Enduring Positive Impact of a Virtual Communication Skills Workshop of VitalTalk Pedagogy in a Non-U.S. Setting.

CONTEXT: While in-person workshops on serious illness communication skills using VitalTalk pedagogy have been shown to have a long-lasting impact, whether changing the format into virtual would maintain its enduring impact is unknown. Objectives. To examine long-term impacts of a virtual VitalTalk communication workshop. METHODS: Physicians in Japan who participated in our virtual VitalTalk workshop were asked to complete a self-assessment survey at 3 time points: before, immediately after, and 2 months after the workshop. We examined self-reported preparedness in 11 communication skills on a 5-point Likert scale at 3 time points, as well as self-reported frequency of practice on 5 communication skills at the pre- and 2-month time points. RESULTS: Between January 2021 and June 2022, 117 physicians from 73 institutions across Japan completed our workshop. Seventy-four participants returned the survey at all the 3 time points. Their skill preparedness significantly improved upon the completion of the workshop in all 11 skills (P < .001 for all items). The improvement remained at the same level at 2 months in 7 skills. In 4 of the 11 skills, there was further improvement at the 2-month point. The frequency of self-directed skill practice also increased significantly in the 2-month survey for all 5 skills. CONCLUSION: A virtual workshop of VitalTalk pedagogy improved self-reported preparedness of communication skills, and the impact was long-lasting in a non-U.S. setting as it likely induced self-practice of skills. Our findings encourage the use of a virtual format in any geographical location considering its enduring impact and easy accessibility.

Associations Between High Pain Catastrophizing and Opioid-Related Awareness and Beliefs Among Patients in Primary Care.

BACKGROUND: Limited studies are available on patients' perspectives regarding opioid-related awareness, beliefs, and pain management in primary care settings in the US. Pain catastrophizing (PC) is a cascade of negative thoughts and emotions in response to actual or anticipated pain. High PC is 1 of the strongest predictors of negative pain outcomes. METHOD: A cross-sectional survey was administered at Family Medicine clinics in the Pacific Northwest, November 2018-January 2019. Logistic regression was used to model the adjusted odds of participants' awareness and beliefs on opioid epidemic issues, side effects/risks, and general beliefs by opioid prescription expectations and PC. RESULTS: 108 participants completed the survey. Compared with participants with low PC, high PC participants were 74% less likely to be aware of opioid epidemic issues (OR = 0.26, P = .005, 95% CI:0.10-0.67), 62% less likely to be aware of opioid side effects/risks (OR = 0.38 P = .040, 95% CI: 0.15-0.96) and had 2.4 times increased odds of holding more positive beliefs about opioids and/or stronger beliefs regarding pain control, yet the latter did not reach statistical significance (OR = 2.40 P = .083, 95% CI: 0.89-6.47). CONCLUSION: Significant gaps existed among our participants with high PC in their awareness of opioid epidemic issues and side effects/risks compared with their low PC counterparts. They may also carry positive beliefs regarding opioids and pain-control in general. In any pain care, it seems important to identify patients with high pain catastrophizing. Doing so may facilitates exploration of their beliefs and expectations regarding pain management and aids in tailoring individualized treatment and prevent adverse side effects.

Culturally Acceptable Emotional Expressions Perceived by Non-U.S. Physicians Undergoing U.S.-Based Serious Illness Communication Skills Training: A Cross-Sectional Study.

CONTEXT: Responding to emotions is a key feature of U.S.-based serious illness communication skills training, VitalTalk®, of which trained actors portraying seriously ill patients is a component. The cultural appropriateness and perceived utility of the actors' emotional expressions remain to be empirically evaluated outside of the U.S. OBJECTIVES: To determine the cultural appropriateness and educational utility of VitalTalk® actors' emotional expressions, as perceived by clinicians. METHODS: From January 2021-April 2022, we conducted a cross-sectional study of physicians in Japan attending virtual VitalTalk® training in Japanese, each session focusing on: responding to emotions (#1) and discussing goals of care (#2), respectively. We examined their perceived authenticity and utility of the actively and passively intense emotional expressions portrayed by actors in VitalTalk® role-plays. RESULTS: Physicians (N = 100, 94% response rate) from across Japan voluntarily attended two-session workshops and completed post-session surveys. Eighty-eight participants (88%) responded that both actively and passively intense emotions portrayed by the actors provided useful learning experiences. For session #1, the participants found actively intense emotional expressions to be more clinically authentic, compared to passively intense ones (4.21 vs 4.06 out of a 5-point Likert scale, PP= .02). For session #2, no such difference was observed (4.16 vs 4.08 of a 5-point Likert scale, P = .24). CONCLUSIONS: Even in a culture where patients may express emotions passively, any intense and authentic emotional expressions by actors can be perceived as facilitating learning. Most participants perceived both the Name, Understand, Respect, Support, and Explore '(NURSE)' statements and Reframe, Expect emotion, Map out patient goals Align with goals and Propose a plan '(REMAP)' frameworks as useful in routine clinical practice in Japan.

The Feasibility of Virtual VitalTalk Workshops in Japanese: Can Faculty Members in the US Effectively Teach Communication Skills Virtually to Learners in Japan?

BACKGROUND: VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. OBJECTIVES: To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. SETTING/SUBJECTS: We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. MEASUREMENTS: To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. RESULTS: All learners (n = 48, male 79%) participated in the survey. The mean score of the learners' satisfaction was 4.69 or higher in all questions. The mean score of the virtual format's satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). CONCLUSION: Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.

