Challenges in primary healthcare Flashcards
what is communication within a healthcare context?
early models follow the process of thought –> encoding –> decoding (Shannon and Weaver, 1926) however these models fail to take into account many important factors such as meaning, relationship, emotion etc. These factors are additionally important within a healthcare setting
what is primary healthcare?
it is often the first point of contact with healthcare for people, it involves many different professionals including nurses, GP’s, physios etc.
why is good healthcare important?
Fallowfield (2002) found that good quality healthcare was predictive of the quality of information collected about symptoms, adherence to medication and patient satisfaction.
doctors may perform over 150,000 consultations (institute for healthcare communication, 2018)
why is power balance a possible issue within primary healthcare?
doctors now have to take the patient into account. this involves the need for more effective communication as they must make the patient aware of their options and ensure their understanding. involves more cooperation with the patient than previously.
what stage of power dynamic is healthcare currently at?
Hall and Rotter (1991) identified four stages: default, paternalism, consumerism and mutuality. there has been a recent shift in healthcare towards mutualism and shared decision making
why is shared decision making justified?
Guadagnoli and Ward (1989) justify it on moral grounds as well as claiming that it leads to better patient outcomes.
Lee et al (2000) found that it was the preferred method of decision making within a sample of 1000 women with early stage breast cancer.
what interventions have their been aiming to improve shared decision making?
Hobma (2006) intervention where doctors watched their own consultations but this is very costly to do on a large scale.
nation-wide programmes such as MAGIC (Making Good decisions in collaboration) have shown to be initially successful (William-johnson, 2017) this involves training doctors to share information and check patient understanding of decisions. especially where there are multiple treatment options.
why is showing empathy a potential barrier to good communication?
showing empathy has been shown to help patients and may also help patients open up to doctors, therefore allowing them to find more accurate information about symptoms.
what effect does empathy have on patients?
Rakel et al (2011) randomly allocated patients with a cold to high empathy or low empathy doctors. they found that those who rated their doctor as highly empathetic had less severe symptoms, reported that their symptoms lasted for less time and showed improved biomarkers. similarly Newmann (2008) found that empathy in doctors was predictive of depression and quality of life.
what are some interventions designed to increase empathy in doctors?
a meta analysis of 64 studies by Kelm et al (2014) found that only 10 studies were of adequately high quality. of these, role play interventions proved most successful. an example of one of these is an intervention by Chunharas (2012) who found that doctors empathy increased when they were trained to inject other medical students and got feedback.
however, Bensing (1989) found that increasing empathy in doctors did not increase the amount of information patients were willing to share with doctors.
who is patient-centredness a possible barrier to communication?
it is a goal of primary healthcare to treat patients in the context of community (Weiner, 2004). therefore it is important for doctors to understand the wider life of the patients they are treating.
who found that patient-centredness was good from a patient’s perspective?
Bagchi et al (2007) found that cultural competency, familiarity and bi-directional exchange were the factors most important to patients in terms of what constitutes good quality healthcare.
this is supported by Saha et al (2005) who found that these factors also increased patient satisfaction.
what are the interventions to improve cultural competency?
one intervention in Denmark (Schouten, 2014) was found not to be overall successful in increasing patient satisfaction but it is now part of nurses training programmes in many different healthcare systems.
why is age important to consider in patient-centredness?
Haug and Ory (1980)found that doctors often didn’t share enough information or came across as patronising to older people which they claimed was due to inherent ageist attitudes.
however, this is likely to have low temporal validity as recent cultural shift in healthcare has occurred towards caring for an ageing population (Poulin and West, 2005)
