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Objective: To investigate whether the surgical process information sharing system could alleviate the parental anxiety during a pediatric selective operation. Design: Randomized controlled trial. Methods: A questionnaire survey was conducted one day before surgery for the enrolled participants. Family members assigned to the intervention group received real-time process information sharing through service reminders during the surgical period, while the control group received standard perioperative education. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality during the perioperative period, and the State of Cohesion-13 Scale (SOC-13) and Self-rating Anxiety Scale (SAS) were used to assess anxiety levels. Satisfaction levels during the perioperative period were assessed through a follow-up survey conducted one day after surgery. Results: The intervention group showed better scores in terms of PSQI, SOC-13, SAS, and postoperative satisfaction levels at various time points compared to the control group, with statistically significant differences observed (P < 0.05). Conclusion: Real-time process information sharing is effective in reducing perioperative sleep disorders and anxiety among family members of pediatric patients, as well as improving satisfaction levels. This approach not only establishes a process and mechanism for effective doctor-patient communication but also helps implement continuous perioperative care, thereby optimizing internet healthcare services. [ABSTRACT FROM AUTHOR]

There is currently insufficient evidence for the use of a specific pharmacological treatment for personality disorders (PD). The research literature lacks a systematic exploration of clinicians' experiences of pharmacological treatment of PD. The aim of the qualitative study was to examine how psychiatrists make decisions about pharmacological treatment for patients with PD. The interviews were analyzed using inductive thematic analysis. The results showed that ambiguous guidelines had the effect that the psychiatrists often relied on their own experience, or that of their colleagues. As a basis for decisions concerning drug treatment, an interpersonal component was also identified. Some of the psychiatrists in the current study argued that medications may be part of the alliance-building with the patient and that medications were a way of tying the patient to the clinic. Our findings show that it is important to work on how the clinical guidelines should be implemented in practice. [ABSTRACT FROM AUTHOR]

The article discusses a 2024 study of the enhanced recovery after surgery (ERAS) approach to improve patients' surgical pathways via multimodal interventions. Topics covered include nurse managers' contribution to ERAS implementation, and results which show the themes of resource, innovation and change management, interprofessional collaboration, developing professional practice, and proximity team management. Also noted are the challenges of unclear roles and practice scope among stakeholders.

OBJECTIVES: To identify the most important attributes related to the process of achieving, and outcomes associated with, successful care for differences of sex development (DSD). METHODS: We developed a best--worst scaling survey administered to 520 DSD stakeholders, including individuals or family members of those with DSD, health care specialists, and patient support and advocacy representatives. Fourteen process-related attributes and 16 outcomerelated attributes were identified through qualitative research. We estimated relative importance scores and coefficients from regression analysis to understand the relative importance of attributes and conducted latent class analysis to explore heterogeneity in preferences. RESULTS: The 3 most important process attributes were (1) good communication between care team and patient/family, (2) care team educated patient/family about condition, and (3) care team incorporates the values of patient/family. The 3 most important outcome attributes were (1) patient satisfaction, (2) patient mental health, and (3) treatment maintains physical health. Latent class analyses showed that respondents had heterogeneous preferences. For processrelated attributes, we identified 3 respondent groups: "Patient autonomy and support" (46% of respondents), "Education and care transitions" (18%), and "Shared decision-making" (36%). For outcome-related attributes, we identified 2 respondent groups: "Preserving function and appearance" (59% of respondents) and "Patient health and satisfaction" (41%). CONCLUSIONS: Outcomes such as patient satisfaction and health were the most important outcome attributes, and good communication and education from the care team were the most important process attributes. Respondents expressed heterogeneous preferences for selected DSD care attributes that providers should consider to improve satisfaction with and quality of DSD care. [ABSTRACT FROM AUTHOR]

Doctors (and sociologists) have a long history of struggling to understand why patients seek medical help yet resist treatment recommendations. Explanations for resistance have pointed to macrostructural changes, such as the rise of the engaged patient or decline of physician authority. Rather than assuming that concepts such as resistance, authority, or engagement are exogenous phenomena transmitted via conversational conduits, we examine how they are dynamically co-constituted interactionally. Using conversation analysis to analyze a videotaped interaction of an oncology patient resisting the treatment recommendation even though she might die without treatment, we show how sustained resistance manifests in and through her doctor's actions. This paradox, in which the doctor can both recommend life-prolonging care and condition resistance to it, has broad relevance beyond cancer treatment; it also can help us to understand other doctor–patient decisional conflicts, for instance, medication nonadherence, delaying emergent care, and vaccine refusal. [ABSTRACT FROM AUTHOR]

