How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

BACKGROUND: While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. OBJECTIVE: This study investigated how social connectedness is associated with patient outcomes in a HaH program. DESIGN: The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. PARTICIPANTS: The quantitative phase included 100 patients (18 years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. ANALYSIS: Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. KEY RESULTS: Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. CONCLUSIONS: Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

How Attributes of Place Threaten Community Trust in the American South: Opportunities for Improving Pandemic-Related Communication.

Trust and mistrust influence the utilization of health services, the quality of overall healthcare, and the prevalence of health disparities. Trust has significant bearing on how communities, and the individuals within them, perceive health information and recommendations. The People and Places Framework is utilized to answer what attributes of place threaten community trust in public health and medical recommendations.Augusta-Richmond County is ranked among the least healthy counties in Georgia despite being home to the best healthcare-to-residence ratios and a vast array of healthcare services. Semi-structured interviews were conducted with 31 neighborhood residents. Data were analyzed using the Sort & Sift, Think & Shift method. Threats to community trust were identified within four local-level attributes of place: availability of products and services, social structures, physical structures, and cultural and media messages. We found a broader web of services, policies, and institutions, beyond interactions with health care, that influence the trust placed in health officials and institutions. Participants spoke to both a potential lack of trust (e.g. needs not being met, as through lack of access to services) and mistrust (e.g. negative motives, such as profit seeking or experimentation). Across the four attributes of place, residents expressed opportunities to build trust. Our findings highlight the importance of examining trust at the community level, providing insight into an array of factors that impact trust at a local level, and extend the work on trust and its related constructs (e.g. mistrust). Implications for improving pandemic-related communication through community relationship building are presented.

The dynamics of trust and communication in COVID-19 vaccine decision making: A qualitative inquiry.

In response to the COVID-19 pandemic, scientists coordinated a complex immunization effort that developed and distributed vaccines by December 2020. This study aimed to explain COVID-19 vaccination decision-making process to inform vaccine communication with patients and the public. Building on quantitative research on COVID-19 vaccine hesitancy, we conducted a grounded theory study, collecting 30 qualitative interviews with employees at a U.S. university that provided vaccine eligibility in December 2020. Analysis followed the Sort and Sift, Think and Shift method. Participants who had chosen to receive the vaccine and those who had not both described five factors that impacted their decision-making: emotional response, understanding, personal values, culture, and social norms. Across these factors, we identified three cross-cutting themes: time, trust, and communication tactics. In a time of emerging science and changing answers, the constant introduction of new information created information overload for participants. COVID-19 vaccine development was a "grand experiment globally," which required trust, not only knowledge, to overcome hesitancy. The complex information environment surrounding COVID-19 vaccination requires multi-level intervention that cannot rely on knowledge translation alone. We need to help patients build trusting relationships with experts that can create scaffolding for future information processing.

Patient Decision-Making About Self-Disclosure of a Type 2 Diabetes Diagnosis: A Qualitative Study.

Background: Effective self-management of type 2 diabetes requires receiving support, which can result from disclosing the diagnosis to a support network, including coworkers, family, and friends. As a primarily invisible disease, diabetes allows people to choose whether to disclose. This study qualitatively explores the factors that influence a person's decision to disclose diabetes to others. Methods: Research coordinators recruited 22 interview participants, ranging in age from 32 to 64 years, whose medical records included a diagnosis code for type 2 diabetes. Participants received care from one of two U.S. medical centers. Semi-structured interviews lasted approximately 1 hour and were audio-recorded and professionally transcribed. Verification strategies such as memo-keeping and maintaining methodological coherence/congruence were used throughout analysis to promote rigor. Results: In patients' descriptions of their decision-making processes regarding whether to disclose their diagnosis, six themes emerged. Three motivations prompted open disclosure: 1) to seek information, 2) to seek social support, and 3) to end the succession of diabetes, and the other three motivations prompted guarded disclosure: 4) to prepare for an emergency, 5) to maintain an image of health, and 6) to protect employment. Conclusion: Based on our findings, we recommend three communicative actions for clinicians as they talk to patients about a diabetes diagnosis. First, clinicians should talk about the benefits of disclosure. Second, they should directly address stereotypes in an effort to de-stigmatize diabetes. Finally, clinicians can teach the skills of disclosure. As disclosure efficacy increases, a person's likelihood to disclose also increases. Individuals can use communication as a tool to gain the knowledge and support they need for diabetes self-management and to interrupt the continuing multigenerational development of diabetes within their family.

