Subject(s)
Breast Neoplasms/therapy , Intraoperative Care/methods , Mastectomy, Segmental/methods , Radiotherapy, Adjuvant/methods , Aged , Aged, 80 and over , Axilla , Breast Neoplasms/metabolism , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Female , Humans , Italy , Lymph Node Excision , Margins of Excision , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging , Prognosis , Proportional Hazards Models , Radiation Dosage , Radiotherapy , Receptor, ErbB-2/metabolism , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , Retrospective Studies , Sentinel Lymph Node Biopsy , Survival Rate , Treatment OutcomeABSTRACT
AIMS: The purpose of this pilot study was to assess the feasibility of a quantitative approach to study occupational therapist-client interactions. Role plays were videotaped in which 10 therapists met three client-actors. A questionnaire assessed the occupational therapists' and the patient-actors' opinion of the role-play experience. A modified version of the Roter Interaction Analysis System (RIAS), OT-RIAS, was used to analyse data. MAJOR FINDINGS: Occupational therapists considered the role play experience to be "highly realistic" (mean score 5.4 on a 1-6 Likert scale). The actors' comfort role playing clients was also high (mean = 4.0; range 1-5). Inter-coder reliability for the OT-RIAS was highly significant (r = 0.919; p = 0.000). The modified version of this system fits well in an occupational therapy context. PRINCIPAL CONCLUSION: The quantitative approach used in this study to explore the therapist-client relationship appears to be effective. The role plays and RIAS may be useful in research exploring correlation between the OT communication style and outcome measures such as client satisfaction or comprehension, or in order to assess and offer feedback in teaching communication skills programmes.
Subject(s)
Communication , Occupational Therapy/methods , Professional-Patient Relations , Adult , Clinical Competence , Female , Humans , Interprofessional Relations , Interview, Psychological , Male , Middle Aged , Pilot Projects , Professional Role , Psychometrics , Reproducibility of Results , Role Playing , Surveys and Questionnaires , Video RecordingABSTRACT
GOAL: Major cross-cultural differences in truth-telling attitudes and practices have been demonstrated. Until recently, in Italy the doctor could conceal both diagnosis and prognosis to seriously ill patients out of beneficence. Signs of change have been reported, but the extent and way patients would be informed is still unknown. The aim of the study was to assess Italian patients' preferences regarding how they would like to be told about their cancer and its treatment. We examined the factor structure of the Measure of Patients' Preferences--Italian version (MPP-It) and whether demographical and medical variables were associated with the dimensions of patients' preferences. MATERIALS AND METHODS: Patients were invited to participate during a visit to the oncology department of the Lecco hospital (Italy) for chemotherapy or follow-up. An Italian version of the MPP-It was administered. Data were analyzed through a factor analysis. MAIN RESULTS: A total of 210 cancer patients agreed to participate. Three main factors were identified: (1) Information (Talking About the Disease). Items in this factor were concerned with the dialogue about the disease and treatment options; (2) Support (The Emotional World of the Patient). These items referred to the supportive and relational aspects of the physician-patient encounter; (3) Care (The Ideal Doctor). These items related to the patients' desires about the doctor's personal attributes. CONCLUSIONS: The first two factors, information and support, were comparable to those of similar American and Asian studies. The study suggests a cross-cultural uniformity among cancer patients who appreciate the informative and clearness of the communication aspects as being primarily important, while also giving high points to relationship aspects. The third factor appears unique to the Italian context.
Subject(s)
Neoplasms/psychology , Patient Preference , Physician-Patient Relations , Truth Disclosure , Adult , Aged , Aged, 80 and over , Communication , Cross-Cultural Comparison , Female , Humans , Italy , Male , Middle Aged , Neoplasms/diagnosis , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To examine how patient-centredness is understood and enacted in an American (US) and an Italian group of health care professionals. METHODS: An action research methodology was used. Two interprofessional groups of US (n = 4) and Italian (n = 5) health care professionals independently wrote a patient-centred dialogue between a doctor and a patient based on the same scenario. The dialogues were then translated and exchanged. Both groups independently commented on the patient-centred aspects of the other's dialogue by completing a written questionnaire. Their respective comments were then shared by international videoconference. The transcript of the videoconference was analysed via content analysis. The participants' opinions about the study were then evaluated. RESULTS: Exploring the patient's illness experience and handling the patient's emotions were identified as core components of patient-centred care by both the US and Italian groups, but were expressed differently in their respective dialogues. Respecting the patient's autonomy was recognised as a component of patient-centred care only by the US group. The Italian group demonstrated a more implicitly paternalistic approach. Participants highlighted the usefulness of one another's feedback to uncover cultural assumptions of patient-centred care and increase self-awareness. CONCLUSIONS: Results suggest that the concept and practice of patient-centred care is variable and may be influenced by culture. The study methodology improved participants' self-awareness of cultural values, and has potential as a cost-effective, experiential educational approach.
Subject(s)
Patient-Centered Care/standards , Physician-Patient Relations , Adult , Aged , Boston , Clinical Competence/standards , Cost-Benefit Analysis , Emotions , Female , Group Processes , Humans , Interprofessional Relations , Italy , Male , Middle Aged , Patient Satisfaction , Patient-Centered Care/economicsABSTRACT
The aim of this study was to explore the physician's communication pattern when breaking a bad unexpected news. 30 videotaped consultations (VRM) were collected in which the physicians met an actress as a patient. The doctors received the x-ray report in which an apical mass was detected before (condition A) or during (condition B) the consultation. The VRM were analysed through the Roter Interaction Analysis System (RIAS). Data suggested in condition B a significant decrease in "process", "counselling" and "emotional" categories. In consultation where a bad unexpected news is communicated doctors seem to be less directive in the content and more emotionally defended.