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Psychiatrike = Psychiatriki 2019The therapeutic relationship is the common place of all medical specialties in therapeutic practice. It is a professional relationship and consists of two components:... (Review)
Review
The therapeutic relationship is the common place of all medical specialties in therapeutic practice. It is a professional relationship and consists of two components: the work component and the interpersonal component. The focus of the studies aims to show the contribution of the dynamics of the therapist - patient interpersonal relationship as a therapeutic factor in achieving the therapeutic outcome. The issue of doctor-patient relationship has been studied since antiquity, in particular by Socrates and beyond. Hippocrates promotes and systematizes medical philosophy, bioethics and medical ethics, as seen in the well-known "Hippocratic Oath". In the new era, S. Freud continued the work of inductive dialectics of Socrates, while formulating the concept of transference and countertransference. The development of psychotherapies has provided enough evidence for the parameters that interact into a therapeutic relationship, as their techniques were merely dialectical. M. Balint supports the value of counter-transference and transference to the therapeutic relationship. G. Bibring & R. Kahana suggest that psychoanalytic techniques and personality types contribute to the understanding of the physical patient. C. Rogers suggested that the attitudes and the empathic understanding of the therapist, not the techniques, contribute primarily to therapeutic success. G. Engel (1970) promotes the patient's biopsychosocial approach. Since 1980, systematic studies have begun to support the value of the therapeutic relationship, believing that it is itself an autonomous therapeutic factor, confirming the views of M. Balint and C. Rogers. They conclude that the therapeutic effect is a function of the quality of the therapeutic relationship, regardless of any therapeutic technique, and that the therapeutic alliance has a significant effect on the clinical outcome for psychotherapies as well as for pharmacotherapy. Empathy, non-possessive warmth, positive respect and authenticity have a significant effect on the treatment results. The common factor model supports the dynamics of the interpersonal relationship contributing 85% to the therapeutic effect whereas the therapeutic techniques contribute 15%. It therefore seems that the dynamics of the interpersonal relationship, the therapist-patient, is an important therapeutic factor. Studies continue and more questions arise as to whether education is available, the dynamics of interpersonal relationships in the context of therapeutic relationships at undergraduate and postgraduate levels. Also, the development of dialectical techniques, as a response to the empathic therapeutic relationship, which contributes at the clinical level to the patient's approach and information within the general health area and not only to mental health.
Topics: Countertransference; Empathy; Ethics, Medical; Humans; Patients; Professional-Patient Relations; Psychotherapy
PubMed: 31425144
DOI: 10.22365/jpsych.2019.302.165 -
Journal of Advanced Nursing Oct 2014This paper is a report of an analysis of the concept of patient autonomy
AIM
This paper is a report of an analysis of the concept of patient autonomy
BACKGROUND
Many problems regarding patient autonomy in healthcare contexts derive from the patient's dependent condition as well as the traditional authoritarian position of healthcare professionals. Existing knowledge and experience reveal a lack of consensus among nurses regarding the meaning of this ethical concept.
DESIGN
Concept analysis.
DATA SOURCES
Medline, CINAHL, The Cochrane Library and PsycINFO were searched (2005-June 2013) using the search blocks 'autonomy', 'patient' and 'nursing/caring'. A total of 41 articles were retrieved.
REVIEW METHODS
The Evolutionary Method of Concept Analysis by Rodgers was used to identify and construct the meaning of the concept of patient autonomy in a caring context.
RESULTS
Five attributes were identified, thus creating the following descriptive definition: 'Patient autonomy is a gradual, time-changing process of (re-)constructing autonomy through the interplay of to be seen as a person, the capacity to act and the obligation to take responsibility for one's actions'. Patient vulnerability was shown to be the antecedent of patient autonomy and arises due to an impairment of a person's physical and/or mental state. The consequences of patient autonomy were discussed in relation to preserving control and freedom.
