Companions' contributions to information gathering in Chinese outpatient clinical interaction.

Patients are commonly accompanied to visit clinicians in Chinese outpatient clinics. Although there has been extensive research on the roles of companions in asymmetric interactions within medical settings, there is a paucity of conversation analytic studies that examine the active participation and contributions of companions on an equal footing in medical consultations. How companions on an equal footing participate and contribute in Chinese outpatient clinical consultations remains under-explored. By employing video recordings of three-party consultations in the Chinese orthopaedic outpatient clinic as the data and adopting conversation analysis as the method, this study investigated how companions participated in and contributed to the information-gathering activity and how their contributions were interactionally negotiated and managed by clinicians and adult patients over sequences of interaction. We showed that companions negotiated epistemic rights in reporting and repairing the information about medical problems in the patients' epistemic domain and displayed different levels of encroachment on patients' epistemic rights by endorsing patients' responses, repairing the information in patients' responses, and offering information directly to clinicians. Companions also exerted deontic authority and shaped the trajectory of the consultations by hindering or facilitating the progressivity of the interaction. We argued that companions' contributions to the information-gathering activity might reflect the family-centred model of the doctor-patient relationship in the Chinese orthopaedic outpatient clinic. Clinicians are suggested to open up opportunities for companions' participation and contributions while respecting patients' rights, especially when there is a collision of knowledge claims between patients and their companions.

The Role of Animal Companions in the Bereavement Experiences of Australian Lesbians and Gay Men.

All too often, humans who experience the death of a partner are directed towards other humans for support, ignoring the important role that animal companions play in the lives of many humans. For lesbians and gay men specifically - whose grief may be disenfranchised - animal companions may play a particularly important role. This paper reports on a secondary analysis of interviews with 10 Australian lesbians or gay men who had lost a partner due to non-HIV related issues. Six of the participants spoke impromptu about the importance of animal companions following the death of a partner. Thematic analysis resulted in the development of three themes: (1) animals provide comfort and company, (2) animals serve as a reminder of partners, and (3) animals give people a reason to go on. The paper concludes by considering the importance of speaking about animals in the context of research and practice related to human bereavement.

Development and early validation of questionnaires to assess system level factors affecting male partners' attendance at childbirth in LMICs.

BACKGROUND: There is evidence that a woman who receives continuous labour support from a chosen companion can have shorter labour duration, is more likely to give birth without medical interventions, and report a satisfying childbirth experience. These outcomes result from the beneficial effects of emotional and practical support from the woman's chosen companion, and care provided by health providers. When a woman's chosen companion is her male partner, in addition to the above benefits, his presence can promote his bonding with the baby, and shared parenthood. However, there may be healthcare system barriers, including organisational, management and individual (staff) factors, that inhibit or restrict women's choice of companion. There are currently no suitable survey tools that can be used to assess the system level factors affecting the implementation of male partners' attendance at childbirth in low- and middle- income countries (LMICs). METHODS: We designed two questionnaires to help to address that gap: the Male Partners' Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs); and the Male Partners' Attendance at Childbirth-Questionnaire for Maternity Staff (MPAC-QMS). We carried out an extensive review to generate initial items of the two questionnaires. We assessed the content and face validity of the two questionnaires in a three-round modified Delphi study. RESULTS: The Male Partners' Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs) focused on organisational and management factors. The Male Partners' Attendance at Childbirth-Questionnaire of Maternity Staff (MPAC-QMS) focused on individual staff factors. The final MPAC-QHMUs and MPAC-QMS included items which garnered over 80% content relevance according to the experts' rating. After all three consensus rounds of the Delphi study, 43 items were retained for the MPAC-QHMUs and 61 items were retained for the MPAC-QMS. CONCLUSIONS: The MPAC-QHMUs and the MPAC-QMS may help understanding of barriers affecting male partners' attendance at childbirth in LMICs in order to devise implementation strategies to enable wider availability and to maximize women's choices during labour and childbirth. The MPAC-QHMUs and the MPAC-QMS as newly-developed questionnaires require further validation of their acceptability and feasibility in different cultural contexts, and languages.

Supporting birth companions for women in labor, the views and experiences of birth companions, women and midwives: A mixed methods systematic review.

