Abstract:
OBJECTIVE:To compare and contrast the duration and content of physician-patient interaction for patients presenting to an emergency department with problems of low acuity in 1990 and 2005 treated by different grades of physician. METHODS:Observational study with data collection in May-July 1990 and May-July 2005. Patients identified at nurse triage as presenting with 'primary care' problems were allocated by time of arrival to senior house officers (1990, n=7; 2005, n=10), specialist registrars/staff grades (1990, n=4; 2005, n=7) or sessionally employed general practitioners (1990, n=8; 2005, n=12) randomly rostered to work in a consulting room that had a wall-mounted video camera. A stratified sample of 430 video-taped consultations (180 (42%) from 1990 and 250 (58%) from 2005) was analysed using the Roter Interaction Analysis System. Main outcome measures -- length of consultation; numbers of utterances of physician and patient talk related to building a relationship, data gathering, activating/partnering (i.e. actively encouraging the patient's involvement in decision-making), and patient education/counselling. RESULTS:On average consultation length was 251s (95% CI for difference: 185-316) longer in 2005 than in 1990. The difference was especially marked for senior house officers (mean duration 385s in 1990 and 778s in 2005; 95% CI of difference: 286-518). All groups of physician showed increased communication related to activating and partnering and building a therapeutic relationship with the patient. While senior house officers demonstrated a greatly increased focus on data gathering, only general practitioners substantially increased the amount of talk centred on patient education and counselling; compared to senior house officers, the odds ratio for the number of such utterances included in consultations was 2.8 (95% CI: 1.4, 5.3). CONCLUSION:Although patient-centredness together with consultation length increased for all three physician groups over the duration of this study, senior house officers and specialist registrars/staff grades continued to place less emphasis on advice-giving and counselling than did general practitioners. The extent to which these observed changes in practice were determined by policy, management and training initiatives, and their impact on patient outcome, needs further study. PRACTICE IMPLICATIONS:Video-recording consultations is feasible in an acute hospital setting, and could be used to support training and workforce development. General practitioners can make a distinctive contribution to the workforce of emergency departments. Their consulting style differs from that of hospital physicians and may benefit patient care through a greater focus on patient education and counselling.
journal_name
Patient Educ Counsjournal_title
Patient education and counselingauthors
Dale J,Sandhu H,Lall R,Glucksman Edoi
10.1016/j.pec.2008.02.005subject
Has Abstractpub_date
2008-08-01 00:00:00pages
320-9issue
2eissn
0738-3991issn
1873-5134pii
S0738-3991(08)00118-3journal_volume
72pub_type
杂志文章abstract::Twelve physicians, 33 nurses, and 30 patients completed questionnaires to elicit similarities and differences in perceptions of educational needs of post-myocardial infarction (MI) patients. Results, using chi-square analysis, indicated that the three groups generally agreed upon which areas should be included in educ...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/0738-3991(84)90038-7
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:To review the literature to identify external influences on information exchange and shared decision-making in healthcare consultations and conceptualise how information is used both outside and within a consultation. METHODS:A 'meta-study' approach (meta-data-analysis, meta-theory, meta-method, and meta-syn...
journal_title:Patient education and counseling
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.pec.2008.09.025
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:There is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN...
journal_title:Patient education and counseling
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.pec.2018.10.009
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:Probabilities of benefits and harms of treatment may help patients when making a treatment decision. This study aimed to examine (1) whether and how radiation oncologists convey probabilities to rectal cancer patients, and (2) patients' estimates of probabilities of major outcomes of rectal cancer treatment. ...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2015.05.009
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe older hospital patients' discharge experiences on participation in the discharge planning. METHODS:A sample of 254 patients aged 80+ was interviewed using a questionnaire developed by the research team. Data were collected by face-to-face interviewing during the firs...
journal_title:Patient education and counseling
pub_type: 杂志文章,多中心研究
doi:10.1016/j.pec.2010.08.025
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening. METHODS:Seven focus groups were conducted with 47 participants, representing three stakeholder groups - men, GPs and PNs. All fo...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2018.01.003
更新日期:2018-05-01 00:00:00
abstract::Tsunami is a fictionalized, based on the true story of a mother and baby patients who attended my rural clinic for 12 months and disappeared. (All personal identifiers have been removed.) It is a story of a family physician trying to establish trust relationship with a young mother, that her past history and living co...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2009.06.008
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:In the Netherlands HIV nursing consultants have participated in HIV-care since 1985; their profession has changed with developments in HIV-treatment over time. The study goal was to gather information about their role in HIV-care and to provide an useful example to other (HIV-)care settings over the world. M...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2009.11.016
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To determine the association between self-efficacy and health-related quality of life (HRQoL) in people with Chronic Obstructive Pulmonary Disease (COPD) and the moderating effect of self-efficacy type (exercise task, exercise barrier, COPD symptom, general) and HRQoL type (generic, COPD specific). METHODS:D...
journal_title:Patient education and counseling
pub_type: 杂志文章,评审
doi:10.1016/j.pec.2019.12.003
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:Our aim was to gather community stakeholder input to inform the development of a digital system linking depression screening to decision support. METHODS:Views and feature requirements were identified through (1) focus groups with patients and consumers with depression, and interviews with primary care clini...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2018.10.002
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To determine the level of agreement between patients and observers regarding the frequency with which health-related quality of life topics are discussed during outpatient clinical oncology visits. METHODS:The sample (n=50) consisted of a consecutive series of cancer patients undergoing chemotherapy. Both th...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2006.06.002
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVE:To examine the informed consent process implementation and quality in Croatia using a specially developed instrument. METHODS:A cross-sectional questionnaire study was conducted in 300 patients (response rate 73%) from six hospitals in Croatia, along with psychometric evaluation of the questionnaire. RESULT...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2015.08.033
更新日期:2016-03-01 00:00:00
abstract::Surveys estimate that 3-6% of the patients seen by physicians are gay or lesbian. There are unique health risks of gays and lesbians that are important to the clinician in determining an accurate diagnosis, providing patient education, and arriving at an appropriate treatment plan. One of the most significant medical ...
