The main objective of this research is to investigate the epistemic and pragmatic management of patient-doctor interactions in Italian online health communities. To achieve this goal, an advanced web scraping methodology was used to extract from an Italian Q&A service (within the healthcare platforms, Il Mio Dottore) 200 pairs of questions and answers concerning two pathological conditions: anxiety and hypothyroidism. We first tagged the two sub-corpora and analyzed them both quantitatively and qualitatively to establish (i) what types of questions were used by patients, and what epistemic attitude and pragmatic function they convey; (ii) whether doctors’ replies were aligned or not; (iii) whether there were differences between the two sub-corpora. The results revealed many similarities between the two sub-corpora, but also some differences, mainly concerning doctors’ response patterns, with a tendency towards misalignment more pronounced in the anxiety sub-corpus. The practical implications of this and similar research may be numerous. First, they can improve understanding of the epistemic and pragmatic dynamics at play in Q&A services. Secondly, such knowledge can be used to formulate practical recommendations to foster better alignment with patients, thereby improving their engagement. Finally, this knowledge can guide the development of chatbot design guidelines.
{"title":"Exploring online patient-doctor interactions. An epistemic and pragmatic analysis of Q&A patterns in an Italian “Ask to the doctor” medical forum","authors":"Ramona Bongelli , Alessia Bertolazzi , Marina Paolanti , Ilaria Riccioni","doi":"10.1016/j.pec.2025.108662","DOIUrl":"10.1016/j.pec.2025.108662","url":null,"abstract":"<div><div>The main objective of this research is to investigate the epistemic and pragmatic management of patient-doctor interactions in Italian online health communities. To achieve this goal, an advanced web scraping methodology was used to extract from an Italian Q&A service (within the healthcare platforms, <em>Il Mio Dottore</em>) 200 pairs of questions and answers concerning two pathological conditions: anxiety and hypothyroidism. We first tagged the two sub-corpora and analyzed them both quantitatively and qualitatively to establish (i) what types of questions were used by patients, and what epistemic attitude and pragmatic function they convey; (ii) whether doctors’ replies were aligned or not; (iii) whether there were differences between the two sub-corpora. The results revealed many similarities between the two sub-corpora, but also some differences, mainly concerning doctors’ response patterns, with a tendency towards misalignment more pronounced in the anxiety sub-corpus. The practical implications of this and similar research may be numerous. First, they can improve understanding of the epistemic and pragmatic dynamics at play in Q&A services. Secondly, such knowledge can be used to formulate practical recommendations to foster better alignment with patients, thereby improving their engagement. Finally, this knowledge can guide the development of chatbot design guidelines.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108662"},"PeriodicalIF":2.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/j.pec.2024.108595
Maichou Lor , Mai Nhia Yang , Roger Brown , Betty Chewning
Objective
This pilot study examines the impact of the Pain Assessment Information Visualization (InfoViz) Tool on the length of the patient visit for Hmong patients with limited English proficiency (LEP).
Methods
A static design study was used to collect data from a triad of 20 Hmong patients with LEP, medical interpreters, and clinicians in the usual care group followed by 20 triads in the intervention group in primary care. We analyzed patient-clinician communication audio-recorded visits in primary care, examining both the length of the visit and the nature of the clinician efforts to gather more information using Svarstad’s clinician conversation conceptualization to explore probing frequencies for three pain categories: pain location, severity, and quality in the intervention group (Pain InfoViz Tool) and usual care group.
Results
The usual care group spent a longer time on pain discussions (Mean = 19.56 min, SD=20.17) compared to the intervention group (Mean = 12.39 min, SD=7.78). Clinicians in the intervention group probed less than those in the usual care group. Patients in the intervention group provided more pain information to clinicians than those in the usual care group.
Conclusions
The tool appears to shorten the time it takes to discuss the patient’s pain. It may have positively impacted Hmong patients with LEP' ability to describe their pain more clearly, resulting in less time and fewer assessment probes needed by clinicians.
Practice implications
Implementing the tool in clinical settings may lead to more efficient pain-related discussions.
