Turnover behavior and intention among dentists and medical doctors: a cross-sectional study in China.

BACKGROUND: Retention of doctors is a global challenge and doctors working in different departments may face different problems. The study aimed to explore the turnover behavior and intention and correlated factors among Chinese dentists and medical doctors in other clinical fields. METHODS: A cross-sectional study was conducted online in 5 regions of China from March 12th to April 12th, 2020. The questionnaire included 3 parts, socio-demographic characteristics, turnover behavior and intention, and concerns about work-related factors. Chi-square test and/or Wilcoxon Mann-Whitney test were applied for comparison, and binary logistic regression was used for finding the factors. RESULTS: A total of 2428 eligible questionnaire were received, comprising 1954 responses from dentists and 474 from medical doctors. Rates of turnover behavior among dentists and medical doctors were 2.87% and 6.96%, respectively. Similarly, rates of turnover intention were 51.79% among dentists and 71.20% among medical doctors. Educational level was negatively correlated with turnover behavior of both medical doctors and dentists, and concern about salary was a unique negatively correlated factor for dentists. Age was negatively correlated with turnover intention in both medical doctors and dentists. Conversely, concerns about workload and doctor-patient relationship were positively correlated with turnover intention in both groups. Concern about salary was the distinct correlated factor of medical doctors' turnover intention, while gender and annual household income were correlated with turnover intention among dentists. CONCLUSIONS: Low turnover rate but high turnover intention rate was the current status of Chinese doctors' employment. Turnover behavior and intention were more optimistic among dentists than medical doctors. Factors related to turnover behavior and turnover intention were not identical among dentists and medical doctors. Therefore, personalized retention measures were necessary for dentists and medical doctors.

Assessing the attitudes and knowledge of medical students towards Patient-Centred Care across different study years: A cross-sectional study.

OBJECTIVE: To determine how medical students viewed the importance of patient-doctor communication, to assess their knowledge about patient-centred care, and to compare the attitudes of medical students in their pre-clinical and clinical years of study towards patient-centred care. METHODS: The cross-sectional study was conducted from April to September 2023 at Federal Medical and Dental College, Islamabad, and Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised medical students of either gender from 2nd to 5th academic year. Data was collected using the Patient-Practitioner Orientation Scale. Data was analysed using SPSS 27. RESULTS: Of the 322 students, 178(55.3%) were males and 144(44.7%) were females. The mean score was 3.60±0.47, while the sharing and caring sub-scores were 3.23±0.66 and 3.99±0.52, respectively. The attitude of students overall was slightly patient-centred. Different study years showed variance in patient-centred scores which were also affected by cultural, demographic and gender parameters (p<0.05). CONCLUSIONS: The attitude of the students leaned slightly towards patient-oriented behaviour.

Patient-centred care attitudes and knowledge: a national study of BDS students in New Zealand.

OBJECTIVE: The aim of this study was to investigate the attitudes and knowledge towards patient-centred care among Bachelor of Dental Surgery (BDS) students in New Zealand. METHOD: The study was a mixed methods cross-sectional national study of the BDS students in New Zealand. All 2021 BDS students at the New Zealand's National Centre for Dentistry, New Zealand, were recruited in the study. The Patient-Practitioner Orientation Scale (PPOS) questionnaire was used to evaluate the dental students' attitudes and knowledge of patient centred care. The students' perspectives on the BDS curriculum regarding patient-centred care were also collected. ANOVA and the Student's T-test were used to compare the difference among the BDS years, gender, and background. RESULTS: A total of N = 277 (277/346; 80% response rate) students completed the study. Female students had higher scores than male students for sharing (difference = 0.19, 95% CI 0.04-0.34, P = 0.01), caring (difference = 0.15, 95% CI 0.01-0.29, P = 0.03) and PPOS (difference = 0.17, 95% CI 0.05-0.30, P < 0.01). Domestic students had higher scores than international students for caring (difference = 0.35, 95% CI 0.21-0.50, P < 0.01) and PPOS (difference = 0.22, 95% CI 0.08-0.35, P < 0.01). Three main themes of patient-centred care were extracted from the qualitative analysis of students' perspectives: (1) Understanding of the concept of patient-centred care, (2) Perception of the importance of patient-centred care in dentistry, and (3) Perspective on the curriculum about patient-centred care. CONCLUSION: Most dental students favoured a patient-centred approach. According to dental students, the patient-centred care component of their education should be increased.

