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GULiVer. Travelling into the heart of good doctor-patient communication from a patient perspective. An international multicentre study
No full textBackground: Numerosi studi dimostrano l'impatto positivo di un approccio centrato sul paziente (PC) su diversi outcomes, tra cui l'adesione al trattamento. Di conseguenza, definire le principali abilità necessarie per implementare l’approccio PC nella pratica clinica, è diventato per i ricercatori un obiettivo fondamentale. Nonostante questi sforzi per dare ai pazienti una posizione centrale nella propria salute, la prospettiva del paziente è a tutt’oggi raramente presa in considerazione, ponendo in luce la necessità di approcci più diretti per dare voce alle opinioni dei pazienti sulla qualità della performance comunicativa dei medici.
Obiettivo: GULiVER è un progetto internazionale multicentrico volto a esplorare come un campione di individui selezionati dalla popolazione generale in Olanda (Utrecht), Inghilterra (Liverpool) e Italia (Verona) valuta la performance comunicativa del medico.
Metodo: In ciascun centro, due set di 4 videoregistrazioni di colloqui OSCE riferiti a due diversi scenari, è stata mostrata a 8 gruppi di 6-9 partecipanti ciascuno. I 4 studenti-medici di ciascun set differivano per le loro abilità comunicative valutate sulla base del punteggio OSCE e della valutazione dei pazienti simulati (punteggi entrambi alti, bassi o discordanti). La selezione dei partecipanti si è basata su due criteri di stratificazione: il sesso (gruppi separati per uomini e donne) e l’età (ciascun gruppo doveva includere almeno 2 partecipanti per ciascuno dei gruppi di età 18-30; 31-50; >50). Per ciascun partecipante sono state raccolte informazioni socio-demografiche, sullo stato di salute fisica (COOP-WONCA) e mentale (GHQ), sulle preferenze comunicative (QUOTE-com), e sulla fiducia nel medico (TMP). I partecipanti erano chiamati a dare la loro valutazione, individualmente o in gruppo, su diversi aspetti della performance comunicativa degli studenti-medico tramite valutazioni quantitative (questionari) e qualitative (focus groups) con una metodologia di indagine di tipo misto.
Un’analisi di contenuto di tipo induttivo è stata applicata ai dati qualitativi (facus groups) al fine di generare un sistema di codifica e produrre diverse categorie. La statistica descrittiva è stata quindi applicata per le distribuzioni di frequenza.
Risultati: Il campione complessivo comprende 211 partecipanti, equamente distribuiti tra i centri (64 dal NL, 72 IT, 75 UK) e bilanciati in termini di età, sesso e scenario, confermando la qualità dei dati raccolti.
Le curve di distribuzione dei punteggi attribuiti dai partecipanti ai 4 medici (valutazione 1-10) risultano più simili di quanto atteso sulla base del loro punteggio OSCE e del paziente simulato, soprattutto per le interviste con punteggio alto o basso per entrambi (Skewness index –0.3 per l’intervista HH and -0.06 per LL).
Tra le variabili oggetto di studio, solo il livello di educazione è risultato significativamente correlato in senso negativo con la valutazione 1-10 data dai partecipanti (scuola superiore, università versus nessuna educazione, scuola elementare rispettivamente: =-0.53, p=-0.03; =-0.64, p=0.01).
Il conteggio di frequenza delle categorie evidenzia che i partecipanti ritengono molto importante che un medico sia: competente, sicuro di sé, in grado di ottenere un quadro completo del problema, rassicurante, gentile, interessato alle problematiche del paziente e flessibile nell’adattare la struttura dell’intervista ai suoi bisogni. Inoltre al 20% dei partecipanti non piace che il medico coinvolga il paziente nelle scelte terapeutiche.
Discussione e conclusioni:
Il protocollo e i risultati preliminari presentati ad oggi hanno portato alle seguenti constatazioni:
La valutazione dei partecipanti sulla performance comunicativa degli studenti-medico non risulta sempre in accordo con la classificazione OSCE dei 4 video suggerendo che i partecipanti basano la loro valutazione su criteri diversi rispetto ai ricercatori.
Le attitudini interpersonali e non verbali del medico sembrano giocare un ruolo preminente nella valutazione dei pazienti. I corsi di formazione non dovrebbero quindi sottovalutare il ruolo di questi aspetti relazionali di base, che sono a rischio di essere dati per scontati.
In particolare, un'alta percentuale di persone ha valutato come negativi gli atteggiamenti volti a coinvolgerli nelle decisioni terapeutiche e sembrano preferire un approccio paternalistico, basato sul costrutto "è il medico che sa cosa è meglio”. Ulteriori analisi andranno ad esplorare le caratteristiche cliniche e socio-demografiche in relazione ai focus consentendo di approfondire tali aspetti in maggior dettagli.
