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PubMedDate not supplied

[New prospects in physician-patient communication: role of the animated model].

UNLABELLED: Today information technology and multimediality play a key role in the field of medicine and only recently have been used to improve the doctor-patient relationship. The authors propose the use of induction movies also in this field improving communication between doctor and patient especially when handling surgical operations and complex procedures. These movies give detailed information to patients showing images and explaining in a simple way surgery, therapy and innovative procedures helping the patients to cope with surgery and therapy reducing anxiety and worry. This innovative method was also used successfully for the training of students helping them to understand important issues. MATERIALS AND METHODS: An induction movie on CD regarding two different surgical techniques was shown to 20 patients (7 females and 13 males, average age 50.8), 20 doctors and 20 students. RESULTS: Doctors and patients appreciated this new communication method enabling doctors to better communicate with patients and patients to better understand operation procedures. Worry for operation was reduced and compliance before and after surgery was increased. As to the notion point of view students understood quicker and easier. CONCLUSIONS: This method is innovative and enables technical information to reach patients, doctors and students faster. Images are kept in mind easier and help patients to evaluate the pros and cons of surgery reducing worry. There was more communication between doctors and patients improving therefore their relationship and at the same time reducing communication barriers.

Communication↗
PubMedDate not supplied

[Barriers to verbal communication and consumer satisfaction with consultations in general medicine].

With the objective of knowing the barriers to verbal communication experienced by general practice users, and their satisfaction with the information received, a sample of 1553 adults (> 14 years old), users of the Basque Health Service general practice services, was interviewed. A questionnaire of 13 questions, administered after the consultation, was employed. The most frequently experienced barrier was the lack of written information, that affected to a 77.7% of those interviewed. This percentage is greater (p < 0.005) among those visiting traditional doctors (81.9%), than among those enrolled with primary care teams (72.4%) or rural doctors (70.0%). Those who were given written information left out the consultation more satisfied than the others (p < 0.001). The provision of written information seems to be related to the user's satisfaction. It is advised to modify the doctors' attitude towards the communicative process with their patients.

Adolescent↗
PubMedDate not supplied

Improving health care experiences of persons who are blind or have low vision: suggestions from focus groups.

Persons who are blind or have low vision face special challenges in obtaining care that is safe, effective, timely, and patient centered. To explore perceptions of care and recommendations for improvements, we conducted 8 interviews with experts and 2 focus groups with 19 persons, all of whom are blind or have low vision. Interviewees perceived that they confront special barriers to care because of being blind or having low vision. Barriers fell into 4 broad categories: basic respect, including concerns about physicians thinking they cannot participate fully in their own care; communication barriers, including difficulties interacting with physicians and office staff; physical access barriers, including difficulties getting to and around physicians' offices; and information barriers, including receiving written materials in inaccessible formats (eg, not in Braille, large print, or audiotape). Using common courtesy and individualized communication techniques, physicians and office staff could improve health care experiences of blind and low-vision patients.

Blindness↗
PubMed2005

Exploring the value of audiotapes for health literacy: a systematic review.

OBJECTIVE: To evaluate the efficacy of audiotapes as a health information exchange intervention, specifically looking for use with the "hard-to-reach" population. METHODS: Examined electronic databases and journals for articles that evaluated potential of audiotapes as an educational tool within diverse populations. The systematic review included randomized controlled trials, surveys and exploratory articles. Primary outcome variables analyzed were knowledge and recall, behavioral change, anxiety, self-care, and satisfaction. RESULTS: Audiotapes were used to record consultations and health-related information in specific health situations. No studies were found that targeted the needs of the "hard-to-reach" population. With the exception of positive patient satisfaction, the benefits of audio taped messages remain unclear. PRACTICE IMPLICATIONS: If even the average person is compromised in the context of information exchange, populations with communication barriers are at even greater risk. Research needs to be conducted, aimed at determining whether audiotapes enhance communication between the "hard-to-reach" population and health professionals.

Anxiety↗
PubMed2003

Care not cure: dialogues at the transition.

Physicians and patients find it hard to communicate when treatment fails to cure or control cancer. Communication barriers include fear of "giving up," losing the medical team, and discussing death. The quality of physician-patient communication affects important outcomes including patient distress, coping, and quality of life, and physician burnout. Communication skills that can be taught, learned, and maintained for physicians at all levels of training, and effective educational programs have been described. Research on communication skills training should focus on the best method of delivery, the "dose-response" effect, and how to measure success of training in complex health care environments.

Adaptation, Psychological↗
PubMed2004

Tri-generational family conversations: communication accommodation and brokering.

