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The purpose of this study was to describe the impact of COVID-19 on fatherhood experiences during pregnancy. A semi-structured interview guide was developed to collect qualitative data from fathers about their experiences in pregnancy and prenatal care, how they communicated with providers, strategies for information seeking, and social support they received during the pregnancy. One-time, virtual interviews were conducted via Zoom with fathers that were either expecting a baby or fathers who had a baby after March 2020 and were 18 years or older. Thematic analysis was used to identify themes that highlighted the fatherhood experience. In total, 34 interviews with new or expectant fathers were completed. Two central themes that highlight the experiences of fathers: missed opportunities to shift toward family-centered care and inequity in the parent dyad during pregnancy. Additional supporting themes included: limited patient-provider relationship, lack of telemedicine use, inadequate uncertainty management for parents, unidirectional information sharing between parents, and limited opportunities for achieving role attainment during pregnancy. The COVID-19 pandemic created a decision point for prenatal care. Instead of focusing on family-centered practices, prenatal care exclusively centered on the mother and fetus, resulting in problematic experiences for fathers including limited access to information about the pregnancy and health of the mother and fetus, heightened stress related to COVID-19 safety requirements, and few opportunities to attain their role as a father. Prenatal care should actively seek robust strategies to improve family-centered care practices that will withstand the next public health emergency. [ABSTRACT FROM AUTHOR]

The rapidly growing racially diverse ageing population in the United States presents unique challenges for the country's social, economic, and healthcare systems. Rising health care costs, increased patient cost-sharing, and limited financial resources make this generation of older Americans susceptible to large medical bills or debt, which disproportionally impacts older adults who are from racial/ethnic minority communities. Cost of care (CoC) conversations between patients and healthcare providers is one recommended approach for containing healthcare costs and alleviating patients' financial burden of care. The current study used focus group methods to qualitatively explore the contextual factors that influence CoC conversations in a diverse sample of older adults (N = 27). Three focus groups were held with non-Hispanic White (n = 10), Black/African American (n = 9), and Hispanic (n = 8) participants. Thematic analysis yielded four broad themes. The results suggest that CoC conversations do not occur with physicians. The facilitators of CoC conversations included positive provider affect, rapport/relationship building, and communication. Barriers included lack of physician training, wait time, lack of focus on the patient, language, provider preferences, fear of physicians, and religion. There were significant differences in the facilitators and barriers across racial/ethnic groups. It is critical for physicians to have the tools and training to successfully discuss CoC with older patients. Cultural competency training and provider awareness of patient preferences and expectations may be important when it comes to enhancing rapport and increase the likelihood of these important conversations within racial/ethnic minority communities. [ABSTRACT FROM AUTHOR]

This qualitative study examines women's experiences with risk information exchange during their pregnancy. Semi-structured interviews were conducted with 15 women (aged 25–38) from September 2018 to February 2019. A non-random purposive sample of women who had given birth in the past year was invited to participate in the study. Women were invited by reaching out to personal contacts as well as through sending out a bulk institutional email, posting on mothers' Facebook groups' pages, and by giving out flyers to OB/mid-wife offices. The women represent an educated sample, and nearly half of the participants reported experiencing complications. Thematic analysis was conducted, with researchers individually engaging in open coding, and then collectively engaging in selective coding across multiple analysis sessions. Thematic analysis showed that all the women had different information preferences. Women who had a prior history of pregnancy risk reported engaging in active information seeking. All of the women in this study felt that information was withheld from them, with the exception of information about C-sections, birth plans, and genetic testing. Some women also reported that information was withheld from them when complications occurred during the pregnancy. Lastly, the data illustrate a need for verifying underlying emotions during information exchange as noted by all women. Women in this study reported varying preferences for information exchange. The women reported unmet information needs. The women highlight the need for providers to attend to emotions during information exchange. [ABSTRACT FROM AUTHOR]