Infine, le valutazioni dei partecipanti risultano notevolmente differenziate e, di conseguenza, la capacità di adottare uno stile di intervista flessibile che risponde alle esigenze individuali acquista un ruolo fondamentale nell'attuazione di un approccio realmente centrato sul paziente.Background: A growing body of evidence is demonstrating the importance of a patient centered approach (PCC) in improving health outcomes, including adherence to treatment. Accordingly, concerted efforts have been made by researchers to define the crucial skills that are required to implement PCC in clinical practice. Despite these efforts to bestow the patients a central position in their own health care, the patient's perspective is rarely taken into account underlying the need of more direct approaches to voice patients’ opinions on the quality of doctor-patient communication.
Aim: GULiVER is an international, multicentre project developed to explore how lay people in the Netherlands (Utrecht), the United Kingdom (Liverpool) and Italy (Verona) evaluate physicians’ communicative performance.
Method: In each centre two set of 4 videotaped OSCE consultations presenting two clinical scenarios was shown to 8 lay panels of 6 to 9 participants each. Among each set, the four medical students differed in their communication skills as assessed by the OSCE examiners and the standardized patient (High-High; High-Low; Low-High; Low-Low). The selection of lay participants was based on two stratification criteria: gender (separate male and female panels) and age (each panel including at least 2 persons across the age bands 18-30; 31-50; >50). Background characteristics included socio-demographics, participants’ own health (COOP-WONCA) and mental health (GHQ), communication preferences (QUOTE-com), and trust in doctors (TMP). Participants were asked to give their assessment, individually or in groups, on different aspects of student-doctor communicative performance through both quantitative (questionnaires) and qualitative (focus groups) assessments in a mixed-methods design.
Inductive content analysis was applied to qualitative data (focus groups) to generate a coding system and produce several categories. Descriptive statistic was then applied for the frequency count distribution.
Results: The overall sample comprised 211 participants, equally distributed among the centres (64 from NL, 72 IT, 75 UK) and balanced in terms of age, gender and scenario, confirming the quality of collected data.
The distribution curves of participants 1-10 evaluations of the 4 videos were less skewed than expected, based on the Expert and SP ratings, particularly for the student-doctors HH (good performance) and LL (low performance) (Skewness index –0.3 for HH and -0.06 for LL).
Among the variables under study, only the level of education resulted significantly negatively related with participants’ 1-10 evaluation (secondary and higher school versus none/primary school respectively: =-0.53, p=-0.03; =-0.64, p=0.01).
Categories count of frequencies showed that participants placed high importance on a doctor who was: competent, self-confident, able to get a complete picture of the patients’ problems, reassuring, nice, interested in the patients’ problems, and flexible in adapting the structure of the interview to the patients’ needs. Moreover 20% of participants disliked a doctor who shared plans and ideas with the patients
Discussion and conclusion:
To date, the protocol and some preliminary results have been presented, which have led to the following observations:
Overall, the lay participants’ ratings of the student-doctors’ performance were not always consistent with the OSCE-based classification of the 4 videos suggesting that lay people have different criteria when they evaluate the communicative quality of a medical consultation.
The interpersonal and nonverbal attitudes of a doctor play a fundamental role in patients’ evaluations. Training courses should therefore avoid underestimating the role of these basic relational aspects, which are at risk to be taken for granted.
Notably, a high proportion of people rated attitudes that focused on involving them in decisions as negative and seem to prefer a paternalistic approach, based on the construct “the doctor knows the best.” Further analyses will deeply explore users’ socio-demographic and clinical variables according to focus group to dissect these differences in greater detail.
Finally, the participants’ assessments varied widely and, therefore, the ability to adopt a flexible interview style that responds to individual needs is fundamental in implementing a truly patient-centered approach
I processi di disintermediazione tra gap di accesso e competenze. Responsabilità ed etica del giornalismo nel caso WikiLeaks
No full textAi media digitali è
riconosciuta una capacità liberatoria
connessa a un potenziale “accesso
democratico” alle informazioni, spesso
però è sottostimato il problema delle
competenze digitali degli individui.
L’informazione è la merce di scambio
del nostro tempo e l’individuo è in
uno stato di perenne tensione:
da un lato la propensione a
immergersi nel costante flusso
informativo, dall’altro una sostanziale
incapacità – percepita o meno – a
governare questo information overload.
Cosa accade perciò quando, come nel
caso di WikiLeaks, le informazioni
prive di un’intermediazione sono
disponibili ai cittadini/utenti?