This brief report concerns a patient interaction in a busy South London Home Treatment Team (HTT) service, where a psychodynamically informed approach was applied to a presentation of psychosis in a crisis setting. We discuss the case in light of the psychodynamic theories on psychosis of Carl Jung and Richard Lucas. Our patient, a young man, had been under the HTT for an extended period of time due to an episode of psychosis that was not resolving. After initially struggling to build rapport, we adapted Lucas' and Jung's models of interacting with acutely psychotic patients to re-establish psychic rapport, which led to our patient agreeing to take the medication that finally pulled him out of this long-standing episode. We believe this case highlights the power of psychodynamic thinking even in acute, short-term settings where extensive psychodynamic intervention may not be appropriate or feasible. [ABSTRACT FROM AUTHOR]

Psychodynamic therapy is commonly used to treat patients with eating disorders. Patients with a diagnosed eating disorder have varying and complex treatment needs. Psychodynamic therapists transitioning their practices to telehealth during COVID-19 experienced the novelty of developing and sustaining a therapeutic connection with their patients without inhabiting a shared physical space. The aim of this qualitative phenomenological study was to gain insight into how psychodynamic therapists treating patients with eating disorders via telehealth during COVID-19 perceived their patients' experiences and personally experienced the therapeutic relationship and therapeutic processes. Twelve respondents met inclusion criteria, consented to participate, provided demographic data, and participated in a 30–45 minute semi-structured interview. Results from the data analysis included four emergent themes: (1) depth of content; (2) manifestations of patient distress; (3) therapist-patient relationship; and (4) implementation of techniques. Participants spoke about the challenges and resilience experienced by themselves and their patients. They highlighted having to rapidly transition their therapy practice to serve patients with exacerbated symptoms. They shared the complexities of navigating a global pandemic and considered the delivery of relational and dynamic therapy via telehealth. Practical implications and considerations for future research are offered with an emphasis on the treatment of patients with eating disorders. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a common functional gastrointestinal condition. A respectful patient-doctor relationship with good communication is crucial for optimal treatment. Q-methodology is a combination of qualitative and quantitative methods used to study subjectivity. The aim of this study was to compare viewpoints on IBS between patients with IBS and general practitioners (GPs). We conducted a Q-methodology study by including 30 patients and 30 GPs. All participants were asked to complete Q- sorting of 66 statements on IBS using an online software program. Data were processed using factor analysis. In addition, 3 patients and 3 GPs were interviewed. Three factors were extracted from both groups: Patient Factor 1 'Question the diagnosis of IBS', Patient Factor 2 'Lifestyle changes for a physical disorder', Patient Factor 3 'Importance of a diagnosis', GP Factor 1 'Unknown causes of great suffering', GP Factor 2 'Lifestyle changes are important, stress makes IBS worse', GP Factor 3 'Recognized the way IBS affects patients'. There was a strong and statistically significant correlation between patient Factor 1 and GP Factor 1, with a Pearson's r of 0.81 (p < 0.001). Correlations between other factors varied. There was consensus between patients and GPs that IBS is a physical and not a psychiatric disorder of unknown etiology. They also seemed to agree that IBS has a great negative impact on patients' lives and that lifestyle changes are beneficial. There were conflicting opinions regarding gender, cultural factors and the use of antidepressants. [ABSTRACT FROM AUTHOR]

This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China. Cross-sectional study. Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching. The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = −0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05). PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional. [ABSTRACT FROM AUTHOR]

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline. We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis. We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP–patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice. Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP–patient relationship must be maintained throughout severe illness and at end-of-life. According to the Norwegian guideline for palliative care, the GP should have a central position in providing primary palliative care. Recent research and public reports suggest that not all GPs have such a central role or adhere to the guidelines. This study highlights individual and structural barriers that could be addressed to increase GPs' participation in palliative care and aid the implementation of the guidelines for palliative care. [ABSTRACT FROM AUTHOR]

Background: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by extreme preoccupation with non‐existent or minor defects in appearance, disrupting daily functioning. Melasma is a common concern among BDD patients with dermatological conditions. This study aimed to estimate the incidence and characteristics of BDD in patients with melasma, and compare the psychological condition of patients and age‐ and sex‐matched healthy controls. Methods: Patients with melasma and healthy controls were screened using the BDD Questionnaire (BDDQ), Self‐rating Anxiety Scale (SAS), and Self‐rating Depression Scale (SDS). A questionnaire was administered to collect demographic information and clinical characteristics. Standard statistical tests were conducted, such as descriptive analysis, chi‐square, and nonparametric tests. The level of statistical significance for all tests was set at a P < 0.05. Results: Among the 470 patients with melasma included in the study, 53 were positive for BDDQ in the preliminary screening and were associated with a history of treatment, higher Melasma Area and Severity Index (MASI), and Melasma Quality of Life (MELASQoL) scores, and higher SAS and SDS scores. The positive rate of BDDQ ranged from 0.4%, using the most stringent criteria to assess melasma severity, to 11.3%, without using objective criteria. Compared to healthy controls, patients with melasma had a higher positive rate of BDDQ and higher SAS and SDS scores. Conclusion: In patients with melasma who exaggerate the severity of the disease, psychiatric treatment and the patient‐physician relationship have a positive effect. This study assessed the positive rate of BDDQ in melasma and proposed the feasibility of psychiatric treatment for patients with melasma. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