Communication between grandparents and grandchildren can be superficial because of insufficient common ground between them. Among Chinese immigrant families in New Zealand, communication is complicated by linguistic mismatches, as grandparents may be proficient only in Chinese and grandchildren in English. To surmount these communication barriers, middle-aged parents (who know the cultures and languages of both grandparents and grandchildren) may play the role of a 'communication broker' to encourage and assist the two generations to conversationally move towards each other. We identified 35 cases (tokens) of brokering in 12 New Zealand Chinese families and found, as hypothesized, that brokering was significantly overrepresented in moderately (compared to high- or low-) acculturated families, and that brokers were mostly middle-aged parents. In the qualitative part of the study, detailed turn-by-turn analyses of brokering were conducted to reveal how brokering was occasioned, its subsequent enactment and eventual outcome. The results extend the understanding of unmediated communication accommodation in dyadic settings to mediated accommodation in group settings wherein a third (and sometimes a fourth) person brokers the accommodation. The resultant framework of brokered accommodation will be useful for research on other group conversations such as those involving a nurse brokering between a doctor and a patient.

Adult↗
PubMedDate not supplied

Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment.

Despite the importance of clinician-patient communication, little is known about rates and predictors of medication miscommunication. Measuring rates of miscommunication, as well as differences between verbal and visual modes of assessment, can inform efforts to more effectively communicate about medications. We studied 220 diverse patients in an anticoagulation clinic to assess concordance between patient and clinician reports of warfarin regimens. Bilingual research assistants asked patients to (1) verbalize their prescribed weekly warfarin regimen and (2) identify this regimen from a digitized color menu of warfarin pills. We obtained clinician reports of patient regimens from chart review. Patients were categorized as having regimen concordance if there were no patient-clinician discrepancies in total weekly dosage. We then examined whether verbal and visual concordance rates varied with patient's language and health literacy. Fifty percent of patients achieved verbal concordance and 66% achieved visual concordance with clinicians regarding the weekly warfarin regimen (P < .001). Being a Cantonese speaker and having inadequate health literacy were associated with a lower odds of verbal concordance compared with English speakers and subjects with adequate health literacy (AOR 0.44, 0.21-0.93, AOR 0.50, 0.26-0.99, respectively). Neither language nor health literacy was associated with visual discordance. Shifting from verbal to visual modes was associated with greater patient-provider concordance across all patient subgroups, but especially for those with communication barriers.Clinician-patient discordance regarding patients' warfarin regimen was common but occurred less frequently when patients used a visual aid. Visual aids may improve the accuracy of medication assessment, especially for patients with communication barriers.

Anticoagulants↗
PubMed1998

The recruitment triangle: reasons why African Americans enroll, refuse to enroll, or voluntarily withdraw from a clinical trial. An interim report from the African-American Antiplatelet Stroke Prevention Study (AAASPS).

Recruitment and retention of study subjects are key to the success of a clinical trial. In the case of minority patients, this may be challenging as minority patients have been underserved by the medical health-care system. Furthermore, minority patients are more likely to experience barriers to entry into a clinical trial such as mistrust of the medical system, economic disadvantages, lack of awareness of study programs, and communication barriers. An open-ended questionnaire was used to determine reasons why subjects in the African-American Antiplatelet Stroke Prevention Study (AAASPS) remained in the study or voluntarily withdrew in the absence of an adverse event. Potential enrollees who refused to participate in the AAASPS also were queried. Enrollees who remained in the program consistently stated that they participated to reduce the risk of stroke recurrence and to help others by finding a "cure" for stroke. Those who withdrew or refused to participate consistently stated that they were afraid of being used as "guinea pigs." A "recruitment triangle" emerged that might predict a patient's likelihood of participation in a clinical trial. The sides of the triangle include the patient, key family members and friends, and the primary medical doctor and other medical personnel. The organizers of a clinical trial need to be aware of the "recruitment triangle" and establish strategies to heighten and maintain its integrity.

Black or African American↗
PubMed2005

An analysis of job satisfaction among physician assistants in Taiwan.

The physician assistant (PA) is a relatively new medical specialty that developed to manage the shortage of resident physicians and to ensure that patients receive high-quality health care in today's increasingly complex and demanding medical environment. PAs in Taiwan are not governed by laws and regulations, and the absence of legislation to define their roles and responsibilities can lead to confusion in the work environment and potential communication barriers with coworkers and supervising physicians. The purpose of this exploratory study was to examine the environmental and sociodemographic factors that influence job satisfaction and job-related communication among PAs in Taiwan. The data source, a self-administered mail survey, was sent to 196 PAs working within medical facilities in northern, central, and southern Taiwan. The response rate to the survey was 71.01%. There was a strong correlation between communication satisfaction and job satisfaction among respondents. The PAs' overall position in the hospital, relationships with coworkers (doctors, nurses, and other medical staff), and ability to perform his or her duties while working with the supervising physician were the major environmental factors that influenced job and communication satisfaction. In addition, the number of working years and marital status were important demographic factors influencing job satisfaction. Demographic and environmental factors influencing job satisfaction are analyzed, and ways in which the roles and responsibilities of PAs can be clarified, strengthened, and improved are discussed in an overall effort to provide management strategies for the current PA system in Taiwan.

