Online Health Communities (OHCs) contributes to patient access to health information and doctor-patient communication. However, how patient engagement types influence doctor service provision in OHCs remains unclear.

With the PACE system, this study employs content analysis and clustering methods to examine the relationship between patient engagement types and doctor service provision. A qualitative study utilizing discourse analysis of online doctor-patient communication was conducted. A total of 300 consultation records from the Chinese OHC, Ding Xiang Doctor (DXY), were collected between August 1 and October 31, 2023.

The study identifies four patient engagement types, including emotional disclosure, decision-making engagement, consumption-oriented, and doctor-driven types. Discourse analysis reveals that doctors adjust their communication strategies according to patient engagement types, prioritizing service provision and communication tasks differently. Specifically, doctors turn to 1) respond with more empathy to emotional disclosure patients, providing more comforting words; 2) discuss more with decision-making engagement patients on treatment plan and provide more medical explanations; 3) focus more on information provision by answering patient inquiries with less interaction with consumption-oriented patients; and 4) demonstrate more authority with higher frequency of use of closed questions, outlining possible conditions and providing concise diagnostic advice with doctor-driven patients.

This study explores the impact of patient engagement in OHCs on doctor service provision. It reveals that doctors adapt their communication approaches based on the patient engagement types.

The results indicate that doctors adjust their service provision based on patient engagement online, emphasizing the importance role of patients in self-report health conditions and concerns. Patients are encouraged to adopt proactive engagement to facilitate the effective online doctor- patient communication, and ultimately improve the quality of online health consultations. In addition, the doctors are expected to be more patient in OHCs compared to offline, and help patients to align their online engagement types accordingly.

The life experience of patients with advanced cancer and limited life expectancy is unique and profoundly complex, often leading to moral discrepancies among the various individuals involved in decision making. There are no data in the literature on the prevalence of ethical issues in the end-of-life care of patients with advanced cancer.

The primary objective of this study is to identify the overall and specific prevalence of ethical issues in the end-of-life care process for patients with advanced cancer.

We performed a secondary analysis using pooled data from the prospective development and validation cohorts of the PALCOM scale, focusing on the complexity of palliative care needs. This was performed to determine the overall and specific prevalence of ethical issues, describe their evolution over a 6-month follow-up period, and analyze their association with the level of palliative care complexity.

A total of 607 patients with advanced cancer and a life expectancy of 6 months or less were included. The consistency in clinical data and the frequencies of the PALCOM scale domains between the development and validation cohorts, conducted in various settings and times, confirmed the reliability of the pooled data sample. Systematic application of the PALCOM scale identified 126 patients (20.7%) who experienced at least one ethical issue. A total of 204 ethical issues (1.6 per patient) were recorded, related to the following: the proportionality of healthcare intervention (15.6%); information (13.0%); research (2.9%); the desire to hasten death (1.8%); and palliative sedation (0.15%). The monthly probability of presenting an ethical issue was significantly higher at the baseline visit (24.0%) compared to the rest of the 6-month follow-up period (14-17%) (p < 0.001). The prevalence of ethical issues was notably higher in patients with greater palliative care complexity as measured by the PALCOM scale: 4.5% in low complexity, 19.5% in medium complexity, and 30.8% in high complexity (p < 0.001).

The prevalence of ethical issues in patients with advanced cancer is high. Most of these issues are directly or indirectly related to the preservation of patient autonomy in the decision-making process. The presence of ethical issues is significantly associated with the greater complexity of palliative care needs. In this context, it is crucial for healthcare professionals to strengthen both communication skills and basic competencies to effectively identify, assess, and manage these ethical issues.

The ASCO Language of Respect (LOR) Guidelines were developed in 2020 to promote patient-respectful language in abstracts and presentations. We assessed adherence to LOR guidelines among renal cell carcinoma (RCC) abstracts presented at the 2023 and 2019 ASCO Annual Meetings.

We systematically evaluated each statement in all RCC abstracts for compliance with the three clauses of LOR guidelines: "Do not blame patients," "Respect the role of patients," and "Do not dehumanize patients." Univariable and multivariable analyses were performed to identify factors associated with noncompliance.

Among 101 abstracts from 2023, the majority involved clinical research (66.3%) and had a character count at limit, defined as within 5% of the 2,600-character limit (51.5%). In 60.4% of abstracts, at least one statement violated the LOR guidelines. Proportions of abstracts with one or more statements with dehumanizing, blaming, or disrespectful language were 46.5%, 21.8%, and 1.0%, respectively. Among all variables examined, including research and author characteristics, abstracts at character limit emerged as the only category with significantly higher rates of noncompliance (62.3% v 35.0%, P = .013). Multivariable analyses showed an odds ratio of 3.3 (95% CI, 1.4 to 7.6, P = .006) for abstracts at character limit to have at least one noncompliant statement. Notably, even among abstracts not at character limit, 46.9% contained statements violating the guidelines. Between 2019 and 2023, the rate of statements that violated the LOR guidelines decreased from 71.0% to 60.4%.