CONCLUSION
Patient autonomy in a caring context does not need to be the same before, during and after a care episode. A tentative model has been constructed, thus extending the understanding of this ethical concept in a caring context.
Topics: Databases, Bibliographic; Humans; Patients; Personal Autonomy
PubMed: 25209751
DOI: 10.1111/jan.12412 -
"Patient's lived experience" : New insights from the "scene" of deep-brain stimulation medical care.Medicine, Health Care, and Philosophy Sep 2019This editorial presents a special issue gathering four contributions about the patient's lived experience in the context of deep-brain stimulation. It aims at clarifying...
This editorial presents a special issue gathering four contributions about the patient's lived experience in the context of deep-brain stimulation. It aims at clarifying the meaning of such an experience and its scope for medical practice, the health system and its legal frame.
Topics: Deep Brain Stimulation; Humans; Patients
PubMed: 31175487
DOI: 10.1007/s11019-019-09896-5 -
International Journal of Technology... Apr 2014Osteoradionecrosis (ORN) is a known complication to radiation therapy for head and neck cancer with a prevalence of 5-7% among radiated patients. Treatment might include... (Review)
Review
Osteoradionecrosis (ORN) is a known complication to radiation therapy for head and neck cancer with a prevalence of 5-7% among radiated patients. Treatment might include dental surgery and reconstruction of the jawbone as well as hyperbaric oxygen treatment (HBOT). HBOT takes place in a closed compartment where patients are breathing 100% oxygen under pressure for 90 minutes once a day every weekday for 6 weeks. In Denmark, HBOT is available at two facilities with very different organizational set-ups.
Topics: Health Knowledge, Attitudes, Practice; Humans; Hyperbaric Oxygenation; Osteoradionecrosis; Patients
PubMed: 24805932
DOI: 10.1017/S0266462314000038 -
HERD Oct 2016Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the... (Review)
Review
Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research.
Topics: Health Facility Environment; Hospital Design and Construction; Hospitals; Humans; Interpersonal Relations; Patient Satisfaction; Patients; Workforce
PubMed: 27492078
DOI: 10.1177/1937586716660825 -
Polski Merkuriusz Lekarski : Organ... Nov 2016Patients' confidence in doctors has been decreased for last years despite successes of Polish medicine. It seems to be related to particular conditions of patient -... (Review)
Review
Patients' confidence in doctors has been decreased for last years despite successes of Polish medicine. It seems to be related to particular conditions of patient - doctor relationship and patient's negative emotions may frequently burden it from the beginning. They may allow an interpersonal game, the Drama Triangle, to appear in the relationship. 3 persons are typically involved in the game: a victim, a persecutor and a rescuer. All of them neither feel guilty about the situation nor their activities are aimed at solving the crucial problem. It maintains continuation of the game. Both patient and doctor are capable to attend the game as any of the person mentioned above. Authors of the article think frameworks of organization of the health care system should permit doctors not only to tackle main disease but also to devote time individually tailored to patient's emotional problems.
Topics: Adaptation, Psychological; Emotions; Humans; Interpersonal Relations; Patients; Physician-Patient Relations; Physicians; Poland; Stress, Psychological
PubMed: 27883355
DOI: No ID Found -
Creative Nursing 2009
Topics: Attitude to Health; Humans; Nurse's Role; Nurse-Patient Relations; Patients; Time Perception
PubMed: 19715090
DOI: 10.1891/1078-4535.15.3.115 -
Advances in Psychosomatic Medicine 2015Communication is the corner stone of the relationship with the patient in all medical settings with the main aims of creating a good inter-personal relationship,... (Review)
Review
Communication is the corner stone of the relationship with the patient in all medical settings with the main aims of creating a good inter-personal relationship, exchanging information, and making treatment-related decisions. In a rapidly changing cultural and social context, the paternalistic approach of doctors knowing the best and deciding what should be done for a patient has been replaced by a shared decision-making approach, with patients being advised to educate themselves, ask questions and influence the course of the discussion with their doctors. Thus, a need for an improvement in the communication skills of physicians is extremely important for patients affected by serious physical illness (e.g. cancer, HIV infection, multiple sclerosis, amyotrophic lateral sclerosis). Certain attitudes, behaviour and skills (e.g. capacity to impart confidence, being empathetic, providing a 'human touch', relating on a personal level, being forthright, being respectful, and being thorough) are part of effective communication. However, some specific aspects influencing doctor-patient communication and relationships, such as personality variables, coping and attachment styles, as well as cultural factors, should also be taken in to account. The development of training curricula to help doctors acquire proper skills in communication is mandatory, since research has shown that training in communication may facilitate the effectiveness of a doctor-patient relationship and the patient's satisfaction with care and give a general sense of humanity, which is easily lost in a biotechnologically oriented medicine.