The "hidden curriculum" in medical school includes a stressful work environment, un‐empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence‐based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real‐world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy. [ABSTRACT FROM AUTHOR]

The study reported in this paper explores the experiences of 95 people with intersex variations constituting an international English-speaking sample who completed a mixed methods survey comprises questions designed by the authors to explore 1) genital variations and medical interventions (and pressures to undertake them), 2) experiences with sex education, and 3) experience of physical intimacy, including use of safer sex devices and sexually transmitted infections. Surgeries on minors were common and typically not consensual, often resulting in the need for revisions. Pressures for surgeries most commonly were made by doctors. Experiences of sex education often failed to be inclusive of intersex bodies, with information about menstruation and hygiene rarely provided, and many participants having to learn on their own. Participants had a diversity of experiences of physical intimacy beyond penetration. For those who had experienced penetration, vaginal intercourse was enjoyable for some, but many found it painful. Conversely, anal intercourse was enjoyed by many and rarely found to be painful. The paper concludes by highlighting the importance of an intersex-specific approach to sexual health for this population. [ABSTRACT FROM AUTHOR]

To determine needs, expectations, facilitators, and barriers of insurance physicians (IPs) for using eHealth in their work. Also, we investigated differences between age groups. All insurance physicians employed at the Dutch Social Security Institute (SSI) received an online anonymous survey in July 2020. Three hundred and fifteen IPs (31%) responded. According to these IPs, the most important need for using eHealth was to collect medical information more effectively and efficiently (71%). Main facilitators were that eHealth could make IPs' work more effectively and efficiently (61%) and more future-proof (60%). Main barriers were losing human interaction (54%) and security issues (51%). Younger IPs saw more options for using eHealth, compared to older IPs. The majority of IPs (in particular younger IPs) had a positive view towards using eHealth in their daily work. Nevertheless, differences in needs, expectations, facilitators and barriers between the age groups should be taken into account for the successful development and implementation of interventions using eHealth in insurance medicine. For the successful development and implementation of eHealth interventions in insurance medicine and rehabilitation, the needs, expectations, facilitators, and barriers that physicians indicate should be taken into account. Insurance physicians support the use of eHealth interventions to collect medical information more effectively and efficiently, to contribute to and maintain the quality of care, in the perspective of managing expected shortages in insurance physicians. When concretizing eHealth interventions for rehabilitation professionals, one should take the importance of face to face interaction with patients into account. Extra education and training for older insurance physicians may improve the implementation of eHealth interventions, because they are less inclined to see its value and feel less competent to use it. [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]

Introduction: An overarching principle for the management of psoriatic arthritis (PsA) is a shared decision-making process between physicians and patients. The aim of this study is to assess the patient–physician relationship in a group of patients with PsA, by using the Perceived Efficacy in Patient–Physician Interactions (PEPPI) and CollaboRATE instruments. Methods: This is a cross-sectional multicenter study where consecutive patients with PsA were enrolled. For each patient, the main demographic, comorbid conditions, and clinical data were collected, including the assessment of disease activity, function, quality of life, and impact of disease. PEPPI and CollaboRATE questionnaires were used, respectively, to evaluate the patient's perception of the patient–physician relationship and the shared decision-making process. Results: A total of 81 patients with PsA were enrolled at four centers in Italy. Overall, our patients showed a high level of confidence in obtaining needed health care, with relatively high median (IQR) values of PEPPI (20; 16–23), and a good shared decision-making process, with high median (IQR) values of CollaboRATE questionnaire (7; 6–9). PEPPI and CollaboRATE scores showed a statistically significant inverse correlation with different clinical variables such as disease duration, Leeds Enthesitis Index, PsA impact of Disease, Health Assessment Questionnaire, pain, patient's global assessment of disease activity and clinical disease activity for PsA. The presence of comorbidities did not appear to be associated with lower values of PEPPI and CollaboRATE. Conclusions: In this study, few patients with PsA were at risk of suboptimal communication with their physician. This phenomenon appeared to be primarily related to higher disease activity and burden. [ABSTRACT FROM AUTHOR]

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. [ABSTRACT FROM AUTHOR]

