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Bulletin of the History of Medicine 2013This article explores how and why the patient came to be repositioned as a political actor within British health care during the 1960s and 1970s. Focusing on the role...
This article explores how and why the patient came to be repositioned as a political actor within British health care during the 1960s and 1970s. Focusing on the role played by patient organizations, it is suggested that the repositioning of the patient needs to be seen in the light of growing demands for greater patient autonomy and the application of consumerist principles to health. Examining the activities of two patient groups-the National Association for the Welfare of Children in Hospital (NAWCH) and the Patients Association (PA)-indicates that while such groups undoubtedly placed more emphasis on individual autonomy, collective concerns did not entirely fall away. The voices of patients, as well as the patient, continued to matter within British health care.
Topics: Consumer Advocacy; Delivery of Health Care; History, 20th Century; Patients; Politics; United Kingdom
PubMed: 23811711
DOI: 10.1353/bhm.2013.0022 -
Clinical Orthopaedics and Related... Apr 2010There are three categories of diagnostic data collected during the physical examination-sign, symptom, and that in between-but only two words to describe them. To fill...
There are three categories of diagnostic data collected during the physical examination-sign, symptom, and that in between-but only two words to describe them. To fill that gap, I modestly propose here that examination responses that are vocalized (and thus symptomlike) yet thought to be specific (hence signifiers) be classified as wigns. I define a wign as the subjective reaction to a provocative examination maneuver deemed to have some valid relationship to the underlying pathology. This word is pronounced "whine" to remind us it is a spoken response, and its spelling echoes that of sign, reminding us likewise a wign is more definitive than a generalized complaint. The distinctions between sign, symptom, and wign are worthy of preservation, particularly regarding their probative value: treatments offered on the basis of signs can be said to be most rigorously indicated, as symptoms, unlike signs, pass through (and are affected by) the prism of patients' perceptions. Remaining skeptical about the value of information provided by our patients is in the interest of these patients, as our skepticism might save them from unnecessary treatments and procedures.
Topics: Communication; Humans; Patients; Physical Examination; Physician-Patient Relations; Terminology as Topic
PubMed: 19557488
DOI: 10.1007/s11999-009-0953-0 -
BMC Health Services Research Apr 2020Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this...
BACKGROUND
Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM.
METHODS
We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers).
RESULTS
We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient's perceived assertiveness, lack of capacity, and level of deference.
CONCLUSIONS
We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.
Topics: Alberta; Anthropology, Cultural; Community Health Services; Decision Making, Shared; Female; Health Personnel; Humans; Male; Patients; Qualitative Research; Rehabilitation
PubMed: 32306972
DOI: 10.1186/s12913-020-05223-4 -
Community Dental Health Dec 2011Very little is known about dentist-patient communicative behaviours in actual practice. This study evaluated dentist and patient perceptions of dentist-patient... (Comparative Study)
Comparative Study
OBJECTIVES
Very little is known about dentist-patient communicative behaviours in actual practice. This study evaluated dentist and patient perceptions of dentist-patient communication and patient outcome.
PARTICIPANTS
The subjects were 171 dentist-patient pairs in Kitakyushu, Japan.
RESEARCH DESIGN
Dentists and patients answered the same questionnaire items using the same response categories to evaluate dentist-patient communication. Based on the scores of patient and dentist perceptions with respect to dentist-patient communication, patient-dentist pairs were categorised into one of 3 groups. Data analyses used one-way ANOVA, multiple linear regression analysis, and multiple logistic regression analysis.
RESULTS
We found that, with respect to dentist-patient communication, patients in the 'patient better' group (i.e., the patient's evaluation was more positive than the dentist's evaluation) were more likely to have a positive outcome (e.g., 'improvement of health and fear,' 'satisfaction with care') than those in the other two groups. Patients in the 'doctor better' group (i.e., the dentist's evaluation was the more positive) were more likely to have a negative outcome than those in the other two groups.
CONCLUSIONS
A positive patient outcome is more likely when the patient's evaluation is better than a dentist's evaluation with respect to dentist-patient communicative behaviours. The method based on patient and dentist perceptions with respect to dentist-patient communication might be effective in evaluating dentist-patient communication.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Attitude to Health; Child; Communication; Comprehension; Dental Anxiety; Dentist-Patient Relations; Dentists; Female; Humans; Japan; Male; Middle Aged; Patient Compliance; Patient Satisfaction; Patients; Young Adult
PubMed: 22320065
DOI: No ID Found -
JAMA Network Open Jun 2021Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month...