{"title":"Exploring the impact of a pain assessment information visualization tool on provider-patient pain discussion with limited English proficiency Hmong patients","authors":"Maichou Lor , Mai Nhia Yang , Roger Brown , Betty Chewning","doi":"10.1016/j.pec.2024.108595","DOIUrl":"10.1016/j.pec.2024.108595","url":null,"abstract":"<div><h3>Objective</h3><div>This pilot study examines the impact of the Pain Assessment Information Visualization (InfoViz) Tool on the length of the patient visit for Hmong patients with limited English proficiency (LEP).</div></div><div><h3>Methods</h3><div>A static design study was used to collect data from a triad of 20 Hmong patients with LEP, medical interpreters, and clinicians in the usual care group followed by 20 triads in the intervention group in primary care. We analyzed patient-clinician communication audio-recorded visits in primary care, examining both the length of the visit and the nature of the clinician efforts to gather more information using Svarstad’s clinician conversation conceptualization to explore probing frequencies for three pain categories: pain location, severity, and quality in the intervention group (Pain InfoViz Tool) and usual care group.</div></div><div><h3>Results</h3><div>The usual care group spent a longer time on pain discussions (Mean = 19.56 min, SD=20.17) compared to the intervention group (Mean = 12.39 min, SD=7.78). Clinicians in the intervention group probed less than those in the usual care group. Patients in the intervention group provided more pain information to clinicians than those in the usual care group.</div></div><div><h3>Conclusions</h3><div>The tool appears to shorten the time it takes to discuss the patient’s pain. It may have positively impacted Hmong patients with LEP' ability to describe their pain more clearly, resulting in less time and fewer assessment probes needed by clinicians.</div></div><div><h3>Practice implications</h3><div>Implementing the tool in clinical settings may lead to more efficient pain-related discussions.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108595"},"PeriodicalIF":2.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.pec.2025.108663
Federica Biassoni , Martina Gnerre
Objectives
Conversational artificial agents such as ChatGPT are commonly used by people seeking healthcare information. This study investigates whether ChatGPT exhibits distinct communicative behaviors in healthcare settings based on the nature of the disorder (medical or psychological) and the user communication style (neutral vs. expressing concern).
Method
Queries were conducted with ChatGPT to gather information on the diagnosis and treatment of two conditions (arthritis and anxiety) using different styles (neutral vs. expressing concern). ChatGPT's responses were analyzed using Linguistic Inquiry and Word Count (LIWC) to identify linguistic markers of the agent's adjustment to different inquiries and interaction modes. Statistical analyses, including repeated measures ANOVA and k-means cluster analysis, identified patterns in ChatGPT's responses.
Results
ChatGPT used more engaging language in treatment contexts and psychological inquiries. It exhibited more analytical thinking in neutral contexts while demonstrating higher levels of empathy in psychological conditions and when the user expressed concern. Wellness-related language was more prevalent in psychological and treatment contexts, whereas illness-related language was more common in diagnostic interactions for physical conditions. Cluster analysis revealed two distinct patterns: high empathy and engagement in psychological/expressing-concern scenarios, and lower empathy and engagement in neutral/physical disease contexts.
Conclusions
These findings suggest that ChatGPT's responses vary according to disorder type and interaction context, potentially improving its effectiveness in patient engagement.
Practice implications
Through context and user-concern language adaptation, ChatGPT can enhance patient engagement.