A significant proportion of RCC abstracts contain language inconsistent with LOR guidelines. Although character limit is a likely contributor, our report highlights the need for our professional societies and abstract reviewers to cultivate greater awareness and adherence to patient-respectful language.

Health and health care disparities confronting sexual minority (i.e. non-heterosexual identified) adults are well-documented. Meanwhile, patient-centered communication (PCC) is shown to be effective for health care delivery and health promotion among sexual minority individuals. However, there remains a dearth of research that links PCC and sexual minority adults' mental health. This study examines the relationship between PCC and mental health among sexual minority adults by focusing on the mediating role of health self-efficacy and the moderating role of eHealth. Data from all non-heterosexual identified respondents (N = 350; mean age = 56.23 years; 65.7% female) of the Health Information National Trends Survey collected in 2017 (HINTS 5 Cycle 1) were analyzed. Results indicate that after controlling for respondents' age, gender, and education, health self-efficacy mediated the relationship between PCC and mental health. Meanwhile, the mediating effect of health self-efficacy was moderated by eHealth. Findings from this study provide a more precise understanding of the mechanism that underlies the relationship between PCC and sexual minority adults' mental health as well as inform the development of interventions to address their health care disparities.

Effective communication between doctors and patients is crucial for the well-being of individuals diagnosed with cancer. This study aimed to develop and validate a cancer-specific Doctor-Patient Communication Satisfaction Scale (DPCSS-Cancer) from the patients' perspective.

Initial items were generated through literature review. Content validity was assessed via feedback from five experts, while face validity was determined through cognitive interviews with 13 patients. The revised DPCSS-Cancer was subsequently tested in a sample of 200 cancer patients to assess test-retest stability, internal consistency, factor structure, and criterion-related validity.

The development process resulted in a 15-item DPCSS-Cancer across two dimensions, using a 4-point rating scale (1 = strongly disagree to 4 = strongly agree). The item-level Content Validity Index (I-CVI) ranged from 0.8 to 1.0, with a scale-level CVI of 0.96. Following expert and patient feedback, no items were eliminated, but modifications were made to item wording. In formal testing, the overall Cronbach's alpha was 0.96, with 0.89 for the first dimension and 0.95 for the second. Test-retest reliability was established at 0.82. The two-dimensional structure was partially confirmed. Criterion-related validity was supported through a significant positive correlation with a measure of trust in the physician (r = 0.86). Factors contributing to higher DPCSS-Cancer scores were identified.

The DPCSS-Cancer shows satisfactory reliability and validity, making it a viable patient-reported outcome measure for assessing cancer patients' satisfaction with doctor-patient communication.

Patient-centered communication is widely acknowledged as an essential element of high-quality healthcare. Our study attempted to explore the weaknesses in the actual doctor-patient communication process and the most critical elements in patient-centered communication to improve the service quality of e-consult. We recruited ten standardized patients presenting fixed cases (urticaria and childhood diarrhea) for 321 valid interactions to measure patient-centered communication and e-consult service quality. The scores of patient-centered communication included exploring the patient's disease experience, understanding the patient's social situation, and reaching a consensus between doctors and patients. We measured the quality of e-consult services by the total words of doctor's responses, accurate diagnosis, appropriate prescription, lifestyle modification advice, patient satisfaction, continuance intention, and cost. Ordinary least-squares and logistic regression were performed to investigate the association between patient-centered communication and e-consult service quality. The total mean score of patient-centered communication was 17.67. The mean words of responses and cost were 178.55 words and 39.46 yuan, respectively. 82.87% of doctors diagnosed accurately, with 21.81% prescribing appropriate prescriptions and 81.93% providing lifestyle modification advice. 254 interactions obtained high satisfaction, and 218 had continuance intention after the interactions. Doctors with higher patient-centered communication levels would provide more words of responses. They were more likely to provide accurate diagnoses, appropriate prescriptions, and lifestyle modification advice, resulting in better patient satisfaction, continuance intention, and higher costs. Therefore, it is necessary to standardize and improve the doctor-patient communication process of e-consult and develop training for different doctors.

While telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations.

We included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities.

Our cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5-14.9; p < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4-1.0; p < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6-1.3; p < 0.001) per 100 index encounters compared to in-person visits.

Contrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.