Topics: Chronic Disease; Communication; Education, Medical; Humans; Patients; Physician-Patient Relations
PubMed: 25832510
DOI: 10.1159/000369050 -
Quality & Safety in Health Care Apr 2010The publication of the report "To err is human: building a safer system" by the Institute of Medicine incited a profuse research addressing improvements in healthcare... (Review)
Review
BACKGROUND
The publication of the report "To err is human: building a safer system" by the Institute of Medicine incited a profuse research addressing improvements in healthcare safety. However, there is still little acknowledgement of the key role of the patient in preventing adverse events of medical care. The aim of this review is to analyse and compare studies about patient's perception and opinion about care safety in hospitals.
METHODS
We searched 10 databases (EMBASE, MEDLINE, PsychINFO, SCOPUS, Science Citation Index Expanded, Social Science Citation, IME, Sociological Abstracts, LILACS and The Cochrane Library) to identify articles and reports on patient's safety perception published between 1989 and 2006.
RESULTS
From the 699 articles, 18 were selected: eight determined the frequency of experiences related to adverse events and the safety perception reported by patients, seven focused on the impact of the adverse events regarding the communication to the patient, and three included patient's opinions about the management and disclosure of adverse events and proposals to prevent them.
CONCLUSIONS
The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patient's concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patient's perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs.
Topics: Attitude to Health; Hospitals; Humans; Medical Errors; Patients; Professional-Patient Relations; Risk Assessment; Safety
PubMed: 20351163
DOI: 10.1136/qshc.2007.025585 -
Cancer Jan 2021Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as...
BACKGROUND
Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as increased caregiver anxiety, distress, depression, and burden. Understanding the factors associated with disagreement may inform interventions to improve the aforementioned outcomes.
METHODS
For this analysis, baseline data were obtained from a cluster-randomized geriatric assessment trial that recruited patients aged ≥70 years who had incurable cancer from community oncology practices (University of Rochester Cancer Center 13070; Supriya G. Mohile, principal investigator). Patient and caregiver dyads were asked to estimate the patient's prognosis. Response options were 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and >5 years. The dependent variable was categorized as exact agreement (reference), patient-reported longer estimate, or caregiver-reported longer estimate. The authors used generalized estimating equations with multinomial distribution to examine the factors associated with patient-caregiver prognostic estimates. Independent variables were selected using the purposeful selection method.
RESULTS
Among 354 dyads (89% of screened patients were enrolled), 26% and 22% of patients and caregivers, respectively, reported a longer estimate. Compared with dyads that were in agreement, patients were more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P = .001), and caregivers reported greater distress (β = 0.12; P = .03). Compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P = .005) and had lower perceived self-efficacy in interacting with physicians (β = -0.10; P = .008).
CONCLUSIONS
Several patient and caregiver factors were associated with patient-caregiver disagreement about prognostic estimates. Future studies should examine the effects of prognostic disagreement on patient and caregiver outcomes.
Topics: Aged; Caregivers; Female; Humans; Male; Neoplasms; Patients; Prognosis
PubMed: 33036063
DOI: 10.1002/cncr.33259