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The perspective of the person in healthcare: Listening to and engaging persons in healthcare
Patient Education and Counseling 100 (2017) 1967–1968
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
From the Editor
The perspective of the person in healthcare: Listening to and engaging persons in healthcare
The present issue of Patient Education and Counseling is a Special Issue with selected papers from the International Conference on Communication in Healthcare arranged by EACH – International Association for Communication in Healthcare in Heidelberg, Germany, September 7-10, 2016. An overarching theme of many of the papers is the importance of taking the perspective of the person in healthcare, not only treating bodies and diseases. We should learn to better address unique people, situations, and challenges and observe the key relevance of considering patients, learners, and health situations, in particular complex situations, as unique entities. Healthcare professionals should approach patients as subjects, rather than as an object of care. Patients should be given the opportunity to reflect on future personal care needs so that at the point of care, they can, together with their families and healthcare professionals, make decisions that incorporate individual patient preferences. Learners should be helped to watch, identify and practice effective communication skills during clinical clerkships and other workplace-based learning. This requires reflection on individual patient interviews, including how more general, or ideal, communication models apply to the reality of particular interactions. Complex health situations require healthcare professionals to adapt their behaviour every time and again to the unique challenges they face, and find out what will work best this time, this place, this patient. Quality assessments, in turn, should be designed to capture quality in idiosyncratic situations. In the first paper of this issue, based on one of the keynote talks at the Heidelberg conference, Iona Heath makes a strong plea for health professionals to realise the importance of attention to the particularity of individual patients’ experience, their life context and stories, and the meaning attached to them [1]. Medicine has drifted to the application of general rules and a vision of what health is and how it is achieved, at the expense of subjective experience of illness. In a section of papers on listening to, seeing and informing patients, van Dulmen, whose paper is also based on a keynote lecture, provides different stakeholder perspectives on the importance of “listening“ in the context of healthcare [2]. She proposes that interventions to promote “listening” need to target health care policy, research and clinical practice: “Listening involves more than hearing but also needs eyes, a heart and undivided attention”. Gorawara-Shat and co-authors explore verbal and non-verbal reactions of physicians to emotional cues and concerns of older http://dx.doi.org/10.1016/j.pec.2017.08.012 0738-3991/© 2017 Published by Elsevier Ireland Ltd.
people, by comparing the scores of two instruments [3]. They especially looked into the incongruences between verbal and nonverbal responses and the influence on older people In the final paper in this section, Gross et al. asked 4517 breast cancer patients about second opinions (SO) and found that younger, well-educated patients who are active decision makers are informed about the possibility of a SO [4]. These discussions may be motivated by patient dissatisfaction with information provided by, and mistrust of, their physician. In a the next section, on the topic of engaging the patient in communication, Lindquist et al. present an intervention to increase the voice of seniors in their future healthcare choices [5]. The interactive tool was designed with input from patients and other stakeholders, with the aim to support planning and communication of health support needs, and may make it easier for seniors and their families to obtain the home care that individuals prefer. Sleath et al. show in the next paper that adolescents with asthma can successfully be more actively involved during medical visits [6]. A prompt list and educational video was constructed and reviewed by teens. In a randomized trial the effect of the material on patient involvement was studied. The intervention group was very positive about the material and thought this was extremely useful for other teens. In two papers, the challenge represented by patients with low health literacy is discussed. Meppelink et al. evaluated whether Dutch online health information (OHI) generally reflects message elements that support information processing and understanding among people with low health literacy [7]. They suggest that communication professionals should make better use of digital message features, since videos, narration, and interactivity were scarcely used but can be valuable for people with low health literacy. Mantwill et al. looked at health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland [8]. They point out that healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups and suggest that communication between patients and providers should be literacy and culturally sensitive. In the next section, which we have called “The healthcare team, the family caregiver, and the context of communication”, Pype et al. use the concept of complexity science as a theoretical framework to explore and understand complex health situations [9]. They conducted a first test of a measure to quantify day-to-day
