Predictors of physicians’ satisfaction with their management of uncertainty during a decision-making encounter with a simulated advanced stage cancer patient

Libert, Yves; Canivet, Delphine; Ménard, Catherine; Achte, Laetitia Van; Farvacques, Christine; Merckaert, Isabelle; Liénard, Aurore; Klastersky, Jean; Reynaert, Christine; Slachmuylder, Jean-Louis; Durieux, Jean‐François; Delvaux, Nicole; Razavi, Darius

doi:10.1016/j.pec.2016.01.008

Cited by 20 publications

(24 citation statements)

References 30 publications

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“…Such partnerships, however, are difficult to achieve: medical encounters related to MUPS are associated with conflicts between patients and doctors who struggle to cooperate with each other (Dowrick et al, 2008; Lian & Nettleton, 2015; Libert et al, 2016). For doctors who are trained to work on the basis of evidence-based biomedical knowledge and technological proof, somatic symptoms unsubstantiated by observable biomarkers to verify organic disease are challenging.…”

Section: Introductionmentioning

confidence: 99%

“…For doctors who are trained to work on the basis of evidence-based biomedical knowledge and technological proof, somatic symptoms unsubstantiated by observable biomarkers to verify organic disease are challenging. When their ability to identify, explain and treat patients’ ailments is constrained by an uncertain biomedical foundation, they often feel powerless, inadequate, dissatisfied, frustrated and anxious (Åsbring & Närvänen, 2003; Chew-Graham, Cahill, Dowrick, Wearden, & Peters, 2008; Chew-Graham, Dowrick, Wearden, Richardson, & Peters, 2010; Howman, Walters, Rosenthal, Ajjawi, & Buszewicz, 2016; Libert et al, 2016; Murray, Toussaint, Althaus, & Löwe, 2016). For patients, experiences of uncertainty can increase psychological distress, intensify sensitivity to pain (Rosendal et al, 2013; Taylor, Marshall, Mann, & Goldberg, 2012; Weiland et al, 2012; Wright, Afari, & Zautra, 2009), and result in poorer health (Neville, 2003), reduced quality of life and diminished confidence (Ogden et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

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“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

Lian

Robson

2017

International Journal of Qualitative Studies on Health and Well

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Purpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

Lian

Robson

2017

International Journal of Qualitative Studies on Health and Well

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“…[ 9 10 11 ] Resulting in more medical errors decreased patient satisfaction, ultimately putting patients at risk. [ 12 13 14 15 ]…”

Section: Introductionmentioning

confidence: 99%

Professional satisfaction of family physicians working in primary healthcare centers: A comparison of two Saudi regions

Bawakid¹,

Rashid²,

Mandoura³

et al. 2018

J Family Med Prim Care

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“…The simulated patient will be played by an actress experienced in simulated patient encounters and will be trained to maintain a standardized script and behavior. Regular feedback sessions will be held to help the actress maintain reproducibility [50]. The simulated patient encounters will take place at the Communication Laboratory (LabComm) of the Centre de Psycho-Oncologie (Brussels, Belgium).…”

Section: Methodsmentioning

confidence: 99%

Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients

et al. 2017

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BackgroundAlthough previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients.Methods/designPhysician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects.DiscussionThe current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients.Trial registrationUS Clinical Trials Register NCT02836197.

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Predictors of physicians’ satisfaction with their management of uncertainty during a decision-making encounter with a simulated advanced stage cancer patient

Cited by 20 publications

References 30 publications

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

Professional satisfaction of family physicians working in primary healthcare centers: A comparison of two Saudi regions

Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients

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