Associations between thin slice ratings of affect and rapport and perceived patient-centeredness in primary care: Comparison of audio and video recordings

OBJECTIVES/SPECIFIC AIMS: To identify areas of variation in primary care clinician responses to secure messaging and to assess the quality of secure messages by clinicians. METHODS/STUDY POPULATION: This mixed-methods study included twenty one primary care clinicians from a Midwestern safety net hospital and Veterans Affairs medical center. Participants were presented with five short clinical vignettes and corresponding secure messages from hypothetical patients and asked to compose responses. Participants were interviewed about their cognitive approach to the responses as well as perspectives on quality of care as related to electronic communications. RESULTS/ANTICIPATED RESULTS: Every participant recalled having patients who misused secure messaging for urgent issues, suggesting the need for more patient education and the possible adverse consequences of overlooked messages. The study also uncovered key differences in several areas, include clinician timeliness, message management, the circumstances in which they would use messaging, and the content of the messages (including patient-centeredness). While participants agreed that messages about clinical issues should not be resolved via secure messaging, there was a lack of consensus regarding emotionally charged messages and messages dealing with medication adjustments. Some participants spoke of the need for more guidance in knowing when best to use secure messaging. “Sometimes,” one physician said, “it feels like we’re just making up [rules for secure messaging].” Although clinician responses were uniformly respectful, the patient-centeredness varied in the use of jargon and social talk, as well as clarity for patients. DISCUSSION/SIGNIFICANCE OF IMPACT: This study revealed variations in provider approaches to secure messaging, and the content of responses. These variations reflect lack of consensus about how care is delivered via secure messaging, and reveal the need for clinician guidance. They also suggest possible negative patient consequences if secure messaging is used ineffectively. The extent to which variations are undesirable remains unknown. Future work will explore the consequences of such variations.

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Empathic Validation in Physician–Patient Communication: An Approach to Conveying Empathy for Problems With Uncertain Solutions

Qualitative Health Research ◽

10.1177/10497323211056312 ◽

2021 ◽

pp. 104973232110563

Author(s):

Caroline K. Tietbohl

Keyword(s):

Older Adults ◽

Primary Care ◽

Conversation Analysis ◽

Communication Strategy ◽

Shared Understanding ◽

Clinical Empathy ◽

Video Recordings ◽

Physician Patient Communication ◽

Patient Responses ◽

Physician Patient

Interest in systematic approaches to improving clinical empathy has increased. However, conceptualizations of empathy are inconsistent and difficult to operationalize. Drawing on video recordings of primary care visits with older adults, I describe one particular communication strategy for conveying empathy—empathic validation. Using conversation analysis, I show that the design of empathic validations and the context in which they are delivered are critical to positive patient responses. Effective empathic validations must (a) demonstrate shared understanding and (b) support the patient’s position. Physicians provided empathic validation when there was no medical solution to offer and within this context, for three purposes: (1) normalizing changes in health, (2) acknowledging individual difficulty, and (3) recognizing actions or choices. Empathic validation is a useful approach because it does not rely on patients’ ability to create an “empathic opportunity” and has particular relevance for older adults.

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Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary Care

Applied Clinical Informatics ◽

10.4338/aci-2012-10-ra-0048 ◽

2013 ◽

Vol 04 (01) ◽

pp. 75-87 ◽

Cited By ~ 11

Author(s):

V. Voncken-Brewster ◽

C.B. Aspy ◽

J.W. Mold ◽

Z.J. Nagykaldi

Keyword(s):

Primary Care ◽

Health Risk ◽

Intervention Group ◽

Preventive Services ◽

Health And Wellness ◽

Patient Centeredness ◽

Web Based ◽

Health Risk Appraisal ◽

Care Practices ◽

Primary Care Practices

SummaryObjectives: Health Risk Appraisals (HRAs) have been implemented in a variety of settings, however few studies have examined the impact of computerized HRAs systematically in primary care. The study aimed at the development and pilot testing of a novel, comprehensive HRA tool in primary care practices.Methods: We designed, implemented and pilot tested a novel, web-based HRA tool in four pair-matched intervention and control primary care practices (N = 200). Outcomes were measured before and 12 months after the intervention using the HRA, patient surveys, and qualitative feedback. Intervention patients received detailed feedback from the HRA and they were encouraged to discuss the HRA report at their next wellness visit in order to develop a personalized wellness plan.Results: Estimated life expectancy and its derivatives, including Real Age and Wellness Score were significantly impacted by the HRA implementation (P<0.001). The overall rate of 10 preventive maneuvers improved by 4.2% in the intervention group vs. control (P = 0.001). The HRA improved the patient-centeredness of care, measured by the CAHPS PCC-10 survey (P = 0.05). HRA use was strongly associated with better self-rated overall health (OR = 4.94; 95% CI, 3.85–6.36) and improved up-to-dateness for preventive services (OR = 1.22; 95% CI, 1.12–1.32). A generalized linear model suggested that increase in Wellness Score was associated with improvements in patient-centeredness of care, up-to-dateness for preventive services and being in the intervention group (all P<0.03). Patients were satisfied with their HRA-experience, found the HRA report relevant and motivating and thought that it increased their health awareness. Clinicians emphasized that the HRA tool helped them and their patients converge on high-impact, evidence-based preventive measures.Conclusions: Despite study limitations, results suggest that a comprehensive, web-based, and goal-directed HRA tool can improve the receipt of preventive services, patient-centeredness of care, behavioral health outcomes, and various wellness indicators in primary care settings.Citation: Nagykaldi ZJ, Voncken-Brewster V, Aspy CB, Mold JW. Novel Computerized Health Risk Appraisal May Improve Longitudinal Health and Wellness in Primary Care. Appl Clin Inf 2013; 4: 75–87http://dx.doi.org/10.4338/ACI-2012-10-RA-0048

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Patient–Provider Relationships Among Vulnerable Patients: The Association With Health Literacy, Continuity of Care, and Self-Rated Health

Journal of Patient Experience ◽

10.1177/2374373519895680 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1450-1457

Author(s):

Akiko Kamimura ◽

Rebecca Higham ◽

Naveen Rathi ◽

Samin Panahi ◽

Edward Lee ◽

...

