A Patient-centered Approach to Breaking Bad News: Communication Guidelines for Health Care Providers

Miscarriage is one of the most common pregnancy complications health care providers discuss with patients. Previous research suggests that women’s distress is compounded by ineffective communication with providers, who are usually not trained to deliver bad news using patient-centered dialogue. The purpose of this study was to use a patient-centered approach to examine women’s experiences with and perspectives of communication during a miscarriage to assist in the development of communication training tools for health care providers. During focus groups, 22 women who had experienced miscarriage discussed video-recorded standardized patient-provider interactions and recalled communication during their own miscarriages. Results of a pragmatic iterative analysis of the transcripts suggest training techniques and communication behaviors that should guide education for providers to deliver the diagnosis of and treatment options for early pregnancy loss, such as demonstrating empathy, creating space for processing, checking for understanding, and avoiding medical jargon and emotionally charged language.

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How to deliver bad news to me? Suggestions for preparing Muslim patients before breaking bad news

Clinical Ethics ◽

10.1177/1477750920959545 ◽

2020 ◽

pp. 147775092095954

Author(s):

Akram Sadat Sadat Hoseini

Keyword(s):

Health Care Providers ◽

Human Growth ◽

Bad News ◽

Spiritual Needs ◽

Breaking Bad News ◽

Family Needs ◽

Care Providers ◽

Breaking Bad ◽

Different Cultures ◽

Delivering Bad News

There are several models for delivering bad news, the most important and widely used being the SPIKES protocol. Cultural differences in breaking bad news in different societies with different cultures call for special attention. Muslim societies are examples of communities with special cultural and religious requirements. Then, when collecting information about a person's perception of the illness or the incident, consider his or her view of spirituality and the effect of calamities on human transcendence so as to assess the type and amount of information the patient or the family needs. When preparing a suitable setting for delivering bad news, pay attention to the spiritual needs of Muslims such as the possibility of prostration, recitation of Qur'an, and talking to God in private or even aloud. Be aware of, pay attention to, and respect particular religious views of the patient, and if necessary, correctly exploit such views to deliver bad news. Although some Muslim patients may have no demands for transcendence and human growth at the first stage, but over time and after accepting the condition, they will have demands. Therefore, health care providers must provide the necessary facilities for Muslim patients in terms of the required information, setting, and people present in the setting and provide information appropriate to the culture of these patients so as to give an excellent and comprehensive care.

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Interdisciplinary Therapy Assessments for the Older Adult

Perspectives on Gerontology ◽

10.1044/gero17.1.11 ◽

2012 ◽

Vol 17 (1) ◽

pp. 11-16

Author(s):

Lynn Chatfield ◽

Sandra Christos ◽

Michael McGregor

Keyword(s):

Older Adults ◽

Health Care ◽

Standardized Testing ◽

Health Care Providers ◽

Outcome Measurement ◽

Care Providers ◽

Patient Centered ◽

Screening Process ◽

Evidenced Based ◽

Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

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Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

Qualitative Health Research ◽

10.1177/10497323211003861 ◽

2021 ◽

pp. 104973232110038

Author(s):

Cecilie Fromholt Olsen ◽

Astrid Bergland ◽

Jonas Debesay ◽

Asta Bye ◽

Anne Gudrun Langaas

Keyword(s):

Health Care ◽

Older People ◽

Health Care Providers ◽

Transitional Care ◽

Care Pathway ◽

Patient Flow ◽

Care Pathways ◽

Care Providers ◽

Patient Centered ◽

Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

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Consent, Refusal, and Waivers in Patient-Centered Dysphagia Care: Using Law, Ethics, and Evidence to Guide Clinical Practice

American Journal of Speech-Language Pathology ◽

10.1044/2016_ajslp-15-0041 ◽

2016 ◽

Vol 25 (4) ◽

pp. 453-469 ◽

Cited By ~ 8

Author(s):

Jennifer Horner ◽

Maria Modayil ◽

Laura Roche Chapman ◽

An Dinh

Keyword(s):

Health Care ◽

Public Policy ◽

Clinical Practice ◽

Health Care Providers ◽

Clinical Decision Making ◽

Clinical Decision ◽

Care Providers ◽

Patient Centered ◽

Legal Advice ◽

Medical Context

PurposeWhen patients refuse medical or rehabilitation procedures, waivers of liability have been used to bar future lawsuits. The purpose of this tutorial is to review the myriad issues surrounding consent, refusal, and waivers. The larger goal is to invigorate clinical practice by providing clinicians with knowledge of ethics and law. This tutorial is for educational purposes only and does not constitute legal advice.MethodThe authors use a hypothetical case of a “noncompliant” individual under the care of an interdisciplinary neurorehabilitation team to illuminate the ethical and legal features of the patient–practitioner relationship; the elements of clinical decision-making capacity; the duty of disclosure and the right of informed consent or informed refusal; and the relationship among noncompliance, defensive practices, and iatrogenic harm. We explore the legal question of whether waivers of liability in the medical context are enforceable or unenforceable as a matter of public policy.ConclusionsSpeech-language pathologists, among other health care providers, have fiduciary and other ethical and legal obligations to patients. Because waivers try to shift liability for substandard care from health care providers to patients, courts usually find waivers of liability in the medical context unenforceable as a matter of public policy.