Patient perspectives on teledentistry and face-to-face doctor interaction during orthodontic treatment.

INTRODUCTION: Teledentistry in orthodontics is growing, yet patient preferences for its use is unknown. This study aimed to determine the perceived value of doctor-to-patient face-to-face interaction, convenience, and attitudes toward specific uses of teledentistry among orthodontic patients. METHODS: Private practice orthodontists emailed an electronic survey to active patients. Patients aged ≥18 years completed the survey regarding their treatment. Parents of patients aged <18 years completed a separate survey regarding their child's treatment. Responses were compared on the basis of patient characteristics (adult vs child, braces vs clear aligners, etc). RESULTS: Three hundred and seventy-seven respondents from 8 orthodontic practices participated in the survey. Eighty-five percent of parents considered face-to-face interaction important, and 85% said that their child's treatment fit conveniently into their schedule. Adult responses were 86% and 89%, respectively. Adult preference for face-to-face was significantly higher than parents of adolescent patients (83% vs 78%; P = 0.038). Adults treated with clear aligners were less likely to strongly agree that their treatment fitted conveniently in their schedule (51% vs 76% in braces; P = 0.0490) and were more likely to be interested in using teledentistry (27% vs 18% in braces; P = 0.0429). CONCLUSIONS: Most orthodontic patients prefer to be seen face-to-face. This is due to the high value placed on face-to-face interaction with the orthodontist. Most patients do not consider their treatment inconvenient. Patients prefer that teledentistry be used to enhance communication as opposed to replacing face-to-face interaction. Implementing teledentistry in orthodontics should be applied on a patient-to-patient basis with continued emphasis on the doctor-patient relationship.

Orthodontic patients and the information found on the web: a cross-sectional study.

BACKGROUND: In recent years, the Web has become a source of medical information for patients, even though the information available online may be incorrect or qualitatively inadequate. Younger generations, immersed in a digital environment since a very tender age, are more likely to get informed online. This study aims to understand the relevance of online information for prospective orthodontic patients and to investigate the effects of digital research on patients' decision-making process, and it also aims to investigate potential generational differences between digital natives and digital immigrants. MATERIALS AND METHODS: An anonymous questionnaire was developed to investigate patients' orthodontic-themed Web searches as well as the effects digital material had on their decision-making process. Before submitting the newly designed survey to patients, it was validated in a pilot study. Univariate analysis was applied to analyze the relationship between the demographic characteristics of respondents and their answers on the use of digital research for the decision-making process. RESULTS: 64.6% of the study population searched the Web for orthodontic information prior to their visit. Google was the most used platform regardless of patients' age. The perceived reliability of online sources varied significantly with age. Men displayed more trusting behavior towards their doctor than women. Prospective patients' satisfaction with affected patients' decision-making processes, and the perceived reliability of online sources of information had repercussions on the doctor-patient relationship. CONCLUSIONS: Orthodontists should be aware that the majority of patients use the Internet as a source for orthodontic information, and that patients who are digital immigrants are more prone to trust the information found online. Patients who perceive the information found on the Web as either useful or reliable don't easily discard it, even if it is inconsistent with the orthodontist's opinion.

[A study on the application of intraoral camera in the identification of oral anatomical landmarks].

