Patients’ negative emotional cues and concerns in hospital consultations: a video-based o…

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Effect of sitting vs. standing on perception of provider time at bedside: a pilot study.
…

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The impact of patient-centered communication on patients’ decision making and evaluation…

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How much is residents’ distress detection performance during a clinical round related to their characteristics?

Patient Educ Couns. 2010 Dec 4;

Authors: Meunier J, Libert Y, Merckaert I, Delvaux N, Etienne AM, Liénard A, Marchal S, Reynaert C, Slachmuylder JL, Razavi D

OBJECTIVE: The aim of this study was to investigate residents’ characteristics associated with their performance in detecting patients’ distress (detection performance). METHODS: Residents’ detection performance was assessed in a clinical round. A mean detection performance score was calculated for each resident by comparing residents’ rating of patients’ distress (VAS) with patients’ reported distress (HADS). Residents’ characteristics include general (socio-demographic, professional and psychological), detection (self-efficacy, attitudes and outcome expectancies) and performance characteristics (communication skills (LaComm), psychological arousal (STAI) and physiological arousal (heart rate and blood pressure) in a highly emotional and complex simulated interview task). RESULTS: Ninety-four residents and 442 inpatients were included. 30% of the variance in residents’ detection performance was related to residents’ performance characteristics: anxiety level (p=.040) and mean arterial blood pressure (p=.019) before the task; empathy (p=.027) and mean heart rate (p=.043) during the task; mean arterial blood pressure changes (p=.012) during the assessment procedure. CONCLUSION: Residents’ detection performance is partly related to their performance characteristics. Psychological and physiological arousals are key characteristics – beside empathic skills – that need to be considered in models designed to determine detection performance. PRACTICE IMPLICATIONS: Future interventions designed to improve residents’ detection performance should focus notably on their performance characteristics.

PMID: 21131159 [PubMed - as supplied by publisher]

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Studying physician-patient communication in the acute care setting: The hospitalist rapport study.

Patient Educ Couns. 2010 May 3;

Authors: Anderson WG, Winters K, Arnold RM, Puntillo KA, White DB, Auerbach AD

OBJECTIVE: To assess the feasibility of studying physician-patient communication in the acute care setting. METHODS: We recruited hospitalist physicians and patients from two hospitals within a university system and audio-recorded their first encounter. Recruitment, data collection, and challenges encountered were tracked. RESULTS: Thirty-two physicians consented (rate 91%). Between August 2008 and March 2009, 441 patients were referred, 210 (48%) were screened, and 119 (66% of 179 eligible) consented. We audio-recorded encounters of 80 patients with 27 physicians. Physicians’ primary concern about participation was interference with their workflow. Addressing their concerns and building the protocol around their schedules facilitated participation. Challenges unique to the acute care setting were: (1) extremely limited time for patient identification, screening, and enrollment during which patients were ill and busy with clinical care activities and (2) little advance knowledge of when physician-patient encounters would occur. Employing a full-time study coordinator mitigated these challenges. CONCLUSION: Physician concerns for participating in communication studies are similar in ambulatory and acute care settings. The acute care setting presents novel challenges for patient recruitment and data collection. PRACTICE IMPLICATIONS: These methods should be used to study provider-patient communication in acute care settings. Future work should test strategies to increase patient enrollment.

PMID: 20444569 [PubMed - as supplied by publisher]

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Costly patients with unexplained medical symptoms: a high-risk population.

Patient Educ Couns. 2008 Feb;70(2):173-8

Authors: Margalit AP, El-Ad A

OBJECTIVES: To identify a group of costly patients with unexplained medical symptoms (UMS), and address their needs. METHODS: Prospective controlled trial; 42 patients with annual costs of care of $6500 or more were randomized into an intervention and a usual care group. A primary care team with expertise in the biopsychosocial (BPS) approach implemented the intervention. RESULTS: In the intervention group, the annual number of visits to consultants declined from 31.8 to 12.6 (p<.0001) and 14.6 (p=.72) after 1 and 2 years, respectively; visits to hospital emergency wards declined from 33.5 to 4.1 (p<.0001) and 3.5 (p=.18); and in-hospital days declined from 112.7 to 19 (p<.0001) and 6.5 (p=.25). Those parameters remained unchanged in the control group. Five years follow-up demonstrated a reduction in mortality rates between the two groups: 6/21 versus 17/21 (p<0.001). CONCLUSIONS: When compared to usual care, a BPS intervention was followed by a decline in patients' visits to medical settings and health-care expenditures, along with significant decline in mortality rate. PRACTICE IMPLICATION: Costly UMS patients should be identified every year and treated using a BPS approach.

PMID: 17983723 [PubMed - indexed for MEDLINE]

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