HEALTH- The Patient -Practitioner Relationship& Adherence Flashcards
Define Non-verbal communication
- Any interactions that take place other than talking, for example body language, clothing.
What was the aim of Mckinstry and Wang
- Aimed to investigate whether patients think the way their doctor dresses is important, what their preference is and whether patients think the way the doctor dresses influences their effectiveness as a doctor
What did McKinstry and wang carry out their study and what was the result
- They showed pictures of 2 doctors to the participants
- One doctor was dressed formally (white coat over a suit or skirt)
- The other doctor dressed informally (jeans)
- Patients were asked to rate how confident they are in each doctors ability
- They found that formally dressed doctor received a higher rating than the informally dressed doctor especially from older patients.
Argyle suggested that non-verbal behaviours have 4 major uses
- To assist speech (Help by showing when you want to say something or emphasize)
- As replacements for speech (e.g. raised eyebrow can replace a verbal question)
- To signal attitudes ( e.g. trying to look cool and unworried by standing in a relaxed position)
- To signal emotional states (e.g. you can tell when someone is happy or angry by the way they sit or stand)
Define Verbal communication
- Any interaction that involves talking
Describe Doctor centered diagnosis
This is where the doctor dominates the discussion by asking all the questions and giving advice and the patient simply expresses what is bothering them
- Doctor mainly gathers info
- Doctor asks direct questions, closed questions about medical facts
- Doctor makes decisions and instructions
- Patient is expected to be passive and ask few questions
Describe patient-centered diagnosis
- This is where the patient talks about what is bothering them and their needs while the doctor listens and adjusts their responses to match
- Doctor listens and reflects
- The doctor offers observations and seeks the patient’s ideas. They are encouraging and indicate understanding
- The doctor involves the patient in the decisions
- Patient is expected to be active, ask questions and influence consultations.
What influences doc-patient discussions
- Characteristics of the practitioner e.g Gender
- Characteristics of the patient
what are heuristics
- These are the logical decisions we make everyday
What are the two types of Heuristics
- Availability Heuristic: Judging the probability that something will happen based on the availability of information about it.
- Representative Heuristic: Judiging people and events based on what we think is typical for that group or event (E.g stereotype or expectation)
Describe a Type I error
- A type I error often referred to as a “false positive” and It occurs when the patient is healthy, but the doctor misdiagnoses them as being unwell
Describe a Type II error
- This is a type I error and is the false acceptance of the null hypothesis. This is known as a false negative and implies that the patient is free of a disease when they are not, which is a dangerous diagnosis.
What are the problems of disclosing information to doctors
- Robinson and West illustrated that patients don’t always fully inform doctors of all their symptoms or other information due to getting info from self-reports
- The study investigated a genitourinary clinic and saw that people were more prepared to reveal more symptoms to a computer than to a doctor
- They concluded that it was probably the impersonal nature of the computer that caused patients to be more open, hence more valid responses.
What are Lay consultations
- When we seek medical advice from friends, families and co-workers
Reasons why people under-use health services.
- symptoms persist longer and adopt a “wait and see” attitude.
- Had a prior experience with a doctor and did not feel listened to or got misdiagnosed.
- The perceived stigma surrounding treatment for mental health concerns
- Treatment expectation- we only seek treatment if it will cure
What are the 3 stages that can account for the delay in seeking treatment according to Safer et al.
- Appraisal delay: The patient takes time to judge a symptom and decide whether or not there is something wrong.
- Illness delay: The time between when the patient decides they are ill and when they decide to seek medical care
- Utilisation delay: Time between deciding to go and turning up for surgery. Consider whether the costs of care (time, money, effort) are worth it.
State 2 other factors that affect delay
- Patients characteristics: gender, age, culture
- Illness factors: Development speed of the symptoms
Safer et al. investigated the effect of the following predicting factors on each of the stages of delay:
- sensory or perceptual experience of the symptom
- Self - appraisal processes
- Coping response to symptoms
- emotional reactions to the health threat e.g fear and distress
- The imagined consequence of the symptoms
- situational barriers to receiving care e.g cost
What is the alternative explanation for delay
- The Health Belief Model
Describe the factors that the health belief model can be applied to non-adherence
- Perceived threat: How they feel about their symptoms
- Perceived susceptibility: The extent to which people think they are vulnerable to having the illness that they think they have
- Perceived seriousness: How serious the person thinks that illness will affect the their life
- Perceived benefits v Perceived barriers: such as side effects, cost. The more beneficial it is, the faster they seek treatment.
Give an example of the subjective method of measuring adherence
- Clinical interviews: The Medical Adherence Measure
- semi-structured
- items assess patients in terms of their knowledge of their treatment regimen.
- It includes questions about their diet, medication and clinical attendance.