To better understand what makes cost-of-care communication between oncologists and cancer patients more or less successful, we conducted in-depth interviews with 32 oncologists (22 male, 10 female) who were board-certified in medical, surgical, or radiation oncology. Through qualitative descriptive analysis by four coders, we found that oncologists used six broad strategies to discuss cost with patients: open discussion, avoidance, reassurance, warning, outsourcing, and educating. We also found that oncologists invoked certain meanings of cost conversations: cost conversations as holistic care, coercion, a matter of timing, risking patient suspicions, advocacy, unwanted distraction, transparency, bad news delivery, problem-solving, pointless, informed decision making, or irrelevant. These meanings appeared to be linked to oncologists enacting certain strategies (e.g., oncologists who invoked cost conversations as holistic care tended to enact open discussion, those who saw cost conversations as risky tended to use avoidance). Theoretically, our results suggest that the invoked meaning of a difficult conversation may be a key explanatory mechanism for differentiating high-quality from low-quality communication in cost conversations. Practically, our findings suggest that oncologists should consider how well the invoked meaning of the cost conversation is serving their own and their patients' goals. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) is an incurable illness of the gastrointestinal tract. Its relapsing–remitting nature negatively impacts physical health and quality of life. Food and eating are key concerns for people with this illness. To provide holistic person‐centred care, healthcare providers (HCPs) need to meet patients' dietary information needs. However, there is a paucity of literature describing these in any meaningful detail. The present study aimed to explore the perceived dietary information needs of individuals with IBD, the perceptions of HCPs and enablers and barriers to communication. Methods: Online and face‐to‐face semi‐structured interviews with 13 HCPs and 29 people with IBD were conducted. The framework method aided thematic analysis of de‐identified interview recordings. Results: The cyclical nature of IBD contextualised the five themes. Both individuals with IBD and HCPs articulated similar ideas viewed from different perspectives: (1) living with IBD is exasperating and unique to the individual; (2) individuals with IBD desire dietary information; (3) diet manipulation is used to exert control on a disease with unpredictable nature; (4) people with IBD and HCPs have different views on the role of diet; and (5) doctors are perceived as gatekeepers to accessing dietetics care. Conclusions: A lack of dietary guidance at diagnosis negatively impacts the patient's journey with food and eating. The present study supports a paradigm shift towards holistic person‐centred care for consistent access to dietetics services to meet the needs of people with IBD. Key points: Dietary information needs appear to be influenced by the stage of Inflammatory Bowel Disease (IBD).The journey of IBD is lonely and fraught with uncertainty.Lack of dietary guidance from diagnosis may partly influence information seeking and adoption of dietary restrictions.Dietary manipulation provides a perceived sense of control. [ABSTRACT FROM AUTHOR]

This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (β = 0.329, p <.01, β = 0.917, p < 0.01), and negatively with physician-patient interaction quality (β = −0.167, p = 0.051; β = −0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = −1.966, p < 0.05) and increased HIV infection concern (z = −1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future. METHODS: A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail. RESULTS: There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training. CONCLUSION: Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees. [ABSTRACT FROM AUTHOR]

Power—the asymmetric control of valued resources—affects most human interactions. Although power is challenging to study with real-world data, a distinctive dataset allowed us to do so within the critical context of doctor-patient relationships. Using 1.5 million quasi-random assignments in US military emergency departments, we examined how power differentials between doctor and patient (measured by using differences in military ranks) affect physician behavior. Our findings indicate that power confers nontrivial advantages: “High-power” patients (who outrank their physician) receive more resources and have better outcomes than equivalently ranked “low-power” patients. Patient promotions even increase physician effort. Furthermore, low-power patients suffer if their physician concurrently cares for a high-power patient. Doctor-patient concordance on race and sex also matters. Overall, power-driven variation in behavior can harm the most vulnerable populations in health care settings. [ABSTRACT FROM AUTHOR]

The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education. [ABSTRACT FROM AUTHOR]