Although it is clear that people experience physiological arousal in anticipation of news-focused medical consultations, our knowledge of people's experiences during and throughout these consultations is scarce. We examine interbeat interval responses (IBI) of patients and doctors during real-life medical consultations to understand how the experiences of both parties change throughout these encounters and whether they differ from each other. We also examine how the type of news delivered affects responses. We measured the IBI responses of patients and their oncologists throughout 102 consultations in which providers delivered news (classified as good, bad, or status quo) to patients about a recent computerized tomography scan. We observed two distinct phases of consultations: an initial "news" delivery phase and a subsequent "information" phase. During the news phase, on average, patients' IBI responses rapidly increased-indicating less autonomic arousal over time - whereas doctors' responses did not change over time. In contrast, throughout the information phase, on average, both patients' and doctors' responses remained steady. During the information phase, responses differed based on news type: on average, status quo consultations involved an increase in autonomic arousal, whereas good and bad news consultations involved no changes. Lastly, we observed significant variability in patients' responses during both phases. In sum, on average, patients (but not doctors) experience decreases in autonomic arousal while news is being delivered, suggesting that anticipatory distress regarding these consultations wanes quickly. However, our results also indicate that patients' experiences vary from one another, and future research should focus on factors explaining this variability.

This study aims to explore the place of the relative in these triadic consultations and how this influences communication.

A mixed-methods research strategy was used. Triadic consultations for the announcement of cancer progression were recorded and following the 3 participants completed questionnaires comprising mirror-items. Recordings and answers were further investigated in a few semi-structured interviews. Comparison of quantitative responses (questionnaires) used Wilcoxon's test for matched series. Qualitative analyses (consultations, interviews) used grounded theory. Patients were over 18, followed for cancer in palliative phase, excluding brain tumors and malignant hemopathies, and presented renewed disease progression. Relatives were over 18 and authorized by the patient to participate.

47 consultations (audio-recordings, answers to questionnaires) and 12 interviews conducted separately with 4 triads were collected. Half the relatives, while remaining in the background, nevertheless contributed to the discussion. For patients, the presence of a relative was considered beneficial and for oncologists it facilitated the announcement. However, symptoms perceived as intimate or private appeared difficult to express for some patients, and for relatives, prognosis was a difficult subject to broach. Although their relationship with time and their expectations may differ, patients and relatives found consultations positive. Oncologists appeared to underestimate the patient's level of understanding (P<0.001) and perceptions of the seriousness of the disease (P=0.009) but not those of relatives. They did not evaluate the relative's state of health and check what the dyad had retained.

Training via simulation sessions should be adapted to communication involving relatives.

In the span of a decade, smartphones have gained popularity and acceptance among both patients and physicians thanks to their advantages in health care delivery. However, research investigating mobile patient-provider communication (MPPC) and its impact on patients' lifestyles is only just beginning. Drawing on the pathway model of health communication and mobile technology (MTI) theory, we developed a research model to explore the effect of MPPC on lifestyle improvement, using health empowerment as a mediator and MTI as a moderator. The findings from 432 participants (Mage = 32.5 years old, female = 212) suggested that after controlling for respondents' age, gender, education, income, and general health status, having greater communication with healthcare providers through mobile devices was positively related to lifestyle improvement and that health empowerment mediated this relationship. Moreover, MTI-emotional energy (MTIE) moderated the direct relationship between MPPC and lifestyle improvement, while MTI-dependency (MTID) moderated the indirect impact of MPPC. Individuals who hold a greater MTIE/MTID were more likely to benefit from MPPC such that they are more likely to be empowered for self-care and maintain healthy lifestyles. This study not only contributes to the growing literature on mobile health communication but also plays a reference role for interventions in patient empowerment and health promotion. Theoretical and practical implications were discussed.

Physician-Patient communication (PPC) has been linked to patient adjustment outcomes. However, conflicting results have been reported and previous systematic reviews showed some methodological weaknesses. It has also been suggested that PPC is related to physicians' own adjustment outcomes. This systematic review aims to explore and synthesize the associations between PPC and both patient and physician adjustment outcomes. A systematic search was conducted primarily in five databases and 11.488 non-duplicated articles were identified. Forty-five studies met the eligibility criteria and data extraction was performed for sample characteristics, PPC measurement, adjustment outcomes under examination and main outcomes. The observed results showed that the majority of the included studies were cross-sectional, assessed PPC by proxy-report and reported an overall positive association with patients' adjustment outcomes. None of the studies examined the association between PPC and physicians' adjustment outcomes. Thirty-three studies were meta-analyzed and showed a positive and significant association between PPC and patients' adjustment outcomes (r = .16). Due to the small number of studies included in the meta-analysis, the heterogeneity was high. Subgroup analysis could not identify sources for heterogeneity. Research on the associations between PPC and physicians' own adjustment outcomes is warranted. Future studies should be rigorous in defining clear PPC definitions, directionality of communication processes, and study design.

