The Role of the Law in Communicating Patient Safety

This chapter considers the role of the law in communicating patient safety. Downie, Lahey, Ford, et al’s (2006) preventing, knowing and responding theoretical framework is adopted to classify the different elements of patient safety law. Rather than setting out all relevant patient safety laws in detail, this chapter highlights key legal strategies which are employed to: prevent the occurrence of patient safety incidents (preventing); support the discovery and open discussion of patient safety incidents when they do occur (knowing),; and guide responses after they occur (responding) (Downie, Lahey, Ford, et al 2006). The law is increasingly being invoked to facilitate open discussion of and communication surrounding patient safety. After highlighting some legal strategies used to communicate patient safety, two practice examples are presented. The practice examples highlight different aspects of patient safety law and are indicative of communication issues commonly faced in practice. The first practice example focuses on the role of the Ccoroner in communicating patient safety. This example highlights the investigative role of the law in relation to patient safety (knowing). It also showcases the preventing responding and preventing elements in respect of the significant number of communication errors that can occur in a multi-disciplinary, networked health system. The main focus of the second practice example is responding example illustrates how the law responds to health service providers’ and professionals’ miscommunication (and subsequent incidents) during treatment, however it also touches upon knowing and preventing.

Chronicling the patient journey: Co-creating value with digital health ecosystems

With the introduction of the PCEHR (Personally Controlled Electronic Health Record), the Australian public is being asked to accept greater responsibility for the management of their health information. However, the implementation of the PCEHR has occasioned poor adoption rates underscored by criticism from stakeholders with concerns about transparency, accountability, privacy, confidentiality, governance, and limited capabilities. This study adopts an ethnographic lens to observe how information is created and used during the patient journey and the social factors impacting on the adoption of the PCEHR at the micro-level in order to develop a conceptual model that will encourage the sharing of patient information within the cycle of care. Objective: This study aims to firstly, establish a basic understanding of healthcare professional attitudes toward a national platform for sharing patient summary information in the form of a PCEHR. Secondly, the studies aims to map the flow of patient related information as it traverses a patient’s personal cycle of care. Thus, an ethnographic approach was used to bring a “real world” lens to information flow in a series of case studies in the Australian healthcare system to discover themes and issues that are important from the patient’s perspective. Design: Qualitative study utilising ethnographic case studies. Setting: Case studies were conducted at primary and allied healthcare professionals located in Brisbane Queensland between October 2013 and July 2014. Results: In the first dimension, it was identified that healthcare professionals’ concerns about trust and medico-legal issues related to patient control and information quality, and the lack of clinical value available with the PCEHR emerged as significant barriers to use. The second dimension of the study which attempted to map patient information flow identified information quality issues, clinical workflow inefficiencies and interoperability misconceptions resulting in duplication of effort, unnecessary manual processes, data quality and integrity issues and an over reliance on the understanding and communication skills of the patient. Conclusion: Opportunities for process efficiencies, improved data quality and increased patient safety emerge with the adoption of an appropriate information sharing platform. More importantly, large scale eHealth initiatives must be aligned with the value proposition of individual stakeholders in order to achieve widespread adoption. Leveraging an Australian national eHealth infrastructure and the PCEHR we offer a practical example of a service driven digital ecosystem suitable for co-creating value in healthcare.

The lived experience of diagnosis delivery in motor neurone disease: A sociological-phenomenological study

Relatively few previous studies of individuals receiving a diagnosis of Motor Neurone Disease within the UK health care system have employed qualitative approaches to examine the diagnostic journey from a patient perspective. A qualitative sociological study was undertaken, involving interviews with 42 participants diagnosed with MND, to provide insight into their experiences of undergoing testing and receiving a diagnosis. Adopting a sociological-phenomenological perspective, this article examines key themes that emerged from participant accounts surrounding the lived experience of the diagnostic journey. The key themes that emerged were: The diagnostic quest; living with uncertainty; hearing bad news; communication difficulties; and a reified body of medical interest. In general, doctor-patient communication both at pre and post diagnosis was experienced as highly stressful, distressing and profoundly upsetting. Participants reported such distress as being due to the mode of delivery and communication strategies used by health professionals. We therefore suggest that professional training needs to emphasize the importance to health professionals of fostering greater levels of tact, sensitivity and empathy towards patients diagnosed with devastating, life-limiting illnesses such as MND.