{"title":"Exploring ChatGPT's communication behaviour in healthcare interactions: A psycholinguistic perspective","authors":"Federica Biassoni , Martina Gnerre","doi":"10.1016/j.pec.2025.108663","DOIUrl":"10.1016/j.pec.2025.108663","url":null,"abstract":"<div><h3>Objectives</h3><div>Conversational artificial agents such as ChatGPT are commonly used by people seeking healthcare information. This study investigates whether ChatGPT exhibits distinct communicative behaviors in healthcare settings based on the nature of the disorder (medical or psychological) and the user communication style (neutral vs. expressing concern).</div></div><div><h3>Method</h3><div>Queries were conducted with ChatGPT to gather information on the diagnosis and treatment of two conditions (arthritis and anxiety) using different styles (neutral vs. expressing concern). ChatGPT's responses were analyzed using Linguistic Inquiry and Word Count (LIWC) to identify linguistic markers of the agent's adjustment to different inquiries and interaction modes. Statistical analyses, including repeated measures ANOVA and k-means cluster analysis, identified patterns in ChatGPT's responses.</div></div><div><h3>Results</h3><div>ChatGPT used more engaging language in treatment contexts and psychological inquiries. It exhibited more analytical thinking in neutral contexts while demonstrating higher levels of empathy in psychological conditions and when the user expressed concern. Wellness-related language was more prevalent in psychological and treatment contexts, whereas illness-related language was more common in diagnostic interactions for physical conditions. Cluster analysis revealed two distinct patterns: high empathy and engagement in psychological/expressing-concern scenarios, and lower empathy and engagement in neutral/physical disease contexts.</div></div><div><h3>Conclusions</h3><div>These findings suggest that ChatGPT's responses vary according to disorder type and interaction context, potentially improving its effectiveness in patient engagement.</div></div><div><h3>Practice implications</h3><div>Through context and user-concern language adaptation, ChatGPT can enhance patient engagement.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108663"},"PeriodicalIF":2.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.pec.2025.108667
Julia A. Ciurria , Jennifer Reyes Lin , Cassandra M. Pruitt , Bryan A. Sisk
Objective
We investigated communication experiences of caregivers of children with medical complexity (CMC) during emergency care.
Methods
Fifteen caregivers of CMC participated in semi-structured interviews regarding communication while seeking care for their child in the emergency department (ED). Thematic analysis was applied using a previously established functional communication model as an a priori framework.
Results
Each of the previously established 8 core functions of communication were identified in this population. “Building relationships” manifested as clinicians soliciting caregiver input and responding to the needs of the caregiver. “Exchanging information” included clearly explaining next steps to caregivers. “Responding to emotions” acknowledged the inherent distress of seeking emergency care. “Providing validation” included recognizing caregivers as the expert of their own child. “Enabling self-management” manifested as identifying caregiver needs and directing toward resources. “Making decisions” manifested as involving caregivers in the decision-making process and recognizing caregiver decision fatigue. “Managing uncertainty” involved developing plans with caregivers. “Supporting hope” was the least commonly described function and manifested as emphasizing positive aspects of a child’s condition. Many caregivers described negative communication experiences in which their concerns and insights were unheard or invalidated.
Conclusion
Caregivers of CMC described communication experiences and goals that align with 8 communication functions that were identified in other serious childhood illnesses with unique operationalizations.
Practice implications
This communication framework can support ED clinicians in better understanding the communication needs of caregivers of CMC during emergency care.
{"title":"Functions of communication during emergency care of children with medical complexity: Caregiver perspectives","authors":"Julia A. Ciurria , Jennifer Reyes Lin , Cassandra M. Pruitt , Bryan A. Sisk","doi":"10.1016/j.pec.2025.108667","DOIUrl":"10.1016/j.pec.2025.108667","url":null,"abstract":"<div><h3>Objective</h3><div>We investigated communication experiences of caregivers of children with medical complexity (CMC) during emergency care.</div></div><div><h3>Methods</h3><div>Fifteen caregivers of CMC participated in semi-structured interviews regarding communication while seeking care for their child in the emergency department (ED). Thematic analysis was applied using a previously established functional communication model as an <em>a priori</em> framework.</div></div><div><h3>Results</h3><div>Each of the previously established 8 core functions of communication were identified in this population. “Building relationships” manifested as clinicians soliciting caregiver input and responding to the needs of the caregiver. “Exchanging information” included clearly explaining next steps to caregivers. “Responding to emotions” acknowledged the inherent distress of seeking emergency care. “Providing validation” included recognizing caregivers as the expert of their own child. “Enabling self-management” manifested as identifying caregiver needs and directing toward resources. “Making decisions” manifested as involving caregivers in the decision-making process and recognizing caregiver decision fatigue. “Managing uncertainty” involved developing plans with caregivers. “Supporting hope” was the least commonly described function and manifested as emphasizing positive aspects of a child’s condition. Many caregivers described negative communication experiences in which their concerns and insights were unheard or invalidated.</div></div><div><h3>Conclusion</h3><div>Caregivers of CMC described communication experiences and goals that align with 8 communication functions that were identified in other serious childhood illnesses with unique operationalizations.</div></div><div><h3>Practice implications</h3><div>This communication framework can support ED clinicians in better understanding the communication needs of caregivers of CMC during emergency care.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108667"},"PeriodicalIF":2.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.pec.2025.108665
Anna Franca Plastina
Objective
To analyse long COVID patients’ reconstruction of medical gaslighting (MG) discourse in online epistemic communities in order to identify the MG types experienced and unfold root causes.
