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Assessment of nonverbal communication in clinical encounters: many methodological approaches, but no gold standard
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L’intervista medica in medicina generale
No full textGli studi pubblicati negli ultimi anni hanno ampiamente dimostrato che l’approccio e lo stile comunicativo adottati durante la conduzione dell'intervista medica condizionano il conseguimento degli obiettivi di diagnosi e cura e, per questa ragione, debbono essere considerati come uno strumento specifico della professione medica. Questo ha fatto si che in letteratura venisse sempre più valorizzato il ruolo di approcci olistici e “centrati” sul paziente, in base ai quali il medico indaga attivamente il punto di vista del paziente, facilitandolo nell’esprimersi e cercando di coinvolgerlo nelle decisioni relative al trattamento.
Di seguito è descritto più in dettaglio l'approccio definito sopra come “centrato sul paziente” che meglio di adatta al contesto della medicina generale. Verrano inoltre illustrati alcuni risultati relativi ad uno studio svolto dal nostro dipartimento su un campione di medici non formati alle tecniche comunicative, allo scopo di comprendere le attuali necessità formative, in vista di un un training pianificato ad hoc
From research to clinical practice: a systematic review of the implementation of psychological interventions for chronic headache in adults
Full text linkBackground: Psychological interventions have been proved to be effective in chronic headache (CH) in adults. Nevertheless, no data exist about their actual implementation into standard clinical settings. We aimed at critically depicting the current application of psychological interventions for CH into standard care exploring barriers and facilitators to their implementation. Secondarily, main outcomes of the most recent psychological interventions for CH in adults have been summarized. Methods: We conducted a systematic review through PubMed and PsycINFO in the time range 2008-2018. A quality analysis according to the QATSDD tool and a narrative synthesis were performed. We integrated results by: contacting the corresponding author of each paper; exploring the website of the clinical centers cited in the papers. Results: Of the 938 identified studies, 28 papers were selected, whose quality largely varied with an average %QATSDD quality score of 64.88%. Interventions included CBT (42.85%), multi-disciplinary treatments (22.43%), relaxation training (17.86%), biofeedback (7.14%), or other interventions (10.72%). Treatments duration (1 day-9 months) and intensity varied, with a prevalence of individual-basis implementation. The majority of the studies focused on all primary headaches; 4 studies focused on medication-overuse headache. Most of the studies suggest interventions as effective, with the reduction in frequency of attacks as the most reported outcome (46.43%). Studies were distributed in different countries, with a prevalent and balanced distribution in USA and Europe. Ten researches (35.71%) were performed in academic contexts, 11 (39.28%) in clinical settings, 7 (25%) in pain/headache centres. Interventions providers were professionals with certified experience. Most of the studies were funded with private or public funding. Two contacted authors answered to our e-mail survey, with only one intervention implemented in the routine clinical practice. Only in three out of the 16 available websites a reference to the implementation into the clinical setting was reported. Conclusion: Analysis of contextual barriers/facilitators and cost-effectiveness should be included in future studies, and contents regarding dissemination/implementation of interventions should be incorporated in the professional training of clinical scientists. This can help in filling the gap between the existing published research and treatments actually offered to people with CH
Communication strategies to motivate patients to follow doctor's advice,Strategie comunicative per motivare i pazienti a seguire i consigli del medico
No full textThe growing attention to the preventive aspects of health care has raised the question how to motivate patients to modify potentially health damaging habits such as smoking, alcohol abuse, wrong diet or poor exercise. The present paper examines the theory and the techniques of the motivational interview and proposes practical examples which illustrate how the physician may overcome patient’s resistance. The authors describe the principal aspects of the process of motivational change and some of the corresponding attitudes and skills which the physician has to adopt in each phase of this process. The basic assumptions are that the patient is the main agent of change and that the physician’s task is to facilitate this process and to sustain the patient’s efforts
Differences in verbal behaviours of patients with and without emotional distress during primary care consultations