Patient Safety - A Psychological Perspective

This comprehensive book takes a psychological perspective on patient safety. It is based on the most recent theoretical and empirical research evidence from psychology (including clinical, work, and organizational psychology) and adjacent social and behavioral sciences such as human factors. Factors that influence safety-related experiences, behaviors, and outcomes of patients and professionals working in clinical settings such as medical practices and hospitals are reviewed, structured, and critically evaluated. Consistent with the complexity of the topic, the author takes a multi-level approach to patient safety, which includes a review of individual, team, and organizational factors and outcomes. The book describes how these factors, by themselves and in combination, can facilitate or impede patient safety. Individual factors include safety-relevant knowledge, skills, abilities, and personality traits such as conscientiousness and emotional stability. Team factors include group communication, training, and leadership. Finally, organizational factors include the safety culture and climate. Throughout the book, different evidence-based intervention programs are described that can help practitioners promote patient safety and prevent accidents. The book is a valuable resource for both researchers and practitioners interested in understanding, maintaining, and improving patient safety in a variety of applied settings. It is based on the most up-to-date research evidence from psychology and neighboring disciplines, and it is written in a clear and non-technical language understandable for a wide audience.

Systematic review of interventions to improve the provision of information for adults with primary brain tumours and their caregivers

Background: Adults with primary brain tumors and their caregivers have significant information needs. This review assessed the effect of interventions to improve information provision for adult primary brain tumor patients and/or their caregivers. Methods: We included randomized or nonrandomized trials testing educational interventions that had outcomes of information provision, knowledge, understanding, recall, or satisfaction with the intervention, for adults diagnosed with primary brain tumors and/or their family or caregivers. PubMed, MEDLINE, EMBASE and Cochrane Reviews databases were searched for studies published between 1980 and June 2014. Results: Two randomized controlled, one non-randomized controlled, and 10 single group pre-post trials enrolled more than 411 participants. Five group, four practice/process change and four individual interventions assessed satisfaction (12 studies), knowledge (four studies) or information provision (2 studies). Nine studies reported high rates of satisfaction. Three studies showed statistically significant improvements over time in knowledge and two showed greater information was provided to intervention than control group participants, although statistical testing was not performed. Discussion: The trials assessed intermediate outcomes such as satisfaction, and only 4/13 reported on knowledge improvements. Few trials had a randomized controlled design and risk of bias was either evident or could not be assessed in most domains.

Comprehending adverbs of doubt and certainty in health communication: A multidimensional scaling approach

This research explored the feasibility of using multidimensional scaling (MDS) analysis in novel combination with other techniques to study comprehension of epistemic adverbs expressing doubt and certainty (e.g., evidently, obviously, probably) as they relate to health communication in clinical settings. In Study 1, Australian English speakers performed a dissimilarity-rating task with sentence pairs containing the target stimuli, presented as "doctors' opinions". Ratings were analyzed using a combination of cultural consensus analysis (factor analysis across participants), weighted-data classical-MDS, and cluster analysis. Analyses revealed strong within-community consistency for a 3-dimensional semantic space solution that took into account individual differences, strong statistical acceptability of the MDS results in terms of stress and explained variance, and semantic configurations that were interpretable in terms of linguistic analyses of the target adverbs. The results confirmed the feasibility of using MDS in this context. Study 2 replicated the results with Canadian English speakers on the same task. Semantic analyses and stress decomposition analysis were performed on the Australian and Canadian data sets, revealing similarities and differences between the two groups. Overall, the results support using MDS to study comprehension of words critical for health communication, including in future studies, for example, second language speaking patients and/or practitioners. More broadly, the results indicate that the techniques described should be promising for comprehension studies in many communicative domains, in both clinical settings and beyond, and including those targeting other aspects of language and focusing on comparisons across different speech communities.

SeaMo plus : a virtual real-time multimedia service framework on handhelds to enable remote real-time patient monitoring for mobile doctors

The key requirements for enabling real-time remote healthcare service on a mobile platform, in the present day heterogeneous wireless access network environment, are uninterrupted and continuous access to the online patient vital medical data, monitor the physical condition of the patient through video streaming, and so on. For an application, this continuity has to be sufficiently transparent both from a performance perspective as well as a Quality of Experience (QoE) perspective. While mobility protocols (MIPv6, HIP, SCTP, DSMIP, PMIP, and SIP) strive to provide both and do so, limited or non-availability (deployment) of these protocols on provider networks and server side infrastructure has impeded adoption of mobility on end user platforms. Add to this, the cumbersome OS configuration procedures required to enable mobility protocol support on end user devices and the user's enthusiasm to add this support is lost. Considering the lack of proper mobility implementations that meet the remote healthcare requirements above, we propose SeaMo+ that comprises a light-weight application layer framework, termed as the Virtual Real-time Multimedia Service (VRMS) for mobile devices to provide an uninterrupted real-time multimedia information access to the mobile user. VRMS is easy to configure, platform independent, and does not require additional network infrastructure unlike other existing schemes. We illustrate the working of SeaMo+ in two realistic remote patient monitoring application scenarios.

