Search

Introduction: Language discordance is a known barrier to diabetes care in patients with type 2 diabetes. This study aimed to better understand the subjective experiences of a group of Spanish-speaking study participants with low English proficiency who were learning to manage their diabetes using a language-concordant health coaching intervention. Methodology: This qualitative exploratory study used structured interview data to understand subjective experiences among participants. Thematic content analysis was conducted from a subset of health coaching phone transcripts (n = 17) performed during a language-concordant health coaching intervention study. Results: Among the 17 participants included in the study, even with language-concordant coaching, participants had challenges in managing their diabetes care. Participants described internal and external factors, such as socioeconomic instability, that complicated their behavior changes and self-management abilities. Discussion: A health coaching intervention in patients with low English proficiency can help to improve health outcomes. Findings from this study can guide the development of health care services and the management of chronic diseases in diverse populations. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHR) are seen as a promising endeavour, in spite of policies, designs, user rights and types of health data varying across countries. In many European countries, including Austria, EHR usage has fallen short when compared to the deployment plans. Objective: By adopting a qualitative approach, this research aimed to explore facilitators and barriers experienced by patients and physicians across the entire EHR usage process in Austria. Method: Two studies were conducted: In Study 1, discussions were held with four homogeneously composed groups of patients (N = 30). In Study 2, eight expert semi-structured interviews were conducted with physicians to gain insights into potential facilitators and barriers Austrian physicians face when utilising personal EHR. Results: A wide range of barriers and facilitators were identified along the entire EHR usage spectrum, emerging on three different levels: the micro-level (individual level), the meso-level (level of the EHR system) and the macro-level (level of the health system). EHR literacy was identified as a booster to support EHR adherence. Health providers were identified as crucial gatekeepers with regard to EHR usage. Conclusion: The implications for mutual benefits arising out of EHR usage among the triad of health policymakers, providers and patients for both theory and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. Objective: The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. Methods: A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. Results: 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy. Conclusions: Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations. [ABSTRACT FROM AUTHOR]

Objective: To explore the treatment experiences of those diagnosed with large to massive rotator cuff tears and the perspectives of healthcare practitioners providing their care. Design: A qualitative descriptive study using reflexive thematic analysis. Setting: In-person focus groups were undertaken in a clinical setting (private practice [ n = 1]; public outpatient [ n = 2]). Semi-structured interviews were conducted online via Microsoft Teams. Participants: Patients diagnosed with these tears (n = 12) and healthcare practitioners (n = 11). Results: Two interlinking themes were identified based on the care received and provided for patients with symptomatic large to massive rotator cuff tears: 1) Positive treatment experiences and management: Education, clear communication and reassurance around prognosis were the foundation of positive patient–clinician care. Sub-themes of pain relief, exercise prescription and confidence in their pathway underpinned this experience. This proficiency in care was affirmed by some healthcare practitioners who spoke about the importance of confidence and experience in their management plan even in times of poor progress. 2) Negative treatment experiences and management: Uncertainty, delays and exacerbation of pain flawed the patient–clinician care. Sub-themes of inappropriate pain relief, inappropriate exercise prescription and uncertainty impacted their care. Some healthcare practitioners acknowledged knowledge gaps led to uncertainty especially when choosing the next step of care and were quick to escalate care to deflect this uncertainty. Conclusions: The findings suggest discordance exists between the patient's experiences and expectations when the delivery of care was by less experienced and confident healthcare practitioners in the management of this condition. This highlights the need for improved education and support for healthcare practitioners. [ABSTRACT FROM AUTHOR]

Explanatory models are culturally informed representations of illness that convey understandings of the etiology and expected course of disease. Substantial research has explored lay explanatory models, but examining physicians' clinical explanatory models can also provide insight into patients' understandings of illness because physicians are a foundational source of authoritative knowledge that shapes lay concepts of illness and disease. This study characterized the explanatory models used by pediatric gastroenterologists when explaining inflammatory bowel disease (IBD) to children. We conducted semi-structured qualitative interviews with 20 pediatric gastroenterologists across the United States about their clinical communication and explanatory models. We identified two primary explanatory models used to describe immune dysregulation in pediatric IBD: the defense and protection model, which characterizes the immune system as an army that erroneously sees the body as "non-self" and attacks it; and the switch model, which conceptualizes treatment as activating a switch that turns off a faulty immune response. We also identified two models used by some physicians to describe inflammation: the scratch and scrape model, which compares IBD inflammation to scratches or scrapes on the skin; and the bonfire model, which compares inflammation to a fire in need of extinguishing. While the use of militaristic metaphors is pervasive in medicine, describing autoimmunity as a battle against the self may lead children to perceive their body as the enemy. This may be compounded by describing the immune system as "confused" while noting its ongoing protective function. Use of these explanatory models may nevertheless improve patient disease-related knowledge. [ABSTRACT FROM AUTHOR]

