Browsing by Subject "patient-provider communication"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    The Influence of Everyday Interpersonal Communication on the Medical Encounter: An Extension of Street’s Ecological Model
    (Taylor & Francis, 2018-06-03) Head, Katharine J.; Bute, Jennifer J.; Communication Studies, School of Liberal Arts
    Street’s ecological model has shaped the research-examining communication during medical encounters for over a decade. Although the model accounts for the variety of contexts that shape the conversations in which patients and health-care providers engage, the model does not adequately address the way that everyday conversations about health carry over into patient–provider interactions. In this essay, we propose an extension of Street’s model that adds the context of everyday communication about health as a contributing factor in the medical encounter. We support the need for this extension by discussing research that points to the ways these conversations with our social network influence communication during the medical encounter and propose new areas for research based on this extension.
  • Thumbnail Image
    Item
    Patient Preferences Matter: A Qualitative Inquiry With Patients About the Surgical Decision for Osteosarcoma in the Lower Extremity
    (2020-06) Panoch, Janet Elizabeth; Goering, Elizabeth; Parrish-Sprowl, John; Hoffman-Longtin, Krista; Beckman, Emily
    Purpose The experience of surgical patient decision-making for amputation, rotationplasty, or limb salvage surgery for the lower extremity was explored with osteosarcoma survivors and parents. Issues and patient concerns were examined prospectively in Facebook posts and retrospectively in personal interviews. Recommendations were sought for the development of a decision aid. Methods A qualitative inquiry was conducted in two studies: 1) a content analysis of 15 Facebook posts on the Osteosarcoma and Ewing’s Sarcoma Support Group about the surgical decision, and 2) a narrative analysis of 20 interviews with survivors and parents about their lived experience. The interview guide was informed by a knowledge translation theoretical model. In-person or video interviews included 29 parents or adolescent-young adults between the ages of 14-71 across 15 states. Results Participants were concerned about making the best decision for themselves or their child. Having little time to make the decision contributes to feeling overwhelmed and uninformed. The lack of information about options, potential limitations, prosthetic needs, and long-term functional outcomes impacts the decision-making process. Resources for finding information are limited. Shared decision-making approaches were preferred though many decisions were made by the surgeon. Patients felt unprepared for complications encountered after limb salvage. Conclusions Limb salvage surgery remains the gold standard for most providers; participants felt there was a bias on the surgeon’s part for salvage. Potential complications and uncertainties of each option were largely omitted in consultations; information about living with a prosthesis is an unmet need for decision-making. The decision affected their quality of life in ways they did not anticipate, resulting in additional decisions. Implications The findings of this study can be used in medical education for orthopedic surgeons to understand the long-term outcomes of limb salvage surgery. Patient preferences matter in the decision and patients who are involved in the decision are more satisfied if they are prepared for the unknown and potential complications. Recommendations for a decision aid include an online format, content that includes a discussion of uncertainties as well as complications of each option, patient stories for long-term outcomes, and resources for psychosocial support.
  • Thumbnail Image
    Item
    Re-­Thinking Shared Decision‐Making: Context Matters
    (2013-05) Matthias, Marianne S.; Salyers, Michelle P.; Frankel, Richard M.
    Objective Traditional perspectives on shared decision-making (SDM) focus attention on the point in a clinical encounter where discussion of a treatment decision begins. We argue that SDM is shaped not only by initiation of a treatment decision, but also by the entire clinical encounter, and, even more broadly, by the nature of the patient–provider relationship. Method The Four Habits Approach to Effective Clinical Communication, a validated and widely used framework for patient–provider communication, was used to understand how SDM is integrally tied to the entire clinical encounter, as well as to the broader patient–provider relationship. Results The Four Habits consists of four categories of behaviors: (1) invest in the beginning; (2) elicit the patient's perspective; (3) demonstrate empathy; and (4) invest in the end. We argue that the behaviors included in all four of these categories work together to create and maintain an environment conducive to SDM. Conclusion SDM cannot be understood in isolation, and future SDM research should reflect the influence that the broader communicative and relational contexts have on decisions. Practice implications SDM training might be more effective if training focused on the broader context of communication and relationships, such as those specified by the Four Habits framework.
  • Thumbnail Image
    Item
    What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations
    (Equinox, 2017) Lee, Joy; Callon, Wynne; Haywood, Carlton, Jr.; Lanzkron, Sophie M.; Gulbrandsen, Pål; Beach, Mary Catherine; Medicine, School of Medicine
    Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.