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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 250 Research Studies Displayed
Rosenberg SM, Gierisch JM, Revette AC
"Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ.
This study investigated the impact of a ductal carcinoma in situ (DCIS) diagnosis by engaging self-identified patients regarding their experience. Findings showed that, in a large, national sample, participants with a history of DCIS reported confusion and concern about the diagnosis and treatment, which caused worry and significant uncertainty.
Citation: Rosenberg SM, Gierisch JM, Revette AC . "Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ. Cancer 2022 Apr 15;128(8):1676-83. doi: 10.1002/cncr.34126..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Healthcare, Clinician-Patient Communication, Patient and Family Engagement, Communication
Richmond J, Boynton MH, Ozawa S
Development and validation of the trust in my doctor, trust in doctors in general, and trust in the health care team scales.
The authors sought to develop and test updated trust measures that are multidimensional and inclusive of relevant domains. They developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care Team (T-HCT) scales. Following an online survey, they concluded that the multidimensional T-MD, T-DiG, and T-HCT scales have sound psychometric properties and may be useful for researchers evaluating trust-related interventions or conducting studies where trust is an important construct or main outcome.
Citation: Richmond J, Boynton MH, Ozawa S . Development and validation of the trust in my doctor, trust in doctors in general, and trust in the health care team scales. Soc Sci Med 2022 Apr;298:114827. doi: 10.1016/j.socscimed.2022.114827..
Keywords: Patient Experience, Clinician-Patient Communication
Fisher KA, Kennedy K, Bloomstone S
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
The purpose of this study was to explore the effect of physicians sharing their clinical notes with patients with chronic obstructive pulmonary disease (COPD) and assess the impact on patient-physician communication and patient self-management. The researchers conducted interviews with 30 patients with COPD, asking them to review their clinic notes. The participants were primarily White (93.3%) with an average age of 65.5 years; more than 50% reported having a high school degree or less, almost half reported sometimes requiring help to read medical materials, and half had challenges understanding spoken information. The study found that patients reported that having the clinic notes gave them an opportunity to learn more about their condition, and encouraged their self-management by reminding them of their action steps, serving as prompts for seeking information, and motivating them. Patients indicated positive reactions to those physician notes that implied their clinician considered them as a person, listened to them, and noticed details about them. The majority of patients reported negative reactions to incorrect information in the notes, wording that they considered disapproving, and medical terms. The study concluded that the act of providers sharing their clinical notes with their patients can serve multiple purposes, including encouraging the exchange of information and self-management, and improving the relationship between patients and providers.
Citation: Fisher KA, Kennedy K, Bloomstone S . Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD. Patient Educ Couns 2022 Mar;105(3):726-33. doi: 10.1016/j.pec.2021.06.004..
Keywords: Respiratory Conditions, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Self-Management
Meisel ZF, Shofer F, Dolan A
AHRQ Author: Rhodes KV
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
The purpose of this trial was to compare the effectiveness of three approaches for communicating opioid risk during an emergency department visit for a common painful condition. Participants were adult patients with kidney stone or musculoskeletal back pain, randomly assigned to one of three risk communication strategies: a personalized probabilistic risk visual aid, a visual aid and video narrative, or general risk information. Findings showed that an emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall.
Citation: Meisel ZF, Shofer F, Dolan A . A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain. Am J Public Health 2022 Feb;112(S1):S45-s55. doi: 10.2105/ajph.2021.306511..
Keywords: Pain, Emergency Department, Education: Patient and Caregiver, Opioids, Comparative Effectiveness, Clinician-Patient Communication, Communication
Gutman CK, Lion KC, Fisher CL
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
The authors discuss the issue of individuals with limited English proficiency (LEP) and the high risk for adverse outcomes in the US health care system, especially in the emergency department. They point out that, although professional language interpretation improves the quality of care for these patients, it remains underused. They find few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP and urge further high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
Citation: Gutman CK, Lion KC, Fisher CL . Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022 Feb;3(1):e12639. doi: .