The quality of communication in oncology significantly impacts patients' health outcomes, as poor communication increases the risk of unnecessary treatment, inadequate pain relief, higher anxiety levels, and acute hospitalizations. Additionally, ineffective communication skills training (CST) is associated with stress, low job satisfaction, and burnout among doctors working in oncology. While acknowledging the importance of effective communication, the specific features of successful CST remain uncertain. Role-play and recorded consultations with direct feedback appear promising for CST but may be time-consuming and face challenges in transferring acquired skills to clinical contexts. Our aim is to bridge this gap by proposing a novel approach: On-site Supportive Communication Training (On-site SCT). The concept integrates knowledge from previous studies but represents the first randomized controlled trial employing actual doctor-patient interactions during CST.

This randomized multicenter trial is conducted at three departments of oncology in Denmark. Doctors are randomized 1:1 to the intervention and control groups. The intervention group involves participation in three full days of On-site SCT facilitated by a trained psychologist. On-site SCT focuses on imparting communication techniques, establishing a reflective learning environment, and offering emotional support with a compassionate mindset. The primary endpoint is the change in percentage of items rated "excellent" by the patients in the validated 15-item questionnaire Communication Assessment Tool. The secondary endpoints are changes in doctors' ratings of self-efficacy in health communication, burnout, and job satisfaction measured by validated questionnaires. Qualitative interviews will be conducted with the doctors after the intervention to evaluate its relevance, feasibility, and working mechanisms. Doctors have been actively recruited during summer/autumn 2023. Baseline questionnaires from patients have been collected. Recruitment of new patients for evaluation questionnaires is scheduled for Q1-Q2 2024.

This trial aims to quantify On-site SCT efficacy. If it significantly impacts patients/doctors, it can be a scalable CST concept for clinical practice. Additionally, qualitative interviews will reveal doctors' insight into the most comprehensible curriculum parts.

April 2023 - ClinicalTrials.gov (NCT05842083). April 2023 - The Research Ethics Committee at the University of Southern Denmark (23/19397).

Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided.

This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology.

This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors.

We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use).

Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.

Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.

This article explores healthcare professionals' experiences of their work with patient communication in standardised cancer patient pathways (CPPs). The theoretical and methodological framework for this study is institutional ethnography. Data were collected through semi-structured interviews with 72 healthcare professionals, including general practitioners, specialist physicians and other hospital staff, in five Norwegian hospitals. The study reveals four aspects of communication work that illuminate how the CPP policy mediates the way healthcare professionals interact with patients through communicating continuity, communicating (by dodging) the dreaded C-word, communicating patient participation, and communicating the relevance of time. Healthcare professionals' balancing of their different experiential realities run as a common thread through the four aspects of communication work identified in this study. The CPP policy, with its explicit focus on transparency, speed, and time frames creates challenges in an already delicate situation.

Lack of adequate knowledge about the disease is one of the key factors that misguide cancer patients and patients' caregivers in choosing a better management plan. The purpose of the study was to assess the patients' and caregivers' knowledge about the disease status and estimated treatment cost. Understanding of disease may improve adherence to treatment plans and quality of care.

It was a cross-sectional study where 120 cancer patients were selected based on convenience sampling and the availability of record files and relevant data. The site, stage and prognosis of disease recorded from patients and caregivers were compared with the record of outpatient department and inpatient files with the help of the Fisher's exact test. The patients' knowledge about their financial estimates was also recorded. Three patients were selected for in-depth interviews based on purposive sampling to further support the findings.

Among 120 analysed patients, 60.83% were female. Around two-thirds of male patients (69.2%) and male caregivers (62.2%) knew about the site but only one-third of female patients (30.8%) and female caregivers (37.8%) knew the same. The primary responsibility for managing financial issues was caregivers in 89.16%. Only 7.5% knew the estimated cost. Nepali as the primary language and better education level is correlated with knowledge of disease status, among both patients and caregivers but was statistically significant only in knowing prognosis among native Nepali speaker caregivers (p < 0.001), and better-educated patients (p < 0.001). As per the in-depth interview, all three patients knew the site of their disease, but only the patient with breast cancer was aware of the stage of the disease. None of the patients were aware of their disease prognosis, treatment plan or the estimated cost of their treatment.

The level of understanding is low for most patients and their immediate caregivers, particularly among those who are female, not literate and whose primary language is not Nepali. Appropriate strategy should be adopted to enhance basic understanding among patients and caregivers in our setting.

To evaluate the association between physicians' behavior and cancer patients' perceived patient-centered care (PCC) and anxiety following medical encounters.