Adult↗
PubMed2006

Patient-physician communication in the context of persistent pain: validation of a modified version of the patients' Perceived Involvement in Care Scale.

The purpose of this study was to evaluate the psychometric properties of a modified version of the Perceived Involvement in Care Scale (M-PICS), a measure designed to assess pain patients' perceptions of patient health care provider communication during the medical consultation. Eighty-seven breast cancer outpatients with persistent pain completed a battery of questionnaires, including the M-PICS. A factor analysis supported four factors. Factor 1 reflected health care provider information behaviors; Factor 2, health care provider facilitation of patient involvement; Factor 3, patient information provision; and Factor 4, patient participation in decision making. The M-PICS total had an internal consistency of 0.87; alphas for subscales ranged from 0.80 to 0.90. M-PICS scores related to measures of patient characteristics and outcomes, including pain-related communication barriers, psychological status, quality of life, and health care satisfaction, in predicted ways. The M-PICS is a reliable and valid measure of perceived patient-provider communication in the context of persistent pain.

Adult↗
PubMed1997

Interviewing adolescents.

Incorporating a functional approach within the traditional structure of the medical interview allows for improved communication with adolescent patients. Using these techniques results in improved patient satisfaction, more accurate psychosocial diagnosis, and better adherence to treatment recommendations. Many physicians think that using patient-centered interviewing techniques is time-consuming and inefficient, but, in fact, a higher quality and quantity of information usually is obtained per unit time using these techniques. An additional benefit is that this approach is more satisfying for the physician; the enhancement of the therapeutic relationship works both ways. Adolescents become more interesting as people; communication barriers become challenges to be creatively solved rather than annoyances to complain about. Adolescents need and deserve high-quality health care to grow into physically and mentally healthy adults, and effective physician-patient communication skills are the key to delivering that care.

Adolescent↗
PubMed2002

Using the Internet to develop an international learning community of pharmacists.

Until recent years, the level of interaction across a profession, necessary to provide for an optimum learning environment which supports professional development, has only been significantly possible in face-to-face interaction and has therefore been place and time dependent. With the explosive development of the internet, communication barriers are breaking down and international interaction, networking and collaboration is becoming increasingly possible. This short report describes the manner in which an Internet-based postgraduate study programme, entitled "Enhancing Pharmacy Practice" has made use of these communication opportunities to develop an international learning community of pharmacists. Programme evaluation data collected from surveys completed online by participants and content analysis of online discussion groups during the first four modules of the programme, demonstrates that there is a high level of interaction amongst participants. It also suggests that this interaction has contributed to the learning experience and professional growth of the participants and impacted positively upon their practice.

Cooperative Behavior↗
PubMedDate not supplied

Communicating to promote justice in the modern health care system.

The systemic prejudices and biases that often limit the effectiveness of health care delivery are examined. How the inherent imbalance in control between consumers and providers of health care, based on the micropolitics of sharing relevant health information, perpetuates a system of marginalization and alienation within health care delivery systems is discussed. Communication barriers that often confront many stigmatized groups of health care consumers, such as the poor, people with AIDS, minorities, the ill elderly, and women, are identified. Such prejudicial treatment is framed within a cultural ideologies model, leading to identification of communication strategies for promoting justice in the modern health care system and enhancing the quality of health care delivery.

Aged↗
PubMedDate not supplied

Improving the nurse-patient relationship: a multi-faceted approach.

AIM: A Corporate Education Session was held to provide concrete strategies for overcoming several specific barriers in the daily nurse-patient relationship that negatively affect the patient, nurse, or both, and to provide the latest information about best practice as it affects nurses in renal care. METHODOLOGY: The session was led by a moderator who presented three video case studies to the audience. Communication strategies for recognising and overcoming nurse-patient communication barriers were presented. The audience expressed their views about each case study using voting pads, and a panel of experts addressed the comments of the audience and discussed guidelines for best practice in renal care. The panel comprised three experienced renal nurses, a senior nephrologist, and an expert in social interaction. CONCLUSIONS: Optimal treatment of patients with renal disease should include early treatment of anaemia, adequate levels of dialysis, and a multidisciplinary approach, responding to both the medical and the social needs of the patient.