Background: In psychiatric care, doctors depend on information from interactions with patients to arrive at the right diagnosis and appropriate therapy (Brisset C, Leanza Y, Rosenberg E, Vissandjée B, Kirmayer LJ, Muckle G, et al. language barriers in mental health care: a survey of primary care practitioners. J Immigr Minor Health. 2014;16(6):1238–46). This is a qualitative descriptive study which seeks to investigate language barriers faced by psychiatrists in their interactions with patients and the effectiveness of the strategies which are employed to deal with the barriers. Methods: Research questions are informed by Convergence (Giles H. Communication Accommodation Theory. In: Baxter LA, Braithewaite DO, editors. Engaging theories in interpersonal communication: multiple perspectives. Thousand Oaks (CA): Sage Publications; 2008. p. 161–73). Using semi-structured interviews, psychiatric doctors from the three state-owned psychiatric hospitals in Ghana report their experiences with convergence strategies they use, and offer suggestions that could inform future studies and policy formulation with regard to psychiatric care in Ghana. A qualitative conventional content analysis was applied whereby coding categories were derived straight from the text data. Results: The literature suggests that the study is novel with reference to Ghana. Similar studies (Lee E. Cross-cultural communication: therapeutic use of interpreters in mental health for professionals and clinicians. In: Lee E, editor. Working with Asian Americans: a guide for clinicians. New York (NY): The Guilford Press; 1997; Swartz L, Drennan G. Beyond Words: notes on the 'irrelevance' of language to mental health services in South Africa. Transcult Psychiatry. 2000;37(2):185–201; Jarvis GE, Ahmed R, Ryder A, Kirmayer LJ. Assessing language barriers to mental health services in a multiethnic population: preliminary findings. Presentation at Health care Access for Linguistic Minorities: Breaking the Barriers. Montreal, Quebec, Canada; 2014) corroborate this paper's findings that language barriers have the potential of causing misdiagnoses if psychiatrists do not employ effective communication strategies. Conclusions: The paper recommends areas for further research and improvement measures which carry policy implications. [ABSTRACT FROM AUTHOR]

Background: Good physician-patient communication is an important aspect of patient-centered care and contributes to positive health outcomes, however, there is a lack of standard European Union (EU) communication training policies for physicians. This study explores the barriers to good communication for both physicians and patients across four EU countries as part of the EU-funded project, Health Communication Training for Health Professionals – H-COM. Method: Focus groups were conducted with 31 patients and 38 physicians from Germany, Greece, Spain, and Cyprus. Two separate discussion guides were constructed for each target group around three themes: perceptions of, barriers to, and needs for health communication. Thematic analysis was used. Results: Commonalities and differences between countries and target groups were identified, with participants discussing attitudinal, emotional, educational, and systemic barriers to good communication. Participants indicated a significant gap in health communication knowledge, skills, and training for physicians, with regional differences. Conclusion: The results imply that there is a need for EU-wide communication training for physicians that would be best addressed by common themes and tailoring to specific regional differences. The results also imply that effective training should encompass a blend of theory and practical methods, and should be delivered via an e-learning platform for maximum accessibility. Training programs that adhere to these suggestions can begin to address the gaps in patient-centered care in the EU. [ABSTRACT FROM AUTHOR]

Background: Electronic Health Records (EHR) can help create patient ownership of information, enhance patient-centered collaborative advising, and increase advice utilization through increases in trust and memory of the information. Using research from advice and collaborative decision-making, we theorized about how doctors' screen sharing EHR during an appointment should be beneficial. Method: Thirteen doctors were interviewed about their perception and experience with screen sharing EHR with patients. Two coders, who are experts in collaborative decision-making, developed nine categories and then independently coded each interview. Results: Doctors reported using screen sharing for repetition and increased recollection of doctor instructions. They reported that screen sharing increased collaborative decision-making and trust, promoted a common ground between the doctor and patient, and helped validate and create ownership of the information for patients. Doctors noted using screen sharing more for younger patients, who they perceived as expecting more use of technology, and new patients, to help increase trust. Further, doctors were more likely to share information they perceived that patients could understand, rather than complex information. Finally, doctors reported problems with screen sharing, like patients seeing sensitive information. Conclusions: Doctor responses support previous research about the benefits of shared information for trusting information and utilizing advice. [ABSTRACT FROM AUTHOR]