BACKGROUND: Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support. METHODS: A convergent segregated mixed-methods systematic review was conducted to explore women's, companions', and midwives' experiences of birth companion support and identify ways to improve the experience for women and companions. A thematic synthesis of qualitative data and a narrative summary of quantitative data were conducted followed by integration of the findings. RESULTS: Companions who cope well in labor reported feeling involved, able to preserve women's internal focus and have a defined role, providing physical or emotional support. LBGTQ+ partners faced barriers to inclusion due to "forefronting" of their sexuality by staff and a lack of recognition in the language and processes used. The experience of birth companions can be enhanced by promoting their role as co-parent, guardian, and coach, provision of timely information and developing a trusting relationship with care providers. Only two papers reported midwives' views on birth companions in labor. CONCLUSIONS: Women's and companions' satisfaction with birth is increased when companions can support the mother, feel supported themselves, and valued as a co-parent. The midwives' role in information provision and guidance can maximize birth companions' experience and ability to provide positive support. LBGTQ+ families need more support to feel included and recognized.

A qualitative exploration of patient safety in a hospital setting in Spain: Policy and practice recommendations on patients' and companions' participation.

INTRODUCTION: Patients' and companions' participation in healthcare could help prevent adverse events, which are a significant cause of disease and disability. Before designing interventions to increase participation, it is first necessary to identify attitudes to patient safety. This study aimed to explore patients' and companions' perceptions, attitudes and experiences of patient safety, taking into account contextual factors, such as cultural background, which are not usually captured in the literature. METHODS: We conducted a qualitative study with a theoretical sampling of 13 inpatients and 3 companions in a university hospital in Barcelona, Spain. Information was obtained from individual and triangular interviews. A descriptive thematic content analysis was conducted by four analysts and a consensus was reached within the research team on the key categories that were identified. We also conducted a card-sorting exercise. RESULTS: All informants emphasized the role of good communication with health professionals, a calm environment and the need for patient education. Discursive positions differed by cultural background. Informants from a Pakistani-Bangladeshi background emphasized language barriers, while those from European and Latin-American backgrounds stressed health professionals' lack of time and the need for more interdisciplinary teamwork. The card-sorting exercise identified several opportunities to enhance participation: checking patient identification and medication dispensation, and maintaining personal and environmental hygiene. CONCLUSION: This exploration of informants' discourse on patient safety identified a wide variety of categories not usually considered from institutional perspectives. The findings of this study could enrich interventions in areas with diverse cultural backgrounds, as well as current frameworks based exclusively on institutional perspectives. PATIENT OR PUBLIC CONTRIBUTION: The results of the study were communicated to patients and accompanying persons via telephone or email. Similarly, a focus group was held with a patient forum to comment on the results. In the design of subsequent interventions to improve patient safety at the hospital, the proposals of patients and companions for their participation will be included together with healthcare professionals' opinions.

Examining Information Needs of Heart Failure Patients and Family Companions Using a Previsit Question Prompt List and Audiotaped Data: Findings From a Pilot Study.

BACKGROUND: Question prompt lists (QPLs) are an effective tool for improving communication during medical visits. However, no studies have attempted to correlate intentions related to question asking and actual questions asked during visits. Moreover, few studies have used QPLs with patients with heart failure (HF) or family companions who accompany them to visits. We examined the use of a previsit QPL for patients with HF and their family companions intended to enhance engagement in HF care. The aim of this research was to assess which questions from the QPL patients and companions selected most frequently to ask and compare this item with which questions were actually asked during the medical visit. METHODS AND RESULTS: This secondary analysis of QOLs and audiotaped visit data from a pilot study enrolled and consented patients with HF, family companions, and HF clinicians. A single group of 30 patients with HF and 23 family companions received the QPL to complete in the waiting room immediately before their cardiology visit. To meet our aims, we calculated the frequencies for each question selected and asked from the QPL, using data derived from completed prompt lists and audiotaped medical visits. A follow-up survey was administered 2 days after the appointment to assess differences in how participants filled out and used the prompt list. Patients and companions primarily selected and asked questions from the QPL regarding the management and treatment of the disease, general questions about HF, and questions about prognosis. Participants rarely asked questions about support for family and friends or health care team roles and responsibilities. Patients and companions did not ask many of the questions they reported wanting to ask. CONCLUSIONS: Prompt lists may empower patients and companions to communicate with their clinician by identifying important questions to help overcome patients' and companions' knowledge gaps. More research is needed to understand the true impact of prompt lists on patient-family-clinician communication and subsequent HF outcomes, and how best to implement them in clinical workflows to increase their potential usefulness.

How companions speak on patients' behalf without undermining their autonomy: Findings from a conversation analytic study of palliative care consultations.

