Browsing by Subject "Doctor–patient communication"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    "Doctor, what would you do?": physicians' responses to patient inquiries about periviable delivery
    (Elsevier, 2015-01) Tucker Edmonds, Brownsyne; McKenzie, Fatima; Panoch, Janet E.; Wocial, Lucia D.; Barnato, Amber E.; Frankel, Richard M.; Department of Obstetrics and Gynecology, IU School of Medicine
    OBJECTIVE: To qualitatively assess obstetricians' and neonatologists' responses to standardized patients (SPs) asking "What would you do?" during periviable counseling encounters. METHODS: An exploratory single-center simulation study. SPs, portraying a pregnant woman presenting with ruptured membranes at 23 weeks, were instructed to ask, "What would you do?" if presented options regarding delivery management or resuscitation. Responses were independently reviewed and classified. RESULTS: We identified five response patterns: 'Disclose' (9/28), 'Don't Know' (11/28), 'Deflect' (23/28), 'Decline' (2/28), and 'Ignore' (2/28). Most physicians utilized more than one response pattern (22/28). Physicians 'deflected' the question by: restating or offering additional medical information; answering with a question; evoking a hypothetical patient; or redirecting the SP to other sources of support. When compared with neonatologists, obstetricians (40% vs. 15%) made personal or professional disclosures more often. Though both specialties readily acknowledged the importance of values in making a decision, only one physician attempted to elicit the patient's values. CONCLUSION: "What would you do?" represented a missed opportunity for values elicitation. Interventions are needed to facilitate values elicitation and shared decision-making in periviable care. PRACTICE IMPLICATIONS: If physicians fail to address patients' values and goals, they lack the information needed to develop patient-centered plans of care.
  • Thumbnail Image
    Item
    Investigating the Effect of a Digital Doctor on Persuasion
    (2021-10) Dai, Zhengyan; MacDormann, Karl F.; Miller, Andrew; Brady, Erin; Chakraborty, Sunandan
    The treatment of chronic diseases requires patient adherence to medical advice. Nonadherence worsens health outcomes and increases healthcare costs. Consultations with a virtual physician could increase adherence, given the shortage of healthcare professionals. However, if the virtual physician is a computer animation, acceptance of its advice may be hampered by the uncanny valley effect, a negative affective reaction to human simulations. Two experiments were conducted to investigate the impact of the virtual physician on patients’ adherence. The first study, a 2 ´ 2 ´ 2 between-groups posttestonly experiment, involved 738 participants playing the role of a patient in a hypothetical virtual consultation with a doctor. The consultation varied in the doctor’s Character, Outcome, and Depiction. Character, Outcome, and Depiction were designed to manipulate the doctor’s level of warmth, competence, and realism. The second study, a 2 ´ 5 between-groups experiment, involved 441 participants assuming a patient’s role in a similar hypothetical virtual consultation with a doctor. The experiment varied the doctor’s Character and Depiction. These independent variables were designed to manipulate the doctor’s level of warmth and eeriness. The first study found that warmth and competence increased adherence intention and consultation enjoyment, but realism did not. On the contrary, the computer-animated doctor increased adherence intention and consultation enjoyment significantly more than the doctor portrayed by a human actor. The enjoyment of the animated consultation caused the doctor to appear warmer and more real, compensating for his realism inconsistency. In the second study, Depiction had a nonsignificant effect on adherence intention, even though the computer animated doctor was perceived as eerier than the real human. The low-warmth, high-eeriness doctor prompted heuristic processing of information, while the high-warmth doctor prompted systematic processing. This pattern runs counter to the literature on persuasion. The doctor’s eeriness, measured in a pretest, had no significant effect on adherence intention via the heuristic-systematic model. Although virtual characters can elicit the uncanny valley effect, they were comparable to a real person in increasing adherence intention, adherence and health behavior. This finding should encourage the development and acceptance of virtual consultation to address the shortage of healthcare professionals.