Purpose: We explored how primary care providers perceive their interactions with low-income African American patients at two inner-city health clinics. Background: Drawing from theories of empowerment and community development, we asked what types of communication strategies health care providers consider crucial for creating/maintaining empowered low-income African American patients. Method: We conducted twelve in-depth interviews and performed data analysis to identify recurring themes and report them within the scope of the qualitative nature of the current data. Results: Healthcare providers reported that they are fully aware of and actively use the patient-centered/collaborative strategies identified in the literature. They expressed their desire/willingness to work with their patients as partners in patient health management/improvement rather than simply instructing them. They also prefer highly motivated patients to improve their own health outcomes. Conclusion: Overall findings suggest providers, working in inner-city health clinics, understand and use accommodating/collaborating and patient-centered strategies daily to empower their low-income African American patients. [ABSTRACT FROM AUTHOR]

Background: As changing guidelines for cervical cancer detection incorporate more human papillomavirus (HPV) testing along with Papanicolaou (Pap) smear testing (‘co-testing’) in clinical practice, there is a need to evaluate patient understanding of these two tests. Methods: Thirty women (mean age = 27.8 years; 90% African-American) with low SEC status were recruited for two clinical research visits; a Pap test and cervical HPV test were performed at the first visit and a doctor shared the test results (i.e. Pap and HPV test) at the second. Then, a semi-structured interview focused on participants’ recall of the discussion with the provider as well as their general understanding of the tests. Results: Findings revealed participants were familiar with the Pap test and were proactive about receiving the test, despite lacking accurate knowledge about the purpose of the test. On the other hand, when participants expressed confusion and anxiety about the HPV test, patient–provider communication helped to ease some of these concerns. Patients expressed a range of ability in reconciling how the two tests were connected, what the two results meant together, and why both are needed. Conclusion: This qualitative data suggests important gaps in women's understandings of Pap test and HPV test results, especially when used together in a clinical visit. There is a need to address this lack of understanding as the use of co-testing in clinical practice increases. Implications for improved communication strategies between patients and providers about how to share and interpret Pap test and HPV tests results in the clinical setting are discussed. [ABSTRACT FROM AUTHOR]

Many parents experience confusion and anxiety when their infant has an abnormal newborn screening result, especially for the heterozygous 'carrier' results that are typically communicated by primary care providers. The Internet is an important media source for health information, so many organizations have developed websites for parents after newborn screening. Surprisingly, little research has been done on the role that the Internet plays for parents after newborn screening. This qualitative study explored parents' comments about the Internet included in open-ended interviews conducted as part of a larger study of parents after newborn screening identifies carrier status for cystic fibrosis or sickle cell disease. Analysis used emergent theme coding and deductive coding grounded in uses and gratifications theory. Parents reported a variety of motivations for searching, and many parents volunteered that they had searched the Internet despite a physician's recommendation to avoid the Internet in this matter. Parents described several strategies for Internet searching and related a mixture of positive and negative experiences. They also gave suggestions for better communication with healthcare providers regarding the Internet search that could have improved their understanding. The study's results may help to guide providers' discussions after newborn screening so that parents can maximize the benefits of the Internet search and minimize negative experiences. Further research may help to quantitatively describe the Internet experience after newborn screening, and to further understand how media use after newborn screening influences psychosocial outcomes. [ABSTRACT FROM AUTHOR]

Background Stroke is the leading cause of death in Indonesia and correspondingly the prevalence of stroke risk factors is high. Improved risk factor screening along with education and counseling for patients on the behavior changes that they need to make to reduce their stroke risk have the potential to lessen stroke burden. Methods Focus groups were conducted with physicians working in community health centers (puskesmas) in Indonesia to explore physicians' practices with regard to stroke risk screening and patient education to reduce stroke risk. Results Physicians perceive that patients commonly have misconceptions about their stroke risk factors, indicating a need for patient education. Screening and education practices vary considerably among Indonesian primary care physicians, suggesting a need for physicians to improve their patient education and counseling practices. Physicians reported lack of time during appointments, as well as their perceptions of patients' reluctance to modify their behaviors and patients' low level of education as barriers to patient education for stroke prevention. Conclusion Physicians reported knowledge, attitudinal, and health care system barriers that need to be addressed as part of interventions aimed at improving stroke screening and patient education and counseling in this setting. [ABSTRACT FROM AUTHOR]

