Top tips to deal with challenging situations: doctor–patient interactions

Hardavella, Georgia; Aamli-Gaagnat, Ane; Frille, Armin; Saad, Neil J.; Niculescu, Alexandra; Powell, Pippa

doi:10.1183/20734735.006616

Cited by 70 publications

(45 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[40] Many patients are unsure about their role in the encounter and the appropriateness of their participation. [90] For patients with some clinical phenotypes, we have limited ability to predict treatment success based on whether research was conducted with patients of similar clinical phenotypes. [91] Quantitative: [34] • Telephone survey of a random sample of residents…”

Section: Resultsmentioning

confidence: 99%

A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

Woodward

Singh

Ndebele-Ngwenya

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Due to striking disparities in implementation of healthcare innovations, it is imperative researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of health care. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal context (including but not limited to social determinants of health). This framework was developed for health care and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance.Methods: We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework.Results: We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures.Conclusion: Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.

show abstract

Section: Resultsmentioning

confidence: 99%

A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

Woodward

Singh

Ndebele-Ngwenya

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…(48) Speci cally, approaches such as active listening, observation of non-verbal communication, choosing words that may not be perceived negatively, breaking down information into small pieces and offering another meeting at an agreed time may help families understand the situation of major stroke with poor prognosis better and help them cope with their emotions. (48,49) Doctors should also consider how to balance the communication of hope with that of realism (50). This can be complex.…”

Section: Summary Of Key Resultsmentioning

confidence: 99%

The considerations, experiences and support needs of family members making treatment decisions for patients admitted with major stroke: a qualitative study.

Visvanathan

Mead

Dennis

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Treatment decision-making by family members on behalf of patients with major stroke can be challenging because of the shock of the diagnosis and lack of knowledge of the patient’s treatment preferences. We aimed to understand how, and why, family members made certain treatment decisions, and explored their information and support needs. Method Semi-structured interviews with family members (n=24) of patients with major stroke, within two weeks of hospital admission. Data were analysed thematically. Results Families’ approach to treatment decision-making lay on a spectrum according to the patient’s state of health pre-stroke (i.e. patient’s prior experience of illness and functional status) and any views expressed about treatment preferences in the event of life-threatening illness. Support and information needs varied according to where they were on this spectrum. At one extreme, family members described deciding not to initiate life-extending treatments from the outset because of the patients’ deteriorating health and preferences expressed pre-stroke. Information from doctors about poor prognosis was merely used to confirm this decision. In the middle of the spectrum were family members of patients who had been moderately independent pre-stroke. They described the initial shock of the diagnosis and how they had initially wanted all treatments to continue. However, once they overcame their shock, and had gathered relevant information, including information about poor prognosis from doctors, they decided that life-extending treatments were no longer appropriate. Many reported this process to be upsetting and expressed a need for psychological support. At the other end of the spectrum were family members of previously independent patients whose preferences pre-stroke had not been known. Family members described feeling extremely distressed at such an unexpected situation and wanting all treatments to continue. They described needing psychological support and hope that the patient would survive. Conclusion The knowledge that family members’ treatment decision-making approaches lay on a spectrum depending on the patient’s state of health and stated preferences pre-stroke may allow doctors to better prepare for discussions regarding the patient’s prognosis. This may enable doctors to provide information and support that is tailored towards family members’ needs.

show abstract

“…[43] Many patients are unsure about their role in the encounter and the appropriateness of their participation. [88] We have limited ability to predict treatment success based on whether research was conducted with patients of similar clinical phenotype. [89] Quantitative: [37] • Telephone survey of a random sample of residents…”

Section: Health Equity Implementation Frameworkmentioning

confidence: 99%

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

Woodward

Singh

Ndebele-Ngwenya

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Due to limited systematic integration of health equity and implementation science, it is imperative to provide researchers and practitioners tools to guide implementation in settings where there is inequitable implementation of an intervention. Our prior work documented and piloted the first published adaptation of an existing implementation science framework with health equity determinants to create the Health Equity Implementation Framework. We suggested how others’ might adapt their preferred implementation science frameworks with three health equity domains: 1) cultural factors of recipients, 2) clinical encounter, or patient-provider interaction, and 3) societal influences (including but not limited to social determinants of health). This manuscript is a practical guide to utilize three health equity domains in implementation research and practice.Methods: We describe in greater depth than in our previous publication domains typical in implementation determinants frameworks and three adaptations: domains known to affect health equity. For each domain, we compiled definitions with supporting literature, defined relevant subdomains, showcased an illustrative example, and suggested sample measures, both quantitative and qualitative.Results: We describe how to incorporate the three health equity domains in one’s preferred implementation science framework, or how to use the Health Equity Implementation Framework specifically. Practical guidelines follow ten published recommendations on how to use frameworks in implementation research and practice. We describe a new case study in which the framework guided evaluation.Conclusions: Incorporating health equity domains within implementation frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally, addressing, implementation and equity barriers simultaneously. The practical guidance and tools provided can assist implementation scientists and practitioners to concretely address inequity in implementation across populations to capture and analyze information used to assess health outcomes.Contributions to the LiteratureSpecific definitions of implementation and three health equity domains with examples of how they have been applied in published literature and sample measures.Practical tools, including a qualitative interview guide and codebookCase study of how the Health Equity Implementation Framework guided analysis in an implementation study

show abstract

Top tips to deal with challenging situations: doctor–patient interactions

Cited by 70 publications

References 5 publications

A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

A More Practical Guide to Incorporating Health Equity Domains in Implementation Determinant Frameworks

The considerations, experiences and support needs of family members making treatment decisions for patients admitted with major stroke: a qualitative study.

A Practical Guide to Incorporating Health Equity Domains in Implementation Frameworks

Contact Info

Product

Resources

About