Companions are individuals who support patients and attend health-care appointments with them. Several studies characterised companions' participation in broad terms, glossing over the details of how they time and design their actions, and how patients and health-care practitioners (HCPs) respond to them. This article aims to examine these aspects in detail by using conversation analysis, focusing on actions whereby companions speak on patients' behalf-mentioning delicate aspects of patients' experience (specifically, by alluding to patients' thoughts or feelings about dying). Some studies suggested that these actions undermine patients' autonomy. By contrast, through examination of palliative care consultations in a UK hospice, we found that these interventions are warranted by contextual circumstances: they are either invited by patients or HCPs (through questions or gaze) or volunteered to help with the progression of an activity (e.g. when a patient does not answer an HCP's question). Additionally, all parties collaborate in constructing these companion interventions as temporary departures from an otherwise prevailing normative orientation to patients' right to speak for themselves. The study contributes to the sociology of health and illness by characterising how companions contribute to the ways in which participants coordinate their relative rights and responsibilities, and ultimately their relationships, within health-care interactions.

Satisfaction differences in bus traveling among low-income individuals before and after COVID-19.

Although all cities in China have promulgated public transportation control measures to choke off the spread of COVID-19, it also has brought severe changes to low-income individuals' bus traveling. However, the study focusing on satisfaction differences in bus traveling before and after COVID-19 is far under-researched, this paper therefore explored satisfaction differences among low-income individuals under socioeconomic attributes, traveling attributes, and psychological attributes by using the data consist of interviews addressed to 930 individuals in Taiyuan, China. Furthermore, the relationship between satisfaction levels and modes of traveling alone and traveling with companions by bus has also been deeply analyzed to reduce single-person driving problem. As a result, many exciting phenomena were discovered: the significant factors affecting low-income individuals' satisfaction occur "shift" on a large scale after COVID-19; risk concern has a significant positive impact on risk perception, but risk concern and risk perception have only a minor impact on satisfaction before and after COVID-19; it was found that there is a significant relationship between satisfaction levels and modes of traveling alone and traveling with companions by bus. Understanding them can be a reference for improving the travel environment between low-income individuals.

Socially assistive robots on the market : Experiences from inpatient care and potentials for care at home.

BACKGROUND: The article addresses commercial socially assistive robots (SAR). There is evidence of the impact of SAR on older persons in institutional settings. Family care at home has not yet been the subject of systematic research; however, especially at home SAR could help to prevent loneliness, provide emotional support, and foster communication. OBJECTIVE: Inspired by evidence on the potential impact of SAR, the article analyzes their potential for supporting family care at home. A participatory research and development (R&D) project stands as an example of how SAR can improve communication and relations at home. MATERIAL AND METHODS: Apart from the results of selected randomized controlled trials (RCT) in institutional settings, the article provides results from tests that were run in the R&D project. RESULTS: SAR can increase the quality of life of users at home. They are capable of improving relations within family care. They inspire communication, change routines, and provide relief to family caregivers; however, it takes trained human companions to support the use of SAR at home and address ethical aspects. CONCLUSION: If SAR are supposed to deliver their potential for care at home, older persons and their caregivers must be actively involved in research and development. These processes must be systematically evaluated.

Does being accompanied make a difference in communication during breast cancer consultations? Results from a multi-centered randomized controlled trial.

OBJECTIVES: This study is based on a multi-centered RCT conducted on breast cancer patients during their first consultation with an oncologist. The main aim was to evaluate whether the introduction of a communication tool (i.e., the Question Prompt Sheet or Question Listing), with or without a companion, impacted the number of questions asked by patients during the consultation, and subsequent psychological and relational outcomes. METHODS: The sample consisted of 324 breast cancer patients who were randomly placed into one of the two intervention groups: Question Prompt Sheet or Question Listing. Before and after the consultation, patients completed a set of standardized instruments: Satisfaction with decisions made during the consultation (SWD), Shared Decision Making Questionnaire (SDMQ-9), Patient Enablement Instrument (PEI), Patient Health Questionnaire Depression scale (PHQ-9), General Health Questionnaire (GHQ-12). RESULTS: The results indicate that the number of questions asked during the consultation was higher when a Question Listing was provided and when the patient was unaccompanied. Unaccompanied patients asked more questions in both groups and had significantly lower scores than accompanied on the GHQ-12 and on the PHQ-9, indicating lower clinical symptomatology. CONCLUSIONS: Results are in contrast with previous literature, indicating that being unaccompanied help patients to interact more with the oncologist. Further studies are needed to evaluate how the presence or not of a companion really impacts breast cancer patients during their first consultation with an oncologist. TRIAL REGISTRATION: ClinicalTrials.gov NCT01510964.