Background: Many adolescent males visit a general practitioner regularly, yet many report unmet health needs and negative experiences. This indicates a gap between provided healthcare and the needs of adolescent males. In order to improve adolescent males' possibilities to discuss their health concerns with general practitioners, the study's aim was to explore and describe how adolescent males understand and assign meaning to their experiences of consultations with general practitioners. Methods: This qualitative study was conducted at two healthcare centres in mid-Sweden in 2022. Nine males 15 to 19 years old described their experiences in semi-structured interviews immediately after consulting a general practitioner, regardless of reason for the consultation and whether or not accompanied by a parent. The analysis was guided by thematic analysis according to Braun & Clarke and reflective lifeworld theory's concepts of openness and sensitivity. Results: One overarching theme, To be listened to, and three themes were developed: To handle insecurity and uneasiness, To be understood and cared for, and To get parental support on his terms. In a good appointment, the general practitioner cares about him, listens attentively, and takes him seriously. More importantly, the general practitioner's understanding permeates the consultation, so that all aspects of it is adapted to him. The adolescent males doubted their ability to express themselves and to understand what would happen in the consultation, and therefore feared being dismissed without receiving any help. Such difficulties may be due to unfinished neurocognitive development and inexperience. They struggled with embarrassment, partly due to notions of masculinity, and strived to balance their needs of parental support, privacy, and being the one that the doctor listens to. Conclusions: We argue that adolescent males are particularly vulnerable due to on-going neurocognitive and emotional development, inexperience, and notions of masculinity. However, good experiences can be generated through rather simple means. Adolescent males need individual adaptations demonstrating that they are cared for, understood and taken seriously. Furthermore, they need an unhurried pace to facilitate understanding, verbal affirmations to mitigate embarrassment, and help in navigating parental involvement. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Educational approaches for training physicians in clinical communications vary, and whether physicians apply the communication skills they learn or find them useful in the clinic is not well known. The aim of this study was to determine how first-year residents who received explicit instruction in 7 communication strategies would apply them in a simulation exercise and in clinical practice. METHODS: First-year Internal Medicine residents at an urban teaching hospital received instruction in 7 systematic communication strategies: Ask-Tell-Ask, Teach-back, open-ended questioning, NURSE, open body language, pausing, and plain language. Residents were evaluated on their use of specific communication behaviors associated with the 7 strategies during a simulation exercise of disclosing a medical error to a standardized patient. Control group residents who did the simulation before attending the training program and training group residents who did the simulation after the training were compared. Residents were queried 6 months after the training program on their use of communication strategies during clinical practice. RESULTS: A total of 27 residents participated (n = 13 control group; n = 14 training group). The training group performed behaviors for "establishing patient understanding" significantly more often than the control group. Both groups used non-verbal communication and behaviors for addressing patient emotions at similar levels. Of the 24 residents who responded to the 6-month follow-up questionnaire, 24 (100%) reported using Ask-Tell-Ask, open-ended questioning, and Teach-back, and 22 (92%) reported using NURSE statements and non-verbal communication. Most respondents reported using the strategies in clinical practice often or very often (79%) and found the strategies useful or very useful (96%). CONCLUSION: Providing explicit instruction in systematic communication strategies, particularly those focused on establishing patient understanding, may be an efficient approach for helping early career physicians develop effective communication skills that can be readily implemented during clinical training and practice. [ABSTRACT FROM AUTHOR]

Objective: Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient‐centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy‐sensitive communication, trust in health‐care providers (HCP), and treatment confidence is examined. Methods: This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy‐sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis. Results: A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy‐sensitive communication and treatment confidence when adding the mediating effect of trust in providers. Conclusion: Patient‐centered communication during MTC in combination with a trustful relationship between participating patients and health‐care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor–patient communication and relationship. Trainings for physicians targeting patient‐centered communication could be a promising approach to strengthen patient participation. [ABSTRACT FROM AUTHOR]

Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physicianpatient communication in each department and to develop patient-centered healthcare services in the future. [ABSTRACT FROM AUTHOR]

Research indicates that patients consider empathy as a key factor contributing to the quality-of-care. However, ambiguities in the definition of this multidimensional construct complicate definite conclusions to-date. Addressing the challenges in the literature, and using a hypothetical physician-patient interaction which explored patient-perceived differences between expressions of affective empathy, cognitive empathy, compassion and no empathy, this study aimed to test whether lay participants’ evaluations of the quality-of-care depend on the type of empathic physician behavior, and on the physician’s gender. We conducted a randomized web-based experiment using a 4 (type of empathy) by 2 (physician gender) between-subjects design. Empathy was subdivided into three concepts: first, affective empathy (i.e. feeling with someone); second, cognitive empathy (i.e. understanding); and third, compassion (i.e. feeling for someone and offering support). Perceived quality-of-care was the primary outcome. Compared with non-empathic interactions, quality-of-care was rated higher when physicians reacted cognitively empathic or compassionate (d = 0.71; 0.43 to 1.00 and d = 0.68; 0.38 to 0.98). No significant difference was found between affective empathy and no empathy (d = 0.13; −0.14 to 0.42). The physician’s gender was not related with quality-of-care. Aspects of participants’ personality but not their age, gender or the number of physician visits were associated with quality-of-care. No interactions were observed. In showing that patients rated quality-of-care higher when physician reactions were described as cognitively empathic and compassionate, as compared with affectively empathic or non-empathic, our findings refine views about the kinds of empathy that are important in patient care with implications for clinical practice, education and communication trainings. [ABSTRACT FROM AUTHOR]