The study seeks to explore experiences and perceived needs of patients in source isolation and healthcare professionals' management of COVID-19 patients to inform practice in the event of emerging health disaster. Participants were recruited through snowball and purposive sampling strategy. We conducted semi-structured telephone interviews to understand their subjective evaluations of these events. We applied inductive thematic analysis, which yielded six themes. The health events resulting from COVID-19 varied and shaped patient perspectives. Response to care received and trust in healthcare providers was encouraging, including expressions of gratitude and resilience towards discomfort brought on by isolation. Processing COVID-19 in isolation describes how patients cognitively and psychologically dealt with the illness. Clinicians' experiences of working in isolation centred around workflow management, maintaining safety, focus on patient-centric approach and expanding roles of health workers, even as complacency towards COVID-19 was on the rise. Effective deployment of resources, efforts of experienced clinicians and staff, along with cooperation and resilience of patients, paves the way for the system to endure through the crisis. These lessons can be preserved for practice as global health entities are pushing for pandemic response, preparedness and prevention through measures such as the pandemic treaty. [ABSTRACT FROM AUTHOR]

Objective: To conduct a cross-cultural adaptation and validation in Primary Care of the PREMEPA doctor-patient relationship perception questionnaire. Design: Descriptive, cross-sectional study, using self-administered questionnaires. Qualitative validation: an adapted version of the original questionnaire, was adapted to our culture. The process consisted of the evaluation, cross-cultural adaptation and consensus of a group of experts. The questionnaire was piloted on a sample of 32 patients diagnosed with at least 2 chronic pathologies. Measures: Cognitive piloting, comprehensibility assessment, content validation and internal consistency analysis using Cronbach's alpha coefficient. Quantitative validation: the internal consistency, construct validity and validity of the questionnaire were studied by means of a confirmatory factor analysis developed in a multicenter study, randomly selecting 202 patients with at least 2 chronic pathologies. Results: Content validity of the new Spanish version was confirmed to be adequate. Comprehensibility and internal consistency (Cronbach's α coefficient = 0.78) were adequate. The confirmatory factor analysis showed good dimensionality, factor relationship and internal consistency, as well as acceptable construct validity. The final result was a 13-item questionnaire consisting of 2 dimensions, which explain 58.5% of the variance: participation in decision-making (accounting for 45.2% of the variance) and person-centered communication (encompassing courtesy, empathy, humanity, and trust). Conclusions: This adapted version of the PREMEPA questionnaire can be considered valid for use in the Spanish population with a history of chronic pathology. This version of PREMEPA provides a new instrument to understand and improve chronic patient care, which can improve the doctor-patient relationship, encouraging adherence to treatment and enhancing health outcomes. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Delivering optimal patient care is impacted by a physician's ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients. Methods: Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic. Results and Conclusions: The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one's internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one's interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients. [ABSTRACT FROM AUTHOR]

Objective: Patients with severe health anxiety have complex interpersonal relationships with medical providers and others in their social context, often resulting in conflictual interactions with providers and perception of poor medical care. An adequate understanding of the causes and consequences of these interactions is lacking, particularly 1 informed by the experience of the patient. This study used qualitative methods to explore the development and maintenance of health anxiety from the perspective of patients with lived experience of coping with health anxiety and their interactions with the healthcare system. Method: We conducted qualitative interviews with 11 primary care patients purposely sampled to describe their experience living with health anxiety, provider interactions, and social and family interactions surrounding health and health anxiety. We extracted themes related to living with health anxiety and interactions with providers and other significant relationships. Results: Thematic content analysis revealed 5 themes including 3 causal themes, 1 response theme, and 1 theme reflecting factors that mitigate health anxiety. Causal themes included subthemes reflecting predisposing factors of the self, key stimulus events from patient learning history, and maladaptive social interaction factors. The response theme was comprised of 2 subthemes: logical conclusions and health anxiety symptoms. The mitigating factors theme included subthemes of a trusting care relationship and recognition of disconfirming evidence. Conclusion: The themes and constituent subthemes identified in this study largely map onto cognitive-behavioral theory of health anxiety, demonstrating alignment between patient experience and theory. The resulting model also identifies potential points of intervention in the developmental and maintenance process. We provide recommendations to maximize those points of intervention. [ABSTRACT FROM AUTHOR]

