Table 4 - uploaded by Richard Frankel
Content may be subject to copyright.
Patient communication behaviors identified through expert consensus and physician communication behaviors within the Four Habits Model Framework

Patient communication behaviors identified through expert consensus and physician communication behaviors within the Four Habits Model Framework

Source publication
Article
Full-text available
The communication literature currently focuses primarily on improving physicians' verbal and non-verbal behaviors during the medical interview. The Four Habits Model is a teaching and research framework for physician communication that is based on evidence linking specific communication behaviors with processes and outcomes of care. The Model conce...

Context in source publication

Context 1
... experts expressed concerns about not including "participate in decision making" in the final list; this was among the behaviors that did not reach consensus. Table 4 presents a proposed framework that includes patient habits and communication behaviors (columns 1 and 2) derived from our consensus process as well as physician habits and communication behaviors (columns 3 and 4) from the original Four Habits Model. ...

Similar publications

Article
Full-text available
Garfield StudyThis communication research continued in 2004 as part of two-region Garfield Memorial Fund research: MD-Patient Communication Study, part of the Clinician-Patient Communication Research Initiative.2 Researchers have consistently found the top predictors of overall patient satisfaction are the quality of the physician-patient relations...

Citations

... It can be tailored to the requirements of the individual research objective, ranging from open and exploratory to standardised confirmatory approaches. 20 The original Delphi study aimed to create a standardised and reproducible assessment of perioperative complications and overall associated morbidity by introduction of the CAMUS Reporting and Classification System (see Table S1). ...
Article
Full-text available
Objectives: The aim of this study is to gain experienced nursing perspective on current and future complication reporting and grading in Urology, establish the CAMUS CCI and quality control the use of the Clavien-Dindo Classification (CDC) in nursing staff. Subjects and methods: The 12-part REDCap-based Delphi survey was developed in conjunction with expert nurse, urologist and methodologist input. Certified local and international inpatient and outpatient nurses specialised in urology, perioperative nurses and urology-specific advanced practice nurses/nurse practitioners will be included. A minimum sample size of 250 participants is targeted. The survey assesses participant demographics, nursing experience and opinion on complication reporting and the proposed CAMUS reporting recommendations; grading of intervention events using the existing CDC and the proposed CAMUS Classification; and rating various clinical scenarios. Consensus will be defined as ≥75% agreement. If consensus is not reached, subsequent Delphi rounds will be performed under Steering Committee guidance. Results: Twenty participants completed the pilot survey. Median survey completion time was 58 min (IQR 40-67). The survey revealed that 85% of nursing participants believe nurses should be involved in future complication reporting and grading but currently have poor confidence and inadequate relevant background education. Overall, 100% of participants recognise the universal demand for reporting consensus and 75% hold a preference towards the CAMUS System. Limitations include variability in nursing experience, complexity of supplemental grades and survey duration. Conclusion: The integration of experienced nursing opinion and participation in complication reporting and grading systems in a modern and evolving hospital infrastructure may facilitate the assimilation of otherwise overlooked safety data. Incorporation of focused teaching into routine nursing education will be essential to ensure quality control and stimulate awareness of complication-related burden. This, in turn, has the potential to improve patient counselling and quality of care.
... The Delphi technique was used by analogy, by following the recommendations of [50,51]. The Delphi process was implemented for the identification of patient behavior in [52]. The structures of the Delphi technique were demonstrated in the work by [53] for the modelling of expert knowledge for ecological problem solution by defining the mangrove composition and estimating the time frame for recovery after the treats. ...
Article
Full-text available
The problems of developing online decision support systems concern the complexity of the transportation management processes, the multi-dimensionality of data warehouses (DWs), and the multi-criteria of decision making. Such issues arise in the management processes by supporting them with adaptable information and communication infrastructure for the management of the freight’s transportation processes. Our research domain involves the assurance of infrastructure for the provision of smart services for the operative management of multi-modal transportation of freights under the conditions of the heterogeneity of communication channels and multi-criteria decision support. The complexity of managing multi-modal transportation processes raises some problems for ensuring the infrastructure for finding more optimal management solutions by the requirements of green development. This research aims to develop the approach for providing the infrastructure of intelligent smart services for adaptable implementation in management processes of online multi-modal freight transportation. The objectives are forwarded to construct the multi-criteria decision-making components and integrate them into the multi-layered, computer-based information management of intelligent systems. We present the steps of extension of the structure of the knowledge-based system with a multi-criteria decision support method, and the possibilities to work under the conditions of wireless networks and the recognition of context-aware situations. The results are demonstrated for the analysis of alternatives by assessing the multi-modal transportation corridors between the East and West regions of Europe, and the opportunities to evaluate them for more effective managerial perspectives under sustainable development requirements.