Aged↗
PubMedDate not supplied

Parent-adolescent communication about sex in Filipino American families: a demonstration of community-based participatory research.

OBJECTIVES: Pregnancy rates among Filipino American adolescents exceed those of other Asian and Pacific Islander adolescents. Strong parent-adolescent communication may promote healthy sexual development and protect against adolescent sexual risk behaviors. We explored communication barriers between Filipino American parents and adolescents. METHODS: Using community-based participatory research (CBPR), we collaborated with Filipino American community leaders, parents, and adolescents to design a focus-group study. Trained bilingual moderators conducted focus groups with 85 Filipino Americans (41 parents and grandparents and 44 adolescents aged 14-18 years) from various neighborhoods in Los Angeles. Sessions were recorded, transcribed, coded, and analyzed for themes. RESULTS: Focus-group participants appeared to divide sex information into 3 categories, which we termed facts, feelings, and values. Adolescents emphasized facts and feelings. Parents and grandparents emphasized facts and values. In general, facts were obtained through school, feelings through friends, and values through parents. The focus groups identified large barriers to value transmission, stemming from adolescent acculturation to the United States. Parents and grandparents felt that values were transmitted best through traditional Filipino respect for parents who often eschewed open discussion. Adolescents believed that open discussion was necessary for value transmission to occur. The result was bilateral withdrawal from family communication about sex. CONCLUSIONS: Our focus groups found that parent-child communication about sex, especially regarding values, was limited. Potential causes included conflicts between Filipino and US beliefs regarding respect for parents and open discussion. Our results raise important questions about the effect of acculturation on sex education for Filipino American adolescents and demonstrate potential advantages of CBPR.

Adolescent↗
PubMed1977

Sociocultural barriers to medical care among Mexican Americans in Texas: a summary report of research conducted by the Southwest Medical Sociology Ad Hoc Committee.

This paper summarizes research findings from members of the Southwest Medical Sociology Ad Hoc Committee concerning sociocultural barriers to medical care among Mexican Americans in Texas. Committee members individually, or in two-person groups, studied a number of factors concerning Mexican-American medical care in Texas such as: 1) mortality, morbidity, and other health status indicators; 2) health manpower and educational needs; 3) political factors impeding economical health care; 4) alienation, familism, and their relationship to utilization of the health services; 5) language and communication barriers; and 6) folk medicine. Findings include documentation that structural alienation of Mexican-Americans from mainstream Anglo-American middle-class society is carried over into their relation with utilization of the health care delivery system; that their emphasis on familism works alternatively to encourage and discourage their seeking access to health care; the language differences serve to perpetuate certain cultural differences that are inimical to health care delivery; and that curanderismo can be seen as complementing other types of health care. The report concludes with a number of recommendations for accomplishing cultural integration that will lead to better care for this segment of the health population.

Communication↗
PubMed1989

Reproductive health of Asian women: a comparative study with hospital and community perspectives.

A comparative study of Asian and non-Asian women's reproductive health was performed. The hospital case notes of 48 Asian and 51 non-Asian women, matched for age, were examined. Asian women had shorter stature, bigger families, booked later for antenatal care, and were less likely to have a cervical smear taken. Of the above, 30 Asian and 24 non-Asian women were interviewed in their homes. Many Asian women had difficulties with the English language and a low literacy rate which gave rise to communication barriers during health care. Their knowledge of procedures and tests such as amniocentesis, self examination of the breast etc. was comparatively low. Fewer Asians attended parent-craft classes or did post-natal exercises. Many disliked, and some refused, vaginal examination by male doctors. Despite equal access, Asian women were less well informed and made lesser use of services. Lack of knowledge and difficulties of communication, rather than negative attitudes, may explain Asian women's lesser use of services and to some extent the poor outcome of pregnancy observed in many studies.

Adult↗
PubMedDate not supplied

The decline and fall of Esperanto: lessons for standards committees.

In 1887, Polish physician Ludovic Zamenhof introduced Esperanto, a simple, easy-to-learn planned language. His goal was to erase communication barriers between ethnic groups by providing them with a politically neutral, culturally free standard language. His ideas received both praise and condemnation from the leaders of his time. Interest in Esperanto peaked in the 1970s but has since faded somewhat. Despite the logical concept and intellectual appeal of a standard language, Esperanto has not evolved into a dominant worldwide language. Instead, English, with all its idiosyncrasies, is closest to an international lingua franca. Like Zamenhof, standards committees in medical informatics have recognized communication chaos and have tried to establish working models, with mixed results. In some cases, previously shunned proprietary systems have become the standard. A proposed standard, no matter how simple, logical, and well designed, may have difficulty displacing an imperfect but functional "real life" system.

History, 19th Century↗