OBJECTIVE: To preliminarily explore the applicable scenarios of an intraoral camera to assist oral anatomical landmarks recognition, so as to improve the clinical diagnosis and treatment mode, cultivate the concept of caring for patients, strengthen doctor-patient communication, assist experts to teach, and improve the clinical diagnosis and efficacy rate. METHODS: A new type of an intraoral camera was applied in the recognition of oral anatomy landmarks and four application scenarios were developed, namely: (1) clinical diagnosis and treatment scenarios, in which doctors used intraoral camera to conduct a comprehensive examination of patients in the mouth and take videos and photos; (2) doctor-patient communication scenarios, when the doctor told the patient about the treatment plan, the video or photo taken by the intraoral camera was displayed to the patient; (3) expert teaching scenarios, when the expert used an intraoral camera to teach in the patient's mouth, and the young doctor learned oral anatomical signs on the projection screen, with the study of theoretical lessons; (4) difficult case recording scenarios, in the process of clinical diagnosis and treatment, when encountering difficult cases, you could use intraoral camera to record and take photos for young doctors to discuss, and experts to comment and guide. RESULTS: The application of intraoral camera could: (1) improve the clinical diagnosis and treatment mode and raise the clinical diagnosis and efficacy rate; (2) stimulate young doctors' interest in learning, use intraoral camera in assessments, and skillfully combine theoretical knowledge of anatomical landmarks with clinical practice, so as to improve the teaching effect; (3) cultivate, through self or mutual use, the concept of caring for patients and reinforce the importance of gentle operation; (4) strengthen doctor-patient communication. Doctors could communicate with patients more visually, so that the patients could better understand their own situation, and strengthen the patients' trust in the doctors. CONCLUSION: Intraoral camera can assist oral clinical diagnosis and treatment, such as the recognition of oral anatomical landmarks. It plays a certain role in promoting the improvement of clinical diagnosis and treatment mode, stimulating learning interest, cultivating the concept of caring for patients, and enhancing doctor-patient communication.

The Mediating Role of Patients' Trust Between Web-Based Health Information Seeking and Patients' Uncertainty in China: Cross-sectional Web-Based Survey.

BACKGROUND: In the physician-patient relationship, patients' uncertainty about diseases and the lack of trust in physicians not only hinder patients' rehabilitation but also disrupt the harmony in this relationship. With the development of the web-based health industry, patients can easily access web-based information about health care and physicians, thus reducing patients' uncertainty to some extent. However, it is not clear how patients' web-based health information-seeking behaviors reduce their uncertainty. OBJECTIVE: On the basis of the principal-agent theory and the perspective of uncertainty reduction, this study aims to investigate the mechanism of how web-based disease-related information and web-based physician-related information reduce patients' uncertainty. METHODS: A web-based survey involving 337 participants was conducted. In this study, we constructed a structural equation model and used SmartPLS (version 3.3.3; SmartPLS GmbH) software to test the reliability and validity of the measurement model. The path coefficients of the structural model were also calculated to test our hypotheses. RESULTS: By classifying patients' uncertainties into those concerning diseases and those concerning physicians, this study identified the different roles of the two types of patients' uncertainty and revealed that web-based disease-related information quality and web-based physician-related information can act as uncertainty mitigators. The quality of disease-related information reduces patients' perceived information scarcity about the disease (ß=-.588; P<.001), and the higher the information scarcity perceived by patients, the higher their uncertainty toward the disease (ß=.111; P=.02). As for physician-related information, web-based word-of-mouth information about physicians reduces patients' perceived information scarcity about the physician (ß=-.511; P<.001), mitigates patients' fears about physician opportunism (ß=-.268; P<.001), and facilitates patients' trust (ß=.318; P<.001). These factors further influence patients' uncertainty about the physician. In addition, from the test of mediating effect, patients' trust in the physician fully mediates the relationship between their perceived information scarcity about the physician's medical service and their uncertainty about the physician. Patients' trust also partially mediates the relationship between their fear of the physician's opportunism and their uncertainty about the physician. As for the two different types of uncertainty, patients' uncertainty about the physician also increases their uncertainty about the diseases (ß=.587; P<.001). CONCLUSIONS: This study affirms the role of disease-related web-based information quality and physician-related web-based word-of-mouth information in reducing patients' uncertainties. With regard to the traits of principal-agent relationships, this study describes the influence mechanism based on patients' perceived information scarcity, fears of physicians' opportunism, and patients' trust. Moreover, information about physicians is effective in reducing patients' uncertainties, but only if the information enhances patients' trust in their physicians. This research generates new insights into understanding the impact of web-based health information on patients' uncertainties.