IMPORTANCE
Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier.
OBJECTIVE
To describe successful navigation and missed opportunities for EOL discussions (eg, advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care, and after-death wishes) between oncologists and outpatients with advanced cancer.
DESIGN, SETTING, AND PARTICIPANTS
This study is a secondary qualitative analysis of outpatient visits audio-recorded between November 2010 and September 2014 for the Studying Communication in Oncologist-Patient Encounters randomized clinical trial. The study was conducted at 2 US academic medical centers. Participants included medical, gynecological, and radiation oncologists and patients with stage IV malignant neoplasm, whom oncologists characterized as being ones whom they "…would not be surprised if they were admitted to an intensive care unit or died within one year." Data were analyzed between January 2018 and August 2020.
EXPOSURES
The parent study randomized participants to oncologist- and patient-directed interventions to facilitate discussion of emotions. Encounters were sampled across preintervention and postintervention periods and all 4 treatment conditions.
MAIN OUTCOMES AND MEASURES
Secondary qualitative analysis was done of patient-oncologist dyads with 3 consecutive visits for EOL discussions, and a random sample of 7 to 8 dyads from 4 trial groups was analyzed for missed opportunities.
RESULTS
The full sample included 141 patients (54 women [38.3%]) and 39 oncologists (8 women [19.5%]) (mean [SD] age for both patients and oncologists, 56.3 [10.0] years). Of 423 encounters, only 21 (5%) included EOL discussions. Oncologists reevaluated treatment options in response to patients' concerns, honored patients as experts on their goals, or used anticipatory guidance to frame treatment reevaluation. In the random sample of 31 dyads and 93 encounters, 35 (38%) included at least 1 missed opportunity. Oncologists responded inadequately to patient concerns over disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation. Only 4 of 23 oncologists (17.4%) had both an EOL discussion and a missed opportunity.
CONCLUSIONS AND RELEVANCE
Opportunities for EOL discussions were rarely realized, whereas missed opportunities were more common, a trend that mirrored oncologists' treatment style. There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatment.
Topics: Adult; Advance Care Planning; Aged; Aged, 80 and over; Communication; Female; Humans; Male; Middle Aged; Neoplasms; Oncologists; Patient Care Planning; Patients; Physician-Patient Relations; Qualitative Research; Terminal Care; United States
PubMed: 34110395
DOI: 10.1001/jamanetworkopen.2021.13193 -
Psychiatria Danubina Sep 2019We wanted to investigate the patient's expectations on the general practitioner's (GP) responsibilities in screening and follow up of disturbed eating behaviour. Then,...
OBJECTIVES
We wanted to investigate the patient's expectations on the general practitioner's (GP) responsibilities in screening and follow up of disturbed eating behaviour. Then, we looked for remediation for some of the mentioned shortcomings in family medicine. We also examined if online aid (offered by the non-profit organisation "Eetexpert.be") is already known and used.
SUBJECTS AND METHODS
Anonymous patient questionnaires were gathered at 4 treatment centres for eating disorders or were collected with help of the Flemish patients organisation for eating disorders (Vlaamse Vereniging Anorexia Nervosa en Boulimia Nervosa). Later, online enquiries were sent to Flemish GPs.
RESULTS
Out of 123 patients responding to the questionnaire, 44 found their GP to have had an important supportive role in their healing process. Active listening and targeted referral were among the most appreciated interventions by those patients. 71 GPs replied the online enquiry. Only 1 out of 5 knew about the free online assistance of "Eetexpert.be". Responders suggested several additional barriers to care.
CONCLUSIONS
In Flanders there is a contrast between expectations and needs of patients on one hand compared to the services provided by GPs on the other. Reassuringly, all responding physicians were open to more education and support regarding eating disorder treatment.
Topics: Attitude of Health Personnel; Belgium; Feeding and Eating Disorders; General Practitioners; Humans; Patient Preference; Patients; Referral and Consultation; Surveys and Questionnaires
PubMed: 31488763
DOI: No ID Found -
The Permanente Journal 2018This article defines empathy as the conveyed expression of awareness, understanding, and sensitivity to the experiences, feelings, and emotions of a patient with a...
