The expression of emotions in online medical consultations: a comprehensive Spanish-English analysis

Doctor-patient interpersonality strategies have evolved considerably in recent years, mainly due to the increase in telephone and online consultations generated by the Covid-19 pandemic. In such interactions, the control and expression of emotions have a crucial influence on the adequacy and effectiveness of communication. Remote interaction makes this affective exchange even more complex than in face-to-face consultations. This study aims to configure a comprehensive model for analysing the affective domain in virtual medical consultations, useful for English and Spanish patients and learners. With this aim, the most recognised theories on professional interpersonality are reviewed and applied to a corpus of doctor-patient interactions in Peninsular Spanish and British English, extracted from representative forums on the Internet. The analysis highlights how specific stance and register variation mechanisms positively and negatively influence the emotional domain in these communicative exchanges. The proposed model allows significant contrastive findings on the occurrence and intensity of sentiment markers in both languages. The results illustrate how doctors in Spanish favour a more cautious, detached and predictable encounter, while doctors in English use a greater number and variety of attitudinal strategies to achieve engagement, empathy and emotional comfort. © 2022, AELFE. All rights reserved.

COVID-19 Vaccination in Patients with Cancer.

Patients with cancer are concerned about the effects of the COVID-19 vaccination. We conducted an online survey on the COVID-19 vaccination status and side effects among patients with cancer in Japan between 8 and 14 August 2021. We included 1182 female patients with cancer aged 20-70 years and registered on an online patient website. Of the patients, 944 had breast cancer, 216 had gynecological cancer, 798 were undergoing drug/radiation therapy, and 370 were in follow-up. At the time of the survey, 885 patients had already received at least one dose. Of these, 580 had also received their second dose. The incidence rate of side effects was equivalent to previous reports. In patients with breast cancer, problems such as the onset or worsening of lymphedema or axillary lymphadenopathy metastasis requiring differential diagnosis were encountered following vaccination. A total of 768 patients were concerned about the vaccine at some point, and 726 consulted with their attending physicians about the timing or side effects of the vaccination. Of the 110 patients undergoing chemotherapy or radiation therapy, 75 adjusted the timing of the vaccination based on their therapy. The cross-analysis revealed that 81% of those who consulted their physician had received at least one dose of the COVID-19 vaccination compared with 65% of those who had not consulted their physician. Consulting with a physician about the COVID-19 vaccination was found to alleviate the concerns of patients with cancer and encourage them to get vaccinated.

Antecedents and consequences of shared decision making for patients with chronic kidney diseases: A cross-sectional survey.

BACKGROUND: Chronic kidney disease (CKD) has a strong negative impact on patients. Finding ways to improve CKD patients' conditions by shared decision-making is receiving much attention. However, little attention has been paid to influencing antecedents and effects of shared decision-making. Meanwhile, as advanced technologies bring in new communication devices, effects of different types of communications used in shared decision-making need to be addressed. OBJECTIVE: This study proposes a research framework to determine the influencing antecedents of shared decision-making, and to evaluate the effects of shared decision-making on patient outcomes when they are computer-mediated and when the decision-makers communicate face-to-face. METHODS: A cross-section survey was conducted and a total of 48 valid samples were obtained. The participants were CKD Stage III, IV, or V patients who had received medical treatment in a hospital in Taiwan. The collected data were subjected to an independent t-test and partial least squares analysis to validate the research framework. RESULTS: Doctor-patient communication (DPC) and doctor-patient relationship (DPR) have no significant direct impact on patient outcomes. Nevertheless, both DPC and DPR significantly impact shared decision-making which in turn impacts patient outcomes. Moreover, patients who use computer-mediated communication were found to have significantly higher perceptions of shared decision-making than those who did not. CONCLUSIONS: The incidence and prevalence of end-stage renal disease in Taiwan are among the highest in the world. The results of this study can serve as a reference for hospitals to improve CKD patients' outcomes. Meanwhile, during the COVID-19 pandemic, this study suggested hospitals should encourage shared decision-making with computer-mediated communication to ensure that patients receive proper treatment and have the desired outcomes.

Online student tutorials for effective peer teaching in digital times: a longitudinal quantitative study.