Method
The mixed-methods of corpus‑based critical discourse analysis was applied to an ad hoc corpus of 18 threads (n = 1176 posts) from two sub-communities on the social media site Reddit. Comparative concordance analyses were performed on the two sub-corpora to semantically code concordance lines as MG types. Critical discourse analysis was conducted to uncover power/ideological drivers of MG discourse.
Results
Keyness log‑likelihood statistical measures displayed higher values for the pronouns I, me, you, it, they and the noun doctor(s). KWIC (Key Word in Context) output for these items exhibited seven main MG types: scapegoating, downplay, treatment refusal, psychosomatic disorder, disbelief, denial and dismissal. Concordance lines revealed three major sites of contention – epistemic knowledge, epistemic authority, long COVID indeterminacy – where MG tactics operate through epistemic injustice, ignorance, discrimination and lack of epistemic humility.
Conclusion
MG discourse is triggered by deep-seated ideologies rather than by mere doctor-patient interaction as a face-saving strategy which faults patients as epistemic agents.
Practical Implications
Patients’ social media mobilisation helps unmask MG tactics, raising providers’ awareness of the need for perspective-taking to build collaborative doctor-patient relationships.
{"title":"Long COVID patients’ reconstruction of medical gaslighting discourse in online epistemic communities","authors":"Anna Franca Plastina","doi":"10.1016/j.pec.2025.108665","DOIUrl":"10.1016/j.pec.2025.108665","url":null,"abstract":"<div><h3>Objective</h3><div>To analyse long COVID patients’ reconstruction of medical gaslighting (MG) discourse in online epistemic communities in order to identify the MG types experienced and unfold root causes.</div></div><div><h3>Method</h3><div>The mixed-methods of corpus‑based critical discourse analysis was applied to an ad hoc corpus of 18 threads (n = 1176 posts) from two sub-communities on the social media site Reddit. Comparative concordance analyses were performed on the two sub-corpora to semantically code concordance lines as MG types. Critical discourse analysis was conducted to uncover power/ideological drivers of MG discourse.</div></div><div><h3>Results</h3><div>Keyness log‑likelihood statistical measures displayed higher values for the pronouns <em>I</em>, <em>me</em>, <em>you</em>, <em>it, they</em> and the noun <em>doctor(s)</em>. KWIC (Key Word in Context) output for these items exhibited seven main MG types: <em>scapegoating</em>, <em>downplay</em>, <em>treatment refusal, psychosomatic disorder</em>, <em>disbelief</em>, <em>denial</em> and <em>dismissal</em>. Concordance lines revealed three major sites of contention – epistemic knowledge, epistemic authority, long COVID indeterminacy – where MG tactics operate through epistemic injustice, ignorance, discrimination and lack of epistemic humility.</div></div><div><h3>Conclusion</h3><div>MG discourse is triggered by deep-seated ideologies rather than by mere doctor-patient interaction as a face-saving strategy which faults patients as epistemic agents.</div></div><div><h3>Practical Implications</h3><div>Patients’ social media mobilisation helps unmask MG tactics, raising providers’ awareness of the need for perspective-taking to build collaborative doctor-patient relationships.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108665"},"PeriodicalIF":2.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1016/j.pec.2025.108666
Wiebke Frerichs , Laura Inhestern , Lene Marie Johannsen , Corinna Bergelt
Aim
To explore healthcare professionals’ (HCPs) experiences when communicating about child- and family-related aspects in cancer care and their attitudes about the importance of including these aspects in cancer care.
Methods
We conduced semi-structured interviews with HCPs working in oncology. Interviews were audio-recorded, transcribed verbatim and analyzed using Kuckartz's method for qualitative content analysis.
Results
N = 20 HCPs working in oncology, either inpatient or outpatient setting in the area of Hamburg, Germany participated. N = 7 were nurses, n = 6 psychologists, n = 5 physicians and n = 2 social workers. Results showed that HCPs’ communication about child- and family-related aspects for cancer patients parenting minor children varies widely, influenced by factors such as diagnosis, structural challenges, individual characteristics, or profession. Additionally, their attitudes about how relevant it is to integrate child- and family-related aspects in routine cancer care varies from low relevance (i.e. lower priority, beyond professional role) to high relevance (i.e. palliative cases, children have a right to know).