1968
A. Finset et al. / Patient Education and Counseling 100 (2017) 1967–1968
functioning of healthcare teams that operate in conditions in which creativity and experimentation are the most efficient ways to handle situations, such as interprofessional palliative healthcare teams. Laidsaar-Powell et al. underscore in their paper the importance of family care givers (FCG) in treatment decision making; yet also pointing out that no theoretic framework has been provided to explain the influence of FCG on decision making [10]. The authors propose the TRIO framework and accompanying TRIO Triangle to deepen our understanding in six important domains of influence on decision making. Crawford et al. identify the complex culture that exists in a hospital unit, and how nurses, although part of the insider culture can broker effective communication with parents [11]. The authors underscore the need for senior hospital staff to support nurses in this communication role and to acknowledge the vitality of that role in bridging the gap between patients and the hospital unit. In the first paper in the section on training communication skills, Rosenbaum identifies key factors in the lack of integration of pre-clinical communication teaching and clinical workplace learning, such as the missing link between medical content and communication process in learners’ educational experiences during clinical clerkships [12]. Presents opportunities for communication skills training in undergraduate education. Glaser et al. conducted an RCT to assess the impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases [13]. They found that such an intervention positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients and suggest its application in primary care. Finally, Schopper et al. report data from a session at the Heidelberg conference in which a group of medical students were invited to explore their experiences with communication skills learning [14]. They all valued communication skills training, but experienced difficulties when the culture does not hold communication skills in high regards. Other difficulties were translating theory into practice and transfer pre-clinic knowledge into clinical setting. They highly appreciated feedback and struggle with interpretation of assessment results. References [1] I. Heath, The missing person: the outcome of the rule-based totalitarianism of too much contemporary healthcare, Patient Educ. Counc. 100 (2017) 1969– 1974. [2] S. van Dulmen, Listen: when words don't come easy, Patient Educ. Counc. 100 (2017) 1975–1978.
[3] R. Gorawara-Bhat, L. Hafskjold, P. Gulbrandsen, H. Eide, Exploring physicians’verbal and nonverbal responses to cues/concerns:learning from incongruent communication, Patient Educ. Counc. 100 (2017) 1979–1989. [4] S.E. Groß, M.A. Hillen, H. Pfaff, N. Scholten, Second opinion in medical encounters—a study among breast cancer patients, Patient Educ. Counc. 100 (2017) 1990–1995. [5] L. Lindquist, V. Ramirez-Zohfeld, P. Sunkara, C. Forcucci, D. Campbell, P. Mitzen, J. Ciolino, G. Kricke, K. Cameron, PhD, MPH PlanYourLifeSpan.org an intervention to help seniors make choices for their fourth quarter of life: results from the randomized clinical trial, Patient Educ. Counc. 100 (2017) 1996–2004. [6] B. Sleath, D.M. Carpenter, S.A. Davis, C.H. Watson, C. Lee, C.E. Loughlin, N. Garcia, D. Etheridge, L. Rivera-Duchesne, D.S. Reuland, K. Batey, C. Duchesne, G. Tudor, Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits, Patient Educ. Counc. 100 (2017) 2005–2011. [7] C.S. Meppelink, C. Julia. van Weert, A. Brosius, E.G. Smit, Dutch health websites and their ability to inform people with low health literacy, Patient Educ. Counc. 100 (2017) 2012–2019. [8] S. Mantwill, P.J. Schulz, Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland, Patient Educ. Counc. 100 (2017) 2020–2027. [9] P. Pype, D. Krystallidou, M. Deveugele, F. Mertens, S. Rubinelli, I. Devisch, Healthcare teams as complex adaptive systems: focus on interpersonal interaction, Patient Educ. Counc. 100 (2017) 2028–2034. [10] R. Laidsaar-Powell, P. Butow, C. Charles, A. Gafni, V. Entwistle, R. Epstein, I. Juraskova, The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making, Patient Educ. Counc. 100 (2017) 2035–2046. [11] R. Crawford, J. Stein-Parbury, D. Dignam, Culture shapes practice: findings from a New Zealand study, Patient Educ. Counc. 100 (2017) 2047–2053. [12] M. Rosenbaum, Dis-integration of communication in healthcare education: workplace learning challenges and opportunities, Patient Educ. Counc. 100 (2017) 2054–2061. [13] E. Glaser, C. Richard PhD, M.-T. Lussier, The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: a randomized control trial, Patient Educ. Counc. 100 (2017) 2062–2070. [14] H. Schopper, N. Mohamed, M. Seegel, K. Gorina, J. Silverman, M. Rosenbaum, Lost in translation: cultural divides in communication skills teaching identified in the ICCH 2016 student symposium, Patient Educ Counc 100 (2017) 2071–2073.
Arnstein Finset* Christiane Bieber Richard F. Brown Myriam Deveugele Arwen Pieterse University of Oslo, Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine, Post Office Box 1111, Blindern, N-0317 Oslo, Norway * Corresponding author. E-mail address: arnstein.fi[email protected] (A. Finset).