+ allows an insight into the patients thoughts and feelings about their treatment/ qualitative analysis which increases validity by using an idiographic approach, doctors get a better understanding
-Time-consuming and expensive method. This results to smaller sample sizes. Participants may not attend due to having work, lowering generalisability
Describe medical dispensers as an objective measure
- They have the correct tablets placed at certain containers for each day of the week
- The doctor will check at the end of the week if there are any tablets left in the dispenser
Describe pill counting as an objective measure
- By asking the patient to bring all medication at each medical review
- count how many pills have remained at a certain period
-relies on the patient bringing all their medication
-unsure of whether they actually take their medication
-cannot track the pattern in which medication was taken
Describe the Track Cup
- This tracks how often a bottle opens allowing you to track whether the bottle was opened at the right times during the day
+Improves tracking the pattern
-Does not provide evidence that the medicine is being taken
-expensive
Describe biological measures
- Blood samples and urine samples.
- They provide the accurate reading of certain drugs in the patients system
+Highly reliable
+Valid as it does not depend on the patients honesty
-Expensive and cannot be performed on a large scale
Ways of improving adherence
Prompts: Through text messages, emails, calls e.t.c
Contracts: A patient will sign agreeing to the terms
Customise treatment: Fitting it in a way that fits their lifestyle to make it more convenient
Describe the main theories and explanations for Yockley and Glenwick
- Research showed that community interventions such as prompts had positive influence on the number of children being immunised
Describe the aim Yockley and glenwick
- To evaluate the effectiveness of 4 different conditions for motivating parents of preschool children to get their children immunised
The 4 conditions were
(IV) :
- A mailed general prompt
- A mailed specific prompt
- A mailed specific prompt and expanded clinic hours to increase access and convenience
- A mailed specific prompt and a monetary incentive, in the form of a cash lottery
Describe the sample in Glenwick and Yokley
- Entire population of immunisation-deficient pre-school clients
- ages 5 and under
- all from a public health clinic in America
- 1,133 out of the 2,101 were found to be in need of at least ONE immunisation
- Even number of boys and girls
- 64% were caucasian
- Mean number of immunisations was 5.2
what are the 3 DVs collected in the study
- The n.o of target children receiving one /more than one immunisation
- Number of target children attending the clinic for any reason
- the total number of immunisations received by the target children
What were the 2 control groups in Yockley
- The contact and no-contact group
(No prompts for either group)
Describe the general and specific prompt group
General: General immunisation info urging parents to get their children immunised
Specific: Had the named target child and specific instructions
were also given the clinics hours and location
Describe the increase access group and the Monetary incentive
Access group: received extra out of hours sessions where childcare facilities were present. Parents could leave their children there
Monetary incentive: Specific prompts plus an additional cash lottery that offered 3 cash prizes.
Yockley And Glenwich
When were the measures collected
- The effect of all conditions was measured after 2 weeks
- There was a follow-up measure taken 2-3 months later
What were the results in Yockley
- As expected, the monetary incentive group had the highest response, followed by the increased access group, then specific group and finally general prompt
- They found the specific prompt was the most cost-effective method and monetary being the least cost-effective
- The specific prompt and money incentive method produced a 29% increase in the number of immunisations given.
Evaluate the study of Yockley
+Large scale with a large sample which was representative so high generalisability
+Longitudinal study increased validity with follow-ups
+There were several controls such as correct immunisations and accuracy of prompts
+Application to everyday life from results
-Lacks generalisability to other cultures
-It may be considered unethical to give one group money in order to get children immunised.
-Participant attrition- sample was 36.9 per cent less than the original sample.
State the aim in savage and armstrong
- To investigate whether patient satisfaction is increased with a sharing style consultation compared to a directed style
Describe the sample in Savage
- Random sampling
- The random number generator was used to select 4 patients for the surgeries
- ages 16-75
- Several symptoms except life-threatening ones
- in total 200 completed al parts of the study
- Patients were given consent forms
Describe the IV in savage
- a set of cards was randomly allocated to either give a directing or shared style of consultation.
- The cards were faced down on the doctors desk and turned over at an appropriate time.
How was the DV collected in savage
- At the end of the consultation, patients filled in a satisfaction questionnaire
- The time of the consultation was recorded along with the demographics
What were the results in Savage
- There was no significant difference in the mean length of consultations between the 2 styles
- There was an overall high satisfaction with only 3 patients showing negative consultations
- Those that received a directing style were more satisfied and felt that the doctor understood them.
What was the conclusion in Armstrong
The directing style leads to higher patient satisfaction in terms of understanding the problem and the quality of explanation
Evaluate the study by Savage
+ Field study increases validity as patients were not aware they were involved in a study
+ Use of closed questionnaires gathered quantitative results for comparisons
+ Use of questionnaires immediately after the consultations as well as once a week improved the validity as it saw the changes overtime
+ Standardised such as having the same doctor and the same prompts for each IV
+ Application to everyday life and is useful for surgeries and doctor advising,
-Sample is weak as patients were from the same surgery over a 4 month period
-Lack of qualitative research