journal_title:Patient education and counseling
pub_type: 杂志文章,评审
doi:10.1016/s0738-3991(02)00189-1
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVE:To examine the changes in performance on heart failure knowledge assessments administered before and after discharge education. METHODS:We conducted a randomized controlled trial comparing the effects of a 1-h, one-on-one teaching session with a nurse educator to the standard discharge process in patients wi...
journal_title:Patient education and counseling
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.pec.2011.05.019
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:To investigate the applied and conceptual relationship between two measures of shared decision making using the OPTION instrument developed in Wales and the Informed Decision Making instrument developed in Seattle, USA using audio-taped consultation data from a UK general practice population. METHODS:Twelve ...
journal_title:Patient education and counseling
pub_type: 杂志文章,多中心研究
doi:10.1016/j.pec.2007.09.001
更新日期:2008-01-01 00:00:00
abstract::Since publication of Unequal Treatment by the Institute of Medicine in 2003, there has been a growing recognition of the role of provider implicit racial bias in patient care. Provider implicit racial bias has been consistently negatively associated with both care satisfaction and provider trust among racial/ethnic mi...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2019.04.023
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To explore demographic-, health-, and smoking-related predictors and moderators of outcome in smokers who participated in two different brief smoking cessation interventions. METHODS:Data were acquired using a quasi-randomized controlled trial that tested the efficacy of computer-generated tailored letters a...
journal_title:Patient education and counseling
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.pec.2009.07.005
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVES:(i) To develop a prototype measure of co-production of health (CPH) in consultations for people with long-term conditions (LTCs); and (ii) to undertake initial validation of it, using a measure of patient-centred care, as defined by the Roter interaction analysis system (RIAS). METHODS:Mixed methods were ap...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2015.07.005
更新日期:2015-07-08 00:00:00
abstract::Knowledge of health care professionals' different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients' understanding of their condition should be taken as the poin...
journal_title:Patient education and counseling
pub_type: 杂志文章,多中心研究
doi:10.1016/s0738-3991(02)00212-4
更新日期:2003-09-01 00:00:00
abstract::We report the evaluation of a pharmacist-led medication education program for the elderly. The program consisted of a single group-based education session followed by individual pre-discharge counseling. Patients also received an individual medication record card. The study design was a nonrandomised trial. Patients i...
journal_title:Patient education and counseling
pub_type: 临床试验,杂志文章
doi:10.1016/0738-3991(90)90090-8
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVE:1) to assess patients' descriptions of concerns, and 2) to inform a conceptual framework in which the impact of the nature of concerns on doctor-patient communication is specified. METHODS:Six focus groups were conducted with 39 cancer patients and survivors. In these focus groups participants were asked to ...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2017.02.002
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:The role of the consultation in mediating improved clinical outcomes has been demonstrated in both conventional and complementary medicine but to date no depth study has explored how complementary medical consultations achieve such benefits. This study explored rheumatoid arthritis (RA) patients' perceptions ...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2011.11.008
更新日期:2012-12-01 00:00:00
abstract:UNLABELLED:Lifestyle modification programs tailored to experience, culture, psychosocial characteristics, and world-view can improve knowledge, self-care behaviors, and glucose control among Latinos with diabetes. Few data exist, however, on improving diabetes self-management among Latinos. In addition, views and pract...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2006.12.003
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:There is a limited understanding of symptom meaning and its significance to clinical practice within symptom experience literature. This study aims to qualitatively explore the ways in which symptom meanings are discussed by patients and responded to by palliative care physicians during consultations. METHOD...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2017.05.006
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. METHODS:We adapted the reflective-impulsive model of social behaviour to explain the...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2012.09.005
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:To experimentally test whether presenting logically equivalent, but differently valenced effectiveness information (i.e. attribute framing) affects perceived effectiveness of the human papillomavirus (HPV) vaccine, vaccine-related intentions and policy opinions. METHODS:A survey-based experiment (N=334) was ...
journal_title:Patient education and counseling
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.pec.2010.08.014
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVE:This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA). METHODS:In 4 month intervals we followed a cohort of 490 PLWHA for 12 months. We conducted hierarchical linear regression models to examine changes ...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2011.07.021
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:Leading health agencies recommend physicians to provide information regarding genetic testing for autism spectrum disorders (ASD) to parents of affected children. How to effectively provide this information, however, is unclear for physicians. This qualitative study examined the information needs regarding AS...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2015.12.023
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:Patient involvement focused the growth of Shared Decision Making (SDM) in contemporary healthcare practice, research, and education. Whilst important, securing appropriate patient involvement or equipping patients to choose is not necessarily the principal purpose of SDM. The purpose of SDM like all medical d...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2019.07.020
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To document cases of adverse or near adverse events in communication skills training (CST) and to identify risk factors and strategies to reduce the likelihood of their occurrence. METHODS:Six physician CST cases meeting criteria for an adverse or near adverse collected from experienced facilitators are anal...
journal_title:Patient education and counseling
pub_type: 杂志文章
doi:10.1016/j.pec.2009.12.009
更新日期:2010-10-01 00:00:00