Patient-centered Communication Behaviors on Primetime Television.

Previous research suggests that television programming may influence viewers' health-related knowledge, perceptions, and behaviors but has yet to examine patient-provider interactions on the most popular primetime television programs. We aimed to characterize the frequency and nature of patient-centered communication (PCC) behaviors on these programs, as cultivation and social cognitive theories suggest that these depictions may influence viewers' expectations of real-life health-care experiences. We examined 203 patient-provider interactions across 84 episodes of 22 primetime television programs-both medical and non-medical-that aired during the spring of 2016 and spring of 2017. Each interaction was analyzed for the presence of 21 optimal PCC behaviors. This study found that the most frequently observed PCC behaviors focused on the provider making good eye contact and displaying good manners. However, PCC behaviors related to managing patient uncertainty and self-management were rare. Overall, providers in medical programs were significantly more likely to exhibit certain PCC behaviors, such as asking a patient questions, having good manners, and self-disclosing personal information, compared to providers in non-medical programs. Implications of these findings include the potential for such depictions to influence patient expectations of real-life experiences and health outcomes. Future research is needed to examine these potential influences.

Condom Communication: Reports of Sexually Active Young Adults' Recent Messages With New Partners.

The incidence of sexually transmitted infections is high, with recent estimates suggesting 110 million cases (CDC, 2013b). A key method to reducing the risk for sexually transmitted infections is the use of a condom. Consequently, this inquiry aimed to describe the content of and reactions to condom communication. Results revealed the following condom conversation strategies: condom possession, condom exploration, condom demand, and health concerns. Results both support and challenge previous condom studies, therefore extending and informing this line of research. Data further describe reactions to condom conversations and reasons for not having a condom conversation. Findings provide tangible evidence to be used in the training of sexually active young adults.

Negotiating the equivocality of palliative care: a grounded theory of team communicative processes in inpatient medicine.

In the majority of U.S. hospitals, inpatient medicine teams make palliative care decisions in the absence of a formalized palliative system. Using a grounded theory approach, interviews with inpatient team members were systematically analyzed to uncover how participants conceptualize palliative care and how they regard the communicative structures that underlie its delivery. During analysis, Weick's model of organizing emerged as a framework that fit the data. The 39 participant inpatient team members discussed palliative care as primarily a communicative process. Themes describing the meaning of palliative care emerged around the concepts of receiver of care, timeline of care, and location of care. The emerging model included four stages in the communicative processes of inpatient palliative care: (a) interpret the need, (b) initiate the conversation, (c) integrate the processes, and (d) identify what works. In contrast to stable, focused palliative care teams or hospice care teams, which have prescribed patient populations and processes, the inpatient medicine team faces the equivocality of providing palliative care within a broader practice. This research offers a four-phase model to show how these inpatient teams communicate within this context. Implications for the provision of palliative care are discussed.

The Influence of Health Literacy and Patient Activation on Patient Information Seeking and Sharing.

This study provided an assessment of how patients looked for information to prepare for a clinical appointment and whether they shared those findings with their provider. A cross-sectional survey allowed insight into patient attitudes, motivations, and behavior in clinical real time. At two hospital-based clinics, 243 patients completed surveys before and after clinical appointments. Younger patients with higher communicative and critical health literacy prepared for clinical appointments with information searches. The predicted association of health literacy and patient activation with information sharing was not supported. This study shows that patients with higher patient activation perceived that their providers responded more positively to patient-obtained medical information. The role of critical health literacy may show that individuals choosing to seek information are considering not just their ability to conduct the search but also their ability to synthesize and critically analyze the results of the information search. An implication for providers is to become skilled in directly asking or passively surveying what outside information sources the patient has engaged with, no matter if the patient does or does not introduce the information.

A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process.

