Awkward moments in patient-physician communication about HIV risk.
ABSTRACT Physicians frequently encounter patients who are at risk for HIV infection, but they often evaluate risk behaviors ineffectively.
To describe the barriers to and facilitators of comprehensive HIV risk evaluation in primary care office visits.
Qualitative thematic and sequential analysis of videotaped patient-physician discussions about HIV risk. Tapes were reviewed independently by physician and patient and were coded by the research team.
Convenience sample of 17 family physicians and general internists. Twenty-six consenting patients 18 to 45 years of age who indicated concern about or risks for HIV infection on a 10-item questionnaire administered before the physician visit were included.
A thematic coding scheme and a five-level description of the depth of HIV-related discussion.
In 73% of the encounters, physicians did not elicit enough information to characterize patients' HIV risk status. The outcome of HIV-related discussions was substantially influenced by the manner in which the physician introduced the topic, handled awkward moments, and dealt with problematic language and the extent to which the physician sought the patient's perspective. Feelings of ineffectiveness and strong emotions interfered with some physicians' ability to assess HIV risk. Physicians easily recognized problematic communication during reviews of their own videotapes.
Comprehensive HIV risk discussions included providing a rationale for discussion, effectively negotiating awkward moments, repairing problematic language, persevering with the topic, eliciting the patient's perspective, responding to fears and expectations, and being empathic. Educational programs should use videotape review and should concentrate on physicians' personal reactions to discussing emotionally charged topics.
Full-textDOI: · Available from: Howard B Beckman, May 15, 2014
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Article: Awkward moments in patient-physician communication about HIV risk.
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ABSTRACT: We developed an iPad-based application to administer an HIV risk assessment tool in a clinical setting. We conducted focus group discussions (FGDs) with gay, bisexual and other men who have sex with men (MSM) to assess their opinions about using such a device to share risk behavior information in a clinical setting. Participants were asked about their current assessment of their risk or any risk reduction strategies that they discussed with their healthcare providers. Participants were then asked to provide feedback about the iPad-based risk assessment, their opinions about using it in a clinic setting, and suggestions on how the assessment could be improved. FGD participants were generally receptive to the idea of using an iPad-based risk assessment during healthcare visits. Based on the results of the FGDs, an iPad-based risk assessment is a promising method for identifying those patients at highest risk for HIV transmission.SpringerPlus 12/2014; 3:708. DOI:10.1186/2193-1801-3-708
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ABSTRACT: Background Innovations are needed to increase universal HIV screening by primary care providers. One potential intervention is self-audit feedback, which describes the process of a clinician reviewing their own patient charts and reflecting on their performance. Methods The effectiveness of self-audit feedback was investigated using a mixed methods approach. A total of 2111 patient charts were analyzed in a quantitative pre-post intervention study design, where the intervention was providing self-audit feedback to all internal medicine residents at one institution through an annual chart review. Qualitative data generated from the subsequent resident focus group discussions explored the motivation and mechanism for change using a knowledge–attitude–behavior framework. Results The proportion of primary care patients screened for HIV increased from 17.9% (190/1060) to 40.3% (423/1051). The adjusted odds ratio of a patient being screened following resident self-audited feedback was 3.17 (95% CI 2.11, 4.76, p < 0.001). Focus group participants attributed the improved performance to the self-audit feedback. Conclusions Self-audit feedback is a potentially effective intervention for increasing universal HIV screening in primary care. This strategy may be most useful in settings where (1) baseline performance is low, (2) behavioral change is provider-driven, and (3) resident trainees are targeted.Journal of Infection and Public Health 09/2014; 8(2). DOI:10.1016/j.jiph.2014.08.010
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ABSTRACT: Context: Human immunodeficiency virus (HIV) and sexually transmitted disease (STD) risk assessment and counseling are recommended for a large proportion of the population, yet measured rates of such counseling remain low.Objective: Use a comprehensive intervention to improve and sustain rates of HIV/STD risk assessment and counseling by providers.Design: Patient telephone survey using a one-group pre- and post-intervention design with measurements over a 62-week period.Setting and Participants: Patients (N=1042) from two outpatient clinics at a health maintenance organization (HMO) presenting for either of two types of index visit: symptomatic (n=210), or routine physical examination or birth control (n=832) visits.Main Outcome Measures: Telephone survey performed within 3 weeks of the index visit. Patients’ recall of a general discussion of HIV/STDs and specific discussion of sexual behaviors/risk factors.Results: The intervention was associated with increased patient recall of providers: discussing HIV/STD in general (OR 1.6; 95% CI, 1.12–2.22), asking about sexual behaviors/risk factors (OR 1.7; 95% CI, 1.2–2.6), discussing HIV prevention generally (OR 2.4; 95% CI, 1.4–4.0), and discussing personal risk reduction (OR 2.6; 95% CI, 1.6–4.3). Provision of written materials concerning HIV/STD also increased significantly (OR 2.8; 95% CI, 1.3–4.3). A clear-cut pattern of improved provider effort was seen, with the most pronounced improvements in high-risk patients. Results were stable over a 38-week follow-up period.Conclusion: A sustained improvement in HIV/STD risk assessment and counseling can be achieved in an outpatient HMO setting using a relatively non-intensive systematized intervention.American Journal of Preventive Medicine 04/2001; 20(3):177-183. DOI:10.1016/S0749-3797(00)00308-1 · 4.28 Impact Factor