A Review of Legal, Ethical, and Governance Issues for Team Doctors.

OBJECTIVE: To provide a review and discussion of a range of legal and ethical issues commonly faced by team physicians, with reference to high-profile international integrity crises in sport that have involved doctors. The article also presents some recommendations and guidance for team doctors and sporting organizations. DATA SOURCES: Media reports, legal cases, and journal articles describing recent sporting integrity crises that have involved medical issues and governance reforms which are emerging in response. MAIN RESULTS: Many of the modern "integrity crises" in sport have a medical aspect (eg, doping cases, catastrophic injuries and illnesses, "Bloodgate" and other "medical cheating," sexual contact between doctors and athletes, harassment/bullying of doctors, concussion mismanagement, and management of the coronavirus pandemic in sport). A key issue is that while doctors bear ultimate responsibility for any perceived medical negligence, they do not always have ultimate power in decision-making. This is common in the traditional governance structure where the coach/manager "outranks" the doctor and can overrule medical decisions. There can be a blurring of the traditional doctor-patient relationship, especially on tour, and conflicts of interests occur when the needs of the employer/sporting organization differ from the player (patient). Further issues can arise in treating other staff members and players' family members. CONCLUSIONS: Doctors must be aware of range of important legal and ethical issues that arise in the team setting. Medical integrity crises have inspired governance reforms, such as policy development, appointment of chief medical officers, medical staff reporting to integrity departments, and sanctions of teams that breach medical integrity requirements. Sporting organizations must continue to implement and strengthen frameworks reinforcing doctors' seniority in the medical area.

Compliance of children with removable functional appliance with microchip integrated during covid-19 pandemic: a systematic review.

Treatments with removable appliances are widely used in Europe to correct dento-skeletal dysgnatia in the growth phase that is a period of poor cooperation of the patients. Adherence to the wear-time prescription is often not achieved and it represent the main argument against the use of removable devices. Suspected non-compliant behavior with the wear time prescription is often the subject of medico-legal disputes, which can deteriorate doctor-patient relationship. The use of microchips allows to document objectively and clarify the patient's behavior. To conduct a systematic review of the orthodontic literature to identify the factors associated with compliance in orthodontic treatment. We conduct a systematic review that aimed to identity the factors associate with compliance in orthodontic treatment. The main purpose was to assess the objective levels of time of use of the removable appliances and the self-reported levels. A literature search was conducted by the electronic databases PubMed and Cochrane Library. The following search terms were used: compliance functional removable orthodontic appliance. Randomized and nonrandomized controlled trials, prospective cohort studies, case series, qualitative and mixed-methods studies objectively assessing compliance levels were included in the study. A total of 94 articles were identified by PubMed and 14 articles by Cochrane. The papers selected were included for the qualitative analysis and categorized according to the subjects age, the clinical appliance, compliance factors, wear time and monitoring. Removable appliances are an important part of orthodontic treatment, used in growth phase of the patient. Collaboration with removable functional devices determines success / failure in treatment.

Empathy and attitude toward communication skill learning as a predictor of patient-centered attitude: a cross-sectional study of dental students in Korea.

BACKGROUND: Enhancing medical students' practice of patient-centered care is a goal of medical schools. In addition to exploring the demographic and academic factors of the students, it is necessary to identify other attitudes and perceptions that may influence the student's patient-centered attitude and inclination toward communication skill learning. This study aimed to assess patient-centered attitudes among dental students in Korea and identify the association between the students' characteristics and empathy, communication skill learning attitude, and patient-centered attitude. METHODS: Data were collected via a cross-sectional online survey, and 312 dental students were included in the analyses. The study participants completed the Patient-Practitioner Orientation Scale (PPOS), the Interpersonal Reactivity Index (IRI), and the Communication Skills Attitude Scale (CSAS). Analyses were performed using independent samples' t-tests, hierarchical multi-variable regression, and ANOVA with a post-hoc Tukey test. RESULTS: The students tend to be moderately patient-oriented toward the sharing subscale of PPOS score (M = 3.78, standard deviation [SD] = 0.54) and slightly more patient-centered toward the caring subscale of PPOS score (M = 4.41, SD = 0.52) of patient-centered attitudes. Being a female and a shorter academic period in dentistry were associated with attitudes toward patient-centered care. Empathy and positive attitude toward learning communication skills were also related to a patient-centered attitude, and among aspects of empathy, "empathic concern" had the greatest significant impact on patient-centered attitude. CONCLUSIONS: Gender, academic period, empathy, and attitudes on learning communication skills were important influencing factors of patient-centered attitudes. Patient-centered attitude can and must be taught. Education programs should focus on enhancing empathy, emphasizing positive attitudes on learning communication skills, and conducting follow-up educational sessions to prevent students from becoming less patient-centered with an increase in duration of their academic period.

Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics.

OBJECTIVES: To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers. DESIGN: A cross-sectional, observational study. SETTING: NHS teaching hospital. PARTICIPANTS: A total of 31 adult patients and their treating clinicians were included in the study. METHODS: The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION12 scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION12 scale. RESULTS: There was excellent inter-rater reliability between the two independent raters using the OPTION12 scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323). CONCLUSIONS: The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.

"Got to build that trust": the perspectives and experiences of Aboriginal health staff on maternal oral health.

BACKGROUND: In Australia, models of care have been developed to train antenatal care providers to promote oral health among pregnant women. However, these models are underpinned by Western values of maternity care that do not consider the cultural needs of Aboriginal and Torres Strait Islander women. This study aimed to explore the perceptions and experiences of Aboriginal health staff towards oral health care during pregnancy. It is part of a larger program of research to develop a new, culturally safe model of oral health care for Aboriginal women during pregnancy. METHODS: A descriptive qualitative methodology informed the study. Focus groups were convened to yarn with Aboriginal Health Workers, Family Partnership Workers and Aboriginal management staff at two antenatal health services in Sydney, Australia. RESULTS: A total of 14 people participated in the focus groups. There were four themes that were constructed. These focused on Aboriginal Health Workers and Family Partnership Workers identifying their role in promoting maternal oral health, where adequate training is provided and where trust has been developed with clients. Yet, because the Aboriginal health staff work in a system fundamentally driven by the legacy of colonisation, it has significantly contributed to the systemic barriers Aboriginal pregnant women continue to face in accessing health services, including dental care. The participants recommended that a priority dental referral pathway, that supported continuity of care, could provide increased accessibility to dental care. CONCLUSIONS: The Aboriginal health staff identified the potential role of Aboriginal Health Workers and Family Partnership Workers promoting oral health among Aboriginal pregnant women. To develop an effective oral health model of care among Aboriginal women during pregnancy, there is the need for training of Aboriginal Health Workers and Family Partnership Workers in oral health. Including Aboriginal staff at every stage of a dental referral pathway could reduce the fear of accessing mainstream health institutions and also promote continuity of care. Although broader oral health policies still need to be changed, this model could mitigate some of the barriers between Aboriginal women and both dental care providers and healthcare systems.

Patient autonomy in dentistry: demonstrating the role for shared decision making.

BACKGROUND: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients' autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings. METHODS: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients' and dentists' preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n = 100), a multiple sclerosis clinic (n = 109), and a university-based prosthodontic clinic (n = 100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. RESULTS: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p = .035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p < .001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p < .001). CONCLUSION: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

[How information on a patient's social status is gathered. An anthropological analysis of the discourses employed in private medical practice]. / Les pratiques de repérage de la situation sociale des patients. Analyse anthropologique de discours de praticiens libéraux.