Service provider recognition of the significance of animal companionship among trans and cisgender women of diverse sexualities.

Extensive literature reveals the many health benefits animal companions can bring to the humans who live with them. However, much of this work has taken place with heterosexual and cisgender populations. To address this gap, we conducted qualitative interviews with 19 trans and cisgender women of diverse sexualities in Australia who reported having significant relationships with animal companions. In this article, we explore the benefits of healthcare providers (e.g. doctors, counsellors) recognising the potential significance of interspecies companionship for the health of trans and cisgender women of diverse sexualities. Findings relating to interactions with animal service providers are used to further illustrate themes of recognition and non-recognition as they relate to the women's genders, sexualities, and relationships with animal companions. In the discussion we consider some of the contextual challenges for such recognition to occur in service provision. Suggestions are then offered in relation to how providers might think about service provision which is both inclusive of all women and takes into account close connections with animal companions.

The Limits of Empowerment: How to Reframe the Role of mHealth Tools in the Healthcare Ecosystem.

This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design.

Relationship between Chinese children's imaginary companions and their understanding of second-order false beliefs and emotions.

We investigated relationship between Chinese children's imaginary companions (ICs) and their understanding of second-order false beliefs and emotions in 180 children, aged 5-6 years old. We examined the potential differences in second-order false belief understanding and emotion understanding between children with and without ICs, children with egalitarian IC relationships and hierarchical IC relationships, as well as children with invisible friends and personified objects. The results revealed that children with ICs had better second-order false belief understanding and emotion understanding than children without ICs. Compared with children with hierarchical relationships, children with egalitarian relationships had better second-order false belief understanding. However, children with invisible friends and personified objects did not differ on their understanding of second-order false beliefs and emotions. The results suggest that compared with IC types, IC status and child-IC relationship qualities may be more relevant to children's theory of mind. It will be interesting for the future researchers to investigate the underlying mechanism of the differences between children with egalitarian IC relationships and hierarchical IC relationships.

"Let him speak:" a descriptive qualitative study of the roles and behaviors of family companions in primary care visits among older adults with cognitive impairment.

OBJECTIVE: Cognitive impairment poses communication challenges in primary care. Although family "companions" commonly attend primary care visits of older adults with cognitive impairment, little is known about how their involvement affects communication. Therefore, we sought to understand how companion involvement affects the quality of primary care visit communication for older adults with cognitive impairment. METHODS: Cross-sectional, descriptive qualitative study participants were as follows: (1) English-speaking adults age 65 or older with mild, moderate, or severe cognitive impairment; (2) family members or other unpaid companions who accompany older adults to primary care visits; and (3) primary care clinicians. Twenty semi-structured and in-depth qualitative interviews of older adults and their companions (N = 20 dyads) and two focus groups (N = 10 primary care clinicians) were conducted. Interviews and focus groups were transcribed and analyzed thematically. RESULTS: Family companions commonly facilitate communication by advocating for patients, ensuring the accuracy of information exchange and understanding, and preserving rapport. Significant communication challenges were also identified, including patient and companion role ambiguity, competing visit agendas, and primary care clinician confusion regarding the most accurate source of information. Patients, companions, and clinicians each identified strategies to improve communication, chief among them being to identify, differentiate, and respect both patient and companion priorities and perspectives. CONCLUSIONS: Family companions actively participate in primary care visits of older adults with cognitive impairment in ways that promote and inhibit effective communication. Findings suggest the need for strategies that more effectively and purposefully involve family in the care of primary care patients with cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.

Invisible friends across four countries: Kenya, Malawi, Nepal and the Dominican Republic.

Cross-cultural comparisons of the prevalence of invisible/imaginary companions are difficult due to the use of various methods of data gathering and the lack of sampling in developing countries. The present study took place among 443 children (3-8-year-olds) in four different countries (Kenya, Malawi, Nepal and the Dominican Republic) employing the same interview method. Among all the children 21% affirmed that they had invisible/imaginary companions at the time of the interview. But the rates between countries varied significantly from a low of 5% in Nepal to a high of 34% in the Dominican Republic. The results suggest that the potential for the phenomenon transcends cultural particularity even as culture plays an important role for supporting or discouraging invisible/imaginary companions.

Chinese children's imaginary companions: Relations with peer relationships and social competence.