Patients with multiple sclerosis (MS) experience various physical symptoms and psychosocial problems that disrupt their normal life, and adapting to these conditions is vital for them. Many factors that serve as facilitators of and barriers to achieving adjustment should be identified to be able to help the patients. This study was conducted to explain the experiences of patients with MS regarding the facilitators of and barriers to adjustment using conventional content analysis. The participants consisted of 18 patients, one nurse, one physician, and one patient companion, who were selected from the Multiple Sclerosis Clinic of BouAli, northern Iran, through purposive sampling. Data were collected through individual, in-depth, and semi-structured interviews and analyzed using the method recommended by Elo and Kyngäs (2008). The data analysis generated five subcategories as facilitators and five subcategories as barriers. The subcategories of facilitators included family's appropriate behavior with the patient, occupation, studying and information gathering, religious beliefs, and turning attitude into disease simplification and optimism. The subcategories of barriers were concerns about the uncertain future of the disease, physicians' poor communication and behavior, society's poor attitude, economic problems, and unsatisfactory support by the government and insurance companies. The results showed that a set of individual, environmental, and social factors serves as facilitators of or barriers to the process of adjustment to MS in patients. Gaining knowledge about these factors in congruence with the sociocultural context of the society, as derived from people's real experiences, can help healthcare staff and the family of these patients provide more efficient assistance to the patients for achieving adjustment earlier. [ABSTRACT FROM AUTHOR]

Person-centered narrative interventions offer potential solutions to facilitate a connection between the person receiving care and the person delivering the care, to improve quality of care, and positively impact a patient's biopsychosocial well-being. This single-arm feasibility study investigates patient-reported outcomes and barriers/facilitators to the implementation of an all-virtually delivered person-centered narrative intervention into the person's electronic health record. Overall, electronic data collection for the patient-reported outcomes was feasible. All 15 participants felt participating in the study was "easy" and "enjoyable," and "not a burden." The facilitators of implementation included: "helpful to the clinician," "appreciated looking at me as whole person," "be seen and heard," "had a connection and trust," and "felt comfortable and relaxing." The barriers to implementation included: "completing all the paperwork," "being rushed for time to complete the PCNI," and some "emotion" during collection of narrative. The use of person-centered narrative interventions is a way to deploy dedicated tools to shift dehumanized healthcare delivery to a more humanized person-centered care that treats people as experts in their own life narratives by incorporating their beliefs, values, and preferences into their plan of care. [ABSTRACT FROM AUTHOR]

In this qualitative study, we explored perspectives of patients in the intensive care unit (ICU) and their families on the Get to Know Me board (GTKMB). Of the 46 patients approached, 38 consented to participate. Of the 66 family members approached, 60 consented to participate. Most patients (26, 89%) and family members (52, 99%) expressed that GTKMB was important in recognizing patient's humanity. Most patients (20, 68%) and families (39, 74%) said that it helped to build a better relationship with the provider team. 60% of patients and families commented that the GTKMB was used as a platform by providers to interact with them. Up to 45 (85%) of the family members supported specific contents of the GTKMB. In structured interviews (11 patients, 7 family members), participants additionally commented on ways providers used the GTKMB to communicate, support patient's personhood, and on caveats in interacting with GTKMB. Critically ill patients and families found the GTKMB helpful in preserving personhood of patient, fostering communication, and building relationships with clinicians. [ABSTRACT FROM AUTHOR]