Avaliação da empatia em médicos de diferentes níveis de atenção à saúde

O desenvolvimento de habilidades de comunicação em médicos tem sido apontado como uma necessidade e uma competência fundamental para o exercício da medicina. A empatia é uma habilidade interpessoal que pode ser descrita como a capacidade de compreender o ponto de vista e os sentimentos de uma outra pessoa sem julgá-los e de comunicar esse entendimento de modo que a pessoa que fala se sinta verdadeiramente compreendida pela pessoa que ouve. Essa habilidade promove um senso de validação na pessoa que fala, especialmente em situações de conflito, reduzindo a probabilidade de rompimento e fortalecendo os vínculos interpessoais. A empatia dos médicos é atribuída à sua educação pessoal, sendo raro o desenvolvimento dessa competência social durante o curso de formação médica. O desconhecimento sobre essa habilidade e sua função no exercício profissional motivou a realização deste estudo sobre a empatia em médicos que atuam em diferentes contextos de atenção à saúde no município do Rio de Janeiro. Participaram desta pesquisa 75 profissionais, dos quais 25 atuavam no nível da Atenção Primária, composto por equipes de saúde da família e por centros municipais de saúde; 12 pertenciam a unidades mais especializadas que correspondem ao nível de Atenção Secundária e 38 trabalhavam nos ambulatórios de hospitais universitários da Atenção Terciária. Foi aplicado o Inventário de Empatia (I.E.), que avalia os quatro fatores que compõem a habilidade empática: 1) Tomada de Perspectiva: capacidade de compreender o ponto de vista e os sentimentos da outra pessoa; 2) Flexibilidade Interpessoal: capacidade de aceitar perspectivas muito diferentes das próprias; 3) Altruísmo: capacidade de suspender temporariamente as próprias necessidades em função do outro; 4) Sensibilidade Afetiva: sentimento de compaixão e de preocupação com o outro. Os resultados mostraram que o grupo avaliado obteve médias semelhantes às apresentadas nos dados normativos do I.E. nos fatores Tomada de Perspectiva e Flexibilidade Interpessoal, enquanto superou a média no fator Altruísmo e ficou abaixo da média no fator Sensibilidade Afetiva. Esses dados indicam que a amostra de médicos avaliada possui uma capacidade mais acentuada de sacrificar suas próprias necessidades para atender ao outro, ainda que não associada necessariamente a um sentimento de compaixão equivalente. Isto pode estar relacionado com a reduzida importância dada ao aspecto emocional na formação médica. Em relação à avaliação da empatia por contexto de atenção em saúde, não foi encontrada diferença significativa entre os grupos com exceção do fator Tomada de Perspectiva. Neste componente, os médicos do Programa Saúde da Família destacaram-se significativamente do grupo de Atenção Secundária, o que parece estar relacionado com a proximidade do profissional com o contexto de vida do paciente e com a educação continuada que recebem através de treinamentos e capacitações onde são valorizadas as habilidades de comunicação desses profissionais. A partir desses resultados propõe-se que o desenvolvimento da empatia seja incluído nos cursos de formação médica e no planejamento das condições de trabalho nos diversos níveis de atenção à saúde.

