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The Cochrane Database of Systematic... Feb 2021Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies.
OBJECTIVES
To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations.
SEARCH METHODS
We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE.
MAIN RESULTS
We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
Topics: Communication; Education, Medical; Empathy; Humans; Information Management; Interpersonal Relations; Medical History Taking; Non-Randomized Controlled Trials as Topic; Patient Satisfaction; Patient Simulation; Randomized Controlled Trials as Topic; Role Playing; Students, Medical
PubMed: 33559127
DOI: 10.1002/14651858.CD012418.pub2 -
Frontiers in Psychiatry 2022
PubMed: 35463488
DOI: 10.3389/fpsyt.2022.890889 -
Cureus Feb 2021Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated... (Review)
Review
Depression is one of the highest prevalent mental illnesses and is one of the common illnesses that can have its onset during childhood or adolescence. It is estimated that up to 20% of children experience mental illness worldwide. Preventing the onset of depression in children and adolescents should be a vital public health goal that will improve public health and decrease health care costs. We reviewed literature that described school-based interventions to prevent the onset of depression, reduce the severity of depressive symptoms, and enhance global functioning in adolescents. Our research also provides strategies for school-based intervention programs that are mainly categorized into three main subtypes. We also discussed each subtype and its advantages and limitations. The goal is to bring the readers an understanding of the importance of preventing depression on a community level, beginning at schools.
PubMed: 33758723
DOI: 10.7759/cureus.13443 -
The Arts in Psychotherapy Sep 2021Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian...
Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian citizens are required to respect, according to which it is strictly forbidden to leave the house if not for reasons of necessity, health, or work. This qualitative study investigated which aspects clients find helpful or hindering in shifting to group tele-psychodrama due to the COVID-19 pandemic, after participation in an in-person psychodrama group. Participants were 15 adults who were members of a pre-existing in-person psychodrama group that shifted to a tele-psychodrama group format facilitated by two psychodrama therapists. The Client Change Interview was used at the end of the tele-psychodrama as a post-treatment assessment. All the interviews were transcribed and then underwent a thematic analysis. The analysis yielded six shared themes: the role of tele-psychodrama sessions during COVID-19 pandemic; perceived effectiveness of tele-psychodrama; main advantages of tele-psychodrama; limitations encountered during the online intervention; the termination of tele-psychodrama; and the relationship with the therapist. The findings provide preliminary evidence for the clinical practice of tele-psychodrama and lays the groundwork for further studies that can contribute to the use of electronic platforms in psychodrama interventions.
PubMed: 34305221
DOI: 10.1016/j.aip.2021.101836 -
Frontiers in Psychology 2023In highly diverse psychotherapy practices, psychotherapists with their individual schemas and personalities treat patients who are just as individual, each with his/her...
In highly diverse psychotherapy practices, psychotherapists with their individual schemas and personalities treat patients who are just as individual, each with his/her own partially dysfunctional schema, personality, worldview, and life situation. Intuition gained through experience is often applied, and a wide range of perspectives, techniques, and treatment options appropriate to the specific situation and psychotherapist-patient relationship are required for successful treatment of eco-anxiety manifestations. Several examples will be used to present the approaches of different psychotherapeutic approaches to eco-anxiety such as analytical psychology, logotherapy and existential analysis, psychodrama, and Morita-therapy. The treatment-possibilities-expanding psychotherapy science is presented, which helps psychotherapists to look beyond their original learned approach and learn about new perspectives and treatment methods in a methodologically sound way, which they already do intuitively.
PubMed: 37143597
DOI: 10.3389/fpsyg.2023.1162616 -
European Review For Medical and... Oct 2023Supporting the psychological well-being of pregnant mothers is critical. The purpose of this study was to map the intervention to improve the psychological well-being of... (Review)
Review
OBJECTIVE
Supporting the psychological well-being of pregnant mothers is critical. The purpose of this study was to map the intervention to improve the psychological well-being of pregnant mothers.
MATERIALS AND METHODS
This research method uses a scoping review with five stages, i.e., problem identification, identification of relevant studies, study selection, data mapping, compiling, summarizing, and reporting results. A systematic search strategy was applied to check for relevant papers dated 2011 until 2021, based on Pubmed, Scopus, Web of Science, Cochrane, Science Direct, Google Scholar, and Grey Literature. PRISMA flowchart was used to select and summarize the studies, and the PCC framework was used for the search strategy. Criteria for inclusion were studies with pure experimental or quasi-experimental designs, focusing on improving women's psychological well-being or mental health, utilizing psychological well-being measures, and written in English with full-text availability.
RESULTS
From 32 articles, 56.24% used randomized control trials (RCT), 28.12% used quasi-experimental, 9.38% used experimental, and 3.13% used a clustered randomized trial and case study methods. 50% of the articles used developed countries, while the remaining 50% used developing countries. 12.50% of the articles used online or web-based for intervention, physical activities, and antenatal education, 9.38% used Cognitive Behavior Therapy (CBT), 21.85% used psychoeducation, 6.25% used mindfulness, Interpersonal Therapy (IPT), training-based, and 3.13% used psychodrama, relaxation, counseling, and happiness therapy. Intervention facilitators were engaged in 25% of the articles, no information regarding facilitators in another 25% of the articles, 21.85% engaged midwives, 12.50% engaged psychologists and physiotherapists, 6.25% engaged health workers, the researchers did 15.63%, and community workers and lectures did the remaining 3.13%.
CONCLUSIONS
Further empirical research to improve the psychological well-being of pregnant mothers needs to be done with a psychoeducational approach considering such communications, the role of the facilitator in intervention, and the research media used.