Conclusion
HCPs’ communication practice and views on the importance of addressing child- and family-related aspects in cancer care vary widely and are shaped by various influences.
Practice implication
Results emphasize the need for training and resources to enhance HCPs communication competencies to provide family-oriented care proactively.
{"title":"Providing care to cancer patients parenting minor children: A qualitative study on healthcare professionals’ communication practice","authors":"Wiebke Frerichs , Laura Inhestern , Lene Marie Johannsen , Corinna Bergelt","doi":"10.1016/j.pec.2025.108666","DOIUrl":"10.1016/j.pec.2025.108666","url":null,"abstract":"<div><h3>Aim</h3><div>To explore healthcare professionals’ (HCPs) experiences when communicating about child- and family-related aspects in cancer care and their attitudes about the importance of including these aspects in cancer care.</div></div><div><h3>Methods</h3><div>We conduced semi-structured interviews with HCPs working in oncology. Interviews were audio-recorded, transcribed verbatim and analyzed using Kuckartz's method for qualitative content analysis.</div></div><div><h3>Results</h3><div>N = 20 HCPs working in oncology, either inpatient or outpatient setting in the area of Hamburg, Germany participated. N = 7 were nurses, n = 6 psychologists, n = 5 physicians and n = 2 social workers. Results showed that HCPs’ communication about child- and family-related aspects for cancer patients parenting minor children varies widely, influenced by factors such as diagnosis, structural challenges, individual characteristics, or profession. Additionally, their attitudes about how relevant it is to integrate child- and family-related aspects in routine cancer care varies from low relevance (i.e. lower priority, beyond professional role) to high relevance (i.e. palliative cases, children have a right to know).</div></div><div><h3>Conclusion</h3><div>HCPs’ communication practice and views on the importance of addressing child- and family-related aspects in cancer care vary widely and are shaped by various influences.</div></div><div><h3>Practice implication</h3><div>Results emphasize the need for training and resources to enhance HCPs communication competencies to provide family-oriented care proactively.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"133 ","pages":"Article 108666"},"PeriodicalIF":2.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-12DOI: 10.1016/j.pec.2025.108652
Veronica Derricks , Eva S. Pietri , India R. Johnson , Daniela Gonzalez
Objectives
Adults with higher body weights experience weight stigma in healthcare, which can heighten concerns about treatment in these settings. This study investigates whether a specific strategy—using an identity-safety cue, or a cue which signals that one’s social identity is valued—mitigates these concerns.
Methods
527 U.S. adults who self-identified as overweight were randomized to read about a hypothetical physician who endorsed a weight-inclusive clinical approach (identity-safety cue condition) or making health information accessible (control condition). Next, participants read a vignette where the physician attributed their persistent knee pain to their age (control diagnosis), lifestyle habits (ambiguous diagnosis), or body weight (stigmatizing diagnosis).
Results
Exposure to the physician who employed the identity-safety (versus control) cue decreased weight stigma concerns, increased perceptions of physician allyship, and promoted identity-safety. While use of the identity-safety cue elicited benefits regardless of the physician’s clinical diagnosis, viewing the identity-safety cue alongside the stigmatizing diagnosis increased perceptions that the physician’s commitment to diversity was dishonest, which subsequently harmed feelings of safety.
Conclusions
Use of identity-safety cues in healthcare can effectively promote inclusion for adults with higher body weights. However, perceiving that the physician’s pro-diversity efforts are dishonest can undermine inclusion.
Practice implications
To effectively promote inclusion for adults with higher body weights, physicians should employ cues which explicitly signal that their weight identity is valued.
