Communication at time of transitions: How to help patients cope with loss and re-define hope
Department of Medicine, Section of Medical Ethics and Palliative Care, Institute for Doctor-Patient Communication, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. The Cancer Journal
(Impact Factor: 4.24).
Patients undergo multiple transitions during the course of their cancer care. Oncologists are uniquely positioned to help patients through these transitions. When patients' situations change, they must cope with loss and associated negative emotions. They then are able to redefine hope. During transitions, patients want their oncologists to provide biomedical information, show that they care about and understand them as individuals, and balance hope and realism. Eliciting concerns and expressing empathy shows patients that their oncologist cares about and understands them and also helps patients to cope with the loss and negative emotions that transitions create. Oncologists can maintain hope by being sensitive to what patients are ready to hear when, and by helping them discover and identify realistic hopes. This is accomplished with the Ask-Tell-Ask and Hope for the Best, Prepare for the Worst techniques, and most importantly by being curious about patients' hopes and fears.
Available from: Paul K. Miller
Available from: Hiangkiat Tan
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ABSTRACT: To use multiple data sources to determine drivers of patient adherence to topical ocular hypotensive therapy.
Retrospective database and chart reviews in combination with prospective patient surveys. Diverse medical environments where insured patients in the research database seek care.
Three hundred patients with a new claim diagnosis for open-angle glaucoma who initially were prescribed one of three prostaglandins and 103 physicians participating in the same medical plans.
A structured interview addressing self-reported adherence, experiences with medication, communication with the physician, and health-related beliefs associated with adherence behavior was administered to surveyed patients. Phone interviews were conducted with participating ophthalmologists.
Of adherence, medication possession ratio.
Eight variables were associated independently with a lower medication possession ratio: (1) hearing all of what you know about glaucoma from your doctor (compared with some or nothing); (2) not believing that reduced vision is a risk of not taking medication as recommended; (3) having a problem paying for medications; (4) difficulty while traveling or away from home; (5) not acknowledging stinging and burning; (6) being nonwhite; (7) receiving samples; and (8) not receiving a phone call visit reminder. The multivariate model explained 21% of the variance.
These findings indicate that doctor-patient communications and health-related beliefs of patients contribute to patient adherence. Patient learning styles that are associated with less concern about the future effects of glaucoma and the risks of not taking medications are associated with lower adherence. Specifically, knowledge about potential vision loss from glaucoma is a critical element that tends to be missed by more passive doctor-dependent patients who tend to be poorly adherent. These findings suggest that educational efforts in the office may improve patient adherence to medical therapies.
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ABSTRACT: Classic trajectories of illness at end of life (EOL) suggest different care needs for patients with cancer versus chronic obstructive pulmonary disease (COPD) and may lead to different experiences of transitions over the course of a life-limiting illness. Patients may experience transitions in different ways than clinicians. No prior studies have examined this issue from patients', families', and clinicians' perspectives.
We sought to explore transitions, defined as experiences that patients and family members viewed as milestones in the evolution of their illnesses and therapies, and compare these perceptions with the perspectives of the patient's physician and nurse to provide insights about communication concerning EOL care.
We conducted a qualitative study using grounded theory to examine participants' perspectives on the experiences of key transitions in the context of living with advanced COPD or cancer. In-depth interviews with patients, family members, nurses, and physicians were conducted by experienced interviewers.
Six themes were identified regarding participants' experiences with transitions. Themes that defined transitions among both patients with COPD and those with cancer included: new or different treatments and no more treatments available. Themes unique to patients with COPD were activity limitations due to functional decline and initiation of oxygen therapy. One theme unique to clinicians was acute exacerbation of illness or hospitalization.
This study identified differences in the meaning of transitions for patients versus clinicians and for patients with COPD versus those with cancer. These findings may offer clinicians the opportunity to provide a more patient-centered approach to communication about end-of-life care by acknowledging and addressing transitions in palliative care from the perspective of the patient and family.
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