A prospective study design with 100 encounters, including 100 cancer patients and 22 oncology/surgery physicians, was performed between November 2019 and July 2021. Before the medical encounters, patients were asked to complete the validated State-Trait Anxiety Inventory (STAI), and physicians and patients completed sociodemographic and clinical data. During the medical encounters, structured 'real-time' observations of the physicians' behaviors were performed using the Four Habits Coding Scheme (4HCS). Following the medical encounters, patients were asked to re-complete the STAI and to fill the validated Perceived PCC questionnaire.

Mean 4HCS was positively associated with perceived PCC (β = 0.351, p < 0.001) and contributed 10.5% to the total 25.3% explained variance beyond the sociodemographic and clinical variables. Of the 4HCS sub scales, 'Demonstrate Empathy' displayed the lowest correlation with perceived PCC as compared to informational behaviors. In contrast, mean 4HCS was not associated with post-meeting anxiety (p > 0.05).

Our 'in-vivo' observations of medical encounters expands on previous studies in educational settings in showing how physicians' behaviors impact real patients' experience. The findings may provide a more accurate picture of physicians' supportive and unsupportive behaviors that impact on perceived PCC and anxiety. Patients may prefer their physicians to focus on the informational content related to their disease trajectory rather than focusing on empathy with their emotions. Physicians should be trained in ways to support patients on how to regain emotional control in stressful medical situations.

Patient-centered communication is a type of communication that takes place between the provider and the patient.

It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction.

The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye.

More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction.

Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.

Patient self-reported satisfaction is commonly used as an assessment of service experience and quality for community pharmacy services. This commentary discusses alternative foundational approaches to evaluating service experience and quality in patient-centered care. It describes historical and recent literature pertaining to the development and use of satisfaction measures for service design and patient experience assessment. It then highlights potential limitations of patient satisfaction as an assessment tool for patient-centeredness and patient experience identified in the pharmacy literature, which include criticisms that use of patient satisfaction may compromise accuracy in measuring quality due to factors such as patients having poor knowledge of and low expectations for quality and having a predisposition toward rating satisfaction highly when experiencing no-cost and/or unfamiliar services. Moreover, satisfaction measurements may change based on service exposure, with patient preferences for service offerings changing with increased service exposure and variation in patient-specific and environmental factors. After discussing limitations and criticism of patient self-reported satisfaction, we introduce alternative assessments methods which may facilitate more accurate assessments of patient experience and patient-centered pharmacy services such as patient-reported outcomes measures (PROMs), patient-reported experience measures (PREMs), and human-centered design techniques such as journey mapping, prototyping, and user testing to design and assess patient-centered pharmacy services. These alternative assessments are rooted in, or related to preferred implementation science approaches to establishing, evaluating, and sustaining pharmacy services.

To develop the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) and examine its validity and reliability.

A cross-sectional, web-based survey was conducted among cancer patients in Japan. The PSQ-J was developed following the forward-backward translation method, using a numerical rating scale. Data on patient characteristics and psychometric scales, like the PSQ-J, willingness to recommend an oncologist to others, trust in the healthcare system, uncertainty, and the Physician Compassion Questionnaire were collected. Validity was examined using exploratory and confirmatory factor analyses and by calculating the correlations between the total PSQ-J score and the criterion variables. Reliability was confirmed by Cronbach's alpha and test-retest score correlations at a two-week interval.

The first and second surveys were conducted on 309 and 107 patients, respectively. One-dimensionality and model fit were verified using factor analyses. The PSQ-J was significantly associated with other comparable scales. Cronbach's alpha was 0.962; the correlation between the PSQ-J test-retest scores was 0.835 (p < .001).

The current study indicates that the PSQ-J can be valid and reliable for assessing satisfaction with oncologist consultation.

The PSQ-J enables the effective assessment of patient satisfaction with oncologist consultations, leading to better practice reflecting the patient's viewpoint.

Children and adolescents with cancer may experience multiple disease- and treatment-related symptoms that negatively affect health-related quality of life. Routine symptom surveillance thus constitutes an important component of supportive care in pediatric oncology. The Symptom Monitoring and Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) system will administer, score, interpret, and display the results of symptom assessments captured weekly using patient-reported outcomes presented via the electronic health record (EHR) portal between clinic visits in oncology ambulatory settings, when patients are likely to be more symptomatic. This study is testing a digital system for routine symptom surveillance that includes EHR-based reports to clinicians and alerts for severe symptoms.

In this randomized trial, we are examining the effects of the SyMon-SAYS system on perceived barriers to symptom management, self-efficacy, and symptom severity. Better self-management and timely clinical intervention to address symptoms promote adherence to treatment plans, strengthen child and parent self-efficacy, improve interactions between children, parents, and their clinical providers, and optimize clinical outcomes.

