Uso de medicina complementaria y alternativa y su asociación con la relación médico-paciente en enfermos con artritis reumatoide / Association between physician-patient relationship and the use of complementary and alternative medicine in patients with rheumatoid arthritis

RESUMEN Introducción: El uso de medicina complementaria y alternativa (MCA) en pacientes con enfermedades reumáticas es prevalente pero la comunicación con el reumatólogo suele ser deficiente, lo cual afecta la relación médico-paciente (RMP). Objetivos: Evaluar la asociación entre el uso de MCA y la RMP en enfermos con artritis reumatoide. Como objetivos adicionales, describir la percepción del paciente sobre la comunicación con su reumatólogo respecto al uso de MCA y el patrón de uso de las diferentes modalidades terapéuticas. Materiales y métodos: Estudio descriptivo de corte transversal. El uso de MCA y la RMP se evaluaron mediante la autoaplicación de cuestionarios validados (I-CAM-Q y PDRQ-9 respectivamente). Resultados: Se incluyó a 246 pacientes ambulatorios de una institución de tercer nivel de atención. Se encontró asociación entre una mayor satisfacción con el tratamiento y el no usar MCA, y entre el hecho de informar al reumatólogo sobre el uso de MCA con un mayor grado de acuerdo con el médico sobre el origen de los síntomas y mayor satisfacción con el tratamiento. Las modalidades más frecuentemente utilizadas fueron: quiropraxia, acupuntura y productos herbales. El 78,5% afirmaron estar de acuerdo con comunicar el uso de este tipo de medicación al reumatólogo, sin embargo, solo el 31,3% lo notificó, por temor a represalias (54,4%). Conclusiones: Pese a la alta prevalencia de uso de MCA en nuestros pacientes, la mayoría no lo comunicó al reumatólogo. Se encontró asociación entre el uso de MCA y una menor satisfacción del paciente con el tratamiento y entre la comunicación médico-paciente sobre la práctica de MCA y una mejor satisfacción con el tratamiento.

ABSTRACT Introduction: Although complementary and alternative medicine (CAM) use among patients with rheumatic diseases is extensive, discussions regarding these treatments occur rarely in the rheumatology setting, directly affecting the physician-patient relationship (PPR). Objectives: The aim of this study was to evaluate the association between patient-physician relationship and complementary and alternative medicine use. As secondary objectives, to describe the patient's perspective towards CAM use and estimate the prevalence of CAM treatments used in patients with rheumatoid arthritis. Methods and materials: A descriptive cross-sectional survey was conducted, in which CAM use and physician-patient relationship were assessed by self-reported validated questionnaires (I-CAM-Q and PDRQ-9, respectively). Results: The study included a total of 246 outpatients of a tertiary care hospital. There were no significant differences between CAM users vs. non-users, or informers vs. non-informers in terms of physician-patient relationship measured by PDQR. The most frequent used CAM treatments were: chiropractice, acupuncture, and herbal products. A large majority (78.5%) of the patients expressed agreement to the discussion of CAM use with the rheumatologist, but only 31.3% of total CAM users did so because of fear of retaliation (54.4%). Conclusion: Despite the extensive practice of CAM among patients with rheumatoid arthritis, most patients did not discuss these treatments with their physicians. Associations were found between MCA use and a lower patient's treatment satisfaction and between physician-patient communication about CAM practice and a higher patient's treatment satisfaction.

Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico.

BACKGROUND: Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS: A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS: A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS: Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

Risk, Activism, and Empowerment: Women's Breast Cancer in Venezuela.

The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.

Barriers and facilitating communication skills for breaking bad news: from the specialists’ practice perspective / Barreras y facilitadores en la comunicación de malas noticias: Perspectiva desde la práctica de médicos especialistas

Introduction: Breaking bad news is one of a physician’s most difficult duties. There are several studies related to the patient’s needs, but few reflect on the doctors’ experience. Materials and method: A descriptive, cross-sectional research was carried out to study issues related to the process of delivering bad news which might act as barriers and facilitating skills from the doctor’s point of view. These issues were identified through a self-administered survey. Results: Participant doctors use different strategies to communicate bad news to their patients. Examples of these strategies are: to be familiar with the patients’ medical history, to ensure that there is enough time, to know the patient’s caregivers and/or relatives, to determine the patient’s level of knowledge about his/her condition, to use non-technical words, to give information in small pieces, to assess the patient’s understanding, to devise a joint action plan, among others. Conclusion: The communication barriers that were identified focused on the emotional issues of the communication process, particularly those related to the recognition of own emotions, and the limited training about communication strategies available to doctors. Consequently, there is a need to implement training programs that provide doctors with tools to facilitate the bad news communication process.

Introducción: La comunicación de malas noticias es una de las tareas más difíciles que deben enfrentar los profesionales de la salud. Existen múltiples estudios acerca de las necesidades del paciente, pero pocos que tengan en cuenta la experiencia de los médicos. Materiales y método: Se realizó una investigación descriptiva, transversal para estudiar aspectos del proceso de comunicación de malas noticias que pueden actuar como barreras y facilitadores desde la percepción del médico; identificados por medio de una encuesta auto-aplicable. Resultados: Los médicos participantes utilizan distintas estrategias durante la comunicación de malas noticias a sus pacientes como: conocer los detalles de la historia clínica, asegurarse de tener tiempo suficiente, conocer a los acompañantes e identificar cuánto sabe el paciente acerca de su situación, utilizar vocabulario sencillo, dar la información por partes, comprobar que el paciente esté comprendiendo, formular en conjunto un plan que se ha de seguir, entre otros. Conclusiones: Las barreras comunicativas identificadas se centraron en los aspectos emocionales del proceso comunicativo, específicamente en lo relacionado con la identificación de emociones propias, y en la limitada formación que reciben los médicos en estrategias comunicativas, lo que genera la necesidad de implementar programas de capacitación que les brinden herramientas para facilitar el proceso de comunicación de malas noticias.