We investigated relationships between Chinese children's imaginary companions (ICs) and peer relationships and social competence in 160 children, aged 5-6 years old. Children and their mothers participated in the interviews regarding the details of the children's ICs, including the type of the companion and the quality of the child-IC relationship. Peer relationships were assessed using sociometric nomination and perceived popularity nomination. Teachers rated children's social competence. Here, 55 children (34.3%) were deemed to have engaged in imaginary companion play. There was no relationship between imaginary companion types and child-IC relationship qualities. Children with invisible friends received more positive nominations than children with personified objects. Children with egalitarian relationships received more positive nominations and popularity nominations, but fewer negative nominations and unpopularity nominations than children with hierarchical relationships. Compared with children with hierarchical relationships, teachers rated the children with egalitarian relationships higher in social competence. The results suggest that imaginary companion types and relationship qualities may represent different dimensions of imaginary companions, calling attentions to the different mechanisms underlying imaginary companion types and relationship qualities with respect to social functioning.

The psychological significance of play with imaginary companions in early childhood.

Although social play is common to many species, humans are unique in their ability to extract some of the benefits of social play through imagination. For example, in play with imaginary companions (ICs), children often practice skills that might be useful for later adaptive social, relational, and emotional functioning. While play with ICs does not provide the same immediate feedback that play with real others affords, this imagined, quasisocial context allows children to experiment with or rehearse events that might occur in real relationships. This symbolic enactment of social relationships might afford opportunities to experience not just social situations but all manner of positive and negative emotions in a risk-free way. In addition, children's interactions with real others around their ICs allow for negotiation of social roles in real relationships. ICs also provide a forum for psychological distance that might help young children manage their real relationships and engage in processes such as negotiation and cooperation, which are needed for successful social adaptation. Although play with ICs is clearly not of adaptive value in an evolutionary sense, for the children who create them, ICs might hold psychological significance for adaptive social development.

The role of companions in outpatient seizure clinic interactions: A pilot study.

PURPOSE: This study explored contributions that patients' companions (seizure witnesses) make to interactions in the seizure clinic and whether the nature of the companions' interactional contributions can help with the differentiation of epilepsy and psychogenic nonepileptic seizures (PNES). METHODS: Conversation analysis methods were used to examine video recordings and transcripts of neurologists' interactions with patients referred to a specialist seizure clinic and their companions. RESULTS: The companions' behavior correlated with interactional features previously observed to distinguish patients with epilepsy from patients with PNES. Patients with PNES, but not those with epilepsy, tended to exhibit interactional resistance to the doctor's efforts to find out more about their seizure experiences and, thereby, encouraged greater interactional contribution from companions. CONCLUSION: The contributions that companions make (in part, prompted by patient's interactional behavior) may provide additional diagnostic pointers in this clinical setting, and a number of candidate features that may help clinicians distinguish between epilepsy and PNES when the patient is accompanied by a seizure witness are described. However, companion contributions may limit the doctor's ability to identify linguistic and interactional features with previously demonstrated diagnostic potential in the conversational contributions made by patients themselves. To help offset potential diagnostic losses, doctors may need to explicitly discuss the role of the companion in the consultation when a seizure witness (or another companion) accompanies the patient.

Robotic Nudges: The Ethics of Engineering a More Socially Just Human Being.

Robots are becoming an increasingly pervasive feature of our personal lives. As a result, there is growing importance placed on examining what constitutes appropriate behavior when they interact with human beings. In this paper, we discuss whether companion robots should be permitted to "nudge" their human users in the direction of being "more ethical". More specifically, we use Rawlsian principles of justice to illustrate how robots might nurture "socially just" tendencies in their human counterparts. Designing technological artifacts in such a way to influence human behavior is already well-established but merely because the practice is commonplace does not necessarily resolve the ethical issues associated with its implementation.

National survey on patient's fears before a general surgery procedure.

OBJECTIVE: To assess the magnitude of the different causes of anxiety in patients and families, facing surgery. METHODS: Cross-sectional multicenter national survey recruiting 1,260 participants between patients and companions, analyzing the impact of 14 areas selected based on scientific publications aimed at the general public, concerning patients and/or companions, focused on concern about surgery. Patient sex, age, type of surgery (minor/major) and expected inpatient or ambulatory surgery were analyzed. For the companions sex and age, and relationship to patient were analyzed. In both cases it was assessed based on a unidimensional scale of 0 to 10, with 0 being be minimal cause for concern and 10, maximum. RESULTS: The most prominent have been the fear of the unknown, possible complications, the impact on quality of life, the accuracy of diagnosis and possible malignancy of the disease, as well as anesthesia and pain control. There are significant differences in the involvement of patients and companions; and are also differences by sex and age of the patient; type of surgery (minor/major) and expected hospital admission or not. CONCLUSIONS: The patient faces surgery with a number of fears that can be reduced with increased information.