Keywords: Communication, Emergency Department, Cultural Competence, Clinician-Patient Communication
Kunneman M, Branda ME, Ridgeway JL
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
The purpose of this trial was to determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Findings showed that using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence, or improved diabetes control in patients with type 2 diabetes.
Citation: Kunneman M, Branda ME, Ridgeway JL . Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention. Endocrine 2022 Feb;75(2):377-91. doi: 10.1007/s12020-021-02861-4..
Keywords: Diabetes, Medication, Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication, Chronic Conditions
Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care.
The patient-provider relationship is considered a cornerstone to delivering high-value healthcare. However, in Medicaid managed care settings, disruptions to this relationship are disproportionately common. In this paper, the researcher evaluated the impact of a primary provider's exit from a Medicaid managed care plan on adult beneficiary healthcare utilization and outcomes.
Citation: Staiger B . Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care. J Health Econ 2022 Jan;81:102574. doi: 10.1016/j.jhealeco.2021.102574..
Keywords: Medicaid, Clinician-Patient Communication, Healthcare Delivery, Chronic Conditions
Brajcich BC, Shallcross ML, Johnson JK
Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study.
This study used semi-structured interviews and focus groups to identify barriers to post-discharge monitoring and patient-clinician communication. Participants were gastrointestinal surgery patients and clinicians, with a total of 15 patients and 17 clinicians. Four themes and four barriers were identified from patient and clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences. Clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.
Citation: Brajcich BC, Shallcross ML, Johnson JK . Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study. J Surg Res 2021 Dec;268:1-8. doi: 10.1016/j.jss.2021.06.032..
Keywords: Hospital Discharge, Clinician-Patient Communication, Care Management, Transitions of Care
Shapiro J, Robins L, Galowitz P
Disclosure coaching: an ask-tell-ask model to support clinicians in disclosure conversations.
The authors developed an "Ask-Tell-Ask" model and materials to guide the disclosure coaching process. In this paper, they described a comprehensive approach to coaching developed over years of coaching experience that incorporates their model, its rationale, step-by-step coaching strategies and guidance, and organizational considerations regarding implementation of a coaching program to support patient-centered transparent communication after harmful events.
Citation: Shapiro J, Robins L, Galowitz P . Disclosure coaching: an ask-tell-ask model to support clinicians in disclosure conversations. J Patient Saf 2021 Dec 1;17(8):e1364-e70. doi: 10.1097/pts.0000000000000491..
Keywords: Clinician-Patient Communication, Communication, Medical Liability, Patient Safety
Aronson PL, Schaeffer P, Niccolai LM
Parents' perspectives on communication and shared decision making for febrile infants ≤60 days old.
This study examined parents’ perceptions of receiving and understanding information in the emergency department (ED) and their perspectives on shared decision making (SDM) in the management of febrile infants 60 days of age or less. The authors conducted semistructured interviews with 23 parents of febrile infants ≤60 days old evaluated in the pediatric ED at an urban, academic medical center. Themes for parents’ perspectives on SDM included: 1) giving parents the opportunity to express their opinions and concerns builds confidence in the decision making process, 2) parents’ preferences for participation in decision making vary considerably, and 3) different perceptions about risk influence parents’ preferences about having their infant undergo a lumbar puncture (LP). Parents valued risk and benefits of having their infant undergo an LP differently, which influences their preferences.
Citation: Aronson PL, Schaeffer P, Niccolai LM . Parents' perspectives on communication and shared decision making for febrile infants ≤60 days old. Pediatr Emerg Care 2021 Dec;37(12):e1213-e19. doi: 10.1097/pec.0000000000001977..
Keywords: Newborns/Infants, Clinician-Patient Communication, Communication, Decision Making, Emergency Department
Quigley DD, Qureshi N, Slaughter ME
Provider and coach perspectives on implementing shadow coaching to improve provider-patient interactions.