Topics: Female; Pregnancy; Humans; Psychological Well-Being; Mothers; Cognitive Behavioral Therapy; Mental Health; Evidence-Based Medicine; Randomized Controlled Trials as Topic
PubMed: 37916351
DOI: 10.26355/eurrev_202310_34161 -
International Journal of Environmental... Jun 2022Spontaneity and its connections to mental health and wellbeing are a central issue in both theory and practice of psychodrama, and the specialized literature sometimes...
Spontaneity and its connections to mental health and wellbeing are a central issue in both theory and practice of psychodrama, and the specialized literature sometimes even associates the presence of pathology to a lack of spontaneity. This paper describes spontaneity in Moreno's theory, its assessment, its association with other measures and concepts, and scientific advances in the field. Specifically, we present results obtained with the English and Portuguese-language versions concerning its assessment. The main purpose of this work was to study the spontaneity measure (SAI-R) in a 3 first-order factors version for a Portuguese sample of 439 subjects, divided into two independent samples. The mean age of participants was 25.6 years (SD = 10.2), and ages ranged between 18 and 64 years. Data was collected through an online platform of a Portuguese market research company. The results revealed that the 3-factor model has acceptable validity for items 1 ("Creative") and 7 ("Euphoric"), confirming the composite reliability, the convergent validity, but not the discriminant validity. Through multi-group analysis, the model proved to be stable. Notwithstanding the need for complementary studies, including clinical samples, the SAI-R is a short and valid instrument in clinical and non-clinical contexts when evaluating spontaneity.
Topics: Adolescent; Adult; Humans; Language; Middle Aged; Psychodrama; Psychometrics; Reproducibility of Results; Surveys and Questionnaires; Young Adult
PubMed: 35805581
DOI: 10.3390/ijerph19137924 -
Noro Psikiyatri Arsivi Sep 2020Relapse is one of the most common problems in the addiction treatment. The aim of this study was to increase the remission rates, reduce relapse rates and investigate...
INTRODUCTION
Relapse is one of the most common problems in the addiction treatment. The aim of this study was to increase the remission rates, reduce relapse rates and investigate the effect of psychodrama on depression, anxiety and locus of control after treatment in a group of inpatients diagnosed with opioid use disorder (OUD).
METHOD
The study was started with 13 inpatients diagnosed with OUD and completed with six members. In addition to psychoeducation, the psychodrama study of 13 sessions lasted. The control group consisted of six individuals with the same diagnosis and characteristics, who had only undergone psychoeducation. Hamilton Depression-Anxiety and Rotter Locus of Control Scales were applied to the participants before and after the group.
RESULTS
Anxiety rates decreased in both groups according to pre-test and post-test results. In the outpatient part of the study, five patients in the patient group remained in treatment and clean at the end of the fifth month and four at the end of the sixth month. In the control group only two people could remain in treatment and clean at the end of the sixth month. The most effective psychodrama techniques were empty chair, doubling and mirroring.
DISCUSSION
Both psychodrama techniques and SAMBA program are applications that reduce anxiety levels of patients. It was concluded that psychodrama applications aimed at increasing the internal control belief may be beneficial in terms of increasing the motivation of the patients and coping with relapse.
PubMed: 32952421
DOI: 10.29399/npa.25001 -
Frontiers in Psychiatry 2021Almost a century after Jacob Levy Moreno pioneered the group practice of psychodrama, research in this area has flourished to include different sub-fields of study and...
Almost a century after Jacob Levy Moreno pioneered the group practice of psychodrama, research in this area has flourished to include different sub-fields of study and psychodramatic intervention for various psychological conditions. By making use of scientometric analysis, particularly document citation analysis and keyword analysis, this study maps out dominant research domains in psychodrama since its inception. From these findings, projections of future research trends and an evaluation of psychodrama research are discussed. Generally, there has been an increased adoption of technology to facilitate psychodrama practice, along with an increasing integration of psychodramatic principles with other psychotherapies. To improve research in this area, this paper recommends greater transparency in the reporting of materials, processes and data used in publications. Finally, we encourage embracing new technological methods such as neuroimaging to provide greater insight into mechanisms of change in psychodrama. The field of psychodrama remains full of potential and innovations to be developed.
PubMed: 34867562
DOI: 10.3389/fpsyt.2021.780542 -
Healthcare (Basel, Switzerland) Mar 2023As a creative form of psychotherapy, drama appears to assist individuals in the COVID-19 pandemic and post-pandemic period in altering crisis conditions and challenging... (Review)
Review
Effectiveness of Drama-Based Intervention in Improving Mental Health and Well-Being: A Systematic Review and Meta-Analysis during the COVID-19 Pandemic and Post-Pandemic Period.
As a creative form of psychotherapy, drama appears to assist individuals in the COVID-19 pandemic and post-pandemic period in altering crisis conditions and challenging negative perspectives. Drama-based intervention is presented as an option for addressing mental health issues in clinical and general populations by utilising various multidisciplinary sources, such as psychodrama and role playing. In this study, a systematic review and meta-analysis were employed to assess the impact of drama on mental health and well-being during the COVID-19 pandemic and post-pandemic. Four electronic databases (PubMed, Cochrane, Web of Science, and ScienceDirect) were extensively searched from December 2019 to October 2022. Quality assessment and Risk of Bias tool of the Cochrane Collaboration were performed. Using a random effect model, standardised mean difference (SMD) values and 95% confidence intervals (CI) were calculated. In the final analysis, 25 studies involving 797 participants were included. The study revealed that drama-based interventions have the potential to improve mental health (e.g., trauma-related disorders) and well-being (e.g., psychological well-being), which could position drama as an adjunctive method of mental health care. This original review offered the newer, more comprehensive recommendations for drama-based intervention based on evidence.
PubMed: 36981496
DOI: 10.3390/healthcare11060839