No full textBackground. In primary care consultations patients with emotional distress tend to give verbal cues or symptom reports with psychological or psychiatric contents. This study examined the cue behaviour defined not only by psychological, but also by medical, social and life episodes related contents in patients with and without emotional distress, recognized and not by their GP. The GP's verbal behaviour in relation to patients' cue emission was also investigated. Method. For the six participating GPs two groups of matched pairs of patients (N = 238) were created. The two groups comprised either patients considered by GPs as being without emotional distress or patients considered as emotionally distressed. Within each pair, one patient was a case (GHQ-12 score > 2) and the other was the matched control (GHQ-12 score < 3). The medical interviews with these patients were transcribed and classified according to the Verona Medical Interview Classification System (VR-MICS). Results. GHQ positive patients of both groups gave more cues in terms of total proportion than their matched controls (GHQ negative patients). The proportion of cues given by patients was related also to GP's verbal behaviour, increasing with closed psychosocial questions and decreasing with the use of active interview techniques. Attribution of emotional distress was more frequent when patients were high attenders and had a past psychiatric history. The content of cues changed in relation to GP's attribution: recognized patients gave more cues and more often with psychological content, patients not recognized as distressed gave mainly cues related to their lifestyle and life episodes. Conclusions. To improve the recognition of those emotionally distressed patients most likely to be missed GPs should increase their attention to cues related to life style and life episodes.Background. in primary care consultations patients with emotional distress tend to give verbal cues or symptom reports with psychological or psychiatric contents. This study examined the cue behaviour defined not only by psychological, but also by medical, social and life episodes related contents in patients with and without emotional distress, recognized and not by their GP. The GP's verbal behaviour in relation to patients' cue emission was also investigated.Method. For the six participating GPs two groups of matched pairs of patients (N = 238) were created. The two groups comprised either patients considered by GPs as being without emotional distress or patients considered as emotionally distressed. Within each pair, one patient was a case (GHQ-12 score > 2) and the other was the matched control (GHQ-12 score < 3). The medical interviews with these patients were transcribed and classified according to the Verona Medical Interview Classification System (VR-MICS).Results. GHQ positive patients of both groups gave more cues in terms of total proportion than their matched controls (GHQ negative patients). The proportion of cues given by patients was related also to GP's verbal behaviour, increasing with closed psychosocial questions and decreasing with the use of active interview techniques. Attribution of emotional distress was more frequent when patients were high attenders and had a past psychiatric history. The content of cues changed in relation to GP's attribution: recognized patients gave more cues and more often with psychological content, patients not recognized as distressed gave mainly cues related to their lifestyle and life episodes.Conclusions. To improve the recognition of those emotionally distressed patients most likely to be missed GPs should increase their attention to cues related to life style and life episodes
Patient cues and medical interwiewing in general practice. Examples of the application of sequential analysis
No full textAIMS:
To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions.
METHODS:
238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions
RESULTS:
Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question.
CONCLUSIONS:
Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions
Uno strumento per la valutazione dell'intervista medica nel contesto della medicina generale: il VR-MICS/D n(Verona Medical Interview Classification System/Doctor)
No full textObjective - To assess the reliability of the VR-MICS/D (Verona-Medical Interview Classification System/Doctor) and to identify the verbal behaviour by general practitioners in interviews conducted with primary care attenders with medical complaints and emotional distress. Setting - Two general practices in South-Verona. Sample - 100 primary care patients attending for a new illness episode with a GHQ-12 score ≥ 3. The five participating GPs contributed each with 20 audiotaped interviews of 10 patients judged by GP as emotionally distressed and of 10 judged without emotional distress. Main outcome measures - The VR-MICS/D classifies GPs' verbal behaviour during the medical interview into 16 categories in terms of form (question or statement) and content and allows to assess their interview skills. Procedure - Two raters classified 30 interviews (15 with patients judged by their GP as emotionally distressed and 15 with patients judged without emotional distress). Having established satis..
COVID-19 and mental health in the obstetric population: A lesson from a case of puerperal psychosis
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