Prognostic conversations present many challenges for patients, caregivers, and providers alike. Most research examining the context of prognostic conversations have used a more siloed approach to gather the range of perspectives of those involved, typically through the lens of patient-centered care. However, the mutual influence evident in prognostic conversations suggests a relationship-centered care model may be useful in cancer communication research. Similarities and differences in preferences for and experiences with prognostic conversations among oncology patients, caregivers, and providers (N = 32) were explored. Identified themes were then mapped to the principles of the relationship-centered care framework to extend our understanding of prognostic conversations and contribute to a new direction in the application of relationship-centered care. Findings suggest fewer similarities than differences, point to important discrepancies among participant perspectives, and reinforce the utility of relationshipcentered care in identifying communication practices that enhance the prognostic conversation experience. [ABSTRACT FROM AUTHOR]

Objectives: In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China. Methods: Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction. Results: The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training. Conclusion: This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction. [ABSTRACT FROM AUTHOR]

A family practitioners' (FP) consultation is usually understood as an interaction between two people. Studies from other countries show that a large proportion of patients, however, attend FP consultations accompanied by another person. Neither the frequency of bringing an accompanying person nor cultural differences have been studied so far for the German-speaking countries. In 2018, an explorative study was conducted in six urban family practices in North Rhine–Westphalia (numerical recording of patients with/without accompaniment in the consultation hour; guideline-based interview of accompanied patients after the consultation). Of the 1155 patients recorded, 27% (95% confidence interval [95% CI] = 24.31–29.41) were accompanied. There is a significant relationship between the existence of a Turkish migration background and bringing an accompanying person to the GP practice (χ2 (2) = 92.37; p < 0.01). Patients with a Turkish migration background were accompanied more often (47%; 95% CI = 41.64–52.98) than patients without a migration background (19%; 95% CI = 16.38–21.95). From all patients recorded, a short interview was conducted with 124 accompanied patients. The average age of all interviewed accompanied patients was 50 years. Women were accompanied more often (67%) than men. The accompanying persons came almost exclusively from the family circle. Slightly more than half of the accompanying persons were women. The majority of the accompanying persons were themselves patients in this family practice and 60% had their own reason for treatment in this consultation. The motives for bringing along a companion related to the areas of organization, communication, and social support. Prominently represented was the wish to involve the family in the illness process, emotional support, and support in communication. Accompanied patients without and with a Turkish migration background, however, differed little with regard to the motives mentioned. [ABSTRACT FROM AUTHOR]

Pregnancy in women living with chronic kidney disease (CKD) was often discouraged due to the risk of adverse maternal–fetal outcomes and the progression of kidney disease. This negative attitude has changed in recent years, with greater emphasis on patient empowerment than on the imperative 'non nocere'. Although risks persist, pregnancy outcomes even in advanced CKD have significantly improved, for both the mother and the newborn. Adequate counselling can help to minimize risks and support a more conscious and informed approach to those risks that are unavoidable. Pre-conception counselling enables a woman to plan the most appropriate moment for her to try to become pregnant. Counselling is context sensitive and needs to be discussed also within an ethical framework. Classically, counselling is more focused on risks than on the probability of a successful outcome. 'Positive counselling', highlighting also the chances of a favourable outcome, can help to strengthen the patient–physician relationship, which is a powerful means of optimizing adherence and compliance. Since, due to the heterogeneity of CKD, giving exact figures in single cases is difficult and may even be impossible, a scenario-based approach may help understanding and facing favourable outcomes and adverse events. Pregnancy outcomes modulate the future life of the mother and of her baby; hence the concept of 'post partum' counselling is also introduced, discussing how pregnancy results may modulate the long-term prognosis of the mother and the child and the future pregnancies. [ABSTRACT FROM AUTHOR]

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as "informed consent." Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will "fix" the problem. They omit critical information about the goals and downsides of surgery and present untenable options as a matter of patient choice. We propose a novel framework called "better conversations." Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. [ABSTRACT FROM AUTHOR]

The article discusses the importance of the clinical interview in psychiatry and the potential drawbacks of a checklist approach to interviewing. The author argues that clinical interviews should prioritize quality over quantity and that the checklist mindset may lead to lower quality care. The article raises concerns about the lack of quality control in clinical interviews and the potential negative impact on the doctor-patient relationship. The author suggests that the rise of the checklist psychiatrist is a sign of lower quality clinical care. [Extracted from the article]

The article offers information on clinical rounding in the neonatal intensive care unit (NICU), emphasizing its role in optimizing infant health before discharge. Topics include the objectives of clinical care in the NICU, the definition of rounds according to Dr. Gordon Caldwell, and the evidence-based practice of rounding.

