Observing and Identifying Hospitalist Best Communication Practices in Patient Interactions.

This study identifies actual hospitalist best communication practices that optimize patient interactions in a busy hospital context. We observed and rated 36 hospitalists and 206 patient encounters using the Kalamazoo Essential Elements of Communication Checklist-Adapted (KEECC-A). We collected descriptive statistics of checklist scores and thematically analyzed fieldnotes to identify communication patterns. Results show hospitalists score highest and most frequently use three of seven KEECC-A dimensions: builds a relationship, shares information, and gathers information. We first identify exemplar behaviors and then provide statistical comparisons by professional and hospital tenure, gender, and day of rounding observed for these three dimensions. Male hospitalists scored higher than females for shares information and significant differences were found for gender between cross-sex patient-hospitalist interactions. Hospitalists early in their professional and hospital tenure received significantly lower ratings than mid-to-late career hospitalists in the three KEECC dimensions. Hospitalists observed on the first day of rounding received significantly higher ratings than those observed on a middle or last day. We offer interpretations to explain study findings and suggest interventions to help hospitalists with less-than-desirable communication skills.

Optimizing Hospitalist-Patient Communication: An Observation Study of Medical Encounter Quality.

BACKGROUND: Optimizing patient-hospitalist interactions heightens patient satisfaction, improves patient health outcomes, and improves hospitalist job satisfaction. A study was conducted to recognize hospitalist communication that enhance encounters, identify hospitalist behaviors for improvement interventions, and explore the association of time and gender with communication quality. METHODS: Researchers observed encounters between 36 hospitalists and 206 adult patients. All but 1 of the hospitalists was observed at a 410-bed, general medical and surgical facility in the Midwest. RESULTS: On the adapted Kalamazoo Essential Elements of Communication Checklist (KEECC), hospitalists scored highest on the Builds a Relationship, Shares Information, and Gathers Information dimensions. Participants were seen using multiple, effective verbal and nonverbal techniques to show care and concern, as well as create relational rapport, often while successfully sharing and obtaining clinical information. Hospitalists scored lowest on the Understands the Patient Perspective and Reaches Agreement dimensions. Hospitalists were observed infrequently and inconsistently empathizing with patients and rarely attempting to gain shared understanding and agreement from patients. Significant difference was found in sharing information (t [194] = 2.47; p = 0.01), with male hospitalists (mean [M] = 4.14; standard deviation [SD] = 1.01) more highly rated than female hospitalists (M = 3.78; SD = 0.90). Hospitalist and patient gender match revealed significant difference in sharing information (F [3,192] = 2.60; p = 0.05). Male hospitalists were rated higher interacting with female patients than female hospitalists interacting with male patients. CONCLUSION: Results identify specific hospitalist communication techniques that may ultimately contribute to better-quality medical encounters. Communication interventions are recommended.

Social Network, Surgeon, and Media Influence on the Decision to Undergo Contralateral Prophylactic Mastectomy.

OBJECTIVES: The rate of contralateral prophylactic mastectomy (CPM) has risen sharply in the past decade. The current study was designed to examine social network, surgeon, and media influence on patients' CPM decision-making, examining not only who influenced the decision, and to what extent, but also the type of influence exerted. METHODS: Patients (N=113) who underwent CPM at 4 Indiana University-affiliated hospitals between 2008 and 2012 completed structured telephone interviews in 2013. Questions addressed the involvement and influence of the social network (family, friends, and nonsurgeon health professionals), surgeon, and media on the CPM decision. RESULTS: Spouses, children, family, friends, and health professionals were reported as exerting a meaningful degree of influence on patients' decisions, largely in ways that were positive or neutral toward CPM. Most surgeons were regarded as providing options rather than encouraging or discouraging CPM. Media influence was present, but limited. CONCLUSIONS: Patients who choose CPM do so with influence and support from members of their social networks. Reversing the increasing choice of CPM will require educating these influential others, which can be accomplished by encouraging patients to include them in clinical consultations, and by providing patients with educational materials that can be shared with their social networks. Surgeons need to be perceived as having an opinion, specifically that CPM should be reserved for those patients for whom it is medically indicated.

Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status.

BACKGROUND: Despite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations. METHODS: Patients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013. Participants answered questions about 11 CPM motivations and provided demographic information. Responses to motivation items were factor analyzed, resulting in 4 motivational factors: reducing long-term risk, symmetry, avoiding future medical visits, and avoiding treatments. RESULTS: Across demographic differences, reducing long-term risk was the strongest CPM motivation. Lower income predicted stronger motivation to reduce long-term risk and avoid treatment. Older participants were more motivated to avoid treatment; younger and more-educated patients were more concerned about symmetry. Greater severity of diagnosis predicted avoiding treatments. CONCLUSIONS: Reducing long-term risk is the primary motivation across groups, but there are also notable differences as a function of age, education, income, and disease severity. To stop the trend of increasing CPM, physicians must tailor patient counseling to address motivations that are consistent across patient populations and those that vary between populations.

Perceived behavioral control, intention to get vaccinated, and usage of online information about the human papillomavirus vaccine.

Objective: Human papillomavirus (HPV) and the HPV vaccine have been examined through multiple lenses over the past several years, though there is little work examining the role of perceived behavioral control (PBC) and its impact on potential recipients retrieving, understanding, and using online information with regard to the vaccine. Method: This study used survey data to examine the role of PBC as a moderator between attitudes and intention, and subjective norms (SN) and intention to get the HPV vaccine; and PBC as a moderator when seeking out Facebook, YouTube, and Twitter as information sources about HPV. Support was found for each prediction. Results: The interaction term of SN × PBC in particular had a strong influence on intention to get the vaccine. Discussion: Planned behavior variables explain intention to get the HPV vaccine, but data also suggest a need to root this research within intervention-based strategies.