... Methods of stakeholder involvement in research prioritisation, including patients, is a fast developing field. In addition to more established techniques such as the Delphi method, recently applied to health care research [26,27], a proliferation of approaches are being suggested in the literature to provide structure and transparency to the process [28]. More structured methods, such as those of the James Lind Alliance and used by the Child Health Nutrition and Research Initiative [28,29], are expected to take precedence over the coming years. ...
Article
Full-text available
Background: People living with and beyond cancer are more likely to have comorbid conditions and poorer mental and physical health, but there is a dearth of in-depth research exploring the psychosocial needs of people experiencing cancer and comorbid chronic conditions. A patient partnership approach to research prioritisation and planning can ensure outcomes meaningful to those affected and can inform policy and practice accordingly, but can be challenging. Methods: We aimed to inform priorities for qualitative inquiry into the experiences and support needs of people living with and beyond cancer with comorbid illness using a partnership approach. A three-step process including a patient workshop to develop a consultation document, online consultation with patients, and academic expert consultation was carried out. The research prioritisation process was also appraised and reflected upon. Results: Six people attended the workshop, ten responded online and eight academic experts commented on the consultation document. Five key priorities were identified for exploration in subsequent qualitative studies, including the diagnostic journey, the burden of symptoms, managing medications, addressing the needs of informal carers, and service provision. Limitations of patient involvement and reflections on procedural ethics, and the challenge of making measurable differences to patient outcomes were discussed. Conclusions: Findings from this research prioritisation exercise will inform planned qualitative work to explore patients' experiences of living with and beyond cancer with comorbid illness. Including patient partners in the research prioritisation process adds focus and relevance, and feeds into future work and recommendations to improve health and social care for this group of patients. Reflections on the consultation process contribute to a broadening of understanding the field of patient involvement.
... These identified interrelationships reflect both the multifaceted nature of the communication concepts, and the interactive nature of doctor-patient communication within medical encounters [37]. Although similar issues are likely to apply to PA-patient encounters, there is a dearth of such data. ...
... The interview consisted of a series of openended questions with supplementary prompts to allow key areas of interest to be explored without being overly prescriptive about content and direction [43]. An initial topic guide was developed based on the study aim, and informed by evidence on clinician-patient communication behaviours associated with patients' positive experiences and satisfaction with medical encounters [27][28][29][30][31][32][33][34][35][36][37]. It was discussed with patient and public representatives, with whom we developed the guide further. ...
Article
Full-text available
Background: Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences. Methods: A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. Results: Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. Conclusions: PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles.
... We identified eight unique interaction patterns that varied according to the communication behaviors of each participant, how the interactions flowed, and which participant dominated the interactions. While most studies on communication in healthcare encounters have measured specific communication behaviors (e.g., asking questions) [22,23] and factors that influence communication (e.g., beliefs about control) [24], our findings add to the literature by providing a qualitatively derived typology of interaction patterns based on naturally occurring healthcare encounters. ...
Article
Full-text available
Purpose: Effective symptom discussion is an essential step to enhance symptom management in patients with advanced pancreatic cancer (APC). However, little is known about how these patients communicate their symptoms during health encounters. The purpose of this study was to develop a typology to describe patterns of interactions between patients with APC, their caregivers, and healthcare providers as regards to symptoms and symptom management. Methods: Thematic analysis was used to analyze 37 transcripts of audio-recorded, naturally occurring encounters among APC patients, caregivers, and healthcare providers. Transcripts were drawn from the Values and Options in Cancer Care study, a larger randomized controlled communication and decision-making intervention trial, which recruited advanced cancer patients and caregivers across the USA. All transcripts from APC patients that were pre-intervention were analyzed. Results: Eight unique types of interaction patterns among patients, caregivers, and healthcare providers were identified as follows: collaborative interactions, explanatory interactions, agentic interactions, checklist interactions, cross-purpose interactions, empathic interactions, admonishing interactions, and diverging interactions. Conclusions: Our findings provide a systematic description of a variety of types of interaction patterns regarding symptom discussion among APC patients, caregivers, and healthcare providers. These typologies can be used to facilitate effective communication and symptom management.
... Starting with the second round, the responses from the previous rounds are provided as feedback to the participants. They are allowed to reassess and change their initial judgments or positions regarding the topic discussed in previous rounds having considered the colleagues' opinions [25]. In the last decades, Delphi method of systematically of gathering input from experts on a topic has been widely applied in education, economics and health [26]. ...