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]

Aims: In this study, we examined the voluntary COVID-19 vaccine coverage among health care workers (HCWs) working in close patient contact. HCWs' beliefs about COVID-19 infection, their opinions of vaccination and reasons for having or declining the COVID-19 vaccination were also evaluated. Methods: In October 2021, a cross-sectional observational study was carried out in five hospitals in Central and Eastern Finland. The anonymous and voluntary survey was targeted at 5120 doctors and nurses working in close patient contact. Results: Some 1837 responses were included in the study. Ninety-seven per cent of the respondents had received at least one COVID-19 vaccine and 68% of the respondents agreed that all HCWs working in close patient contact should be vaccinated against COVID-19. Vaccination coverage and support for vaccination were higher among older HCWs and doctors. HCWs' main reasons for having the COVID vaccine were willingness to protect themselves, their family and their patients from COVID-19. Concerns about adverse reactions to the COVID-19 vaccine was the main reason for declining it. Conclusions: The overall COVID-19 vaccination coverage and support for vaccinations among HCWs working in close patient contact were high without actual mandatory policies being introduced. Prioritising HCWs for COVID-19 vaccinations and widespread vaccine availability, as well as low general vaccine hesitancy and high seasonal influenza vaccination coverage among the study population were check marks in achieving high COVID-19 vaccination coverage rapidly. [ABSTRACT FROM AUTHOR]

Objective: To assess for differences in how patients and otolaryngologists define the term dizziness. Methods: Between June 2020 and December 2022, otolaryngology clinicians and consecutive patients at 5 academic otolaryngology institutions across the United States were asked to define the term "dizziness" by completing a semantics-based questionnaire containing 20 common descriptors of the term within 5 symptom domains (imbalance-related, lightheadedness-related, motion-related, vision-related, and pain-related). The primary outcome was differences between patient and clinician perceptions of dizzy-related symptoms. Secondary outcomes included differences among patient populations by geographic location. Results: Responses were obtained from 271 patients and 31 otolaryngologists. Patients and otolaryngologists selected 7.7 ± 3.5 and 7.1 ± 4.3 symptoms, respectively. Most patients (266, 98.2%) selected from more than 1 domain and 17 (6.3%) patients identified symptoms from all 5 domains. Patients and clinicians were equally likely to define dizziness using terms from the imbalance (difference, −2.3%; 95% CI, −13.2%, 8.6%), lightheadedness (−14.1%; −29.2%, 1.0%), and motion-related (9.4; −0.3, 19.1) domains. Patients were more likely to include terms from the vision-related (23.6%; 10.5, 36.8) and pain-related (18.2%; 10.3%, 26.1%) domains. There were minor variations in how patients defined dizziness based on geographic location. Conclusions: Patients and otolaryngologists commonly described dizziness using symptoms related to imbalance, lightheadedness, and motion. Patients were more likely to use vision or pain-related terms. Understanding of these semantic differences may enable more effective patient-clinician communication. [ABSTRACT FROM AUTHOR]

Background: Isolated rapid‐eye‐movement sleep behavior disorder (iRBD) is associated with a high risk for phenoconversion to a neurodegenerative disorder, but the optimal approach for disclosure of this risk to patients is still debated. Objectives: The aim of this study was to explore views and experiences of iRBD experts regarding risk disclosure. Methods: In this qualitative study, semi‐structured interviews with sleep experts caring for patients with iRBD were analyzed through a conventional content analysis approach. Results: We interviewed 22 iRBD experts (eight female, average age of 51.8 years) from 18 Italian sleep centers; 21/22 regularly disclosed the risks associated with iRBD, usually after the video‐polysomnography, and 8/22 regularly mentioned phenoconversion rates. Content analysis allowed us to identify three main themes. First, sleep experts reported several points in favor of risk disclosure, especially related to the principle of beneficence, but some highlighted the need for specific learning on the topic. Second, experts favored a patient‐tailored disclosure that should not upset the patient unnecessarily, since phenoconversion is uncertain. Third, risk disclosure was seen by participants as a relational task that should be carried out in person in the context of a trusting patient‐physician relationship, while they had contrasting views regarding patients' previous knowledge. Conclusions: Sleep experts generally preferred a tailored and reassuring approach to risk disclosure within a framework of relational autonomy. The results of this study indicate the need for specific education, training, and recommendations concerning risk disclosure that should also include patients' and families' preferences. [ABSTRACT FROM AUTHOR]

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated how exposure to geriatric medicine before medical school through Hospital Elder Life Program (HELP) impacts students' interest and attitudes toward geriatrics. Topics discussed include self-assessment of perceptions of the field of geriatrics by respondents before and after participating in the HELP program, students' retrospective assessments about themselves before the program, and limitation of this type of assessment.