BACKGROUND: Given the increasing number of young adult cancer survivors and the impacts of cancer on various life domains, interventions addressing the psychosocial needs of young adult survivors are crucial. However, such intervention research is limited, and the existing literature has often: 1) overlooked young adult survivors' psychosocial needs; 2) targeted depression, anxiety, or fear of recurrence - rather than positive outcomes like well-being; and 3) failed to consider scalable approaches, like digital health. METHODS: This paper documents the development and refinement of an 8-week digital, coach-assisted intervention targeting hope among young adult cancer survivors (ages 18-39, within 3 years of treatment completion) and presents the protocol of the 2-arm RCT (comparing intervention vs. attention control). The intervention builds upon a 2017-2018 pilot trial (n = 56); intervention refinements were based on subsequent semi-structured interviews among young adult survivors (n = 23). RESULTS: The pending trial design involves an increased sample size (n = 150) to increase power and diversified recruitment efforts (i.e., clinic-based, social media, community-based organizations, etc.) to facilitate intervention reach, accessibility, and scalability. The intervention was enhanced by integrating highly relevant theoretical and therapeutic frameworks, specifically the concept of hope and Acceptance and Commitment Therapy, as well as updating intervention delivery technology. Intervention outcomes include feasibility and acceptability at end-of-treatment and preliminary efficacy on hope (primary outcome) and quality of life measures (secondary outcomes) at end-of-treatment and 16-week follow-up. CONCLUSIONS: This paper may facilitate discussion regarding approaches for addressing the significant psychosocial challenges faced by young adult survivors and catalyze dissemination of trial results. TRIAL REGISTRATION: NCT05905250.

Young Adult Cancer Survivors' Perspectives on Cancer's Impact on Different Life Areas Post-Treatment: A Qualitative Study.

Purpose: Young adult cancer survivors experience disruptions in various life domains (e.g., relationships, academic/career) during and after treatment. This study examined life disruptions and related supports to update interventions to improve psychological outcomes. Methods: In April-July 2023, young adult survivors (n = 23) were recruited (via clinics, support groups, nonprofit organizations, etc.) to complete semi-structured interviews assessing cancer's impact across life domains, how they coped with related disruptions, and facilitators to improved psychosocial well-being. We used a dual deductive-inductive approach to develop a codebook and then coded transcripts in Dedoose. Results: This sample was on average 33.7 years old (standard deviation [SD] = 4.4), 78.3% female, 73.9% non-Hispanic White, 47.8% married/cohabitating, 2.4 (SD = 1.0) years post-diagnosis, 1.4 years (SD = 0.9) post-treatment, and largely diagnosed with breast cancer (52.1%) or leukemia/lymphoma (34.7%). The most salient themes related to disruptions included mental health, feelings of isolation during survivorship, and disruptions to career and relationships with family or partners. Participants reported challenges navigating these feelings and disruptions, and difficulty understanding and conveying their needs. Many experienced limited support for navigating cancer-related trauma and life disruptions as a survivor. Participants also reported some positive impacts, like reevaluating their values and goals or feeling resilient, and emphasized the need to identify supports, accept that life had changed because of cancer, and have their needs and continued struggles validated by others during survivorship. Conclusions: Young adults experience ongoing disruptions across multiple life domains, underscoring the need for integrated, longer-term psychosocial supports to help them navigate these disruptions and reevaluate their goals.

Patient outcomes of a clinician curriculum on how to deliver a diabetes diagnosis.

AIMS: To investigate the effects of a curriculum that teaches medical decision making and interpersonal communication in the context of prediabetes (preDM) and type 2 diabetes (T2DM). METHODS: This evaluation was an active-controlled trial of 56 patients, including patients who received their diagnosis from intervention-trained clinicians or a control group. Patients attended a research appointment for informed consent and collection of baseline measures. Over the following six months, both groups were mailed surveys and informational handouts monthly. Upon conclusion, we recorded the most recent A1c from the patient's record. RESULTS: An analysis of covariance test revealed patients who received a T2DM diagnosis from an intervention-trained clinician reported higher reassurance from the diagnosing clinician and had a higher perception of threat. Although not statistically significant, patients with T2DM in the intervention group had a lower A1c at follow up and patients in the intervention group reported less poor eating and a higher degree of diet decision making. CONCLUSIONS: The curriculum itself does not influence glycemic control, but our results demonstrate the positive impact on patients of the curriculum to teach critical skills to clinicians delivering a diabetes diagnosis.

Residency Leader Motivations to Engage Residents and Residency Faculty in Scholarship: A Qualitative Study.