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
From the Editor
The perspective of the person in healthcare: Listening to and engaging persons in healthcare
The present issue of Patient Education and Counseling is a Special Issue with selected papers from the International Conference on Communication in Healthcare arranged by EACH – International Association for Communication in Healthcare in Heidelberg, Germany, September 7-10, 2016. An overarching theme of many of the papers is the importance of taking the perspective of the person in healthcare, not only treating bodies and diseases. We should learn to better address unique people, situations, and challenges and observe the key relevance of considering patients, learners, and health situations, in particular complex situations, as unique entities. Healthcare professionals should approach patients as subjects, rather than as an object of care. Patients should be given the opportunity to reflect on future personal care needs so that at the point of care, they can, together with their families and healthcare professionals, make decisions that incorporate individual patient preferences. Learners should be helped to watch, identify and practice effective communication skills during clinical clerkships and other workplace-based learning. This requires reflection on individual patient interviews, including how more general, or ideal, communication models apply to the reality of particular interactions. Complex health situations require healthcare professionals to adapt their behaviour every time and again to the unique challenges they face, and find out what will work best this time, this place, this patient. Quality assessments, in turn, should be designed to capture quality in idiosyncratic situations. In the first paper of this issue, based on one of the keynote talks at the Heidelberg conference, Iona Heath makes a strong plea for health professionals to realise the importance of attention to the particularity of individual patients’ experience, their life context and stories, and the meaning attached to them [1]. Medicine has drifted to the application of general rules and a vision of what health is and how it is achieved, at the expense of subjective experience of illness. In a section of papers on listening to, seeing and informing patients, van Dulmen, whose paper is also based on a keynote lecture, provides different stakeholder perspectives on the importance of “listening“ in the context of healthcare [2]. She proposes that interventions to promote “listening” need to target health care policy, research and clinical practice: “Listening involves more than hearing but also needs eyes, a heart and undivided attention”. Gorawara-Shat and co-authors explore verbal and non-verbal reactions of physicians to emotional cues and concerns of older http://dx.doi.org/10.1016/j.pec.2017.08.012 0738-3991/© 2017 Published by Elsevier Ireland Ltd.
people, by comparing the scores of two instruments [3]. They especially looked into the incongruences between verbal and nonverbal responses and the influence on older people In the final paper in this section, Gross et al. asked 4517 breast cancer patients about second opinions (SO) and found that younger, well-educated patients who are active decision makers are informed about the possibility of a SO [4]. These discussions may be motivated by patient dissatisfaction with information provided by, and mistrust of, their physician. In a the next section, on the topic of engaging the patient in communication, Lindquist et al. present an intervention to increase the voice of seniors in their future healthcare choices [5]. The interactive tool was designed with input from patients and other stakeholders, with the aim to support planning and communication of health support needs, and may make it easier for seniors and their families to obtain the home care that individuals prefer. Sleath et al. show in the next paper that adolescents with asthma can successfully be more actively involved during medical visits [6]. A prompt list and educational video was constructed and reviewed by teens. In a randomized trial the effect of the material on patient involvement was studied. The intervention group was very positive about the material and thought this was extremely useful for other teens. In two papers, the challenge represented by patients with low health literacy is discussed. Meppelink et al. evaluated whether Dutch online health information (OHI) generally reflects message elements that support information processing and understanding among people with low health literacy [7]. They suggest that communication professionals should make better use of digital message features, since videos, narration, and interactivity were scarcely used but can be valuable for people with low health literacy. Mantwill et al. looked at health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland [8]. They point out that healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups and suggest that communication between patients and providers should be literacy and culturally sensitive. In the next section, which we have called “The healthcare team, the family caregiver, and the context of communication”, Pype et al. use the concept of complexity science as a theoretical framework to explore and understand complex health situations [9]. They conducted a first test of a measure to quantify day-to-day