The authors propose an approach that focuses on maintaining and enhancing patients' trust in their clinicians. They discuss the elements required in maintaining and enhancing patients' trust through deprescribing, motives for deprescribing, and potential deprescribing measures. They also mention aligning recommendations with patients' circumstances and goals.

The article discusses the ethical issues surrounding telesurgery, including its precise definition, concerns about equitable access to technology, and potential conflicts of interest in marketing and financial incentives. It reports the improved patient outcomes, it also highlights the need for accurate marketing and patient-centered decision-making, despite potential misleading marketing.

The article discusses the challenges clinicians face in conducting goals of care discussions for patients with chronic critical illness, and it highlights the difficulties in patient participation, decision-making complexity, and the importance of building strong relationships. It emphasizes the ethical obligation to ensure treatment decisions reflect patient values and provide support during serious illness.

Qualitative research on the experiences of those living with premenstrual dysphoric disorder (PMDD) is limited. Utilising the material–discursive–intrapsychic (MDI) framework, the purpose of the study was to privilege the voices present within individuals who have moved into a space of recovery, management, or transformation of PMDD, and explore these narratives. The study involved seven, in-depth narrative interviews. The data were then analysed using the Listening Guide, a feminist, poststructural method used to capture the polyphony of perspectives surrounding PMDD experiences. The analysis generated two broad narrative themes, with four subsequent voices under each: (a) "within abjection"—the voice toward the Other, the voice silenced, the voice of anger, the voice of agency; and (b) "beyond abjection"—the voice of action, the voice of surrender, the voice of resistance, the voice of reembodiment. Significant findings from the research involved identifying the movement toward a space of recovery, management, or transformation of PMDD as attainable, with PMDD being a negotiable and therefore plastic experience for participants. Further, the participant accounts of dismissive, uninformed, and harmful treatment from medical providers were heard; experiences which led participants toward self-help options for PMDD management. [ABSTRACT FROM AUTHOR]

Objective A limited range of neuropsychiatric symptoms have been reported in systemic autoimmune rheumatic diseases (SARDs), with varied symptom prevalence. This study aimed to investigate a wider range of potential symptoms than previous studies, compare patient self-reports with clinician estimates, and explore barriers to symptom identification. Methods Mixed methods were used. Data from SARDs patients (n  = 1853) were compared with controls (n  = 463) and clinicians (n  = 289). In-depth interviews (n  = 113) were analysed thematically. Statistical tests compared means of survey items between patients and controls, 8 different SARD groups, and clinician specialities. Results Self-reported lifetime prevalences of all 30 neuropsychiatric symptoms investigated (including cognitive, sensorimotor and psychiatric) were significantly higher in SARDs than controls. Validated instruments assessed 55% of SARDs patients as currently having depression and 57% anxiety. Barriers to identifying neuropsychiatric symptoms included: (i) limits to knowledge, guidelines, objective tests and inter-speciality cooperation; (ii) subjectivity, invisibility and believability of symptoms; and (iii) under-eliciting, under-reporting and under-documenting. A lower proportion of clinicians (4%) reported never/rarely asking patients about mental health symptoms than the 74% of patients who reported never/rarely being asked in clinic (P  < 0.001). Over 50% of SARDs patients had never/rarely reported their mental health symptoms to clinicians, a proportion underestimated at <10% by clinicians (P  < 0.001). Conclusion Neuropsychiatric symptom self-reported prevalences are significantly higher in SARDs than controls, and are greatly underestimated by most clinicians. Research relying on medical records and current guidelines is unlikely to accurately reflect patients' experiences of neuropsychiatric symptoms. Improved inter-speciality communication and greater patient involvement is needed in SARD care and research. [ABSTRACT FROM AUTHOR]

Introduction: A key element of advance care planning (ACP) is the goals of care (GOC) conversation between the provider and the patient. The value of meaningful GOC conversations for the patient, provider, and health care institution is well documented. However, if the GOC documentation is buried in the medical record, not well defined, or poorly documented, that value is squandered. The Improvement Process: Interventions were implemented with oncology physicians and nurse practitioners (NPs). These included education, system reform including improving the ease and consistency of documentation of ACP, and regular feedback. Results: Participants reported increased confidence in communication skills about GOC conversations postworkshops. Data results for the tracked metrics, health care power of attorney, code status, and GOC, all showed improvement. Conclusion: Physicians and NPs recognized the importance of GOC conversations as part of ACP. Considerable progress was made by focusing on GOC conversations, maximizing information technology, participating in coaching, and ongoing data monitoring. [ABSTRACT FROM AUTHOR]