BACKGROUND AND OBJECTIVES: Research shows that limited time, lack of funding, difficulty identifying mentors, and lack of technical support limit resident and faculty ability to fully participate in scholarly activity. Most research to date focuses on medical student and resident attitudes toward research. This study aimed to understand the underlying attitudes of family medicine residency (FMR) leaders toward scholarship. METHODS: Two focus groups of family medicine residency leaders were conducted in March 2018. The sample (N=19) was recruited through the membership directory of the Family Physicians Inquiry Network. RESULTS: Leaders shared positive attitudes toward scholarship; however, motivation to engage residents and residency faculty in scholarship diverged. Motivations for promoting scholarly activity among participants were either extrinsic (through ACGME, program graduation, or promotion requirements) or intrinsic (through personal interest and natural drive). CONCLUSIONS: Emerging themes illustrate differences in how FMR program leaders perceive the role of scholarship in residency programs. As programs aim to increase research and scholarship, more attention must be paid to the motivating messages communicated by the program's leadership.

Turning Points as Opportunities to Partner with Patients Living with type 2 Diabetes or Prediabetes.

INTRODUCTION: Understanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health. METHODS: Research coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point. RESULTS: Patients reported 5 interrelated turning points occurring at various times after diagnosis: 1) gaining knowledge, either through patients own research and/or a health care class; 2) making lifestyle changes, including exercising and healthier eating; 3) encountering a life-changing event/transition, including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) receiving social support, either through holding patients accountable or encouraging them to enact healthy behavior; and 5) interacting with clinicians, such as medication changes or behavior changes critical to disease management. DISCUSSION: These turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care.

How patients make sense of a diabetes diagnosis: An application of Weick's model of organizing.

AIMS: To identify communication cycles patients use to make sense of a diabetes diagnosis and barriers patients encounter in their sensemaking process. METHODS: Researchers conducted interviews with 33 participants with type 2 diabetes mellitus or prediabetes at medical centers in Georgia and Nevada. A thematic analysis using the constant comparative method identified communication cycles. RESULTS: Patients reported engaging three communication cycles to make sense of the diagnosis: (1) interacting with healthcare clinicians; (2) seeking information online; and (3) taking a nutrition/diabetes management class. Patients reported system-level barriers that impact sensemaking: (1) lack of consistent or routine care; and (2) lack of access to resources. CONCLUSION: Results here reinforce the theoretical proposition that receiving a diagnosis is an equivocal process that requires patients to make sense of new information through communication cycles. Patients in this sample repeatedly described communication cycles to interpret this new information rather than relying on assembly rules. Clinicians can promote patient understanding of diabetes and self-management by taking time to explain the diagnosis, maintaining consistent care, providing guidance to online sources, and ensuring patients have access to diabetes education.

Diabetes ROADMAP: Teaching Guideline Use, Communication, and Documentation When Delivering the Diagnosis of Diabetes.

Introduction: Most interventions to date regarding breaking bad news focus on late-stage disease or disclosing a cancer diagnosis. Little attention has been given to delivery of chronic metabolic disease diagnoses such as prediabetes/type 2 diabetes. Methods: Informed by the American Diabetes Association standards of care and formative research conducted by our research team, we developed this curriculum through the six-step approach to curriculum development. The curriculum consists of a 2- or 3-hour intervention that teaches medical decision-making, interpersonal communication, and clinical documentation in the context of prediabetes and type 2 diabetes followed by role-play and clinical practice. Results: Across three cohorts, 53 clinicians completed the curriculum. Across the three iterations, learners rated the curricular intervention as worthwhile and delivered at an appropriate level. In a community hospital setting, learners scored significantly higher on a knowledge check than did a control group of six clinicians (p < .001). Learners in the community hospital also indicated high response efficacy and self-efficacy. At the academic medical center, simulated patients indicated high measures on the Diabetes Health Threat Communication Questionnaire. Discussion: The moment of diagnosis presents a key opportunity to affect patients' perceptions of the disease. This curriculum guides clinicians in making the most of diagnosis delivery. Pairing of qualitative, patient-centered research alongside the iterative curriculum design process allows the curriculum to be adaptable and scalable to multiple settings and learner types.

Mobile application as a prenatal education and engagement tool: A randomized controlled pilot.