Background: Patients with schizophrenia in rural areas of China face severe delays in getting appropriate treatment due to poverty, transportation, and limited availability of mental healthcare services. However, the experiences of care-seeking among patients with delayed diagnosis and treatment in rural areas remain poorly understood, and it remains unclear how these experiences influence patients' medical mistrust or expectations of care. This study aims to fill that void. Methods: We applied a qualitative phenomenological method. Patients were recruited through purposive sampling at a psychiatric hospital in Harbin, China. Semi-structured, one-to-one interviews were conducted, guided by an interview outline. Thematic analysis was performed using Colaizzi's seven-step method. Results: Data saturation was achieved after interviewing 13 participants aged 21 to 53 years. Three themes with eight subthemes were identified: (i) Barriers to seeking care, (ii) Feelings for psychiatric treatment, and (iii) Demand for mental healthcare. Several factors that may impede the timely diagnosis and treatment were identified, including patients, physicians, and institutions. The participants described their feelings of adverse treatment experiences, as well as expectations arising from this process. It predominantly covers awareness of the disease, supportive access to care, and geographic accessibility of services. Conclusion: Patients with delayed diagnosis and treatment in rural areas often have negative experiences and various needs for mental health services in the pursuit of effective treatments. Policymakers and health planners should seriously consider the current challenges in rural mental healthcare to develop comprehensive strategies for improving prehospital delays and medical experience for this group of patients. [ABSTRACT FROM AUTHOR]

Email is a born-digital form of communication, which can be studied in a number of ways using a variety of methods, as with any other socially and culturally mediated phenomenon. However, despite a great number of studies, the methodologies of the studies have attracted only little attention. In this paper, we wish to extend our knowledge regarding methodological challenges in studying emails. In particular, we will consider the methodological challenges, which any scholar will encounter when email in its digital form is transformed to and preserved as an object of study. Based on a review of existing studies' archiving strategies as well as our own study on email consultations in a healthcare setting, we will examine and discuss analytical and methodological consequences of different approaches to archiving and data management of emails. We demonstrate that the archived record is shaped by its context of creation. Since collection methods and archiving tools are not neutral, we call for a greater attentiveness to this part of the research process. We conclude by outlining implications for systematic empirical research into emails as a form of communication. [ABSTRACT FROM AUTHOR]

This study examined the experience of contraceptive counseling and care in a Federally Qualified Health Center in Maryland. Patients attending medical visits in 2021 were surveyed using the Interpersonal Quality of Family Planning scale to assess the quality of contraceptive counseling. Medical chart reviews were performed to identify alignment between contraceptive care received, and preferences patients had expressed. Primary care providers, reproductive health providers, and a subgroup of patients were interviewed to further contextualize survey and chart review findings. The average item score for the 94 survey participants was 4.39 (SD: 0.9) out of 5. Factor analysis showed high internal consistency reliability (alpha = 0.96). Eighty percent of patients received contraceptive care that aligned with their preferences, 4% did not, and 16% lacked clear contraceptive preferences. Qualitative analysis revealed that patients desired more guidance from providers in selecting a contraceptive method, while providers noted logistical and insurance-related barriers to care. While the quality of contraceptive counseling was high, patient experience of care may be improved by implementing team-based care. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An autism diagnosis in adulthood can increase women's self-compassion and inform appropriate supports. This study explored what helped and hindered autistic women when accessing an adulthood autism diagnosis in Australia. Ten autistic women diagnosed as adults within the past 5 years participated in a semi-structured interview about their experiences of accessing a diagnosis. Framework analysis was used to identify barriers and facilitators on person, provider and system levels. Person-level factors included women's recognition of their autism, motivation, preparation, social support and approach during the assessment. Provider-level factors related to providers' level of knowledge and skill in working with autistic women, as well as the women's experience of being dismissed or misdiagnosed. Interactions between person- and provider-level factors highlighted that the diagnostic process is relational. System-level factors included the requirements of the diagnostic process (time, financial costs, and technology) and the nature of diagnostic criteria and assessment tools used. These factors provided the context in which person-level and provider-level factors operated. The experiences of participants highlight improvements that could be made to accessing an adulthood autism diagnosis for women in Australia, including provider knowledge of the heterogeneity of autism and the development of resources to help autistic women prepare for their diagnostic assessment. An autism diagnosis can have a big impact on women and make it possible to access support. This study explored women's experiences of being diagnosed with autism as an adult in Australia, to try to understand what was helpful (facilitators) and unhelpful (barriers) for them during this process. We interviewed 10 autistic women who had been diagnosed in the last 5 years. Framework analysis was used to understand the data. We wanted to understand barriers and facilitators relating to the individual participants, the professionals they saw and the system they went through for their diagnostic assessment. Women reported that being able to recognise they were autistic, being motivated, preparing for the assessment, having social support and unmasking to be themselves were helpful during the diagnostic process. They reported that having a knowledgeable diagnostician who made accommodations for their needs assisted them during the assessment process. When providers dismissed the participants when they first raised the possibility they were autistic, it delayed them in seeking an assessment. At the system level, the women in this study found some aspects of the healthcare system difficult to navigate, particularly costs and long waitlists. Some found the assessment tools used were not well suited to them. The experiences of the women in this study highlight improvements that could be made to accessing an adulthood autism diagnosis in Australia. These include improving provider knowledge of the varied presentation of autism and the development of resources to help autistic women prepare for their diagnostic assessment. [ABSTRACT FROM AUTHOR]

