Strategies to Improve Medical Communication.

This JAMA Insights summarizes strategies for effective medical communication, with considerations for the message delivered, the messenger source, and the social context.

Effects of one-hour discussion on the choice of dialysis modality at the outpatient clinic: A retrospective cohort study using propensity score matching.

BACKGROUND: The aim of present study was to evaluate the effects of one-hour discussion on the choice of dialysis modality at the outpatient clinic. METHODS: Charts of consecutive patients who had started maintenance dialysis from May 2013 to April 2021 were retrospectively reviewed. Characteristics at the start of dialysis were compared between patients participated and not participated in the discussion. RESULTS: Of the 620 incident dialysis patients, 128 patients had participated in the discussion. After propensity score matching (1:1), 127 patients who participated in the discussion tended to have fewer urgent hospitalizations (13.4% vs. 21.3%, p = 0.068). In addition, more patients who initiated peritoneal dialysis (PD) (30.7% vs. 9.4%, p < 0.001). On multivariate analysis, participation in the discussion (OR 4.81, 95% CI 2.807-8.24; p < 0.001) was related to PD initiation. CONCLUSION: One-hour discussion on the choice of dialysis modality may increase PD initiations and decrease the number of urgent hospitalizations.

Enhanced Communication for Interhospital Transfers Increases Preparedness in an Academic Tertiary Care Center.

OBJECTIVES: This quality improvement project sought to enhance clinical information sharing for interhospital transfers to an inpatient hepatology service comprised of internal medicine resident frontline providers (housestaff) with the specific aims of making housestaff aware of 100% of incoming transfers and providing timely access to clinical summaries. INTERVENTIONS: In February 2020, an email notification system to senior medicine residents responsible for patient triage shared planned arrival time for patients pending transfer. In July 2020, a clinical data repository ("Transfer Log") updated daily by accepting providers (attending physicians and subspecialty fellows) became available to senior medicine residents responsible for triage. METHODS: Likert scale surveys were administered to housestaff before email intervention (pre) and after transfer log intervention (post). The time from patient arrival to team assignment (TTA) in the electronic medical record was used as a proxy for time to patient assessment and was measured pre- and postinterventions; >2 hours to TTA was considered an extreme delay. RESULTS: Housestaff reported frequency of access to clinical information as follows: preinterventions 4/31 (13%) sometimes/very often and 27/31 (87%) never/rarely; postinterventions 11/26 (42%) sometimes/very often and 15/26 (58%) never/rarely (p = 0.02). Preinterventions 12/39 (31%) felt "not at all prepared" versus 27/39 (69%) "somewhat" or "adequately"; postinterventions 2/24 (8%) felt "not at all prepared" versus 22/24 (92%) somewhat/adequately prepared (p = 0.06). There was a significant difference in mean TTA between pre- and posttransfer log groups (62 vs. 40 minutes, p = 0.01) and a significant reduction in patients with extreme delays in TTA post-email (18/180 pre-email vs. 7/174 post-email, p = 0.04). CONCLUSION: Early notification and increased access to clinical information were associated with better sense of preparedness for admitting housestaff, reduction in TTA, and reduced frequency of extreme delays in team assignment.

Creating opportunities for patient participation in managing medications across transitions of care through formal and informal modes of communication.

BACKGROUND: Communicating about medications across transitions of care is important in older patients who frequently move between health care settings. While there is increasing interest in understanding patient communication across transitions of care, little is known about older patients' involvement in formal and informal modes of communication regarding managing medications. OBJECTIVE: The aim of this paper was to explore how older patients participated in managing their medications across transitions of care through formal and informal modes of communication. METHODS: The study was conducted across two metropolitan hospitals: an acute hospital and a geriatric rehabilitation hospital in metropolitan Melbourne, Australia. A focused ethnographic design was used involving semi-structured interviews (n = 50), observations (203 h) and individual interviews or focus groups (n = 25). Following thematic analysis, data were analysed using Fairclough's Critical Discourse Analysis. RESULTS: Data analysis revealed two major discursive practices, which comprised of an interplay between formal and informal communication and environmental influences on formal and informal communication. Self-created patient notes were used by older patients to initiate informal discussion with health professionals about medication decisions, which challenged traditional unequal power relations between health professionals and patients. Formal prompts on electronic medication administration records facilitated the continuous information discourse about patients' medications across transitions of care and encouraged health professionals to seek out older patients' preferences through informal bedside interactions. Environmental influences on communication comprised health professionals' physical movements across private and public spaces in the ward, their distance from older patients at the bedside and utilization of the computer systems during patient encounters. CONCLUSION: Older patients' self-created medication notes enabled them to take on a more active role in formal and informal medication communication across transitions of care. Older patients and family members did not have continuous access to information about medication changes during their hospital stay and systems often failed to address older patients' key concerns about their medications, which hindered their active involvement in formal and informal communication. PATIENT OR PUBLIC CONTRIBUTION: Older adults, family members and health professionals volunteered to be interviewed and observed.

