges of conducting such dialogues. Ultimately, our goal was to explore the potential role of race dialogues in medical education and clinical practice. METHODS: Our scoping review included articles published prior to June 2, 2022, in the biomedicine, psychology, nursing and allied health, and education literatures. Ultimately, 54 articles were included in analysis, all of which pertained to conversations about race occurring between adults possessing different racial identities. We engaged in an interactive group process to identify key takeaways from each article and synthesize cross-cutting themes. RESULTS: Emergent themes reflected the processes of preparing, leading, and following up race dialogues. Preparing required significant personal introspection, logistical organization, and intentional framing of the conversation. Leading safe and successful race dialogues necessitated trauma-informed practices, addressing microaggressions as they arose, welcoming participation and emotions, and centering the experience of individuals with minoritized identities. Longitudinal experiences and efforts to evaluate the quality of race dialogues were crucial to ensuring meaningful impact. DISCUSSION: Supporting race dialogues within medicine has the potential to promote a more inclusive and justice-oriented workforce, strengthen relationships amongst colleagues, and improve care for patients with racially minoritized identities. Potential levers for supporting race dialogues include high-quality racial justice curricula at every level of medical education and valuation of racial consciousness in admissions and hiring processes. All efforts to support race dialogues must center and uplift those with racially minoritized identities.

Childbirth as Fault Lines: Justifications in Physician-Patient Interactions About Postnatal Rehabilitation.

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients' well-being.

Patient Communication Innovations in Breast Imaging.

Effective patient communication is paramount in breast radiology, where standardized reporting and patient-centered care practices have long been established. This communication profoundly affects patient experience, well-being, and adherence to medical advice. Breast radiologists play a pivotal role in conveying diagnostic findings and addressing patient concerns, particularly in the context of cancer diagnoses. Technological advances in radiology reporting, patient access to electronic medical records, and the demand for immediate information access have reshaped radiologists' communication practices. Innovative approaches, including image-rich reports, visual timelines, and video radiology reports, have been used in various institutions to enhance patient comprehension and engagement.

Evaluation of Prompts to Simplify Cardiovascular Disease Information Generated Using a Large Language Model: Cross-Sectional Study.

In this cross-sectional study, we evaluated the completeness, readability, and syntactic complexity of cardiovascular disease prevention information produced by GPT-4 in response to 4 kinds of prompts.

Evaluating a conceptual framework for quality assessment of medical interpretation.

OBJECTIVE: We aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings. METHODS: A mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants' satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as "altered," whereby the interpreter changed the meaning of the source utterance, or "unaltered (accurate)." Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described. RESULTS: Interpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes. CONCLUSION: A new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations. PRACTICE IMPLICATIONS: Healthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.

Communication between physicians, patients, their companions and other healthcare professionals in home medical care in Japan.

OBJECTIVE: To examine communication in home medical care. METHODS: Conversations that happened during home medical care involving physicians at nine clinics were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Additional categories were developed to code aspects of home medical care. RESULTS: Overall, 55 conversations were analyzed. The mean age of the patients was 82.9 ± 10.1 years old. The most common triad was physician, patient, and patient's companion. Information about home medical care professionals who were not present during the conversation was provided by the physician in 21 cases (38.2%), the patient in nine cases (16.4%), and companions in 21 (39.6%) cases. CONCLUSION: In home medical care, the participants mentioned home medical care professions who were not present at the time, suggesting that these conversations may have facilitated interprofessional collaboration. PRACTICE IMPLICATIONS: Physicians should be aware that during home medical care, the presence of multiple attendants and other medical professionals contributing to communicate with the patient.

Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers.

AIM: We aimed to develop two question prompt lists (QPLs), one for Indian cancer patients undergoing radiation therapy and the second for their primary family caregivers. METHODS: The study comprised three phases: (1) qualitative interviews with patients (n = 65) and PFCs (n = 39) to identify their information needs, queries and concerns regarding RT; (2) development of draft QPLs using conventional content analysis and translation into Hindi and Marathi using European Organisation Research and Treatment of Cancer guidelines; and, (3) A readability analysis, and acceptability study with patients (n = 22), PFCs (n = 26) and Radiation Oncology (RO) staff (n = 20) exploring barriers to QPL implementation. RESULTS AND DISCUSSION: Analysis in Phase I identified questions patients and PFCs asked or wanted to ask their physician. A list of 125 and 136 questions were generated for patients and PFCs, respectively. After five iterations, the draft QPLs were finalised, translated, and back-translated from English into Hindi and Marathi (Phase II). In Phase III, most patients and PFCs reported the QPLs were easy to read, they did not find it difficult to ask the questions, and the questions were not emotionally upsetting. Conversely, RO staff reported concerns that patients may find it difficult to discuss the questions with their physician. CONCLUSION: The study highlights the need to empower patients and PFCs to ask questions and for staff to feel comfortable answering them. Implementing physician-endorsed QPLs could achieve these aims.

