Assessing Physician-Patient Communication and Shared Decision-making Skills in IBD Patient Care: ACG/AstraZeneca Fellow Award: Presidential Poster

Background The ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data. Objective To examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings. Methods Variance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions “shared decision making”, “effective and open communication” and “satisfaction” were considered. Results Physician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians’ communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error). Conclusion The ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.

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Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine ◽

10.1093/jmp/jhaa032 ◽

2020 ◽

Author(s):

Paul Muleli Kioko ◽

Pablo Requena Meana

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Patient Autonomy ◽

Intellectual Ability ◽

Medical Decision ◽

Shared Decision ◽

Physician Patient Relationship ◽

Good Healing ◽

The Right ◽

Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

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Disparity in Physician-Patient Communication by Ethnicity: Evidence from Bangladesh

10.21203/rs.3.rs-91474/v1 ◽

2020 ◽

Author(s):

Muhammad Zakaria ◽

Rezaul Karim ◽

Murshida Rahman ◽

Feng Cheng ◽

Junfang Xu

Keyword(s):

Decision Making ◽

Linear Regression ◽

Ethnic Minority ◽

Health Problem ◽

Patient Communication ◽

Medical Consultation ◽

Medical Decision ◽

Medical Consultations ◽

Physician Patient Communication ◽

Physician Patient

Abstract Background: Physician-patient communication is the primary process by which medical decision-making occurs and health outcome depends. Physician-patient communication differences may partly from the ethnic disparities. To examine this problem, this study aims to explore whether physician-patient communication differs by ethnic in primary care medical consultations. Methods: The study was conducted among the Bengali and ethnic minority patients (N = 850) who visited the physician for medical consultations. Data were collected using a structured post-consultation questionnaire. T-test was conducted to compare the communication between the Bengali and ethnic minority patients. Multiple linear regression analyses were performed to identify the factors associated with favorable communication behavior from the physicians. Results: Bengali patients received more supportive communication behaviors from the Bengali doctors than that of ethnic minority patients including physicians’ cheerful greetings, encouraging patients to express health problems and asking questions, listening carefully, responding to the questions and concerns, explaining the patients about a medical test, medication, and probable side effects, discussing the treatment options, involved the patients in decisions and spending adequate time. Results of linear regression explored that respondents’ education year, internet use, knowledge on the health problem, having a pre-plan about the content of medical consultation, information seeking about the health problem, visiting female doctors, and quiet ambience of the doctor’s room are significantly associated with better PPCB score for the Bengali patients. In contrast, age, being the resident of an urban area, perception of affecting a minor health problem, having a pre-plan about the content of medical consultation, patients’ involvement in physicians’ decision-making about the treatment, and talking time resulted in better physician-patient communication for the ethnic minority patients. Conclusion: This study suggests for reducing the disparity in the socio-economic status of the ethnic minority people through development program and teaching healthcare providers how to use patient-centered communication skills to engage their patients is one solution to improve equity in the delivery of healthcare and make sure patients are receiving high-quality treatment, no matter their race or ethnicity.

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Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

Irish Journal of Paramedicine ◽

10.32378/ijp.v3i2.145 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

Eamonn Byrne ◽

Sasha Selby ◽

Paul Gallen ◽

Alan Watts

Keyword(s):

Decision Making ◽

Patient Care ◽

Shared Decision Making ◽

Vital Signs ◽

Ambulance Service ◽

Guidance Document ◽

Shared Decision ◽

Clinical Guidance ◽

Decision Making Model

IntroductionEvery patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.AimFor patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.MethodsAll NAS incidents closed with a refusal of treatment or transport, from 1st Jan 2017 to 9th November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.Results31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.ConclusionClinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.

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