BACKGROUND: A number of studies have highlighted differences and even discrimination in health care offer according to social category, and shown that they contribute to the production of inequality. On the other hand, when the health care system treats every patient equally, and does not take personal difficulties into consideration, some authors have suggested inequality "by omission". That is why public health actors at different levels have recommended systematic collection of information on patients' social status. The objective of this article is to analyze data gathering on patients' socio-economic condition and its repercussions. METHODS: The survey is based on more than 50 semi-structured face-to-face interviews with doctors and dentists in private practice. Their answers were subjected to socio-anthropological analysis. RESULTS: While some practitioners collect information on patients' social status proactively by systematic interrogation, others proceed indirectly and in accordance with subjective criteria. Quite often, patient status remains ignored, usually due to lack of interest, and less frequently because practitioners wish to guard against any risk of stigmatizing underprivileged patients. Different rationales may explain these attitudes: need to prioritize relevant information, wish to observe equity and equality, determination to refrain from social labeling, desire to protect patient self-esteem and to reinforce the practitioner-patient relationship. When identification does occur, it is essentially justified by a desire to adapt the care pathway to potential socio-economic obstacles. CONCLUSION: When a patient's social situation is sought out by private doctors and dentists, they are mainly concerned with customizing care pathways by taking financial impediments into close consideration. In most cases, their justifications for asking questions are subjective; by doing so, they inadvertently introduce arbitrariness in an area where the French state endeavors to produce social justice via provisions such as "CMU" ("universal", across the board health coverage). Systematic questioning on a patient's social status can represent a form of supplementary if unconscious symbolic violence toward frequently disqualified persons; what is more, it runs the risk of inducing stereotypes and manifesting prejudice. Only when contextualized does such questioning seem appropriate. On the other hand, when a practitioner misses out on social issues liable to impede care and treatment, he will probably have no "second chance" to address these concerns. Some practitioners have emphasized a need for suitable timing and contextualizing of questions on a patient's social status, and for putting them forward in a climate of trust.

Exploring the impact of online information signals in leveraging the economic returns of physicians.

INTRODUCTION: With the growth in Internet technology, online rating websites encourage patients to contribute actively in rating their physicians. These rating sites provide more information for patients, such as electronic word of mouth (eWOM) and physician trustworthiness. Although several studies in e-commerce have investigated the role of eWOM and seller trustworthiness in the consumer purchase decision-making process and the price premium for products or services, studies on the role of different information sources that reflect the service quality and delivery process in choosing a competent physician remain scarce. This research develops a two-equation model to examine the effect of different signals, i.e., patient-generated signals (PGSs) and system-generated signals (SGSs), on patient choice, which is an important predictor of physicians' economic returns. METHODS: A secondary data econometric analysis and structural modeling using 2896 physicians' real data from a publicly available online physician rating site, i.e., Healthgrades.com, were conducted using a mixed-methods approach. A hybrid text mining approach was adopted to calculate the sentiment of each review. RESULTS: We find that both PGSs and SGSs have a significant impact on patient choice at different stages of health consultation. Furthermore, disease risk negatively moderates the association between PGSs and information search, while the impact of both signals on patient willingness to pay a price premium is positively moderated by the disease risk. CONCLUSION: Our study contributes to the unified framework of signaling theory and Maslow's hierarchy of needs theory by making a clear distinction between PGSs or SGSs and their influence on patient decision-making across different disease risks. Moreover, PGSs and SGSs are two essential factors for physicians to increase their income.

Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review.

BACKGROUND: Lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals experience higher rates of health disparities. These disparities may be driven, in part, by biases of medical providers encountered in health care settings. Little is known about how medical, nursing, or dental students are trained to identify and reduce the effects of their own biases toward LGBTQ individuals. Therefore, a systematic review was conducted to determine the effectiveness of programs to reduce health care student or provider bias towards these LGBTQ patients. METHODS: The authors performed searches of online databases (MEDLINE/PubMed, PsycINFO, Web of Science, Scopus, Ingenta, Science Direct, and Google Scholar) for original articles, published in English, between March 2005 and February 2017, describing intervention studies focused on reducing health care student or provider bias towards LGBTQ individuals. Data extracted included sample characteristics (i.e., medical, nursing, or dental students or providers), study design (i.e., pre-post intervention tests, qualitative), program format, program target (i.e., knowledge, comfort level, attitudes, implicit bias), and relevant outcomes. Study quality was assessed using a five-point scale. RESULTS: The search identified 639 abstracts addressing bias among medical, nursing, and dental students or providers; from these abstracts, 60 articles were identified as medical education programs to reduce bias; of these articles, 13 described programs to reduce bias towards LGBTQ patients. Bias-focused educational interventions were effective at increasing knowledge of LGBTQ health care issues. Experiential learning interventions were effective at increasing comfort levels working with LGBTQ patients. Intergroup contact was effective at promoting more tolerant attitudes toward LGBTQ patients. Despite promising support for bias education in increasing knowledge and comfort levels among medical, nursing, and dental students or providers towards LGBTQ persons, this systematic review did not identify any interventions that assessed changes in implicit bias among students or providers. CONCLUSIONS: Strategies for assessing and mitigating implicit bias towards LGBTQ patients are discussed and recommendations for medical, nursing, and dental school curricula are presented.