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Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.002 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Victor Okunrintemi ◽

Erica Spatz ◽

Joseph Salami ◽

Haider Warraich ◽

Salim Virani ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Medical Expenditure Panel Survey ◽

Medical Expenditure ◽

Atherosclerotic Cardiovascular Disease ◽

Care Providers ◽

Patient Centered ◽

Patient Reported ◽

Centered Care ◽

Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

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Instilling the core concept of inter professional education

Health Renaissance ◽

10.3126/hren.v9i3.5591 ◽

1970 ◽

Vol 9 (3) ◽

pp. 201-206

Author(s):

S Bhattacharya ◽

SK Bhattacharya ◽

AP Gautam

Keyword(s):

Health Care ◽

Health Professional ◽

Health Care Providers ◽

Professional Education ◽

Care Delivery ◽

Care Providers ◽

Patient Centered ◽

Innovative Teaching ◽

Centered Care ◽

Teaching Learning

The Inter Professional Education (IPE) is an innovative teaching learning intervention in Health Professions’ Education during which members of more than one health profession learn interactively together to improve collaborative practice and/health of the patients. Thus this approach provides positive outcomes for students enhancing their awareness towards other professional groups, improving knowledge and understanding of how to work in an inter professional team and strengthening their communication and collaboration skills. Within the hierarchical nature of many clinical settings, the aims of IPE courses intersect with socialization of health professional (HP) students into roles of responsibility and authority. The IPE in HP courses emphasizes the practice of frequent high quality communication, strong relationships and partnerships among health care providers to maximize the quality of care thus improving the efficiency of care thereby improving clinical outcomes. Health Professional Schools are this motivated to opt for inter professional education to improve the learning of the students, health care delivery and patient outcomes. Keywords: Inter professional relations; patient centered care; education DOI: http://dx.doi.org/10.3126/hren.v9i3.5591 HR 2011; 9(3): 201-206

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Perceptions of Health Care Providers' Communication: Relationships Between Patient-Centered Communication and Satisfaction

Health Communication ◽

10.1207/s15327027hc1603_6 ◽

2004 ◽

Vol 16 (3) ◽

pp. 363-384 ◽

Cited By ~ 157

Author(s):

Melissa Bekelja Wanzer ◽

Melanie Booth-Butterfield ◽

Kelly Gruber

Keyword(s):

Health Care ◽

Health Care Providers ◽

Care Providers ◽

Patient Centered

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A Consensus-Based Set of Measures for Oral Health Care

Journal of Dental Research ◽

10.1177/0022034517702331 ◽

2017 ◽

Vol 96 (8) ◽

pp. 881-887 ◽

Cited By ~ 10

Author(s):

F. Baâdoudi ◽

A. Trescher ◽

D. Duijster ◽

N. Maskrey ◽

F. Gabel ◽

...

Keyword(s):

Health Care ◽

Oral Health ◽

Health Care Providers ◽

Health Care Systems ◽

Routine Data ◽

Oral Health Care ◽

Care Providers ◽

Patient Centered ◽

Dental Practitioners ◽

Care Systems

Increasingly more responsive and accountable health care systems are demanded, which is characterized by transparency and explicit demonstration of competence by health care providers and the systems in which they work. This study aimed to establish measures of oral health for transparent and explicit reporting of routine data to facilitate more patient-centered and prevention-oriented oral health care. To accomplish this, an intermediate objective was to develop a comprehensive list of topics that a range of stakeholders would perceive as valid, important, and relevant for describing oral health and oral health care. A 4-stage approach was used to develop the list of topics: 1) scoping of literature and its appraisal, 2) a meeting of experts, 3) a 2-stage Delphi process (online), and 4) a World Café discussion. The aim was to create consensus through structured conversations via a range of stakeholders (general dental practitioners, patients, insurers, and policy makers) from the Netherlands, Germany, the United Kingdom, Ireland, Hungary, and Denmark. The study was part of the ADVOCATE project, and it resulted in a list of 48 topics grouped into 6 clusters: 1) access to dental care, 2) symptoms and diagnosis, 3) health behaviors, 4) oral treatments, 5) oral prevention, and 6) patient perception. All topics can be measured, as they all have a data source with defined numerators and denominators. This study is the first to establish a comprehensive and multiple-stakeholder consented topic list designed for guiding the implementation of transparent and explicit measurement of routine data of oral health and oral health care. Successful measurement within oral health care systems is essential to facilitate learning from variation in practice and outcomes within and among systems, and it potentiates improvement toward more patient-centered and prevention-oriented oral health care.

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