Patient-physician communication about cancer-related fatigue: a survey of patient-perceived barriers.

PURPOSE: Cancer-related fatigue is a subjective, distressing, and common sequela of cancer which is often disregarded and underdiagnosed. Fatigue is assessed by self-report requiring communication between patient and physician. In this study, we investigated the patients' perspective on the patient-physician communication about fatigue. METHODS: On average five months after diagnosis 1179 cancer patients, recruited in Germany, completed a survey as part of the LIFT project. The survey included questions on sociodemographic data, fatigue, depression, fatigue management, patient-physician communication, and communication barriers. Data were analyzed descriptively and using logistic regression analyses. RESULTS: Half of the participants reported that their physician had never asked them whether they felt exhausted. Patients undergoing chemo-, radio-, or immunotherapy were more likely to be asked about fatigue, while older age and major depression decreased the likelihood. Sixty-four percent of the patients felt impeded by communication barriers. Common barriers were not knowing who to turn to for fatigue (39%), time constraints (31%), and the fear of being perceived as weak (22%). Almost half of the participants indicated that their physicians were not appreciative and did not deal adequately with fatigue-related questions. CONCLUSION: This study revealed gaps in the patient-physician communication regarding cancer-related fatigue. Contrary to guideline recommendations a minority of physicians addressed fatigue. On the other hand, cancer patients felt reluctant to bring up this topic due to structural barriers and fears. Physicians should routinely address fatigue and adopt a communication style which encourages patients to likewise state their symptoms and raise their questions. TRIAL REGISTRATION: Clinicaltrials.gov, identifier: NCT04921644. Registered in June 2021.

"If I Become a Vegetable, Then no": A Thematic Analysis of How Patients and Physicians Refer to Prognosis When Discussing Cardiopulmonary Resuscitation.

Background: Documenting decisions about the relevance cardiopulmonary resuscitation (CPR) is a standard practice at hospital admission yet a complex task. Objective: Our aim was to explore how physicians approach and discuss CPR prognosis with older patients recently admitted to a post-acute care unit. Method: We recorded 43 conversations between physicians and patients about the relevancy of CPR that took place at admission at the geriatric rehabilitation service of a Swiss university hospital. Thematic analysis determined (i) who initiated the talk about CPR prognosis, (ii) at what point in the conversation, and (iii) how prognosis was referred to. Results: Prognosis was mentioned in 65% of the conversations. We categorized the content of references to CPR prognosis in five themes: factors determining the prognosis (general health, age, duration of maneuvers); life (association of CPR with life, survival); proximal adverse outcomes (broken ribs, intensive care); long-term adverse outcomes (loss of autonomy, suffering a stroke, pain, generic, uncertainty); and being a burden. Discussion and conclusion: Discussing CPR is important to all patients, including those for whom it is not recommended. Information about CPR prognosis is essential to empower and support patients in expressing their expectations from life-prolonging interventions and attain shared decision-making.

Differences in patient-physician communication between the emergency department and other departments in a hospital setting in Taiwan.

BACKGROUND: Communication fosters trust and understanding between patients and physicians, and specific communication steps help to build relationships. Communication in the emergency department may be different from that in other departments due to differences in medical purposes and treatments. However, the characteristics of communication in the clinical settings of various departments have not been explored nor compared. OBJECTIVES: This study aimed to construct the steps in patient-physician communication based on the Roter Communication Model and compare communication performance between the emergency department and three other clinical settings-internal medicine, surgery, and family medicine departments. METHODS: Both qualitative and quantitative approaches were adopted. First, in-depth interviews were used to analyze clinical communication steps and meanings. Then, a quantitative questionnaire was designed based on the interview results to investigate differences in communication between the emergency department and the other three departments. Qualitative and quantitative data were analyzed from 20 interviews and 98 valid questionnaires. RESULTS: Patient-physician communication consists of four steps and ten factors. The four steps-greeting and data gathering, patient education and counseling, facilitation and patient activation, and building a relationship-had significant progressive effects. Patient education and counseling had an additional significant effect on building a relationship. The emergency department performed less well in the facilitation and patient activation, building a relationship step and the evaluation method, enhancement method, and attitude factors than the other departments. CONCLUSIONS: To improve the quality of patient-physician communication in the emergency department, physicians should strengthen the steps of facilitation and patient activation to encourage patients' active engagement in their health care.

Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction.

Objective: Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations. Methods: A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed. Results: Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication. Conclusions: Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.

Navigating adalimumab biosimilars: an expert opinion.

The patent expiry of Humira® in 2018 opened up the current European market to eight adalimumab biosimilars - (in alphabetical order) Amgevita®, Amsparity®, Hulio®, Hukyndra®, Hyrimoz®, Idacio®, Imraldi® and Yuflyma® - for the treatment of various immune and inflammatory conditions. Amjevita, Hadlima®, Hyrimoz and Yuflyma have recently become available in the USA, with others expected to reach this market in 2023 as the US patent protection for Humira ends. Although adalimumab biosimilars demonstrate efficacy, safety and immunogenicity similar to the originator, they may differ in product excipient(s) and preservatives, along with their device type(s). Physicians may find it both difficult and time consuming to navigate their way among the array of available adalimumab biosimilars when they need to make a treatment decision. This article explores the characteristics of various adalimumab biosimilars to help clinicians navigate the various options available across Europe and the USA. In addition to drug selection, effective patient-physician communication is needed to nurture realistic patient expectations and minimise potential nocebo effects when prescribing biosimilars.

Kidney Biopsy Utility: Patient and Clinician Perspectives from the Kidney Precision Medicine Project.

Rationale & Objective: Limited data exist on patient perspectives of the implications of kidney biopsies. We explored patients' perspectives alongside those of clinicians to better understand how kidney biopsies affect patients' viewpoints and the clinical utility of biopsies. Study Design: Prospective Cohort Study. Setting & Participants: Patient participants and clinicians in the Kidney Precision Medicine Project, a prospective cohort study of patients who undergo a research protocol biopsy, at 9 recruitment sites across the United States. Surveys were completed at enrollment before biopsy and additional timepoints after biopsy (participants: 28 days, 6 months; clinicians: 2 weeks). Analytical Approach: Kappa statistics assessed prebiopsy etiology concordance between clinicians and participants. Participant perspectives after biopsy were analyzed using a thematic approach. Clinician ratings of clinical management value were compared to prebiopsy ratings with Wilcoxon matched-pairs signed-rank tests and paired t tests. Results: A total of 167 participants undergoing biopsy (124 participants with chronic kidney disease [CKD], 43 participants with acute kidney injury [AKI]) and 58 clinicians were included in this study. CKD participants and clinicians had low etiology concordance for the 2 leading causes of CKD: diabetes (k = 0.358) and hypertension (k = 0.081). At 28 days postbiopsy, 46 (84%) participants reported that the biopsy affected their understanding of their diagnosis, and 21 (38%) participants reported that the results of the biopsy affected their medications. Participants also shared biopsy impressions in free-text responses, including impacts on lifestyle and concurrent condition management. The biopsy positively shifted clinician perceptions of the procedure's clinical management benefits, while perceptions of prognostic value decreased and diagnostic ratings remained unchanged. Limitations: Our study did not have demographic data of clinicians and could not provide insight into postbiopsy experiences for participants who did not respond to follow-up surveys. Conclusions: Participant perspectives of the personal implications of kidney biopsy can be integrated into shared decision-making between clinicians and patients. Enhanced biopsy reports and interactions between nephrologists and pathologists could augment the management and prognostic value of kidney biopsies. Plain-Language Summary: The utility of kidney biopsy is debated among clinicians, and patients' perspectives are even less explored. To address these gaps, we synthesized perspectives from clinicians and patient participants of the Kidney Precision Medicine Project (KPMP). Both before and after biopsy, clinicians were surveyed on how the procedure affected their clinical management, diagnosis, and prognosis. After biopsy, participants shared how the procedure affected their diagnosis, medication, and lifestyle changes. Clinicians and patients shared an appreciation for the biopsy's impact on medical management but diverged in their takeaways on diagnosis and prognosis. These findings highlight the need for greater collaboration between patients and clinicians, particularly as they navigate shared decision-making when considering kidney biopsy.

Introducing a standardized assessment of patients' interest in and usage of CAM in routine cancer care: chances and risks from patients' and physicians' point of view.