The Institute of Medicine's list of 100 priority topics for comparative effectiveness research highlights the importance of translating and disseminating medical information to clinicians and consumers. In line with these priorities, the National Heart, Lung, and Blood Institute supported a study of the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in children and adolescents prior to its release. The primary purpose of the study was to identify implementation of the Guidelines and communication barriers among clinicians who see children. The innovative, evidence-based guidelines encompass the development, progression, and management of 14 risk factors from birth through 21 years of age. A growing body of evidence supports the need for active multifaceted dissemination and implementation support strategies to address chronic health problems. This study qualitatively assessed clinician receptivity to guideline implementation and communication of pediatric cardiovascular risk factors to patients and caregivers using a theoretical framework tailored for clinicians. Results indicated that clinicians were generally receptive to the guideline recommendations but were less likely to implement recommendations associated with counseling patients about certain behavioral risk factors (i.e. nutrition and diet; growth, overweight, and obesity; and physical activity). Strategies to enhance or obtain these skills as part of medical training are needed. Recommendations are provided to address the barriers identified by clinicians in the intervention development phase of this research. [ABSTRACT FROM AUTHOR]

Although crying is universally recognized as a sign of distress in adults, its role in assessing and diagnosing depression in medical settings has received little attention. We sought to describe the interactional circumstances surrounding patients who cry during routine periodic health examinations and the subsequent actions of their physicians. Qualitative content analysis of audio-recorded visits and administrative claims data for adult primary care patients for one year before and after an index visit were used to explore the context of patients' crying and how physicians responded. Most patients began to cry while discussing emotional pain over the loss or illness of a loved one. While physicians generally responded with immediate expressions of empathy, the intensity of their responses varied. Some patients received minimal assessment regarding their mental health, whereas others were assessed more extensively. Although most physicians did express empathy in response to patients' tears, some did not systematically assess patients' mental health status and overall functioning. Physicians may want to view crying as a sign of distress and more fully evaluate whether it fits into a more complex clinical presentation of depression. [ABSTRACT FROM AUTHOR]

This research explores the connection between physician talk and patient perceptions of care, respect, and assurance. Using interview methods, this pilot study uncovered key findings related to positive and negative communication acts performed by healthcare providers during cancer diagnosis or treatment phases. Data illustrate that physicians communicated care and respect when they spent time talking with patients at length (or repeatedly). Interviews also show that providers fail to communicate enough information to meet the ethic of significant choice. Finally, exploratory findings indicate that more should be done by healthcare providers to offer social support and financial resources to cancer patients -- as cancer impacts more than just a person's physical body. This project emphasizes improved communication from healthcare workers who discuss diagnosis and treatment with cancer patients. Implications for healthcare explore specific ways that doctors and other health providers can verbally and nonverbally communicate care, information, and resources to cancer sufferers. [ABSTRACT FROM AUTHOR]

Although scientific evidence concerning harms and benefits of direct-to-consumer advertising (DTCA) is constantly growing, there is a paucity of published research focusing on gaining a better understanding of the perceptions and experiences of involved parties. This gap in the literature becomes even more salient when it comes to the indirect target audiences of DTCA, such as healthcare providers. This study explores American physician perceptions of prescription drug advertising, while elucidating the perceived impact of DTCA in a US context. Our results suggest that 15 years after the introduction of DTCA, physician concerns about its impact on the doctor-patient relationship persist. Negative effects of DTCA include patient acquiring a false sense of autonomy; requests for unnecessary or more expensive drugs; exaggerated perception of advertised drugs' side effects; as well as additional workload and time commitment. Nevertheless, DTCA is also viewed as a stimulus for 'opening communication opportunities' with the patient. Results of this study can be used to inform the dialogue not only in the United States, but also in other countries where efforts are being made to reduce restrictions on DTCA. [ABSTRACT FROM AUTHOR]