BACKGROUND: Peer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students. METHODS: Second-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students' learning success. RESULTS: Out of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (Mstudents = 4.60±0.71; Mtutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen's d = 0.36-0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (Mnonverbal = 3.90±0.83; Mverbal = 4.88±0.35). CONCLUSIONS: Interaction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient-physician encounter. Thus, online tutorials are a valuable amendment to medical education.

Oscilacije povjerenja i komunikacijski izazovi: liječnici kao medijske zvijezde u doba koronakrize u Hrvatskoj

Rad se bavi medijskom eksponiranošću medicinskih stručnjaka, a ujedno i osoba na rukovodećim funkcijama pojedinih državnih institucija – ministra zdravstva Vilija Beroša, ravnatelja Hrvatskog zavoda za javno zdravstvo Krunoslava Capaka i ravnateljice Klinike za infektivne bolesti "Dr. Fran Mihaljević" Alemke Markotić – tijekom epidemije bolesti COVID-19 u Hrvatskoj. U istraživačkom fokusu je prvih nekoliko mjeseci javnog djelovanja tih liječnika u okviru Nacionalnog stožera civilne zaštite i ispred zdravstvenog sustava, pri čemu se analizom medijskog narativa nastoji ispitati utjecaj njihove komunikacije s javnošću na stupanj povjerenja koje im građani poklanjaju u doba koronakrize. Na tragu Giddensova i Luhmannova promišljanja povjerenja u kasnoj/refleksivnoj modernosti te primjena njihovih teza u području istraživanja zdravstvene skrbi raspravljaju se utvrđene oscilacije povjerenja i komunikacijski izazovi. Pritom se, uz prepoznavanje međusobne povezanosti fenomena straha, rizika i povjerenja, upozorava na metaprocese medijatizacije i celebritizacije liječničke struke u specifičnim, kriznim društveno-političkim okolnostima.Alternate :This paper deals with the media exposure of medical experts in management positions in state institutions during the COVID-19 epidemic in Croatia – the Minister of Health, Vili Beroš, the director of the Croatian Public Health Institute Krunoslav Capak and the director of the Dr. Fran Mihaljević Clinic for Infectious Diseases, Alemka Markotić. The article focuses on the first several months of their work within the National Civil Protection Headquarters and as representatives of the healthcare system. The analysis of the media narrative is an attempt to investigate the influence of their public communication on the citizens' level of trust in them during the corona crisis. The article discusses oscillations in trust and communicative challenges identified in the analysis from the point of view of Giddens's and Luhmann's views of trust in late/reflexive modernity, by applying their ideas to the healthcare system. In addition to recognizing the interconnections between fear, risk and trust, the article points to the metaprocesses of mediatization and celebritization of doctors in sociopolitical crises.

IMPROVING COMMUNICATION ON MEDICAL WARD ROUNDS IN PATIENTS WITH LIMITED ENGLISH BY IMPLEMENTING MEDICAL COMMUNICATION CHARTS

Aim To improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart. Introduction King’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations. Method Face-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Pre-intervention and post-intervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles. Results At baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only 2/8 doctors felt they could communicate effectively with patients. In PDSA 1, 4/5 patients reported high satisfaction in communicating physical symptoms, anxieties or concerns pre-intervention with 5/5 post-chart implementation. 5/5 patients reported high satisfaction in communicating ongoing needs pre-intervention but only 3/5 post-intervention. In PDSA 2, 2/5 patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with 4/4 doctors reporting improved satisfaction in communication in PDSA 2 and 2/3 doctors reporting higher satisfaction in communication in PDSA 3. Conclusion Medical communication charts can help in delivering high-quality, patient-centred care in multicultural and multilingual healthcare settings within the NHS.

General Practitioners' Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study.

BACKGROUND: Uncertainties are omnipresent in health care, but little is known about general practitioners' (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. OBJECTIVE: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. METHODS: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. RESULTS: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. CONCLUSIONS: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs' working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships-not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology.

