A systematic review of reasons for and against asking patients about their socioeconomic contexts.

BACKGROUND: People's social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients' socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients' socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not, be enquired about. METHODS: Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a 'snowball' search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients' socioeconomic information; 'screening' patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients' healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. 'Reason data' was extracted from eligible publications by two authors, then analysed and organised. RESULTS: We identified 138 eligible publications. Most offered reasons for why patients' should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary. CONCLUSIONS: This first summary of literature on the subject found many published reasons for why patients' social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician's role in responding to patients' social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.

Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis.

Background Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised. Objective To estimate the effects of empathy and expectations interventions for any clinical condition. Design Systematic review and meta-analysis of randomised trials. Data sources Six databases from inception to August 2017. Study selection Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older. Review methods Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis. Results We identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference -0.43 [95% confidence interval -0.65 to -0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons. Conclusions Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain. Protocol registration Cochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.

Primary care follow-up and measured mental health outcomes among women referred for ultrasound assessment of pain and/or bleeding in early pregnancy: a quantitative questionnaire study.

OBJECTIVES: To examine the extent of primary care follow-up and mental health outcomes among women referred for ultrasound assessment of pain and/or bleeding in early pregnancy, including those whose pregnancy is found to be viable on ultrasound assessment. DESIGN: Questionnaire study with prospective follow-up. SETTING: Urgent gynaecology clinic in secondary care, England. PARTICIPANTS: 57 women participated in the study. Entry criteria: referral to the urgent gynaecology clinic with pain and/or bleeding in early pregnancy; gestation less than 16 weeks (the clinic's own 'cut-off'); no previous attendance at the clinic during the current pregnancy. EXCLUSION CRITERIA: inability to understand English or to provide informed consent. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence of primary care follow-up among women referred to the urgent gynaecology clinic; incidence of women with measured mental health scores suggesting significant symptoms of distress. RESULTS: Fewer than 1 in 10 women referred for ultrasound assessment of pain and/or bleeding in early pregnancy had follow-up arrangements made with their general practitioner (GP). Most women who had GP follow-up found it helpful and a significant minority of women who did not have GP follow-up felt that it would have been helpful. Following ultrasound assessment, more than one-third of women had significant symptoms of distress. Symptoms of distress, particularly anxiety, were present among those women found to have viable pregnancies, as well as among those with non-viable pregnancies. CONCLUSIONS: GPs are advised to consider offering follow-up to all women referred for ultrasound assessment of pain and/or bleeding in early pregnancy. Researchers in this area are advised to consider the experiences of women with pain and/or bleeding in early pregnancy whose pregnancies are ultimately found to be viable on ultrasound scan.

'Miscarriage or abortion?' Understanding the medical language of pregnancy loss in Britain; a historical perspective.

Clinical language applied to early pregnancy loss changed in late twentieth century Britain when doctors consciously began using the term 'miscarriage' instead of 'abortion' to refer to this subject. Medical professionals at the time and since have claimed this change as an intuitive empathic response to women's experiences. However, a reading of medical journals and textbooks from the era reveals how the change in clinical language reflected legal, technological, professional and social developments. The shift in language is better understood in the context of these historical developments, rather than as the consequence of more empathic medical care for women who experience miscarriage.

Mental health of young adult patients who do not attend appointments in primary care: a retrospective cohort study.

OBJECTIVE: The objective is to examine the relation between young adults' non-attendance at primary care appointments and mental health problems, using a retrospective cohort study, in a urban primary health care facility in a relatively deprived and ethnically diverse area of Oxford, England. METHODS: Two hundred and nine patients aged between 15 and 35 years who failed to attend a doctor's appointment in primary care during 2008 each matched with two control patients of the same age and gender who had attended appointments during the same period. Main outcome measure is the presentation with a mental health problem within 12 months following the missed appointment. RESULTS: Non-attendance in primary care among 15-35 year olds was strongly associated with presentation of mental health problems. Those who did not attend an appointment were more likely to have presented mental health problems in the past [31.0% versus 8.9%, odds ratio (OR) 4.72, 95% confidence interval (CI) 3.00-7.42] and to present mental health problems within the ensuing 12 months (32.0% versus 7.4%, OR 5.91, 95% CI 3.69-9.46) when compared with those who attended appointments. Patients with no known past history of mental health problems were more likely to make their first recorded mental health presentation in the 12 months following a non-attendance when compared with those who attended (10.3% versus 3.1%, OR 3.60, 95% CI 1.76-7.35). CONCLUSIONS: Non-attendance of a young adult for a doctor's appointment in primary care may signal a mental health problem. This applies whether or not the patient is known to have presented mental health problems in the past.