Drawing lessons from the COVID-19 pandemic: science and epistemic humility should go together.

During the COVID-19 pandemic, scientific experts advised governments for measures to be promptly taken; they also helped people to understand the situation. They carried out this role in the face of a worldwide emergency, when scientific understanding was still underway. Public scientific disputes also arose, creating confusion among people. This article highlights the importance of experts' epistemic stance under these circumstances. It suggests they should embrace the intellectual virtue of epistemic humility, regulating their epistemic behavior and communication accordingly. In so doing, they would also favour the functioning of the broad network of knowledge-based experts, which is required to properly address all the aspects of the global pandemic.

COVID-19 vaccination and the power of rumors: Why we must "Tune in".

Rumors have significantly affected immunization campaigns in the past. The ongoing COVID-19 vaccination program in India needs to frame public communication messages both to promote vaccine demand and update as well as counter COVID-related rumors. COVID-related rumors have had wide-ranging effects in the country, from stigmatization of health workers to a crash of prices in the poultry sector. Appropriate communication strategies are critical for tracking, negotiating, and shaping perceptions around the vaccines and the program. Issues that will shape perceptions around the vaccines include product development, prioritization strategies, program rollout activities, and adverse effects following immunization and adverse effects of special interest.

Hesitancy Toward a COVID-19 Vaccine.

The scientific community has come together in a mass mobilization to combat the public health risks of COVID-19, including efforts to develop a vaccine. However, the success of any vaccine depends on the share of the population that gets vaccinated. We designed a survey experiment in which a nationally representative sample of 3,133 adults in the USA stated their intentions to vaccinate themselves and their children for COVID-19. The factors that we varied across treatments were: the stated severity and infectiousness of COVID-19 and the stated source of the risk information (White House or the Centers for Disease Control). We find that 20% of people in the USA intend to decline the vaccine. We find no statistically significant effect on vaccine intentions from the severity of COVID-19. In contrast, we find that the degree of infectiousness of the coronavirus influences vaccine intentions and that inconsistent risk messages from public health experts and elected officials may reduce vaccine uptake. However, the most important determinants of COVID-19 vaccine hesitancy seem to be distrust of the vaccine safety (including uncertainty due to vaccine novelty), as well as general vaccine avoidance, as implied by not having had a flu shot in the last two years.

Shifting the National Consciousness about Pain Treatment: The Critical Need for a National Public Education Campaign.

The failure of past practices and policies related to opioid prescribing for chronic pain has led federal agencies and professional organizations to recommend multimodal approaches that prioritize evidence-based nonpharmacological pain treatments (NPTs). These multimodal approaches, which include both traditional and complementary/integrative approaches, hold great promise for reducing the burden of chronic pain and reducing opioid use. Unfortunately, NPT approaches are underutilized due to a daunting array of interrelated barriers including the public's attitudes and beliefs about chronic pain and its treatment. Given the dual crises of chronic pain and opioid use, there is a critical need for a national public health campaign on chronic pain and its treatment to help educate the American public about NPT pain management options, while countering the misleading messages promulgated by the pharmaceutical industry, including but not limited to messages promoting the broad use of prescription opioids and minimizing its risks. Despite these dual crises of chronic pain and opioid use in the U.S., there has never been a concerted effort to broadly educate the American public about these issues and NPT pain management options.

Anti-intellectualism and the mass public's response to the COVID-19 pandemic.

Anti-intellectualism (the generalized distrust of experts and intellectuals) is an important concept in explaining the public's engagement with advice from scientists and experts. We ask whether it has shaped the mass public's response to coronavirus disease 2019 (COVID-19). We provide evidence of a consistent connection between anti-intellectualism and COVID-19 risk perceptions, social distancing, mask usage, misperceptions and information acquisition using a representative survey of 27,615 Canadians conducted from March to July 2020. We exploit a panel component of our design (N = 4,910) to strongly link anti-intellectualism and within-respondent change in mask usage. Finally, we provide experimental evidence of anti-intellectualism's importance in information search behaviour with two conjoint studies (N ~ 2,500) that show that preferences for COVID-19 news and COVID-19 information from experts dissipate among respondents with higher levels of anti-intellectual sentiment. Anti-intellectualism poses a fundamental challenge in maintaining and increasing public compliance with expert-guided COVID-19 health directives.