Doctors frequently encounter patients who fail to follow advice. Living in a knowledge-based society, patients are now more critical about the information they receive from their doctors, because they have more access to resources with health information. Patient compliance is important, however, to guarantee better health outcomes. This study uses clinical examples to describe the many ways in which doctors influence their patients' behaviors or decisions. Simultaneously, this study looks at how patients execute persuasion and how they assert themselves in response to doctors' persuasive strategies. Results showed that doctors often present medical information selectively and use authority to persuade patients. They also employ the marker of inevitability to create an obligation and adopt the marker of conditional inevitability to stress the desirability of their advice. Patients, in contrast, often present information selectively and change topics during the course of persuasion. Given these tendencies, this study argues that no strategy can guarantee the success of a persuasive discourse and that successful persuasion does not always occur with just one effort. This study argues that even if persuasion is unsuccessful initially, it is important for the participants to keep the discussion open and effective, which might enhances future compliance. [ABSTRACT FROM AUTHOR]

Intrigued by developments in aesthetic surgery and minimally invasive applications, and an accompanying increase in demand for these procedures, this study attempts to understand patients' decision-making processes by employing the affect-behavior-cognition (ABC) model. Affect stands for the feelings, whereas behavior stands for patient behavior towards the surgery and the physician, and the cognition stands for related thoughts. The assumption in this paper is that patients with different physical, social, and psychological 'needs' have different orientations towards the specific service and toward the physician. Qualitative data collection methods are employed to understand underlying thoughts and feelings. Interviews are conducted with 30 different individuals. Results indicate three groups of patients who follow different processes, specifically CAB (patients with physical problems), CBA (patients without major health concerns), and ABC (patients of minimally invasive procedures). The study also points out, with a conclusive analytical framework, that these patients can be treated as patient-consumers in order for a mutually satisfying, doctor-patient relationship. [ABSTRACT FROM AUTHOR]

One of the oldest goals of the medical profession is to benefit, and do no harm to, the patient. The role of the physician was once a paternal one, with total physician control, and little value given to patient knowledge of their own illness experiences. With changing patient expectations and medical education reform, patient-centeredness has emerged as a dominant ideal in doctor-patient communication. Patient autonomy is increasingly valued. In this changing time of increased patient involvement in medical decision making, how do physicians describe their professional roles/identities? Self-described professional identity is often quite reflective of professional beliefs and practice. The present study offers a qualitative perspective on self-perceived physician professional roles from primary care physicians of three age groups, in their 50s, 40s, and 30s. Younger physicians in the sample expect patients to have the most autonomy and most control over their decision making, while older physicians still expect to have the most control. It is possible that these age-based patterns of physician professional identity reflect an increasingly autonomous patient role and a decreasing role for physician beneficence. Implications and practical applications of these results for the medical interview will be discussed. [ABSTRACT FROM AUTHOR]

This study of patients and family members of patients who believed they had experienced a medical error sought to describe their perceptions of what had occurred; the impact of the error on the patient and family; their perceptions of how the providers and institutions involved responded to the error; and how the providers' response or non-response influenced the patient's reaction. In-depth, qualitative telephone interviews were conducted with community members who believed they or a family member had experienced a medical error. During 17 interviews, 23 incidents which were perceived as errors were reported and described. Errors impacted patients and family members in a variety of ways, causing physical and emotional harm, disrupting day-to-day life, and leading to changes in health-related behaviours. Providers' responses varied, and often did not meet the needs of the patient and family members. Based on these findings, the study recommends open communication about errors and adverse events. Lack of disclosure will not ensure that the patient will not learn that an error has occurred, and omitting information about non-preventable adverse events may lead patients to suspect errors when no error occurred. In addition, healthcare providers should seek to understand the full impact of the error on the patient and the family, to respond in a way that demonstrates this awarehess, and match the specific needs of the affected patient and family Finally, encouraging patients to report errors, and responding appropriately when they do may help healthcare systems to identify and correct weak systems, preventing recurrences. [ABSTRACT FROM AUTHOR]