{"title":"Examining the impact of identity-safety cues on inclusion for adults with higher body weights in healthcare settings","authors":"Veronica Derricks , Eva S. Pietri , India R. Johnson , Daniela Gonzalez","doi":"10.1016/j.pec.2025.108652","DOIUrl":"10.1016/j.pec.2025.108652","url":null,"abstract":"<div><h3>Objectives</h3><div>Adults with higher body weights experience weight stigma in healthcare, which can heighten concerns about treatment in these settings. This study investigates whether a specific strategy—using an identity-safety cue, or a cue which signals that one’s social identity is valued—mitigates these concerns.</div></div><div><h3>Methods</h3><div>527 U.S. adults who self-identified as overweight were randomized to read about a hypothetical physician who endorsed a weight-inclusive clinical approach (identity-safety cue condition) or making health information accessible (control condition). Next, participants read a vignette where the physician attributed their persistent knee pain to their age (control diagnosis), lifestyle habits (ambiguous diagnosis), or body weight (stigmatizing diagnosis).</div></div><div><h3>Results</h3><div>Exposure to the physician who employed the identity-safety (versus control) cue decreased weight stigma concerns, increased perceptions of physician allyship, and promoted identity-safety. While use of the identity-safety cue elicited benefits regardless of the physician’s clinical diagnosis, viewing the identity-safety cue alongside the stigmatizing diagnosis increased perceptions that the physician’s commitment to diversity was dishonest, which subsequently harmed feelings of safety.</div></div><div><h3>Conclusions</h3><div>Use of identity-safety cues in healthcare can effectively promote inclusion for adults with higher body weights. However, perceiving that the physician’s pro-diversity efforts are dishonest can undermine inclusion.</div></div><div><h3>Practice implications</h3><div>To effectively promote inclusion for adults with higher body weights, physicians should employ cues which explicitly signal that their weight identity is valued.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108652"},"PeriodicalIF":2.9,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143331551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1016/j.pec.2025.108649
Lauren M. Hamel , Diliara Bagautdinova , Bill Winkler , Fred Hardy , Cindy Sulad , Marie Lumpkin , Elisabeth Heath , Susan Eggly
Objective
Racial disparities in clinical communication quality are well-established but most clinical communication assessment tools are created without the collaboration of racially-diverse patient populations. Our objective was to collaborate with Black and White cancer survivors, caregivers, and advocates to develop and validate a tool to assess physicians’ patient-centered communication.
Methods
A panel of Black and White cancer survivors, caregivers, and advocates (n = 11) and researchers observed and discussed video-recorded patient-physician cancer clinical interactions to generate and refine a list of physician communication behaviors considered critical for high-quality patient-centered communication. Raters applied the 22-item scale (Patient-Informed Cancer Communication Scale; PICCS) assessing physicians’ patient-centered communication to video-recorded interactions (n = 61) from a larger study. We determined constructs using scale development and factor analysis and validated the scale through correlation with existing scales.
Results
Factor analysis identified five factors: treatment options; clinical relationship; prognosis and goals of treatment; explanations; and context. Treatment options, prognosis and goals of treatment, and the full scale correlated with a validated patient active participation scale. Clinical relationship and context correlated with a validated physicians’ patient-centered communication scale.
Conclusion
This community-engaged research produced a reliable and valid scale to assess physician patient-centered communication in the context of Black and White people with cancer.
Practice Implications
With further validation work, this scale can be used to train and assess physician communication quality when discussing cancer treatment in diverse cancer patient populations.