See-Hear-Feel-Speak: A Protocol for Improving Outcomes in Emergency Department Interactions With Patients With Autism Spectrum Disorder.

The presentation of children and adolescents with autism in the emergency department (ED) poses a unique set of challenges to clinicians and their teams, which have not yet been met. Children and adolescents with autism spectrum disorder (ASD) are more likely than their age and ethnically matched counterparts to visit both pediatric and general EDs and are more likely to use it for primary care complaints and dental care and to present for psychiatric concerns including suicidality. Despite the higher relative frequency, individuals with ASD demonstrate lower patient satisfaction, lower healthcare self-efficacy, and higher odds of unmet healthcare needs related to physical health, mental health, health maintenance, and vaccination. This can be ameliorated by simple strategies regarding communication, sensory and environmental modification, and distraction. After performing a literature review of existing evidence-based recommendations via PubMed as well as resources from autism advocacy and self-advocacy groups, we compiled a 4-step system: "See-Hear-Feel-Speak" an approach conducive to learning with the goal of enabling clinicians and their teams to facilitate patient-centered encounters with pediatric patients with ASD. The protocol meets the practicality requirements defined by published research.

Communication and Healthcare: Self-Reports of People with Hearing Loss in Primary Care Settings.

Objectives: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access. Methods: Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP. Results: Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one's name when called in the waiting room, hearing when the speaker's back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication. Conclusions: This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit. Clinical Implications: Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one's mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.

[Series: Communication in the dental practice. Delivering bad news]. / Serie: Communicatie in de tandartspraktijk. Het slechtnieuwsgesprek.

In general practice a dentist will from time to time have to convey bad news to his patients. Often they feel burdened by this because of the emotional impact of such a conversation. This article discusses the way in which patients prefer to have bad news relayed to them. Using cases suggestions are made how to structure the bad news conversation.

Quality of life in thyroid cancer-assessment of physician perceptions.

BACKGROUND: Thyroid cancer is the fastest growing malignancy in the United States. Previous studies have shown a decrease in quality of life (QoL) after the treatment of thyroid cancer. To date, there have been no studies assessing physician perceptions regarding how a diagnosis of thyroid cancer affects QoL. Based on this and other findings from our study, we aim to assess physician perceptions on the effect of thyroid cancer on QoL. MATERIALS AND METHODS: Physicians were recruited from two national organizations comprised physicians focusing on thyroid cancer. A 37-question survey was administered evaluating physician's perceptions of thyroid cancer patient satisfaction in various aspects of treatment, complications, and overall effects on QoL. QoL responses were categorized into overall QoL, physical, psychological, social, and spiritual well-being. RESULTS: One hundred five physicians completed the survey. Physician's estimates of patient's overall QoL after thyroid cancer treatment was similar to overall QoL reported by patients. However, medical physicians overestimated the decrease in thyroid cancer survivor's QoL in several subcategories including physical, psychological, and social (P < 0.05). Both surgeons and medical physicians underestimated the percentage of patients with reported symptoms of temporary and permanent voice changes, temporary dry mouth, cold/heat sensitivity, and temporary and permanent hypocalcemia (P = 0.01-0.04). CONCLUSIONS: Physicians have a varied estimation of the detrimental impact of thyroid cancer treatment on QoL. In addition, physicians underestimated the amount of physical symptoms associated with thyroid cancer treatments. Increased physician awareness of the detrimental effects of a thyroid cancer diagnosis on QoL should allow for a more accurate conversation about expected outcomes after thyroid cancer treatment.