Misinformation and public opinion of science and health: Approaches, findings, and future directions.

A summary of the public opinion research on misinformation in the realm of science/health reveals inconsistencies in how the term has been defined and operationalized. A diverse set of methodologies have been employed to study the phenomenon, with virtually all such work identifying misinformation as a cause for concern. While studies completely eliminating misinformation impacts on public opinion are rare, choices around the packaging and delivery of correcting information have shown promise for lessening misinformation effects. Despite a growing number of studies on the topic, there remain many gaps in the literature and opportunities for future studies.

The narrative truth about scientific misinformation.

Science and storytelling mean different things when they speak of truth. This difference leads some to blame storytelling for presenting a distorted view of science and contributing to misinformation. Yet others celebrate storytelling as a way to engage audiences and share accurate scientific information. This review disentangles the complexities of how storytelling intersects with scientific misinformation. Storytelling is the act of sharing a narrative, and science and narrative represent two distinct ways of constructing reality. Where science searches for broad patterns that capture general truths about the world, narratives search for connections through human experience that assign meaning and value to reality. I explore how these contrasting conceptions of truth manifest across different contexts to either promote or counter scientific misinformation. I also identify gaps in the literature and identify promising future areas of research. Even with their differences, the underlying purpose of both science and narrative seeks to make sense of the world and find our place within it. While narrative can indeed lead to scientific misinformation, narrative can also help science counter misinformation by providing meaning to reality that incorporates accurate science knowledge into human experience.

Emotion and humor as misinformation antidotes.

Many visible public debates over scientific issues are clouded in accusations of falsehood, which place increasing demands on citizens to distinguish fact from fiction. Yet, constraints on our ability to detect misinformation coupled with our inadvertent motivations to believe false science result in a high likelihood that we will form misperceptions. As science falsehoods are often presented with emotional appeals, we focus our perspective on the roles of emotion and humor in the formation of science attitudes, perceptions, and behaviors. Recent research sheds light on how funny science and emotions can help explain and potentially overcome our inability or lack of motivation to recognize and challenge misinformation. We identify some lessons learned from these related and growing areas of research and conclude with a brief discussion of the ethical considerations of using persuasive strategies, calling for more dialogue among members of the science communication community.

NewsMeSH: A new classifier designed to annotate health news with MeSH headings.

MOTIVATION: In the age of big data, the amount of scientific information available online dwarfs the ability of current tools to support researchers in locating and securing access to the necessary materials. Well-structured open data and the smart systems that make the appropriate use of it are invaluable and can help health researchers and professionals to find the appropriate information by, e.g., configuring the monitoring of information or refining a specific query on a disease. METHODS: We present an automated text classifier approach based on the MEDLINE/MeSH thesaurus, trained on the manual annotation of more than 26 million expert-annotated scientific abstracts. The classifier was developed tailor-fit to the public health and health research domain experts, in the light of their specific challenges and needs. We have applied the proposed methodology on three specific health domains: the Coronavirus, Mental Health and Diabetes, considering the pertinence of the first, and the known relations with the other two health topics. RESULTS: A classifier is trained on the MEDLINE dataset that can automatically annotate text, such as scientific articles, news articles or medical reports with relevant concepts from the MeSH thesaurus. CONCLUSIONS: The proposed text classifier shows promising results in the evaluation of health-related news. The application of the developed classifier enables the exploration of news and extraction of health-related insights, based on the MeSH thesaurus, through a similar workflow as in the usage of PubMed, with which most health researchers are familiar.

Experience, experts, statistics, or just science? Predictors and consequences of reliance on different evidence types during the COVID-19 infodemic.

As an unprecedented global disease outbreak, the COVID-19 pandemic is also accompanied by an infodemic. To better cope with the pandemic, laypeople need to process information in ways that help guide informed judgments and decisions. Such information processing likely involves the reliance on various evidence types. Extending the Risk Information Seeking and Processing model via a two-wave survey (N = 1284), we examined the predictors and consequences of US-dwelling Chinese's reliance on four evidence types (i.e. scientific, statistical, experiential, and expert) regarding COVID-19 information. Overall, Risk Information Seeking and Processing variables such as information insufficiency and perceived information gathering capacity predicted the use of all four evidence types. However, other Risk Information Seeking and Processing variables (e.g. informational subjective norms) did not emerge as important predictors. In addition, different evidence types had different associations with subsequent disease prevention behaviors and satisfaction with the US government's action to address the pandemic. Finally, discrete emotions varied in their influences on the use of evidence types, behaviors, and satisfaction. The findings provide potentially valuable contributions to science and health communication theory and practice.