This article defines empathy as the conveyed expression of awareness, understanding, and sensitivity to the experiences, feelings, and emotions of a patient with a medical condition. This article is a reflective short story addressing empathy through the eyes of Maria (a fictitious patient), who is confronted with the challenges of negotiating her first encounter at a medical facility, and through the actions of Dr Jones (a fictitious physician) who, at a critical juncture, fails to engage empathically with her patient donning the ubiquitous hospital gown. The gown is instructive in this context because it compounds the deidentification of an already nondescript person. Maria's story is a collage of multiple clerkship experiences of a fourth-year medical student, and of shared anecdotal accounts from patients and medical practitioners.In this article, I explore the following: 1) the insecurities and anxieties experienced by individuals with medical ailments, 2) the critical role that empathy can play in reassuring and comforting patients in pain, 3) the belief held by some individuals that empathy erodes with the practice of medicine, 4) the ongoing threats and barriers to empathy in the medical profession, and 5) the vigilance and diligence required of medical practitioners to ensure maintenance of this essential human quality. Additionally, I describe the challenges of identifying who is responsible for screening for empathy in aspiring medical school applicants, incorporating empathy training in the classroom and in clinical apprenticeships, and monitoring and ensuring empathy maintenance among physicians in training and physicians in practice.
Topics: Clinical Clerkship; Clothing; Empathy; Humans; Patients; Physician-Patient Relations
PubMed: 29911965
DOI: 10.7812/TPP/17-169 -
Journal of Medical Internet Research Jul 2020Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications.
OBJECTIVE
The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined.
METHODS
Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed.
RESULTS
Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1).
CONCLUSIONS
We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.
Topics: Cross-Sectional Studies; Humans; Patients; Randomized Controlled Trials as Topic; User-Computer Interface
PubMed: 32729837
DOI: 10.2196/18839 -
Cancer Dec 2018
Topics: Clinical Trials as Topic; Health Knowledge, Attitudes, Practice; Humans; Patients; Social Media; Social Support
PubMed: 30339288
DOI: 10.1002/cncr.31747 -
Annals of Medicine 2023Understanding patient and caregiver experience is key to providing person-centered care. The palliative care approach includes holistic assessment and whole-person care...
INTRODUCTION
Understanding patient and caregiver experience is key to providing person-centered care. The palliative care approach includes holistic assessment and whole-person care at the end of life, that also involves the patient's family and loved ones. The aim of this study was to describe the way that family caregivers experienced patients' deaths during their loved ones' last hospital admission, comparing inpatient palliative care (PCU) and non-palliative care (Non-PCU) units.
METHODS
A qualitative case study approach was implemented. Family caregivers of terminally ill patients admitted to the Infanta Elena Hospital (Madrid, Spain) between 2016 and 2018 were included using purposeful sampling. Eligible caregivers were first-degree relatives or spouses present during the patient's last hospital admission. Data were collected in-depth interviews and researchers' field notes. Semi-structured interviews with a question guide were used. A thematic inductive analysis was performed. The group of caregivers of patients admitted to the PCU unit and the group of caregivers of patients admitted to Non-PCU were analyzed separately, through a matrix.
RESULTS
In total 24 caregivers (12 from the PCU and 12 from Non-PCU units) were included. Two main themes were identified: caregivers' perception of scientific and technical appropriateness of care, and perception of person-centred care. Scientific appropriateness of care was subdivided into two categories: diagnostic tests and treatment, and symptom control. Perception of person-centred care was subdivided as: communication, emotional support, and facilitating the farewell process. Caregivers of patients admitted to a PCU unit described their experience of end-of-life care as positive, while their Non-PCU unit counterparts described largely negative experiences.
CONCLUSIONS
PCU provides a person-centered approach to care at the end of life, optimizing treatment for patients with advanced disease, ensuring effective communication, establishing a satisfactory professional relationship with both patients and their loved ones, and facilitating the farewell process for family caregivers.
Topics: Humans; Inpatients; Caregivers; Terminal Care; Death; Hospitalization
PubMed: 37738527
DOI: 10.1080/07853890.2023.2260400