OBJECTIVES: Research has shown that mobile applications provide a powerful alternative to traditional paper diaries; however, little data exists in comparing apps to the traditional mode of paper as a patient education and engagement tool in the clinical setting. This study was designed to compare the effectiveness of a mobile app versus a spiral-notebook guide throughout prenatal care. METHODS: This randomized (n=173) controlled pilot was conducted at an East Coast community hospital. Chi-square and repeated-measures analysis of variance was used to test intervention effects in the sample of 127 pregnant mothers who completed their prenatal care in the healthcare system. RESULTS: Patients who were distributed the mobile application used the tool to record information about pregnancy more frequently (p=.04) and developed greater patient activation (p=.02) than patients who were distributed notebooks. No difference was detected on interpersonal clinical communication. CONCLUSION: A mobile application successfully activated a patient population in which self-management is a critical factor. PRACTICE IMPLICATIONS: This study shows that mobile apps can prompt greater use and result in more activated patients. Findings may be translated to other patient populations who receive recurring care for chronic disease.

Socializing Identity Through Practice: A Mixed Methods Approach to Family Medicine Resident Perspectives on Uncertainty.

OBJECTIVE: Uncertainty is a central theme in the practice of medicine and particularly primary care. This study explored how family medicine resident physicians react to uncertainty in their practice. METHODS: This study incorporated a two-phase mixed methods approach, including semi-structured personal interviews (n=21) and longitudinal self-report surveys (n=21) with family medicine residents. RESULTS: Qualitative analysis showed that though residents described uncertainty as an implicit part of their identity, they still developed tactics to minimize or manage uncertainty in their practice. Residents described increasing comfort with uncertainty the longer they practiced and anticipated that growth continuing throughout their careers. Quantitative surveys showed that reactions to uncertainty were more positive over time; however, the difference was not statistically significant. DISCUSSION: Qualitative and quantitative results show that as family medicine residents practice medicine their perception of uncertainty changes. To reduce uncertainty, residents use relational information-seeking strategies. From a broader view of practice, residents describe uncertainty neutrally, asserting that uncertainty is simply part of the practice of family medicine.

Differences in physician communication when patients ask versus tell about religion/spirituality: a pilot study.

BACKGROUND AND OBJECTIVES: Research suggests that physicians should pursue spiritual issues and that patients desire to discuss religion/spirituality (R/S) in medical encounters. This study explored the differences in physician communication in response to patient inquiry or disclosure of R/S and hypothesizes that physician communication will differ when patients disclose R/S as contrasted to inquire about R/S. METHODS: Family physicians and family medicine resident physicians were recruited from a family medicine department at a community hospital (n=27). An objective structured clinical examination, with a standardized patient encounter, was used to expose the participants to a conversation regarding R/S. Participants were assigned, by alternating clustered assignment, to two conditions: patient disclosure of R/S or patient inquiry about physician R/S. The primary outcome measure was physician response, specifically physician-control, partnership-building, and supportive-talk messages. RESULTS: When the patient asks questions about R/S, physicians communicate more control messages and less supportive talk messages than when the patient discloses information about R/S. CONCLUSIONS: Training physicians to anticipate and respond to patient disclosure and inquiry will increase the likelihood they can enact patient-centered strategies. These methods should focus on teaching residents how to be sensitive to the R/S context of their patients and to recognize their own intuitive reactions to patient communication in that context.

Microblog use and student engagement in the large-classroom setting.

BACKGROUND AND OBJECTIVES: Encouraging student engagement in the large-classroom setting can be difficult. Challenges include the depersonalized nature of the environment and the fact that students frequently find asking questions and participating in class discussion intimidating. Social media has the potential to address these barriers, but this has not yet been formally evaluated. Our study analyzed the impact of microblog use on students' question-asking behaviors (an indicator of student engagement) in a large-classroom setting. METHODS: Formative evaluation of a large-classroom medical humanities course identified microblog use as a potential tool to facilitate greater student engagement. A microblog was thereafter incorporated into the course. Student engagement was operationalized as question-asking behaviors before and after microblog incorporation. RESULTS: Paired t tests showed that the total number of questions asked was significantly greater in the microblog-available classes, t (2)=12.12. In addition, significantly more individual students asked questions in the microblog-available classes, t (2)=17.39. CONCLUSIONS: Our study, demonstrating an increase in question-asking behavior after incorporation of a microblog, has important implications for educators who seek to enhance student engagement and learning in the large-classroom setting. In addition, innovative use of emerging technologies (such as microblogs) as educational tools requires continuous assessment and iterative change to maximize benefit. More research is needed to evaluate what specific barriers to engagement are overcome by microblog use and whether microblog use can similarly benefit other courses.