Objectives: People with cirrhosis are encouraged to participate in shared decision-making with their doctors, but studies suggest that doctors limit the amount of information that is shared. In this study we explore the presence of medical power in clinical encounters in 2015 from a patient perspective and highlight its effects on healthcare interactions. Methods: Qualitative semi-structured interviews were conducted with ten people with cirrhosis attending a tertiary liver transplant centre in southern England. We explored their understanding of their disease and prognosis, and their participation in decision-making. Using the lens of medical power as a framework, we analysed findings into thematic sentences to summarise key ideas whilst preserving the complexity of identified concepts. Results: Three key concepts explained patient perspectives of their communication with doctors: (1) portraying a positive image to doctors, (2) avoiding confrontation with doctors, (3) feeling powerless in the face of doctors' medical knowledge. These concepts show deeper dynamic issues of power during healthcare encounters, illustrated by participants' reluctance to voice their concerns and express themselves, challenge decisions, or seek information. Conclusion: People with cirrhosis struggle to articulate their concerns or challenge decisions on their care and treatment and may worry about potential consequences. Our findings demonstrate the continuing persistence of issues of power at play in contemporary health care. [ABSTRACT FROM AUTHOR]

Background: Around half the US population uses dietary supplements (DS), and concomitant use with medications is common. Many DS include bioactive substances that can interact with medications; therefore, accurate tracking is critical for patient safety. Unfortunately, documentation of patients' DS use is often missing or incomplete in the electronic medical record (EMR), leaving patients susceptible to potential adverse events. Novel approaches to assist healthcare professionals (HCPs) in capturing patients' DS use are needed. Objective: To assess HCPs' perspectives on challenges and facilitators of DS documentation in the EMR and their opinions on a proposed mHealth application (app) to aid in DS capture. Methods: HCPs, recruited from professional networks, largely in North Carolina, using purposive sampling, took part in semistructured interviews. We inquired about HCPs' experiences with DS documentation in the EMR and their opinions about our proposed mHealth app. Interviews were recorded, transcribed, and coded. Thematic analysis included deductive codes based on the interview guide, and inductive codes that emerged during transcript review. Results: HCPs (N = 30) included 60% females, mean age 46 ± 10; 70% White. Pharmacists (20%), nurses (17%), and physicians (17%) were the most represented professions. Years in practice ranged from 3-35 years. Most HCPs were concerned about DS safety and potential supplement-drug interactions, and cited several barriers to accurate EMR DS documentation including time constraints, database inconsistencies, and poor patient-HCP communication about DS. HCPs' views on our proposed mHealth app were generally positive. They expressed that our proposed mHealth app could streamline documentation processes and enhance patient-provider communication. HCPs expressed desire for a high-quality mHealth app that includes access to evidence-based DS information, integrates with the EMR, and does not increase time burdens. Conclusion: HCPs believe documentation of patients' DS use is important but not accurately captured in the EMR. Support was expressed for our proposed barcode-scanning DS mHealth app. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut–brain interaction and poses a significant burden to patients. Pharmacotherapy, diet, and psychotherapy all have largely comparable clinical efficacy. Therefore, factors outside efficacy can have an important impact in determining preferences for a specific therapeutic entity. The aim of this study was to compare the patient and physician perspectives and identify important treatment characteristics regarding the management of IBS. Semistructured interviews were performed among IBS patients (n = 8), fulfilling the Rome IV criteria, and surveys were sent to physicians involved in IBS care (n = 15). Nine important treatment characteristics were revealed: effectiveness, time until response, cessation of response, side effects, location, waiting period, treatment burden, frequency of healthcare appointments, and willingness to pay. Time to response, location, and waiting time were less important for patients compared to physicians. This study assessed important IBS treatment characteristics and provided context to preferences from a patient and physician perspective. These data could be relevant during shared decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Michael Balint conducted several multi-year training programs for general practitioners designed to teach lessons from a psychoanalytic perspective on the relationships doctors have with their patients and contribute to their healing skills. This group process evolved, and it was described along with an elaboration of significant researched observations of interferences in those relationships. There were several other similar multi-year experiential group endeavors conducted and/or inspired by Michael and Enid Balint which were designed to further investigate the subtleties in relationships between doctors and patients. However, none have been done since the late 1990's. Instead, research about the impact of Balint group impact has been dominated by the evidence-based approach to all medical research, and it has been typified by variations on randomized controlled, double blind research methodologies. A recent literature review has highlighted the limited results of such studies along with questions about methodological approach. However, the authors continue to support the search for appropriate dependent variables to validate the value of Balint groups for physicians. This paper identifies and examines the implicit assumptions that underly current research efforts. In addition, there is an exploration of Michael Balint's approach to "research cum training" along with describing his assumptions and the results of his research approach. In addition, recommendations are made to extend the work of the work of uncovering healing dynamics in doctor patient relationships. [ABSTRACT FROM AUTHOR]