E, soprattutto, come si modificano i
concetti di responsabilità ed etica per i
giornalisti
Genesi, modulazione e impatto dell'evento avverso nella prospettiva psicologica
No full textNel presente capitolo saranno discussi gli elementi che favoriscono il verificarsi dell'errore in medicina, suggerendo come in alcuni casi esso sia da ritenersi inevitabile e purtroppo parte dell'operare clinico. Partendo da tale presupposto, saranno quindi discusse le modalità di gestione della criticità e dell'evento avverso, volte a responsabilizzare, valorizzare e supportare l'operatore sanitario all'interno di una cultura che promuova la prevenzione e la patrimonializzazione dell'errore. Il presupposto teorico alla base di quanto verrà proposto è che la competenza di un clinico si fonda sulla creazione di un'attitudine mentale che lo porta ad essere attento, curioso, autoconsapevole e orientato al riconoscimento e alla correzione degli errori commessi
Providing Information and Involving the Patient in the Therapeutic Process
No full textSpecific conceptualization of each clinical case is crucial to provide a framework for understanding the patient’s maladaptive behaviors and modifying dysfunctional attitudes. The therapist should formulate the case at an early stage, preferably during the evaluation process (or assessment stage); the formulation can be modified at any time whenever new information is collected. After the assessment phase, the therapist should be in a position to provide the patient with a preliminary formulation of the problem. This would include a brief description of the current problem, an explanation of how the problem has developed, and a summary of the contributing factors. As the treatment is based on this formulation, it is important that patients are asked for feedback on its accuracy and for their opinions about it. Sharing this conceptualization with the patient can also help the data-gathering process and the assessment stage since it provides a guide to the patient as to which aspects to focus on, and what interpretations and underlying beliefs to identify. After testing new material, the patient and therapist can then add it into the preliminary formulation. As new data are collected, the therapist can reformulate the case on the basis of these new data
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
How patients want their doctor to communicate. A literature review on primary care patients' perspective.
No full textOBJECTIVE: To review the literature on the communicative behaviours primary care patients want from a "good" physician. METHODS: An electronic search used the key words doctor-patient relation AND patient desires OR patient expectations OR patient preferences (from now on referred to as expectations). The qualitative and quantitative articles meeting the selection criteria were analysed separately, comparing methods, definitions, measures and outcomes. The physician behaviours desirable from a patient perspective were grouped by linking them to the communicative functions of an effective medical encounter as defined from a professional perspective. RESULTS: Twenty-seven studies were included. Critical issues were the heterogeneity of definitions and measures and the lack of integration between quantitative and qualitative findings. Most of the expectations in qualitative studies were related to the function "Fostering the relationship". Similar expectations arose less often in quantitative studies. CONCLUSIONS: Patients do have concrete expectations regarding each of the functions to be met in the medical encounters. The research approach tends to bias the results. PRACTICE IMPLICATIONS: The collected expectations suggest how physicians may perform each of their tasks according to the patient perspective. Future research on patients' communicative expectations needs to overcome the gap between qualitative and quantitative findings
Comparing swab- and different symptoms-based strategies to ascertain COVID-19 recovery in healthcare workers: a cost-effectiveness analysis
No full textObjective Given the human and economic cost of the COVID-19 pandemic, protecting healthcare workers (HCW) and ensuring continuity of care is critical. The aim of this study is to evaluate the cost-effectiveness of different strategies to ascertain COVID-19 recovery in HCWs. Methods Data were collected from the hospital health surveillance program on HCWs at the University Hospital of Verona between 29/02/2020 and 14/04/2021. The diagnosis of SARS-CoV-2 infection and the assessment of the recovery were made through RT-PCR on oro-nasopharyngeal swab-sample. Recovery time and probability were estimated through Kaplan-Meier estimate. For each recovery assessment strategy costs (laboratory diagnostics and human resources), expressed in local currency (euro-euro), and working days saved (WDS-effectiveness) were estimated. A decision-tree was created where each knot was a time point scheduled by the different recovery assessment strategies. A Monte Carlo simulation method was used, and probabilistic sensitivity analysis assessed the effect of input uncertainty. Results In the study period 916 (9.9%) HCWs tested positive. Recovery time through symptom-based strategy (21 days 0.95 CI 16-24) was significantly lower compared to swab-based one (25 days 0.95 CI 23-28, p < 0.001). The swab-based strategy was dominated by all symptoms-based ones. Symptoms-based with a swab on days 14 and 17 had an ICER of 2 euro/WDS and 27 euro/WDS compared to the one scheduled on days 10 and 17 and with only one swab on the 17th day. Conclusions Scheduling swabs on days 14 and 17 in a symptom-based strategy was the most cost-effective, saving 7.5 more working days than the standard one with swabs on days 10 and 17
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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