BACKGROUND: Cancer patients often use complementary and alternative medicine (CAM), however, standardized assessment in clinical routine is missing. The aim of this study was to evaluate a screening questionnaire on CAM usage that was published in the S3 Guideline Complementary Medicine in the Treatment of Oncological Patients. METHODS: We developed a survey questionnaire to assess the practicability of the guideline questionnaire and communication on CAM between health care providers (HCPs) and patients. We collected 258 guideline questionnaires and 116 survey questionnaires from ten clinics and held twelve semi-structured interviews with HCPs. RESULTS: 85% used at least one of the listed CAM methods, 54 participants (N = 77) never disclosed usage to a physician. The most frequently used CAM methods were physical activity (76.4%) and vitamin D (46.4%). 25.2% used at least one method, that was labeled risky by the guideline. 53.4% did not know of CAM's risk of interactions and side effects. Introducing the guideline questionnaire in routine cancer care increased the rate of patients talking to an HCP regarding CAM significantly from 35.5 to 87.3%. The HCPs stated positive effects as an initiation of conversation, increased safety within CAM usage and patients feeling thankful and taken seriously. However, due to the limited amount of time available for discussions on CAM, generalized distribution to all patients was not feasible. CONCLUSION: Institutions should focus on implementing standard procedures and resources that help HCPs discuss CAM on a regular basis. HCPs should meet the patient's demands for CAM counseling and make sure they are equipped professionally.

Readability and quality of online patient resources regarding knee osteoarthritis and lumbar spinal stenosis in Japan.

BACKGROUND: This study aimed to quantify the readability and quality of online patient resources on knee osteoarthritis and lumbar spinal stenosis in Japan. METHODS: Three search engines (Google, Yahoo, and Bing) were searched for the terms knee osteoarthritis and lumbar spinal stenosis. The first 30 websites of each search were screened. Duplicate websites and those unrelated to the searched diseases were excluded. The remaining 125 websites (62 on knee osteoarthritis, 63 on lumbar spinal stenosis) were analyzed. The text readability was assessed using two web-based programs (Obi-3 and Readability Research Lab) and lexical density. Website quality was evaluated using the DISCERN score, Clear Communication Index, and Journal of American Medical Association benchmark criteria. RESULTS: Readability scores were high, indicating that the texts were difficult to understand. Only 24 (19%) and six (5%) websites were classified as average difficulty readability according to Obi-3 and Readability Research Lab, respectively. The overall quality of information was low, with only four (3%) being rated as having sufficient quality based on the Clear Communication Index and Journal of American Medical Association benchmark criteria. None of the websites satisfied the DISCERN quality criteria. CONCLUSIONS: Patient information on Japanese websites regarding knee osteoarthritis and lumbar spinal stenosis were difficult to understand. Moreover, the quality of the websites was insufficient. Orthopaedic surgeons should contribute to the creation of high-quality easy-to-read websites to facilitate patient-physician communication.

Real-world patient-reported outcomes and concordance between patient and physician reporting of side effects across lines of therapy in multiple myeloma within the USA.

PURPOSE: We aimed to explore patient-reported outcomes (PROs) and patient and physician concordance of side effects perception across lines of therapy (LOT) in multiple myeloma (MM) within the United States of America (USA). METHODS: Data were drawn from the Adelphi Real World MM III Disease Specific Programme™, a point-in-time survey of hemato-oncologists/hematologists and their patients with MM conducted in the USA between August 2020 and July 2021. Physicians reported patient characteristics and side effects. Patients reported side-effect bother and health-related quality of life (HRQoL) using validated PRO tools (European Organisation for the Research and Treatment of Cancer Quality of Life Core Questionnaire/-MM Module [EORTC QLQ-C30/-MY20], EQ-5D-3L and Functional Assessment of Cancer Therapy-General Population physical item 5). Descriptive, linear regression and concordance analyses were performed. RESULTS: Records from 63 physicians and 132 patients with MM were analyzed. EORTC QLQ-C30/-MY20 and EQ-5D-3L scores were consistent across LOTs. Scores tended to be worse with higher side-effect bother; patients "very much" bothered by side effects had lower median (interquartile range) global health status scores (33.3 [25.0-50.0]) than those "not at all" bothered (79.2 [66.7-83.3]). Patient and physician concordance on side-effect reporting was poor to fair. Patients frequently reported fatigue and nausea as bothersome side effects. CONCLUSION: HRQoL of patients with MM was worse with greater side-effect bother. Discordant patient and physician reporting of side effects indicated a need for improved communication during management of MM.