The tertiary structure of the human Xkr8-Basigin complex that scrambles phospholipids at plasma membranes.

Xkr8-Basigin is a plasma membrane phospholipid scramblase activated by kinases or caspases. We combined cryo-EM and X-ray crystallography to investigate its structure at an overall resolution of 3.8 Å. Its membrane-spanning region carrying 22 charged amino acids adopts a cuboid-like structure stabilized by salt bridges between hydrophilic residues in transmembrane helices. Phosphatidylcholine binding was observed in a hydrophobic cleft on the surface exposed to the outer leaflet of the plasma membrane. Six charged residues placed from top to bottom inside the molecule were essential for scrambling phospholipids in inward and outward directions, apparently providing a pathway for their translocation. A tryptophan residue was present between the head group of phosphatidylcholine and the extracellular end of the path. Its mutation to alanine made the Xkr8-Basigin complex constitutively active, indicating that it plays a vital role in regulating its scramblase activity. The structure of Xkr8-Basigin provides insights into the molecular mechanisms underlying phospholipid scrambling.

Physicians' Perceptions and Suggestions for the Adaptation of a US-Based Serious Illness Communication Training in a Non-US Culture: A Qualitative Study.

CONTEXT: US-based serious illness communication training pedagogy has not been well studied outside of the United States. OBJECTIVES: To explore the perception of a US-based, serious illness communication training pedagogy in a non-US culture and to identify aspects requiring cultural adaptations. METHODS: In September 2019, we conducted a qualitative study using convenient sampling at two urban, academic medical centers in Tokyo, Japan. Semistructured interviews were conducted to Japanese physicians who participated in the four-hour VitalTalk training in Japanese. We explored six majored themes: 1) global impression of the training; 2) main goals from participation; 3) appropriateness of didactics; 4) role play experiences; 5) take away points from the training; and 6) changes in their own communication practice after the training. Interviews were transcribed, coded, and analyzed using phenomenological approach. RESULTS: All 24 participants found the VitalTalk pedagogy novel and beneficial, stressing the importance of demonstrating empathy, reflecting on own skills, and recognizing the importance of feedback that emphasizes the use of specific words. Participants also pointed out that Japanese patients generally do not express their strong emotions explicitly. CONCLUSION: Our study found empirical evidence that the VitalTalk pedagogy is perceived to be novel and beneficial in a non-US cultural setting. Cultural adaptations in expression and response to emotion may be required to maximize its efficacy in Japan. To meet the needs of clinical practice in Japan, further studies are needed to empirically test the suggested refinements for the VitalTalk pedagogy.

Patient "Catastrophizing" Associated with Expectations of Opioid Prescriptions for Acute Pain Control.

BACKGROUND: The prescription of opioids for acute pain may be a driving factor in chronic opioid abuse. We examined patients' characteristics associated with the expectation of the receipt of opioid prescriptions for acute pain control. METHODS: A 1-time survey was administered to adult patients at family medicine clinics in the Pacific Northwest between November 2018 and January 2019. Logistic regression modeled adjusted odds of expecting an opioid prescription in ≥ 3 of the 4 dispositional acute pain scenarios by patient demographics, opioid use, past-week pain intensity and duration, past-week anxiety, and pain catastrophizing. RESULTS: The survey was completed by 108 patients (62% female, 48% between 30 and 49 years of age, 75% non-Hispanic Whites). Most patients (71%) expected an opioid prescription in ≥ 1 of the 4 scenarios; 26% expected a prescription in ≥ 3 scenarios. Patients with higher levels of pain catastrophizing had more than 3 times greater odds of expecting opioids than those with lower pain catastrophizing (OR, 3.73; P = .032; 95% CI, 1.12-12.46); no other characteristics were statistically significant. CONCLUSION: Higher pain catastrophizing was associated with increased odds of expecting opioids in dispositional acute pain scenarios in outpatient settings. Future studies can determine whether addressing pain catastrophizing reduces expectations of opioid prescribing for acute pain control. The finding that most patients expected opioid prescriptions in acute pain scenarios needs further exploration into other potential factors associated with these expectations. Evidence-based guidelines for condition-specific acute pain management are warranted for appropriate opioid prescribing and to guide treatment expectations.

Comparison of Opioid Prescribing Patterns in the United States and Japan: Primary Care Physicians' Attitudes and Perceptions.

INTRODUCTION: Far fewer opioids are prescribed in Japan than in the United States. METHODS: We conducted an online physician survey assessing attitudes and perceptions that might influence prescribing. A Japanese version was distributed to members of the Japan Primary Care Association and an English version to members of the American Academy of Family Physicians practicing in Oregon. RESULTS: We received 461 Japanese responses and 198 from the United States, though overall response rates were low (Japan: 10.1%, United States: 18.5%). Japanese respondents reported far less opioid prescribing than US respondents, especially for acute pain (acute pain: 49.4% vs 97.0%; chronic pain: 63.7% vs 90.9%; P < .001 for both). Almost half of respondents from both countries indicated that patient expectations and satisfaction were important factors that influence prescribing. US respondents were significantly more likely to identify medical indication and legal expectation as reasons to prescribe opioids for acute pain. Most US respondents (95.4%) thought opioids were used too often, versus 6.6% of Japanese respondents. CONCLUSIONS: Lower opioid use was reported in Japan, especially for acute pain, which may help minimize long-term use. Patient expectations and satisfaction seem to influence opioid prescribing in both countries. The United States could learn from Japanese regulatory and cultural perspectives.