Keyword(s):

Primary Care ◽

Health Literacy ◽

Continuity Of Care ◽

Underserved Populations ◽

The United States ◽

Medical Provider ◽

Patient Centeredness ◽

Self Rated Health ◽

Vulnerable Patients ◽

Primary Care Patients

While the patient–provider relationship is one factor that can improve access to primary care for underserved populations, vulnerable patients often experience challenges to have a good relationship with providers. The purpose of this study is to examine factors that affect patient–provider relationship among vulnerable patients; in particular, among uninsured primary care patients. This study focused on health literacy, continuity of care, and self-rated health as predictors of patient–provider relationship. A self-administered survey was collected from uninsured primary care patients utilizing a free clinic in the metropolitan area in the Rocky Mountain Region in the United States from May to July in 2018. Higher levels of health literacy and continuity of care are associated with a better patient–provider relationship. Better self-rated health is associated with better patient–provider relationship. Health literacy may improve by the communication and connection with a specific provider because patients better understand the care and/or medications that are being prescribed. Seeing the same provider helps patients develop a better relationship and make clinical decisions in a way that they prefer. Improving the patient–provider relationship can potentially change health outcomes positively for vulnerable patients. Informing patients that they can request a specific medical provider may allow them to increase continuity of care, and improve communication, partnering, connection, and patient centeredness, leading to an increase in health literacy and better self-rated health.

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The Power of Non-Verbal Communication: Predicting Job Performance by Means of Thin Slices of Non-Verbal Behaviour

South African Journal of Psychology ◽

10.1177/008124630503500212 ◽

2005 ◽

Vol 35 (2) ◽

pp. 362-383 ◽

Cited By ~ 3

Author(s):

Deléne Visser ◽

John D. L. Matthews

Keyword(s):

Job Performance ◽

Selection Method ◽

Verbal Communication ◽

Effect Sizes ◽

Call Centre ◽

Thin Slice ◽

Video Recordings ◽

Verbal Behaviour ◽

Audio Channel ◽

Thin Slices

The purpose of the study was to investigate whether ratings of brief exposures to ‘non-verbal’ and ‘non-verbal plus verbal’ behaviour could successfully predict on-the-job performance in a call centre. A panel often judges who were exposed to 30-second silent video recordings of 29 call centre operators carrying out their jobs were asked to rate the non-verbal behaviour of the operators on several dimensions. Two weeks later they were asked to repeat their judgments with the audio channel included. The judgments were correlated with management ratings and customer ratings of the operators' performance. The correlations varied between 0.31 and 0.46, representing medium to large effect sizes. The inclusion of the verbal channel did not significantly improve the accuracy of the thin-slice judgments of non-verbal behaviour. The implications of using ratings of non-verbal behaviour as a selection method were discussed.

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Development and validation of the patient centeredness index for primary care

Journal of Clinical Nursing ◽

10.1111/jocn.16177 ◽

2022 ◽

Author(s):

Gail L. Rose ◽

Levi N. Bonnell ◽

Jennifer B. O'Rourke‐Lavoie ◽

Constance Eeghen ◽

Paula Reynolds ◽

...

Keyword(s):

Primary Care ◽

Patient Centeredness ◽

Development And Validation

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Patient centeredness: The perspectives of uninsured primary care patients in the United States

International Journal of Care Coordination ◽

10.1177/2053434519836424 ◽

2019 ◽

Vol 22 (1) ◽

pp. 19-26 ◽

Cited By ~ 2

Author(s):

Akiko Kamimura ◽

Shannon Weaver ◽

Bianca Armenta ◽

Bethany Gull ◽

Jeanie Ashby

Keyword(s):

United States ◽

Primary Care ◽

Health Outcomes ◽

Patient Involvement ◽

The United States ◽

Patient Centered Care ◽

Patient Centeredness ◽

Patient Centered ◽

Centered Care ◽

Primary Care Patients

Introduction Patient-centered care has become increasingly important within the United States (US) healthcare system. Given that patient-centered care predicts patient satisfaction, health outcomes, and cost-effectiveness, it is of the utmost importance to study patient-centered care from the perspectives of marginalized populations including minorities, immigrants, and other underserved populations. The purpose of this study is to examine factors that affect underserved primary care patients’ perceptions of patient centeredness. Methods The data were cross-sectional and collected in Fall 2016. Free clinic patients (N = 723) completed a self-administered survey, which measures patient centeredness, patient involvement in care, and clinical empathy. Validated measures were part of the survey, and the internal consistency of scales was tested. The general linear model was performed to predict factors associated with patients’ perceptions of patient centeredness. Results Higher levels of perceived patient involvement in care and higher levels of perceived empathy in consultation are related to higher levels of patient centeredness. While better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not. Conclusions Patients’ perceptions of involvement and empathy are important factors for patient-centered care, although this study did not show causal directions among variables. Based on the findings of this study, it is recommended that future studies should focus on the following three points: (1) to develop and evaluate trainings for providers, (2) develop education classes for patients who utilize free clinics, (3) analyze how these programs affect patient-centered care and health outcomes.

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