{"title":"From community to scale: Using community engagement to develop and validate a patient-informed cancer communication scale","authors":"Lauren M. Hamel , Diliara Bagautdinova , Bill Winkler , Fred Hardy , Cindy Sulad , Marie Lumpkin , Elisabeth Heath , Susan Eggly","doi":"10.1016/j.pec.2025.108649","DOIUrl":"10.1016/j.pec.2025.108649","url":null,"abstract":"<div><h3>Objective</h3><div>Racial disparities in clinical communication quality are well-established but most clinical communication assessment tools are created without the collaboration of racially-diverse patient populations. Our objective was to collaborate with Black and White cancer survivors, caregivers, and advocates to develop and validate a tool to assess physicians’ patient-centered communication.</div></div><div><h3>Methods</h3><div>A panel of Black and White cancer survivors, caregivers, and advocates (<em>n</em> = 11) and researchers observed and discussed video-recorded patient-physician cancer clinical interactions to generate and refine a list of physician communication behaviors considered critical for high-quality patient-centered communication. Raters applied the 22-item scale (Patient-Informed Cancer Communication Scale; PICCS) assessing physicians’ patient-centered communication to video-recorded interactions (<em>n</em> = 61) from a larger study. We determined constructs using scale development and factor analysis and validated the scale through correlation with existing scales.</div></div><div><h3>Results</h3><div>Factor analysis identified five factors: <em>treatment options; clinical relationship; prognosis and goals of treatment; explanations;</em> and <em>context</em>. <em>Treatment options, prognosis and goals of treatment</em>, and the <em>full scale</em> correlated with a validated patient active participation scale. <em>Clinical relationship</em> and <em>context</em> correlated with a validated physicians’ patient-centered communication scale.</div></div><div><h3>Conclusion</h3><div>This community-engaged research produced a reliable and valid scale to assess physician patient-centered communication in the context of Black and White people with cancer.</div></div><div><h3>Practice Implications</h3><div>With further validation work, this scale can be used to train and assess physician communication quality when discussing cancer treatment in diverse cancer patient populations.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"134 ","pages":"Article 108649"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11DOI: 10.1016/j.pec.2025.108648
Maria K. Venetis, Shawnika J. Hull, Haley Nolan-Cody, Jorlanditha T. Austin, M.J. Salas, ShuXian (Jenny) Mai, Lillianna Shields, Cimmiaron F. Alvarez
Objective
We conducted a systematic scoping review to characterize the landscape of communication scholarship within racial health equity in and through the patient-provider interaction.
Methods
We employed three waves of data collection to identify relevant articles (N = 454) about racial equity within provider-patient interactions. We iteratively developed a codebook concerning article characteristics, coding for journal names, data source, descriptive characteristics for the study samples, and presence of theory and equity in sections of the manuscripts.
Results
This search identified studies (N = 206) that were published in 76 peer-reviewed scientific journals. The majority of studies reported primary data analyses and used survey and interview methodology. Many studies examined participants as patients generally rather than in reference to particular health conditions. Among those with a specific health condition, the largest proportion focused on cancer control. Very few studies included samples with Native American and Pacific Island heritage. Most studies included cisgender men and/or women, but none included transgender men or women. The vast majority of research focused on the patient experience; few centered on providers’ and caregivers’ experiences. The body of scholarship was largely atheoretical; the most frequently noted constructs were patient-provider communication (including patient-centered communication and patient-centered care), implicit/explicit racial bias, shared decision-making. There was wide variation in the extent to which equity was woven through the manuscripts. Equity is typically mentioned in the literature review, and racial identity in the sample may serve as a marker of racialized experiences.
Conclusion
This study demonstrates the need for the development of theory that elevates the centrality of health equity to attend to the bi- or multi-directional flow of communication that shapes the quality of these interactions.
Practice Implications
These insights can serve as a strong foundation for the development of interventions to address equity in clinical interactions.
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Pub Date : 2025-01-10DOI: 10.1016/j.pec.2025.108650
Marie C. Haverfield , Yuwei Li , Rachyl Pines , Tyler Kyte , Daria Titova , Jennifer A. Theiss
Objective
Relationship-centered care (RCC) positions the exchange between patient and provider as central to patient care. Due to limitations in analytical approach, how the relational exchange develops throughout the clinical visit remains unclear. Dynamic dyadic systems (DDS) perspectives overcome these limitations to reveal interdependencies and evolving patterns in turn-taking sequences within dyads. We applied DDS analyses to examine how features of RCC manifest during clinical visits with Spanish-speaking Latinx and English-speaking non-Latinx patients.
Methods
We analyzed transcripts from 13 primary care visits (5 with Latinx patients, 8 with non-Latinx patients). Interaction turns totaled N = 2394 units of analysis. Dyadic time series plots examined the trajectory of clinical encounters and contributions made by patients and providers. Sequence analysis identified distinct turn patterns—or conversational motifs among dyads.
Results
Conversational motifs reflected four patterns. In our example, motif distribution differed such that with Latinx Spanish-speaking patients, the provider largely engaged in patient-focused probing dialogue, while relational features of communication were underrepresented. In contrast, with non-Latinx English-speaking patients, providers engaged in more instructive exchange.
Conclusion
Results support DDS to analyze patient-provider communication by illustrating interdependencies in reciprocal exchange and inequities in RCC delivery.
Practice implications
Findings demonstrate opportunities for behavioral change to enhance cultural sensitivity in the delivery of care.
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