The SyMon-SAYS system is integrated into the EHR to streamline the presentation of symptom scores and delivery of alerts for severe symptoms to clinicians using EHR (Epic) messaging functionalities. Children (aged 8 to 17 years) complete the weekly symptom assessment and review the symptom report by logging into the patient portal (Epic MyChart). This single-institution waitlist randomized controlled trial is recruiting 200 children (aged 8-17 years) with cancer and their parents, guardians, or caregivers. Participating dyads are randomly assigned to receive the intervention over 16 weeks (Group A: 16-week SyMon-SAYS intervention; Group B: 8-week usual care and then an 8-week SyMon-SAYS intervention). Analyses will (1) evaluate the efficacy of SyMon-SAYS at week 8 and the maintenance of those effects at week 16; (2) evaluate factors associated with those efficacy outcomes, including contextual factors, adherence to the SyMon-SAYS intervention, demographic characteristics, and clinical factors; and (3) evaluate predictors of adherence to the SyMon-SAYS intervention and preference of SyMon-SAYS versus usual care.

Data collection is currently in progress. We hypothesize that at 8 weeks, those receiving the SyMon-SAYS intervention will report decreased parent-perceived barriers to managing their children's symptoms, increased parent and child self-efficacy, decreased child symptom burden, and ultimately better child health-related quality of life, compared to waitlist controls. Feasibility, acceptability, and engagement from the perspectives of the children with cancer, their parents, and their clinicians will be examined using mixed methods.

We anticipate that this system will facilitate prompt identification of problematic symptoms. Additionally, we hypothesize that with the availability of graphical symptom reports over time, and timely provider responses, children or parents will become better informed and take an active role in managing their symptoms, which will further improve clinical outcomes.

ClinicalTrials.gov NCT04789720; https://clinicaltrials.gov/study/NCT04789720.

DERR1-10.2196/50993.

Patient use of verbal and nonverbal communication to signal what is most important to them can be considered empathetic opportunities. Orthopaedic surgeons may have mixed feelings toward empathetic opportunities, on one hand wanting the patient to know that they care, and on the other hand fearing offense, prolonged visit duration, or discussions for which they feel ill prepared. Evidence that action about empathetic opportunities does not harm the patient's experience or appreciably prolong the visit could increase the use of these communication tactics with potential for improved experience and outcomes of care.

Using transcripts from musculoskeletal specialty care visits in prior studies, we asked: (1) Are there factors, including clinician attentiveness to empathetic opportunities, associated with patient perception of clinician empathy? (2) Are there factors associated with the number of patient-initiated empathetic opportunities? (3) Are there factors associated with clinician acknowledgment of empathetic opportunities? (4) Are there factors associated with the frequency with which clinicians elicited empathetic opportunities?

This study was a retrospective, secondary analysis of transcripts from prior studies of audio and video recordings of patient visits with musculoskeletal specialists. Three trained observers identified empathetic opportunities in 80% (209 of 261) of transcripts of adult patient musculoskeletal specialty care visits, with any uncertainties or disagreements resolved by discussion and a final decision by the senior author. Patient statements considered consistent with empathetic opportunities included relation of emotion, expression of worries or concerns, description of loss of valued activities or loss of important roles or identities, relation of a troubling psychologic or social event, and elaboration on daily life. Clinician-initiated empathetic opportunities were considered clinician inquiries about these factors. Clinician acknowledgment of empathetic opportunities included encouragement, affirmation or reassurance, or supportive statements. Participants completed post-visit surveys of perceived clinician empathy, symptoms of depression, and health anxiety. Factors associated with perceived clinician empathy, number of empathetic opportunities, clinician responses to these opportunities, and the frequency with which clinicians elicited empathetic opportunities were sought in bivariate and multivariable analyses.

After controlling for potentially confounding variables such as working status and pain self-efficacy scores in the multivariable analysis, no factors were associated with patient perception of clinician empathy, including attentiveness to empathetic opportunities. Patient-initiated empathetic opportunities were modestly associated with longer visit duration (correlation coefficient 0.037 [95% confidence interval 0.023 to 0.050]; p < 0.001). Clinician acknowledgment of empathetic opportunities was modestly associated with longer visit duration (correlation coefficient 0.06 [95% CI 0.03 to 0.09]; p < 0.001). Clinician-initiated empathetic opportunities were modestly associated with younger patient age (correlation coefficient -0.025 [95% CI -0.037 to -0.014]; p < 0.001) and strongly associated with one specific interviewing clinician as well as other clinicians (correlation coefficient -1.3 [95% CI -2.2 to -0.42]; p = 0.004 and -0.53 [95% CI -0.95 to -0.12]; p = 0.01).

Musculoskeletal specialists can respond to empathic opportunities without harming efficiency, throughput, or patient experience.

Given the evidence that patients prioritize feeling heard and understood, and evidence that a trusting patient-clinician relationship is protective and healthful, the results of this study can motivate specialists to train and practice effective communication tactics.

In the Netherlands, patients with ovarian cancer are offered genetic testing. Pre-test preparation may help counseling patients. The aim of this study was to determine if use of a web-based intervention, leads to more effective genetic counseling of ovarian cancer patients.

Between 2016 and 2018, 127 ovarian cancer patients referred for genetic counseling in our hospital participated in this trial. 104 Patients were analyzed. All patients filled out questionnaires pre- and post-counseling. The intervention group also completed a questionnaire after visiting an online tool. Length of consultation, patients' satisfaction, knowledge, anxiety, depression and distress were compared before and after counselling.

The intervention group had the same level of knowledge compared to the counseling group, but at an earlier point in time. They were satisfied with the intervention (86%) and better prepared for counseling (66%). The intervention did not lead to shorter consultations. No differences in levels of anxiety, depression, distress and satisfaction were observed.

Although consultation length was unaffected, the improvements in knowledge after online education and patients satisfaction indicates that this tool can be an effective addition to genetic counseling.

Use of an educational tool may lead to a more effective, personalized way of genetic counselling and enables shared decision making.

With the rapid advances of digital technology, computer-mediated medical practices are becoming increasingly dominant in medical visits. However, the question of how to ensure effective, patient-centered communication in this transition remains crucial. In this mini-review, we explore this topic by reviewing quantitative and survey-based studies, as well as discursive-interactional studies that focus on the visit as a communicative event. The review is organized into four sections: the introductory section provides a brief synthesis of the two main models used in medical practice and describes the effects of patient-centered communication practices on patients' health and well-being. The second section presents and discusses qualitative and quantitative studies that assess the effect of technology on medical interaction and its impact on patient-centered communication. The third section focuses on whether and how the digital medical record represents a "potential communication risk" during doctor-patient interactions and explores how certain pen-and-paper literacy practices could help mitigate these challenges. In the concluding section, we outline and analyze three key considerations for utilizing technologies to foster and enhance patient-centered communication during medical visits.

To evaluate a newly developed blended learning programme for general practitioners (GPs) and nurses in supporting shared decision making (SDM) about palliative cancer treatment in a simulated setting.

In a pre-posttest study, healthcare professionals (HCPs) participated in the blended learning (i.e. e-learning and (online) training session). HCPs filled out surveys (T0 (baseline), T1 (after e-learning) and T2 (after full blended learning)) and engaged in simulated consultations at T0 and T2. The primary outcome was observed SDM support (Triple-S; DSAT-10 for validation). Secondary outcomes included satisfaction, knowledge about and attitude towards SDM support. Repeated measures General Linear Models were conducted.

33 HCPs (17 GPs and 16 nurses) participated. SDM support significantly improved after training (Triple-S; medium effect). Observers' overall rating of SDM support (medium effect) as well as HCPs' knowledge (large effect) and beliefs about their capabilities (medium effect) improved after training. There was no difference in decision support skills (DSAT-10), HCPs' other clinical behavioural intentions and satisfaction. HCPs evaluated the training positively.

Blended learning for HCPs on supporting SDM in palliative cancer care improved their skills, knowledge and confidence in simulated consultations.

These first findings are promising for evaluating interprofessional SDM in clinical practice.

Effective communication is crucial in cancer care due to the sensitive nature of the information and the psychosocial impact on patients and their families. Patient-centered communication (PCC) is the gold standard for providing quality cancer care, as it improves patient satisfaction, treatment adherence, clinical outcomes, and overall quality of life. However, doctor-patient communication can be complicated by ethnic, linguistic, and cultural differences. This study employed the ONCode coding system to investigate PCC practices in oncological visits (doctor's communicative behavior, patient's initiatives, misalignments, interruptions, accountability, and expressions of trust in participants' talk, Markers of uncertainty in doctor's talk, markers of emotions in doctor's talk). Forty-two video-recorded patient-oncologist encounters (with 22 Italian and 20 foreign patients), including both first and follow-up visits, were analyzed. Three discriminant analyses were conducted to assess differences in PCC between patient groups (Italian or foreign patients) according to the type of encounter (first visit or follow-up) and the presence or absence of companions during the encounters. Multiple regression analyses were performed to evaluate the PCC differences by oncologist age, patient age, and patient sex, controlling for the type of encounter, the presence of a companion during the visit, and patient group on ONCode dimensions. No differences were found in PCC by patient group in discriminant analyses and regressions. Doctor communication behavior, interruptions, accountability, and expressions of trust were higher in first visits than in follow-ups. The disparities in PCC were primarily linked to the type of visit and the age of the oncologist. However, a qualitative analysis showed notable differences in the types of interruptions during visits with foreign patients compared to Italian patients. It is essential to minimize interruptions during intercultural encounters to foster a more respectful and conducive environment for patients. Furthermore, even when foreign patients demonstrate sufficient linguistic competence, healthcare providers should not solely rely on this factor to ensure effective communication and quality care.

There are few robust evaluations of disease-specific question prompt sheets (QPS) in patient-physician communication among patients with advanced cancer.

To compare the patient perception of helpfulness, global evaluation, and preference for the QPS vs a general information sheet (GIS), and to examine the effect of the QPS on participants' anxiety, participants' speaking time, number of questions asked, and length of the clinical encounter.

This controlled, double-blind randomized clinical trial was conducted at an outpatient palliative and supportive care clinic in a cancer center in the US. Eligible patients were 18 years or older, had a cancer diagnosis, and were undergoing their first outpatient consultation visit with a palliative care physician from September 1, 2017, to May 31, 2019. Data analysis used a modified intention-to-treat design. Data were analyzed from May 18 to June 27, 2022.

QPS, a 25-item list of questions developed by expert palliative care clinicians using a Delphi process and tested among ambulatory advanced cancer patients. The control was GIS, generic information material given routinely to patients seen at the supportive care clinic.

The main outcome was patient perception of helpfulness. Secondary outcomes included global evaluation and preference of QPS compared with GIS immediately after the encounter.

A total of 130 patients (mean [SD] age, 58.6 [13.3] years; 79 [60.8%] female) were randomized to receive either QPS (67 patients [51.5%]) or GIS (63 patients [48.5%]). Patients considered QPS and GIS equally helpful, with no statistically significant difference (mean [SD] helpfulness score, 7.2 [2.3] points vs 7.1 [2.7] points; P = .79). The QPS group, compared with the GIS group, had a higher global positive view of the material (mean [SD] global perception score, 7.1 [1.3] vs 6.5 [1.7]; P = .03) and felt it prompted them more to generate new questions (mean [SD] rating, 7.0 [2.9] vs 5.3 [3.5]; P = .005). Of 47 patients asked their preference between the items, more participants preferred the QPS to the GIS in communicating with their physicians (24 patients [51.1%] vs 7 patients [14.9%]; P = .01) at the 4-week follow-up. No significant differences between the QPS and GIS groups were observed regarding participant anxiety, speaking time, number of questions asked, or consultation length (eg, mean [SD] anxiety rating, 2.3 [3.7] vs 1.6 [2.7]; P = .19).

In this randomized clinical trial, participants perceived both QPS and GIS as equally helpful, but they had a more positive global view of and preferred the QPS. QPS facilitated generation of new questions without increasing patient anxiety nor prolonging the consultation. The findings provide support for increased adoption and integration of QPS into routine oncologic care.

ClinicalTrials.gov Identifier: NCT03287492.

Unhelpful thoughts and feelings of worry or despair about symptoms account for a notable amount of the variation in musculoskeletal symptom intensity. Specialists may be best positioned to diagnose these treatable aspects of musculoskeletal illness. Musculoskeletal specialists might be concerned that addressing mental health could offend the patient, and avoidance might delay mental health diagnosis and treatment. Evidence that conversations about mental health are not associated with diminished patient experience might increase specialist confidence in the timely diagnosis and initial motivation to treat unhelpful thoughts and feelings of worry or despair.

Using transcripts of videotaped and audiotaped specialty care visits in which at least one instance of patient language indicating an unhelpful thought about symptoms or feelings of worry or despair surfaced, we asked: (1) Is clinician discussion of mental health associated with lower patient-rated clinician empathy, accounting for other factors? (2) Are clinician discussions of mental health associated with patient demographics, patient mental health measures, or specific clinicians?

Using a database of transcripts of 212 patients that were audio or video recorded for prior studies, we identified 144 transcripts in which language reflecting either an unhelpful thought or feelings of distress (worry or despair) about symptoms was detected. These were labeled mental health opportunities. Patients were invited on days when the researcher making video or audio records was available, and people were invited based on the researcher's availability, the patient's cognitive ability, and whether the patient spoke English. Exclusions were not tracked in those original studies, but few patients declined. There were 80 women and 64 men, with a mean age of 45 ± 15 years. Participants completed measures of health anxiety, catastrophic thinking, symptoms of depression, and perceived clinician empathy. Factors associated with perceived clinician empathy and clinician discussion of mental health were sought in bivariate and multivariable analyses.

Greater patient-rated clinician empathy was not associated with clinician initiation of a mental health discussion (regression coefficient 0.98 [95% confidence interval 0.89 to 1.1]; p = 0.65). A clinician-initiated mental health discussion was not associated with any factors.