Laços e nós: A comunicação na relação médico- paciente com câncer e dor crônica

É alta a prevalência de dor crônica em pacientes com câncer, que é comprovadamente associada ao sofrimento psicológico acentuado e muitas vezes não é adequadamente diagnosticada e tratada. Estudo que realizamos com 120 pacientes adultos em atendimento ambulatorial na Clínica de Dor do Instituto Nacional de Câncer, no Rio de Janeiro que demonstrou que os pacientes mesmo conhecendo o seu diagnóstico de câncer, não se sentiam informados sobre a doença e a dor oncológica a contento, o que trazia insatisfação com o tratamento recebido e maior exigência com os resultados do mesmo. Nosso estudo revelou, ainda, que o comportamento do profissional durante o atendimento pode ser percebido pelos pacientes como fator tanto de melhora como de piora da dor, sendo o comportamento atencioso do profissional muitas vezes mais valorizado pelos pacientes que a supressão da dor. Estes resultados suscitaram questões relativas à qualidade da interação entre médicos e pacientes, desenvolvidas nesta dissertação. Embora não sejam suficientemente investidas nem na relação médico-paciente, nem na educação e no treinamento profissional, as habilidades de comunicação do médico afetam diretamente o nível de informação e de satisfação do paciente, suas crenças e os resultados do tratamento. Ao longo do tempo a relação médico paciente vem mudando, deixando de ser tão centrada na doença e no médico, para centrar-se mais no doente como um ser integral, o que implica no reconhecimento, pelo médico, de saberes diferentes dos seus e de que o seu saber não constitui uma verdade absoluta a ser acatada pelos demais. Apesar de bem-vindas, estas mudanças trazem uma certa confusão nos papéis a serem desempenhados por médicos e pacientes e dificuldades aos médicos de lidarem com as diferenças, com as queixas subjetivas dos pacientes, com as emoções destes e as suas próprias. Se hoje é esperado que os pacientes sejam participativos, corresponsáveis por seus tratamentos e recuperação e que se deem conta do poder que eles têm, individual e coletivamente, espera-se que os médicos sejam estudiosos, bem informados, experientes, sinceros, empáticos, sensíveis, atenciosos, compassivos, perspicazes, bem treinados, hábeis em compartilhar informações e decisões com os pacientes, compreendendo o que estes querem e o que não querem e ajudando-os a expressar suas crenças, preferências e receios, disponibilizando tempo suficiente para isso. Tantas expectativas terminam por trazer conflitos que só poderão ser resolvidos com a melhoria da comunicação entre médicos e pacientes, num esforço de ambas as partes.

A comunicação na prática homeopática: como a racionalidade homeopática se expressa na comunicação entre médico e paciente?

No atual contexto da prática médica no Brasil, observa-se o predomínio de uma comunicação de caráter informativo, normativo e com pouca ênfase na promoção da autonomia dos pacientes, secundarizando o diálogo e a compreensão do paciente sobre o processo saúde-doença-cuidado. Esse tipo de prática baseia-se fortemente no Modelo Biomédico, que enfoca prioritariamente a doença e as lesões orgânicas, o que em muitas situações colabora para a medicalização, a (super)especialização e fragmentação do cuidado, comprometendo a qualidade da relação médico-paciente e a resolutividade das ações de saúde. Em contrapartida, uma prática médica centrada no paciente e que valorize a compreensão de sua interpretação da saúde-doença favorece a construção da integralidade do cuidado e a maior efetividade das ações. A presente pesquisa exploratória, predominantemente qualitativa com componente quantitativo investiga as práticas comunicacionais na relação médico-paciente na consulta homeopática, pautada pelo paradigma Vitalista. Nessa especialidade médica oferecida desde 1988 pelo Sistema Único de Saúde, e desde 2006, integrante da Polícia Nacional de Práticas Integrativas e Complementares do Ministério da Saúde, compreender múltiplas dimensões da existência e adoecer humanos demanda competência narrativa para a prática de sua semiologia, baseada na escuta atenta e implicada dos contextos biopatográficos, valorizadora dos sentidos atribuídos às vivências pelos sujeitos. Foram gravadas oito consultas de primeira vez realizadas num ambulatório-escola por médicos experientes, transcritas e submetidas à Análise de Conteúdo, que permitiram analisar como os fundamentos da racionalidade homeopática podem contribuir para a produção compartilhada de sentidos. Os resultados estão organizados nas categorias: Tomada de Turnos e Controle de Tópicos, Concepção de Saúde-Doença-Cuidado, Itinerários Terapêuticos, Ethos científico e Ethos do Mundo da Vida, Capacidade empática (atitudes de apoio, legitimação e polidez) e O Papel do Médico. Observa-se que a comunicação que estabelecida nesse tipo de prática em saúde avança na construção da integralidade da atenção e pode contribuir para a maior resolutividade do cuidado em saúde na medida em que minimiza a dicotomia entre mental e somático, individual e social.

Broadening public input into science policy decision making: can the democratic model for science communication influence scientific, innovation and technological trajectories?