Doctors and patients rely on verbal and nonverbal resources to co-construct clinical empathy. In language-discordant consultations, interpreters' communicative actions might compromise this process. We aim to explore doctors, patients, and professional interpreters' perspectives on their own and others' actions during their empathic interaction in interpreter-mediated consultations (IMCs). We analyzed 20 video stimulated recall interviews with doctors, patients, and interpreters using qualitative content analysis. Doctors and patients found ways to connect with each other on the level of empathic communication (EC) that is not limited by interpreters' alterations or disengaged demeanor. Some aspects of doctors and interpreters' professional practices might jeopardize the co-construction of EC in IMCs. The co-construction of EC in IMCs is not only subject to participants' communicative (inter)actions, but also to organizational and subjective factors. These results provide evidence of the transactional process between the behavioral, cognitive, and affective components of clinical empathy in the context of IMCs. [ABSTRACT FROM AUTHOR]

Background: The impact of assisted hydration on symptoms and survival at the end of life is unclear. Little is known about optimal strategies for communicating and decision-making about this ethically complex topic. Hydration near end of life is known to be an important topic for family members, but conversations about assisted hydration occur infrequently despite guidance suggesting these should occur with all dying people. Aim: To explore the views and experiences of doctors experienced in end-of-life care regarding communicating with patients and families and making decisions about assisted hydration at the end of life. Design: Qualitative study involving framework analysis of data from semi-structured interviews. Setting/participants: Sixteen UK-based Geriatrics and Palliative Medicine doctors were recruited from hospitals, hospices and community services from October 2019 to October 2020. Results: Participants reported clinical, practical and ethical challenges associated with this topic. The hospital setting provides barriers to high-quality communication with dying patients and their families about assisted hydration, which may contribute to the low incidence of documented assisted hydration-related conversations. Workplace culture in some hospices may make truly individualised decision-making about this topic more difficult. Lack of inclusion of patients in decision-making about assisted hydration appears to be common practice. Conclusions: Proactive, routine discussion with dying people about hydration-related issues is indicated in all cases. There is room for debate regarding the limits of shared decision-making and the benefits of routine discussion of assisted hydration with all dying people. Clinicians have to navigate multiple barriers as they strive to provide individualised care. [ABSTRACT FROM AUTHOR]

Objectives: To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF). Methods: Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data. Results: Themes presented reflect four inter-related challenges: GPs' 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages. Discussion: HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface. [ABSTRACT FROM AUTHOR]

At the beginning of the 21st century, the interdisciplinary model for treating patients suffering from chronic pain has been adopted by a growing number of health centers. There is not, however, enough research examining how patients treated in clinics guided by this philosophy experience their condition and treatment. The purpose of this study is, therefore, to gain a closer understanding of the experience of these chronic pain patients. Semistructured interviews were conducted with 15 men and women aged 24 to 54 years who have suffered from chronic pain for over a year. The interviews were analyzed using the interpretative phenomenological analysis method. According to our analysis, participants experience themselves as trapped within endless pain that blurs their sense of identity and autonomy and isolates them from their environment. Participants expressed their desire for a close and caring relationship with their doctors as a way of relieving their sense of isolation. Based on our analysis, we suggest a patient-centered model for guiding doctors caring for chronic pain patients, which highlights the patients' social and emotional experiences in addition to their medical condition. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Secondary prevention strategies reduce disease progression to heart failure. Rural cardiac patients typically have less access to health care resources to support them in managing secondary prevention, and services to improve quality of life tend to be lacking in rural settings. The study aim was to examine the process that rural cardiac patients go through to access health care and cardiac rehabilitation (CR) following myocardial infarction (MI). In-depth interviews with 11 post-MI participants using Straussian grounded theory were undertaken. Analysis revealed a linear process from hospital discharge to maintaining health. There were five elements: comfort with health information, relationship with health care providers, social support, taking ownership, and availability of/for CR. The core category was "being uncertain." Findings can be used to identify ways to improve access and address uncertainty stemming from a lack of perceived information and supports following discharge. [ABSTRACT FROM AUTHOR]

