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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 -
International Journal of Environmental... Sep 2020In the context of population aging, enhancing the health of older patients has become an urgent issue for public health. Health education and health literacy need to be...
In the context of population aging, enhancing the health of older patients has become an urgent issue for public health. Health education and health literacy need to be further understood from the healthcare providers' standpoint to increase older patients' effective application of such information into their daily lives. We aimed to further understand nurses' perspectives on the education of older patients and their health literacy, as nurses are one of the frontline providers interacting with older patients. In total, 16 nurses and nurse practitioners who had 5 or more years of clinical experience participated. Data were collected via face-to-face interviews and emails. Data analysis followed the thematic analysis suggested by Braun and Clarke. Five themes emerged from the analysis, as follows: attitudes that are hard to change; physical and cognitive functional barriers to understanding teaching materials; family caregivers-surrogate vs. gatekeeper; major contexts that moderate the elderly's health literacy; and strategies to enhance teaching effectiveness and health literacy. These findings illustrate the conditions pertinent to communication with older adults from the patients', providers' and healthcare delivery viewpoints. Systemic assistance and interventions specialized for older patients and their healthcare providers need to be developed and tested to improve clinical practice and patient health literacy.
Topics: Adult; Aged; Female; Health Literacy; Health Personnel; Humans; Nurses; Patients
PubMed: 32899759
DOI: 10.3390/ijerph17186455 -
BMJ Open Sep 2021Patient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study...
OBJECTIVES
Patient satisfaction is an important indicator of hospital healthcare quality. Little up-to-date information of patient satisfaction in China is available. This study attempts to gain a holistic understanding of patient satisfaction in China and identify the key antecedents of patient satisfaction.
DESIGN
A cross-sectional national survey was conducted in 2018.
SETTING
Hospitals in 27 provinces and 4 municipalities in 4 regions of China.
PARTICIPANTS
A random sample of 15 699 patients who visited 1304 hospitals were surveyed, with around 500 from each of the 27 provinces and 4 municipalities.
PRIMARY AND SECONDARY OUTCOME MEASURES
The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire was used to measure patients' overall satisfaction and willingness to recommend the hospital.
RESULTS
We found significant variation in overall patient satisfaction but little variation in hospital recommendation across the four broad regions. Moreover, we examined determinants of patient satisfaction and their likelihood to recommend the hospital. The overall satisfaction for inpatients and outpatients is commonly influenced by communication with doctors (inpatient: β=0.524, p<0.001; outpatient: β=0.541, p<0.001), hospital cleanness (inpatient: β=0.165, p<0.05; outpatient: β=0.144, p<0.001) and acceptable charges (inpatient: β=1.481, p<0.001; outpatient: β=1.045, p<0.001). Both inpatients and outpatients are more likely to recommend the hospital if there are communication with doctors (inpatient: OR=1.743, p<0.001; outpatient: OR=1.647, p<0.001), acceptable charges (inpatient: OR=2.660, p<0.001; outpatient: OR=2.433, p<0.001). Outpatient satisfaction and hospital recommendation are also influenced by time spent with doctors (satisfaction: β=0.301, p<0.001; recommend: OR=1.430, p<0.001) and waiting time (satisfaction: β=-0.318, p<0.001; recommend: OR=0.844, p<0.001).
CONCLUSIONS
There are regional differences of patient satisfaction in China. Patient satisfaction is influenced by a variety of hospital factors and province/municipality factors. The influencing factors of patient satisfaction may not motivate patients to recommend the hospital.
Topics: China; Cross-Sectional Studies; Humans; Inpatients; Outpatients; Patient Satisfaction; Surveys and Questionnaires
PubMed: 34493518
DOI: 10.1136/bmjopen-2021-049570 -
PloS One 2019To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey.
PURPOSE
To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey.
METHODS
A qualitative study of orthopaedic patients admitted for hip and knee replacement surgery in a 250-bed university hospital was performed. Eight patients were shadowed from the time they entered the hospital to the time of transfer to rehabilitation. Four patients and sixteen professionals, including orthopaedists, head nurses, nurses and administrative staff, were interviewed.