Healthcare organizations want to improve patient care experiences. Some use 'shadow coaching' to improve interactions between providers and patients. In this study, the investigators aimed to characterize lessons and barriers to implementing shadow coaching as a mechanism to improve interactions with patients and change organizational culture. The investigators concluded that regular messaging by leadership about the priority and purpose of shadow coaching was essential for both physician engagement and its mature implementation across the organization.
Citation: Quigley DD, Qureshi N, Slaughter ME . Provider and coach perspectives on implementing shadow coaching to improve provider-patient interactions. J Eval Clin Pract 2021 Dec;27(6):1381-89. doi: 10.1111/jep.13575..
Keywords: Clinician-Patient Communication, Patient Experience, Practice Improvement
Choe AY, Schondelmeyer AC, Thomson J
Improving discharge instructions for hospitalized children with limited english proficiency.
Research was conducted on an intervention for patients with limited English proficiency (LEP) who are discharged from the hospital without instructions in their preferred language. The objective was to increase the percentage of patients with LEP on the hospital medicine service who received translated discharge instructions from 12% to 80%. During the 18-month study period 540 patients with LEP were discharged. Spanish was the preferred language of 66% of these patients. The percentage of patients who received translated discharge instructions increased from 12% to 50% in 3 months, and to 77% in 18 months. For Spanish-language patients, the percentage increased to 96% by 18 months.
AHRQ-funded; HS026763; HS025138.
Citation: Choe AY, Schondelmeyer AC, Thomson J . Improving discharge instructions for hospitalized children with limited english proficiency. Hosp Pediatr 2021 Nov;11(11):1213-22. doi: 10.1542/hpeds.2021-005981.
AHRQ-funded; HS026763; HS025138..
AHRQ-funded; HS026763; HS025138..
Keywords: Children/Adolescents, Hospital Discharge, Clinician-Patient Communication, Cultural Competence, Communication
Hofstetter AM, Opel DJ, Stockwell MS
Associations between health care professional communication practices and influenza vaccination of hospitalized children.
The objective of this study was to describe the communication of health care professionals (HCPs) with parents of hospitalized children concerning the influenza vaccine. A survey was conducted online or via telephone with English- and Spanish-speaking parents of influenza vaccine-eligible children hospitalized at a pediatric hospital after discharge. Findings showed that a parent-reported HCP conversation and recommendation were associated with influenza vaccination during hospitalization.
Citation: Hofstetter AM, Opel DJ, Stockwell MS . Associations between health care professional communication practices and influenza vaccination of hospitalized children. Acad Pediatr 2021 Sep-Oct;21(7):1142-50. doi: 10.1016/j.acap.2021.06.014..
Keywords: Children/Adolescents, Influenza, Vaccination, Communication, Health Promotion, Clinician-Patient Communication
Hershberger PJ, Pei Y, Bricker DA
Advancing motivational interviewing training with artificial intelligence: ReadMI.
The research team developed and tested a training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), that uses natural language processing to provide immediate motivational interviewing (MI) metrics and thereby address the need for more effective MI training. They found that the more time a physician spent talking, the less likely the physician was engaging in MI-consistent interview behaviors, including open-ended questions, reflective statements, or use of a change ruler. They concluded that ReadMI produced specific metrics that a trainer can share with a student, resident, or clinician for immediate feedback.
Citation: Hershberger PJ, Pei Y, Bricker DA . Advancing motivational interviewing training with artificial intelligence: ReadMI. Adv Med Educ Pract 2021 Jun 4;12:613-18. doi: 10.2147/amep.S312373..
Keywords: Lifestyle Changes, Clinician-Patient Communication, Patient and Family Engagement
Links AR, Callon W, Wasserman C
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. In this study, the authors characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. The investigators concluded that clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.
Citation: Links AR, Callon W, Wasserman C . Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language. Patient Educ Couns 2021 Jun;104(6):1371-79. doi: 10.1016/j.pec.2020.11.015..
Keywords: Children/Adolescents, Surgery, Caregiving, Decision Making, Clinician-Patient Communication, Communication, Provider: Physician, Provider
Zellmer BM, Nacht CL, Coller RJ
BedsideNotes: sharing physicians' notes with parents during hospitalization.