Observing the Patient Experience: Inside the Doctor's Office in a Pandemic

Focusing on the clinical doctor-patient consultation setting, this paper outlines the methodology and presents the results from a series of observational studies between doctor and patients undertaken in September and October 2020 within a public hospital setting during the COVID-19 pandemic. Using a design thinking methodology, the authors gained empathy and insights into the challenges experienced from both doctor and patient perspectives, during this period. This paper also discusses emergent themes from this qualitative investigation and examines the role of empathy in helping define the extent of the challenges that arose. As the first phase in a planned set of research phases, this work is informing and helping to shape subsequent ideation and design of multimedia related interventions to see if these human-centred design interventions can assist in improving the complex doctor-patient communication process. © 2021 IEEE.

Collaborative domestication How patients account for their experience of video consultations with their general practitioner

This article proposes an extension to domestication theory by introducing the concept of collaborative domestication, which we define as the ongoing mutual influence and interdependence of technology users in specific interactional contexts. This concept arose from our investigation of how patients integrate healthcare-related video consultations into their daily lives. In Denmark, the Covid-19 pandemic has expedited the implementation of video consultations in general practice, yet little is known about their use in this context. To address this, we conducted 13 interviews with patients and analysed the interviews from the perspective of domestication theory. We find that the general practitioner plays a central role throughout patients’ domestication processes, and the doctor–patient relationship significantly influences how patients experience video consultations. We argue that there is a collaborative aspect to domesticating video consultations that needs to be considered in both future studies and the ongoing implementation of video consultations. © 2021 Society of Media Researchers In Denmark. All rights reserved.

Factors influencing COVID-19 vaccination intention: The roles of vaccine knowledge, vaccine risk perception, and doctor-patient communication.

OBJECTIVE: This study aims to investigate factors influencing COVID-19 vaccination intention in the United States. METHODS: A cross-sectional survey was conducted with 800 respondents recruited from an online panel managed by a survey company. Path analysis was employed to examine the relationships between the study variables. RESULTS: First, perceived susceptibility to COVID-19 vaccine side effects was negatively associated with vaccination intention whereas perceived severity did not show any significant impact. Second, vaccine-related knowledge was not directly related to vaccination intention, but it had an indirect and positive effect on vaccination intention via decreasing perceived susceptibility. Third, doctor-patient communication strengthened the negative effect of vaccine knowledge on perceived susceptibility and severity. CONCLUSION: The results of this study offer insights on how to increase people's vaccination intention and reduce their psychological concerns when making COVID-19 vaccine-related decisions. PRACTICE IMPLICATIONS: Government agencies should actively promote the effectiveness and importance of vaccination, while addressing concerns about vaccine safety in the public; Health initiatives also need to enhance the level of knowledge about COVID-19 vaccines through various media channels; Doctors can start the conversations about COVID-19 vaccination with their patients at the point of care and/or via online communication platforms.

The Society for Integrative Oncology Practice Recommendations for online consultation and treatment during the COVID-19 pandemic.

OBJECTIVE: The Society for Integrative Oncology (SIO) Online Task Force was created in response to the challenges facing continuity of integrative oncology care resulting from the COVID-19 pandemic. The Task Force set out to guide integrative oncology practitioners in providing effective and safe online consultations and treatments for quality-of-life-concerns and symptom management. Online treatments include manual, acupuncture, movement, mind-body, herbal, and expressive art therapies. METHODS: The SIO Online Practice Recommendations employed a four-phase consensus process: (1) literature review and discussion among an international panel of SIO members, identifying key elements essential in an integrative oncology visit; (2) development, testing, and refinement of a questionnaire defining challenges and strategies; (3) refinement input from integrative oncology experts from 19 countries; and (4) SIO Executive Committee review identifying the most high-priority challenges and strategies. RESULTS: The SIO Online Practice Recommendations address ten challenges, providing practical suggestions for online treatment/consultation. These include overcoming unfamiliarity, addressing resistance among patients and healthcare practitioners to online consultation/treatment, exploring ethical and medical-legal aspects, solving technological issues, preparing the online treatment setting, starting the online treatment session, maintaining effective communication, promoting specific treatment effects, involving the caregiver, concluding the session, and ensuring continuity of care. CONCLUSIONS: The SIO Online Practice Recommendations are relevant for ensuring continuity of care beyond the present pandemic. They can be implemented for patients with limited accessibility to integrative oncology treatments due to geographic constraints, financial difficulties, physical disability, or an unsupportive caregiver. These recommendations require further study in practice settings.