RESULTS
Through analysis of the data collected four main themes emerged: the information gap; the covering patient-professionals relationship; the effectiveness of family closeness; and the micro-integration of hospital services. The three different standpoints (patient shadowing, health professionals' interviews and patients' interviews) allowed different issues to be captured in the various phases of the journey.
CONCLUSIONS
Hospitals can significantly improve the quality of the service provided by exploring and understanding the individual patient journey. When dealing with a key cross-functional business process, the time-space dynamics of the activities performed have to be considered. Further research in the academic field can explore practical, methodological and ethical challenges more deeply in capturing the whole patient journey experience by using multiple methods and integrated tools.
Topics: Aged; Attitude to Health; Female; Hospital-Patient Relations; Hospitalization; Humans; Male; Middle Aged; Patient Care; Patients; Quality of Health Care
PubMed: 31805061
DOI: 10.1371/journal.pone.0224899 -
Social Science & Medicine (1982) Aug 2007Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with...
Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Attitude of Health Personnel; Communication; Humans; Middle Aged; Patient Compliance; Patient Satisfaction; Patients; Perception; Physician-Patient Relations; Physicians; Racial Groups; Sex Factors; Socioeconomic Factors
PubMed: 17462801
DOI: 10.1016/j.socscimed.2007.03.036 -
The Oncologist Jan 2016A medical student reflects on his own experiences as a patient and how they will shape his practice as a physician.
A medical student reflects on his own experiences as a patient and how they will shape his practice as a physician.
Topics: Humans; Neoplasms; Patients; Students, Medical
PubMed: 26675740
DOI: 10.1634/theoncologist.2015-0318 -
Applied Clinical Informatics Mar 2023The patient's voice, which we define as the words the patient uses found in notes and messages and other sources, and their preferences for care and its outcomes, is too...
The patient's voice, which we define as the words the patient uses found in notes and messages and other sources, and their preferences for care and its outcomes, is too small a part of the electronic health record (EHR). To address this shortcoming will require innovation, research, funding, perhaps architectural changes to commercial EHRs, and that we address barriers that have resulted in this state, including clinician burden and financial drivers for care. Advantages to greater patient voice may accrue to many groups of EHR users and to patients themselves. For clinicians, the patient's voice, including symptoms, is invaluable in identifying new serious illness that cannot be detected by screening tests, and as an aid to accurate diagnosis. Informaticians benefit from greater patient voice in the EHR because it provides clues not found elsewhere that aid diagnostic decision support, predictive analytics, and machine learning. Patients benefit when their treatment priorities and care outcomes considered in treatment decisions. What patient voice there is in the EHR today can be found in locations not usually used by researchers. Increasing the patient voice needs be accomplished in equitable ways available to people with less access to technology and whose primary language is not well supported by EHR tools and portals. Use of direct quotations, while carrying potential for harm, permits the voice to be recorded unfiltered. If you are a researcher or innovator, collaborate with patient groups and clinicians to create new ways to capture the patient voice, and to leverage it for good.
Topics: Humans; Electronic Health Records; Patients
PubMed: 36990457
DOI: 10.1055/s-0043-1767685 -
AMA Journal of Ethics Apr 2019This abstract painting represents how patients' experiences of darkness and doubt can be replaced by a sense of buoyancy and lightness. Color and movement convey a...
This abstract painting represents how patients' experiences of darkness and doubt can be replaced by a sense of buoyancy and lightness. Color and movement convey a patient's sense of striving, aspiration, and optimism.
Topics: Adaptation, Psychological; Humans; Paintings; Patients; Stress, Psychological
PubMed: 31012425
DOI: 10.1001/amajethics.2019.370 -
Journal of Medical Internet Research Jun 2020Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have... (Review)
Review
BACKGROUND
Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life.
OBJECTIVE
This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors.
METHODS
A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health-related tasks, (2) cognitive health-related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools).
RESULTS
In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support.
CONCLUSIONS
This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one's internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.
Topics: Female; Humans; Male; Patients; Self-Management; Work
PubMed: 32484449
DOI: 10.2196/16656 -
CMAJ : Canadian Medical Association... Aug 2021
Topics: Humans; Patients; Publishing
PubMed: 34344781
DOI: 10.1503/cmaj.211092-f