Article
Full-text available
Research with minors, especially for preventive purposes, e.g., suicide prevention, investigating risk or self-destructive behaviors such as deviance, drug abuse, or suicidal behavior, is ethically sensitive. We present a Delphi study exploring the ethical implications of the needs formulated by researchers in an international pre-conference who would benefit from ethics support and guidance in conducting Mental Health Research with minors. The resulting List of Ethical Issues (LEI) was submitted to a 2-rounds Delphi process via the Internet, including 34 multidisciplinary experts. In the first round, the experts reviewed the LEI and completed a questionnaire. Results from this round were analyzed and grouped in nine categories comprising 40 items. In the second round, the experts had to agree/disagree with the needs expressed in the LEI leading to a final list of 25 ethical issues considered relevant for Mental Health Research with minors such as: confidentiality of the sensitive data, competence for consenting alone and risk of harm and stigma related to the methodology used in research. It was shown that studies like SEYLE (Saving and Empowering Young Lives in Europe) trigger among researchers wishes to obtain specific recommendations helping to comply with standards for good practice in conducting research with minors.
... Because they are more likely to be stereotyped as dependent or as possessing diminished capacity simply because of their age (Adams-Price & Morse, 2009), they often start out in a position of amplified disadvantage relative to other actors. Thus, it is crucial that elders and their advocates be adequately prepared to anticipate stereotypical responses, proactively seize the initiative, and ask the kinds of questions that will steer the direction of discourse toward attainment of desired outcomes (Cegala, Street, & Clinch, 2007;Rao et al., 2010). ...
Article
Full-text available
Unequal power relations lie just below the surface in much of today’s discourse on health care communication with older adults. Focusing on pathologies or deficits tends to reinforce stereotypes of frailty and dependency, thus framing elders as a vulnerable group requiring special assistance. Implicit stereotyping frequently colors interactions of health care personnel with older clients and their families—interactions likely to affect elders’ perceptions and health outcomes. Health care providers need to be attuned to the vast and growing diversity in today’s older population, wherein many older adults are exemplars of what it takes to marshal resources and cope with multifaceted challenges. Thus, elders have the potential to teach medical personnel through narratives of resilience as well as tribulation. This potential can be fully realized, however, only in contexts where communication patterns characterized by paternalism, consumerism, and collaboration are mutually recognized and selectively challenged or implemented. Promising interventions to facilitate health care communication in older adulthood might well be directed toward (a) educating both recipients and providers to become more mindful of cues that evoke stereotypical thinking, (b) promoting an institutional culture that normalizes situationally appropriate assertive responses to stereotyping, and (c) formally ratifying older adults’ life experience in the training of health care personnel.
... While there could be any number of important communicative tasks in clinicianpatient care, Epstein and Street (2007) identify six key functions -effective information exchange, fostering healing relationships, responding to emotions, making quality decisions, enabling patient self-management, and with respect to this chapter, managing uncertainty. Street and de Haes (2013) have in turn proposed a theory-driven functional approach to conceptualizing communication skills as a situation-specific, goal-oriented process (see also , Hulsman 2009;Rao et al. 2010) intended to achieve immediate (e.g., shared understanding, trust, reassurance) or intermediate (e.g., commitment to treatment, self-care skills) outcomes that improve patients' health and well-being (see, for instance, Street et al. 2009). ...
... This needs to consider the different stakeholders and account for those costs over time, in particular, considering how effective implementation of an intervention links to the later experience and outcomes of a patient's care. ( Rao et al. 2010) Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters (Focus on patient interventions) ...
... [19][20][21][22][23] Specific communication skill-development programs have been shown to be effective in improving clinician-patient relationships and in turn to improve patient outcomes. [24][25][26][27] Healing relationships also occur outside of the clinical encounter. Social support is critical to health and wellbeing. ...
Article
Full-text available
There is universal agreement that a healing environment is desirable for patients and for providers. What constitutes a healing environment is open to discussion and depends on individual perspectives. The Samueli Institute coined the term Optimal Healing Environment (OHE) in 2004 to describe a healthcare system that is designed to stimulate and support the inherent healing capacity of patients, families, and their care providers. An OHE consists of people in relationships, their health-creating behaviors, and the surrounding physical environment.¹ The OHE framework (Figure) is a conceptual framework applicable to health professionals; patients, their families, and significant others; healthcare organizations; and healthcare systems. As an organizing framework, the 8 concepts contained in the 4 environments of the OHE framework provide direction to patients, families, care providers, and organizations to optimize the potential for healing. Each of the environments and constructs of the OHE framework work synergistically to support and stimulate health creation and healing (a concept known as salutogenesis).