Understanding the Impact of Initial COVID-19 Restrictions on Physical Activity, Wellbeing and Quality of Life in Shielding Adults with End-Stage Renal Disease in the United Kingdom Dialysing at Home versus In-Centre and Their Experiences with Telemedicine.

Early in the coronavirus-2019 (COVID-19) containment strategy, people with end-stage renal disease (ESRD) were identified as extremely clinically vulnerable and subsequently asked to 'shield' at home where possible. The aim of this study was to investigate how these restrictions and the transition to an increased reliance on telemedicine within clinical care of people living with kidney disease impacted the physical activity (PA), wellbeing and quality of life (QoL) of adults dialysing at home (HHD) or receiving in-centre haemodialysis (ICHD) in the UK. Individual semistructured telephone interviews were conducted with adults receiving HHD (n = 10) or ICHD (n = 10), were transcribed verbatim and, subsequently, thematically analysed. As result of the COVID-19 restrictions, PA, wellbeing and QoL of people with ESRD were found to have been hindered. However, widespread support for the continued use of telemedicine was strongly advocated and promoted independence and satisfaction in patient care. These findings highlight the need for more proactive care of people with ESRD if asked to shield again, as well as increased awareness of safe and appropriate PA resources to help with home-based PA and emotional wellbeing.

Classroom teaching with simulated patients during COVID-19: the communication skills course in the second year of the model medical curriculum HannibaL.

Objective: In the spring of 2020 in response to the COVID-19 pandemic, the question arose at Hannover Medical School as to how simulated patients (SP) could still be utilized in the communication course that is part of the module "Diagnostic methods" taught in the second year of the model medical curriculum known as HannibaL. Methods: This short report summarizes the process of implementing the utilization of SP in analog classroom teaching and describes the relevant results on the concluding Objective Structured Clinical Examination (OSCE) in comparison to the previous year. Results: Overall, the analog SP deployments were practicable under local conditions and in compliance with precautionary measures to curb the risk of infection, whereby the OSCE scores did not deviate significantly from those in the prior year. Conclusion: During the COVID-19 pandemic and perhaps other epidemics as well, it will continue to be important in the future to make locally adapted, purpose-oriented, and preventively effective decisions regarding university didactics in undergraduate studies.

Doctor-patient communication training with simulated patient during the coronavirus pandemic / Orvos-beteg kommunikációs gyakorlat szimulált pácienssel a koronavírus-járvány idején. (A COVID-19-pandémia orvosszakmai kérdései)

INTRODUCTION: During the state of emergency caused by the coronavirus pandemic, the Doctor-patient communication training for medical students at the University of Szeged was moved online. The training is based on the method of video analysis, involving simulated patients, making online implementation extremely challenging. AIM: The study aims to present our experiences with the online training and to analyse the students' evaluations. METHOD: We used the free version of Zoom for small groups of five students, a trainer and a simulated patient. All students participated in a situation that we recorded. The viewing of the recordings was followed by group discussion. Then, the students evaluated the course using an online questionnaire. We used descriptive statistics and content analysis. RESULTS: 74.4% of the students (n = 64) completed the questionnaire. 78.1-100% of them gave a good (4) or excellent (5) evaluation for the questions. The highest average score (4.95 ± 0.21) was given to the professionalism of the trainers, the lowest was given to the choice of topic of the theoretical part (4.06 ± 1.02). The majority of the students were satisfied with the course, they would be happy to attend it again; however, in-person learning still seems to be the preferred option. CONCLUSION: The online practice was a success. In many ways, it proved to be an adequate replacement for the traditional form. The students evaluated the training similarly to those of previous years. The lack of personal contact is a limiting factor, thus, online practice should not be seen as an alternative to personal communication trainings; however, as an independent form of training, it can make a significant contribution to effective, modern education. Orv Hetil. 2020; 161(33): 1355-1362.