Background: Lesbian, gay, and bisexual (LGB) older women have unmet communication needs around palliative and end-of-life care. Past research has found communication differences for LGB women patients. Consequently, older LGB women may experience healthcare communication barriers around advance care planning. Aim: To explore experiences of bereaved LGB older women to understand perspectives regarding advance care planning communication between clinicians, patients, and dyads. Design: Guided by queer gerontology as a theoretical framework, this qualitative descriptive study employed individual interviews with purposively recruited participants. Interviews were conducted in person using a semi structured protocol and analyzed using inductive thematic analysis. Setting/participants: Sixteen LGB women, age 60 years or older from across the United States who had lost a spouse/partner within the past 5 years. Results: Four main themes emerged from the transcripts, LGB older women: (1) experience unclear advance care planning communication and end-of-life care support from clinicians, (2) often avoid advance care planning discussions with spouse or partners, (3) lack of knowledge about palliative or end-of-life care, and (4) have more positive experiences when there is consistent communication with spouse or partner and clinicians during a spouse/partner's illness and end-of-life. Discussion: While certain experiences and opinions may reflect those of non-LGB older adults, novel advance care planning barriers exist for LGB older women. Greater understanding among clinicians is needed regarding advance care planning conversations with LGB dyads. We recommend four improvements in training, recognition, acceptance, and dyad-based communication interventions. [ABSTRACT FROM AUTHOR]

Background: Addressing social needs, health behaviors, and mental health may help patients more than traditional medical care. However, these root causes of poor health are difficult to address and the role of primary care is unclear. This qualitative study assesses patient's willingness and motivations to discuss and accept assistance for these needs from their primary care team. Methods: In July and August of 2020, semi-structured virtual interviews were conducted with family medicine patients (n = 6) and residents of low resource neighborhoods (n = 11) in Richmond, Virginia. Interviews were conducted over Zoom. We conducted a qualitative analysis of patient and resident interview transcripts. A rapid qualitative analysis approach and immersion-crystallization processes were used to identify themes and categories. Results: Interviewees reported varying degrees of comfort discussing topics with their health care team. They were less comfortable discussing needs they considered outside the realm of "traditional primary care" including finances, transportation, and housing, but interviewees expressed willingness to discuss these needs under certain conditions. Important factors were a strong patient-clinician relationship to create a trusted and safe space for discussion, adequate time for discussion during visits, communication of practices' ability to provide resources to help patients, and ensuring appropriate high quality referrals. Conclusions: Primary care provides opportunity for identifying and addressing needs that adversely impact health. Some needs are more sensitive for patients to work with their care team on, though, there was willingness to work on any need when a strong provider relationship and clinic structure for providing support were in place. This study highlights critical care delivery factors which may be used to enhance patient comfort accepting support for their needs and ultimately improve clinical care and chronic disease management. [ABSTRACT FROM AUTHOR]

Developing safety interventions using patient feedback is valuable for creating safer systems of health care. A qualitative process evaluation of a patient feedback on safety intervention was undertaken in six primary care practices. The purpose was to theorize factors mediating with the implementation of the intervention using existing theories. The intervention required practices to obtain patient feedback on safety using a validated tool and respond using quality improvement methods. Multiple methods of qualitative data collection were used, including interviews and overt observation. Abductive reasoning informed the iterative process of analysis that examined theories relevant to the intervention and setting. A theoretical framework was developed, which encompassed mediating factors grouped under three concepts: practice readiness, utilization of problem-solving skills, and agency. Theorizing mediating factors was necessary to understand the complexities of primary care practices, and to identify the essential components for implementation of the intervention on a larger scale. [ABSTRACT FROM AUTHOR]