Care teams misunderstand what most upsets patients about their care.

BACKGROUND: Negative healthcare delivery experiences can cause lasting patient distress and medical service misuse and disuse. Yet no multi-site study has examined whether care-team members understand what most upsets patients about their care. METHODS: We interviewed 373 patients and 360 care-team members in the medical oncology and ambulatory surgery clinics of 11 major healthcare organizations across six U.S. census regions. Patients deeply upset by a service-related experience (n = 99, 27%) answered questions about that experience, while care-team members (n = 360) answered questions about their beliefs regarding what most upsets patients. We performed content analysis to identify memorably upsetting care (MUC) themes; a generalized estimating equation to explore whether MUC theme mention frequencies varied by participant role (care-team member vs. patient), specialty (oncology vs. surgery), facility (academic vs. community), and gender; and logistic regressions to investigate the effects of participant characteristics on individual themes. RESULTS: MUC themes included three systems issues (inefficiencies, access barriers, and facilities problems) and four care-team issues (miscommunication, neglect, coldness, and incompetence). MUC theme frequencies differed by role (all Ps < 0.001), with more patients mentioning care-team coldness (OR = 0.37; 95% CI, 0.23-0.60) and incompetence (OR = 0.17; 95% CI, 0.09-0.31); but more care-team members mentioning system inefficiencies (OR = 7.01; 95% CI, 4.31-11.40) and access barriers (OR, 5.48; 95% CI, 2.81-10.69). CONCLUSIONS: When considering which service experiences most upset patients, care-team members underestimate the impact of their own behaviors and overestimate the impact of systems issues. IMPLICATIONS: Healthcare systems should reconsider how they collect, interpret, disseminate, and respond to patient service reports. LEVEL OF EVIDENCE: Level III.

Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health.

BACKGROUND: Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans. PURPOSE: We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets. METHODS: Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument. RESULTS: In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans. CONCLUSIONS: Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health.

Let your preference be your guide? Preferences and choices are more tightly linked for North Americans than for Indians.

Using experimental paradigms from economics and social psychology, the authors examined the cross-cultural applicability of 3 widely held assumptions about preference and choice: People (a) recruit or construct preferences to make choices; (b) choose according to their preferences; and (c) are motivated to express their preferences in their choices. In 6 studies, they compared how middle-class North American and Indian participants choose among consumer products. Participants in both contexts construct nonrandom preferences at similar speeds. Those in Indian contexts, however, are slower to make choices, less likely to choose according to their personal preferences, and less motivated to express their preferences in their choices. The authors infer that the strong link between preferences and choices observed among North Americans is not a universal feature of human nature. Instead, this link reflects the disjoint model of agency, which prescribes that people should choose freely on the basis of their preferences. In contrast, Indian contexts reflect and promote a conjoint model of agency, according to which agency is responsive to the desires and expectations of important others and may require restraining one's preferences.