This PhD thesis investigates the potential use of science communication models to engage a broader swathe of actors in decision making in relation to scientific and technological innovation in order to address possible democratic deficits in science and technology policy-making. A four-pronged research approach has been employed to examine different representations of the public(s) and different modes of engagement. The first case study investigates whether patient-groups could represent an alternative needs-driven approach to biomedical and health sciences R & D. This is followed by enquiry into the potential for Science Shops to represent a bottom-up approach to promote research and development of local relevance. The barriers and opportunities for the involvement of scientific researchers in science communication are next investigated via a national survey which is comparable to a similar survey conducted in the UK. The final case study investigates to what extent opposition or support regarding nanotechnology (as an emerging technology) is reflected amongst the YouTube user community and the findings are considered in the context of how support or opposition to new or emerging technologies can be addressed using conflict resolution based approaches to manage potential conflict trajectories. The research indicates that the majority of communication exercises of relevance to science policy and planning take the form of a one-way flow of information with little or no facility for public feedback. This thesis proposes that a more bottom-up approach to research and technology would help broaden acceptability and accountability for decisions made relating to new or existing technological trajectories. This approach could be better integrated with and complementary to government, institutional, e.g. university, and research funding agencies activities and help ensure that public needs and issues are better addressed directly by the research community. Such approaches could also facilitate empowerment of societal stakeholders regarding scientific literacy and agenda-setting. One-way information relays could be adapted to facilitate feedback from representative groups e.g. Non-governmental organisations or Civil Society Organisations (such as patient groups) in order to enhance the functioning and socio-economic relevance of knowledge-based societies to the betterment of human livelihoods.

Can metaphors and analogies improve communication with seriously ill patients?

OBJECTIVE: It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated with better patient ratings of their physicians' communication skills. DESIGN: Cross-sectional observational study of audio-recorded conversations between patients and physicians. SETTING: Three outpatient oncology practices. PATIENTS: Ninety-four patients with advanced cancer and 52 physicians. INTERVENTION: None. MAIN OUTCOME MEASURES: Conversations were reviewed and coded for the presence of metaphors and analogies. Patients also completed a 6-item rating of their physician's ability to communicate. RESULTS: In a sample of 101 conversations, coders identified 193 metaphors and 75 analogies. Metaphors appeared in approximately twice as many conversations as analogies did (65/101, 64% versus 31/101, 31%; sign test p < 0.001). Conversations also contained more metaphors than analogies (mean 1.6, range 0-11 versus mean 0.6, range 0-5; sign rank test p < 0.001). Physicians who used more metaphors elicited better patient ratings of communication (rho = 0.27; p = 0.006), as did physicians who used more analogies (Spearman rho = 0.34; p < 0.001). CONCLUSIONS: The use of metaphors and analogies may enhance physicians' ability to communicate.

Risk communication in clinical trials: a cognitive experiment and a survey.

BACKGROUND: A Royal Statistical Society Working Party recently recommended that "Greater use should be made of numerical, as opposed to verbal, descriptions of risk" in first-in-man clinical trials. This echoed the view of many clinicians and psychologists about risk communication. As the clinical trial industry expands rapidly across the globe, it is important to understand risk communication in Asian countries. METHODS: We conducted a cognitive experiment about participation in a hypothetical clinical trial of a pain relief medication and a survey in cancer and arthritis patients in Singapore. In part 1 of the experiment, the patients received information about the risk of side effects in one of three formats (frequency, percentage and verbal descriptor) and in one of two sequences (from least to most severe and from most to least severe), and were asked about their willingness to participate. In part 2, the patients received information about the risk in all three formats, in the same sequence, and were again asked about their willingness to participate. A survey of preference for risk presentation methods and usage of verbal descriptors immediately followed. RESULTS: Willingness to participate and the likelihood of changing one's decision were not affected by the risk presentation methods. Most patients indicated a preference for the frequency format, but patients with primary school or no formal education were indifferent. While the patients used the verbal descriptors "very common", "common" and "very rare" in ways similar to the European Commission's Guidelines, their usage of the descriptors "uncommon" and "rare" was substantially different from the EU's. CONCLUSION: In this sample of Asian cancer and arthritis patients, risk presentation format had no impact on willingness to participate in a clinical trial. However, there is a clear preference for the frequency format. The lay use of verbal descriptors was substantially different from the EU's.

Patient beliefs and behaviors about genomic risk for type 2 diabetes: Implications for prevention

Copyright © Taylor & Francis Group, LLC 2015.Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing type 2 diabetes risk for many patients; however, to date, there is little evidence that genetic testing positively affects type 2 diabetes prevention. Genetic information may not fit patients illness representations, which may reduce the chances of risk-reducing behavior changes. The present study aimed to examine illness representations in a clinical sample who are at risk for type 2 diabetes and interested in genetic testing. The authors used the Common Sense Model to analyze survey responses of 409 patients with type 2 diabetes risk factors. Patients were interested in genetic testing for type 2 diabetes risk and believed in its importance. Most patients believed that genetic factors are important to developing type 2 diabetes (67%), that diet and exercise are effective in preventing type 2 diabetes (95%), and that lifestyle changes are more effective than drugs (86%). Belief in genetic causality was not related to poorer self-reported health behaviors. These results suggest that patients interest in genetic testing for type 2 diabetes might produce a teachable moment that clinicians can use to counsel behavior change.