1968
A. Finset et al. / Patient Education and Counseling 100 (2017) 1967–1968
functioning of healthcare teams that operate in conditions in which creativity and experimentation are the most efficient ways to handle situations, such as interprofessional palliative healthcare teams. Laidsaar-Powell et al. underscore in their paper the importance of family care givers (FCG) in treatment decision making; yet also pointing out that no theoretic framework has been provided to explain the influence of FCG on decision making [10]. The authors propose the TRIO framework and accompanying TRIO Triangle to deepen our understanding in six important domains of influence on decision making. Crawford et al. identify the complex culture that exists in a hospital unit, and how nurses, although part of the insider culture can broker effective communication with parents [11]. The authors underscore the need for senior hospital staff to support nurses in this communication role and to acknowledge the vitality of that role in bridging the gap between patients and the hospital unit. In the first paper in the section on training communication skills, Rosenbaum identifies key factors in the lack of integration of pre-clinical communication teaching and clinical workplace learning, such as the missing link between medical content and communication process in learners’ educational experiences during clinical clerkships [12]. Presents opportunities for communication skills training in undergraduate education. Glaser et al. conducted an RCT to assess the impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases [13]. They found that such an intervention positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients and suggest its application in primary care. Finally, Schopper et al. report data from a session at the Heidelberg conference in which a group of medical students were invited to explore their experiences with communication skills learning [14]. They all valued communication skills training, but experienced difficulties when the culture does not hold communication skills in high regards. Other difficulties were translating theory into practice and transfer pre-clinic knowledge into clinical setting. They highly appreciated feedback and struggle with interpretation of assessment results. References [1] I. Heath, The missing person: the outcome of the rule-based totalitarianism of too much contemporary healthcare, Patient Educ. Counc. 100 (2017) 1969– 1974. [2] S. van Dulmen, Listen: when words don't come easy, Patient Educ. Counc. 100 (2017) 1975–1978.
[3] R. Gorawara-Bhat, L. Hafskjold, P. Gulbrandsen, H. Eide, Exploring physicians’verbal and nonverbal responses to cues/concerns:learning from incongruent communication, Patient Educ. Counc. 100 (2017) 1979–1989. [4] S.E. Groß, M.A. Hillen, H. Pfaff, N. Scholten, Second opinion in medical encounters—a study among breast cancer patients, Patient Educ. Counc. 100 (2017) 1990–1995. [5] L. Lindquist, V. Ramirez-Zohfeld, P. Sunkara, C. Forcucci, D. Campbell, P. Mitzen, J. Ciolino, G. Kricke, K. Cameron, PhD, MPH PlanYourLifeSpan.org an intervention to help seniors make choices for their fourth quarter of life: results from the randomized clinical trial, Patient Educ. Counc. 100 (2017) 1996–2004. [6] B. Sleath, D.M. Carpenter, S.A. Davis, C.H. Watson, C. Lee, C.E. Loughlin, N. Garcia, D. Etheridge, L. Rivera-Duchesne, D.S. Reuland, K. Batey, C. Duchesne, G. Tudor, Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits, Patient Educ. Counc. 100 (2017) 2005–2011. [7] C.S. Meppelink, C. Julia. van Weert, A. Brosius, E.G. Smit, Dutch health websites and their ability to inform people with low health literacy, Patient Educ. Counc. 100 (2017) 2012–2019. [8] S. Mantwill, P.J. Schulz, Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland, Patient Educ. Counc. 100 (2017) 2020–2027. [9] P. Pype, D. Krystallidou, M. Deveugele, F. Mertens, S. Rubinelli, I. Devisch, Healthcare teams as complex adaptive systems: focus on interpersonal interaction, Patient Educ. Counc. 100 (2017) 2028–2034. [10] R. Laidsaar-Powell, P. Butow, C. Charles, A. Gafni, V. Entwistle, R. Epstein, I. Juraskova, The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making, Patient Educ. Counc. 100 (2017) 2035–2046. [11] R. Crawford, J. Stein-Parbury, D. Dignam, Culture shapes practice: findings from a New Zealand study, Patient Educ. Counc. 100 (2017) 2047–2053. [12] M. Rosenbaum, Dis-integration of communication in healthcare education: workplace learning challenges and opportunities, Patient Educ. Counc. 100 (2017) 2054–2061. [13] E. Glaser, C. Richard PhD, M.-T. Lussier, The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: a randomized control trial, Patient Educ. Counc. 100 (2017) 2062–2070. [14] H. Schopper, N. Mohamed, M. Seegel, K. Gorina, J. Silverman, M. Rosenbaum, Lost in translation: cultural divides in communication skills teaching identified in the ICCH 2016 student symposium, Patient Educ Counc 100 (2017) 2071–2073.
Arnstein Finset* Christiane Bieber Richard F. Brown Myriam Deveugele Arwen Pieterse University of Oslo, Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine, Post Office Box 1111, Blindern, N-0317 Oslo, Norway * Corresponding author. E-mail address: arnstein.fi[email protected] (A. Finset).