Physicians increasingly share ambulatory visit notes with patients to meet new federal requirements, and evidence suggests patient experiences improve without overburdening physicians. Whether sharing inpatient notes with parents of hospitalized children yields similar outcomes is unknown. In this pilot study, the investigators evaluated parent and physician perceptions of sharing notes with parents during hospitalization. The investigators concluded that parents all valued having access to physicians' notes during their child's hospital stay; however, some physicians remained concerned about the potential negative consequences of sharing.
Citation: Zellmer BM, Nacht CL, Coller RJ . BedsideNotes: sharing physicians' notes with parents during hospitalization. Hosp Pediatr 2021 May;11(5):503-08. doi: 10.1542/hpeds.2020-005447..
Keywords: Children/Adolescents, Clinician-Patient Communication, Communication, Caregiving, Hospitalization
Patel M, Cadzinski AJ, Bell AM
Interprofessional consultations (eConsults) in urology.
This study examined the implementation of an asynchronous form of telehealth called eConsult which is used by primary care providers to consult with a specialist in place of an in-person consultation. The use of eConsult in the practice of urology was analyzed at four academic institutions: University of Michigan, University of California-San Francisco, University of Washington, and Montefiore Medical Center. Data looked at was eConsult conversion rate (to an in-person consultation), response time, completion time, and diagnosis categories. Out of a total of 462 urological eConsults requested, 36% were converted to a traditional in-person visit. Among resolved eConsults, 53.8% were addressed in less than 1 day; 28.6% in 1 day, 8.4% in 2 days, 3.4% in 3 days; 3.4% in 4 days, 1.7% in 5 days, and 0.8% in 6 days or more. Half were completed in 1-10 minutes; 46.7% in 11-20 minutes, 2.8% in 21-39 minutes, and less than 1% in 31 minutes or more.
Citation: Patel M, Cadzinski AJ, Bell AM . Interprofessional consultations (eConsults) in urology. Urol Pract 2021 May;8(3):321-27. doi: 10.1097/upj.0000000000000209..
Keywords: Telehealth, Health Information Technology (HIT), Clinician-Patient Communication, Communication, Implementation
Walsh KE, Bacic J, Phillips BD
Misuse of pediatric medications and parent-physician communication: an interactive voice response intervention.
Children take 1 medication each week on average at home. Better communication between parents and providers could support safer home medication use and prevent misuse of pediatric medications, such as intentional underdosing or overdosing. The primary objective of the study was to assess the impact of an interactive voice response system on parent-provider communication about medications. The investigators concluded that pediatric medication misuse was common in this study.
Citation: Walsh KE, Bacic J, Phillips BD . Misuse of pediatric medications and parent-physician communication: an interactive voice response intervention. J Patient Saf 2021 Apr 1;17(3):e207-e13. doi: 10.1097/pts.0000000000000375..
Keywords: Children/Adolescents, Medication: Safety, Medication, Clinician-Patient Communication
Kirby JB, Berdahl TA, Stone RA
AHRQ Author: Kirby JB, Berdahl TA
Perceptions of patient-provider communication across the six largest Asian subgroups in the USA.
Investigators sought to estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups. Using MEPS data, they found that negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. They recommended that researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care avoid categorizing all Asians into a single group.
Citation: Kirby JB, Berdahl TA, Stone RA . Perceptions of patient-provider communication across the six largest Asian subgroups in the USA. J Gen Intern Med 2021 Apr;36(4):888-93. doi: 10.1007/s11606-020-06391-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), Clinician-Patient Communication, Communication, Patient Experience, Racial / Ethnic Minorities, Cultural Competence
Szymczak JE, Keller SC, Linder JA
"I never get better without an antibiotic": antibiotic appeals and how to respond.
In this paper, the investigators present various scenarios in which patients who do not meet guideline criteria for antibiotic prescribing, appeal to clinicians for antibiotics. The authors discuss the issue of antiobiotic appeals and provide examples of responses for clinicians. They suggest that clinicians should acquire a stock of responses to these appeals grounded in the latest evidence about antibiotics.
AHRQ-funded; 233201500020I; HS026506; HS025782.
Citation: Szymczak JE, Keller SC, Linder JA . "I never get better without an antibiotic": antibiotic appeals and how to respond. Mayo Clin Proc 2021 Mar;96(3):543-46. doi: 10.1016/j.mayocp.2020.09.031..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinician-Patient Communication, Communication, Practice Patterns
Kostick KM, Blumenthal-Barby JS
Avoiding "toxic knowledge": the importance of framing personalized risk information in clinical decision-making.
In this article, the authors discuss personalized risk information in clinical decision making, concluding that the framing of this information’s intended purpose at the patient level should be tailored to the decision-making context as a patient perceives it, which may vary from patient to patient.
Citation: Kostick KM, Blumenthal-Barby JS . Avoiding "toxic knowledge": the importance of framing personalized risk information in clinical decision-making. Per Med 2021 Mar;18(2):91-95. doi: 10.2217/pme-2020-0174..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Clinician-Patient Communication, Communication
Nair D, Malhotra S, Lupu D
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
This paper uses case vignettes to highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the COVD-19 pandemic for patients with kidney disease. The authors include best practice recommendations to mitigate those issues and conclude with implications for interdisciplinary models of care in crisis settings. Concerns about certain biomarkers, demographics, and medical comorbidities that can predict an increased risk for mortality among patients with COVID-19 and kidney disease are discussed, because there may be communication barriers related to physical exposure and conservation of personal protective equipment with those at-risk patients.
Citation: Nair D, Malhotra S, Lupu D . Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings. Curr Opin Nephrol Hypertens 2021 Mar 1;30(2):190-97. doi: 10.1097/mnh.0000000000000689..
Keywords: COVID-19, Dialysis, Kidney Disease and Health, Decision Making, Clinician-Patient Communication, Communication, Chronic Conditions
Antunez AG, Saari A, Miller J
Patient preferences in cases of inter-system medical error discovery (IMED).
This study looked at patients’ preferences in reporting by physicians when there are medical errors, both self-discovered by the physician, and for inter-system medical error discoveries (IMEDs). Telephone interviews were conducted with 30 patient volunteers from Michigan from January to March 2018. Two medical vignettes were presented, one involving a single physician discovering their own error and the other involving an IMED scenario. Analysis showed that patients considered IMED essentially equivalent to self-discovered errors, and strongly preferred disclosure for both scenarios. Patients said they would likely take certain actions following disclosure of another physician’s error, ranging from confronting the physician to changing providers to taking legal action.
Citation: Antunez AG, Saari A, Miller J . Patient preferences in cases of inter-system medical error discovery (IMED). Ann Surg 2021 Mar;273(3):516-22. doi: 10.1097/sla.0000000000003507..
Keywords: Medical Errors, Adverse Events, Medical Liability, Clinician-Patient Communication, Communication
Kelly MM, Smith CA, Hoonakker PLT
Stakeholder perspectives in anticipation of sharing physicians' notes with parents of hospitalized children.
Researchers sought to elicit stakeholder perspectives on the anticipated benefits and challenges of sharing hospital physicians' admission and daily progress notes with parents at the bedside during their child's hospitalization and to identify strategies to aid implementation of inpatient note sharing. Focus groups with 34 stakeholders at a children's hospital were conducted. The researchers identified four anticipated benefits of sharing inpatient notes, five expected challenges, and three suggested implementation strategies.
Citation: Kelly MM, Smith CA, Hoonakker PLT . Stakeholder perspectives in anticipation of sharing physicians' notes with parents of hospitalized children. Acad Pediatr 2021 Mar;21(2):259-64. doi: 10.1016/j.acap.2020.11.018..
Keywords: Children/Adolescents, Inpatient Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Communication, Clinician-Patient Communication
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
Citation: Fenton JJ, Jerant A, Franks P . Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial. Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication