Getting airtime: Exploring how patients shape the stories they tell health practitioners.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 7605655 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2923 (Electronic) Linking ISSN: 03080110 NLM ISO Abbreviation: Med Educ Subsets: MEDLINE

Publication: Oxford : Wiley-Blackwell
Original Publication: Oxford, Blackwell Scientific Publications.

Communication* ; Patient-Centered Care*; Chronic Disease ; Female ; Grounded Theory ; Humans ; Male

Introduction: Effective communication during health encounters is known to decrease patient complaints, increase patient adherence and optimise health outcomes. While the aim of patient-centred care is to find common ground, health practitioners tend to drive the encounter, often interrupting patients within the first minute of the clinical conversation. Optimal care for people with chronic illnesses requires individuals to interact with health practitioners regarding their health concerns, but given these constraints, we know little about how patients strategise conversations with their care providers. This understanding may further our efforts to educate health practitioners and trainees to learn and practice patient-centred care.
Methods: A constructivist grounded theory approach with iterative data collection and analysis was used to explore the processes patients use to present and shape their stories for interactions with health practitioners. Twenty-one patients (n = 16 female; 5 male) representing a variety of chronic illnesses participated in semi-structured interviews. Using the constant comparative method of analysis, salient themes were ascertained.
Results: Patients engage in extensive strategic preparations for productive health encounters. From the data, we identified four related elements comprising patients' process of planning, preparing, and strategising for health encounters: deciding to go, organising to get airtime, rehearsing a game plan, and anticipating external forces. By focusing on the extensive preparatory work patients engage in, our study expands the dimensions of how we understand illness-related work. Assembling personal health information, gathering disease information and achieving equanimity represent the dimensions of this 'health interaction work'.
Conclusion: The work patients engage in for health encounters is noteworthy yet often invisible. And work that is unseen may also be undervalued. Acknowledging, illuminating and valuing patients' preparatory work for health encounters add to how we understand patient-centred care, and this offers new targets for us to effectively teach and deliver it.
(© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Comment in: Med Educ. 2021 Oct;55(10):1118-1120. (PMID: 34311497)

Kee JWY, Khoo HS, Lim I, Koh MYH. Communication skills in patient-doctor interactions: learning from patient complaints. Health Prof Educ. 2018;4(2):97-106.
Zolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826-834.
Jani BD, Blane DN, Mercer SW. The role of empathy in therapy and the physician-patient relationship. Complement Med Res. 2012;19(5):252-257.
Weston WW, Brown JB. Challenges in learning and teaching patient-centred clinical method. In: Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR, eds. Patient-Centered Medicine: Transforming the Clinical Method, 3rd ed. London, UK: Radcliffe Publishing; 2014:220-251.
Ospina NS, Phillips KA, Rodriguez-Gutierrez R, et al. Eliciting the patient’s agenda-secondary analysis of recorded clinical encounters. J Gen Intern Med. 2019;34(1):36-40.
Essers G, Van Weel-Baumgarten E, Bolhuis S. Mixed messages in learning communication skills? Students comparing role model behaviour in clerkships with formal training. Med Teach. 2012;34(10):e659-e665.
Bensing JM, Deveugele M, Moretti F, et al. How to make the medical consultation more successful from a patient's perspective? Tips for doctors and patients from lay people in the United Kingdom, Italy, Belgium and the Netherlands. Patient Educ Couns. 2011;84(3):287-293.
Truglio-Londrigan M, Slyer JT, Singleton JK, Worral PS. A qualitative systematic review of internal and external influences on shared decision-making in all health care settings. JBI Libr Syst Rev. 2014;12(5):121-194.
Briere R. Institute of Medicine: Crossing the Quality Chasm. Washington, DC: National Academies Press (US); 2001. https://doi.org/10.17226/10027.
Langberg EM, Dyhr L, Davidsen AS. Development of the concept of patient-centredness-a systematic review. Patient Educ Couns. 2019;102(7):1228-1236.
Eklund JH, Holmström IK, Kumlin T, et al. “Same same or different?” A review of reviews of person-centered and patient-centered care. Patient Educ Couns. 2019;102(1):3-11.
Louw JM, Marcus TS, Hugo JF. How to measure person-centred practice-an analysis of reviews of the literature. Afr J Prim Health Care Family Med. 2020;12(1):1-8.
Street RL Jr. Mapping diverse measures of patient-centered communication onto the conceptual domains of patient-centered care. Patient Educ Couns. 2019;102(7):1225-1227.
Brouwers M, Rasenberg E, van Weel C, Laan R, van Weel-Baumgarten E. Assessing patient-centred communication in teaching: a systematic review of instruments. Med Educ. 2017;51(11):1103-1117.
Patel V, Buchanan H, Hui M, et al. How do specialist trainee doctors acquire skills to practice patient-centred care? A qualitative exploration. BMJ Open. 2018;8(10):e022054.
Naldemirci Ö, Lydahl D, Britten N, Elam M, Moore L, Wolf A. Tenacious assumptions of person-centred care? Exploring tensions and variations in practice. Health. 2018;22(1):54-71.
Tran BQ. Strategies for effective patient care: Integrating quality communication with the patient-centered approach. Soc Personal Psychol Compass. 2021;15(1):e12574.
Keifenheim KE, Teufel M, Ip J, et al. Teaching history taking to medical students: a systematic review. BMC Med Educ. 2015;15(1):1-12.
Denniston C, Molloy E, Nestel D, Woodward-Kron R, Keating JL. Learning outcomes for communication skills across the health professions: a systematic literature review and qualitative synthesis. BMJ Open. 2017;7(4):e014570.
Hartley BR, Elowitz E. Barriers to the enhancement of effective communication in neurosurgery. World Neurosurg. 2020;133:466-473.
Wilcox MV, Orlando MS, Rand CS, et al. Medical students’ perceptions of the patient-centredness of the learning environment. Perspect Med Educ. 2017;6(1):44-50.
Appiah JO, Agyemang-Duah W, Peprah C, Adei D, Peprah P, Fordjour AA. Transportation barriers to formal healthcare utilisation and associated factors among poor older people under a social protection programme in Ghana. J Transp Health. 2020;19:100965.
Green G, Davison C, Bradby H, Krause K, Mejías FM, Alex G. Pathways to care: how superdiversity shapes the need for navigational assistance. Sociol Health Iln. 2014;36(8):1205-1219.
Yellapa V, Devadasan N, Krumeich A, et al. How patients navigate the diagnostic ecosystem in a fragmented health system: a qualitative study from India. Globl Health Action. 2017;10(1):1350452.
Driscoll MA, Knobf MT, Higgins DM, Heapy A, Lee A, Haskell S. Patient experiences navigating chronic pain management in an integrated health care system: a qualitative investigation of women and men. Pain Med. 2018;19:S19-S29.
Straiton ML, Myhre S. Learning to navigate the healthcare system in a new country: a qualitative study. Scand J Prim Health Care. 2017;35(4):352-359.
Humphris R, Bradby H, Padilla B, Phillimore J, Pemberton S, Samerski S. After encounters: revealing patients’ unseen work through their pathways to care. Int J Migr Health Soc Care. 2020;16(2):173-187.
Willis K, Collyer F, Lewis S, Gabe J, Flaherty I, Calnan M. Knowledge matters: producing and using knowledge to navigate healthcare systems. Health Sociol Rev. 2016;25(2):202-216.
Townsend A, Leese J, Adam P, et al. eHealth, participatory medicine, and ethical care: a focus group study of patients’ and health care providers’ use of health-related internet information. J Med Internet Res. 2015;17(6):e155.
Benetoli A, Chen TF, Aslani P. How patients’ use of social media impacts their interactions with healthcare professionals. Patient Educ Couns. 2018;101(3):439-444.
Gupta P, Khan A, Kumar A. Social media use by patients in health care: a scoping review. Intl J Healthc Managt. 2020;18:1-11.
Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR, eds. Patient-Centered Medicine: Transforming the Clinical Method, 3rd ed. London, UK: Radcliffe Publishing; 2014.
Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087-1110.
Clayman ML, Gulbrandsen P, Morris MA. A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter. Patient Educ Couns. 2017;100(3):600-604.
Barry MJ, Edgman-Levitan S. Shared decision making-pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780-781.
Charmaz K. Constructing Grounded Theory, 2nd ed. Thousand Oaks, CA: Sage; 2014.
Mills J, Bonner A, Francis K. Adopting a constructivist approach to grounded theory: Implications for research design. Int J Nurs Pract. 2006;12(1):8-13.
Corbin J, Strauss A. Managing chronic illness at home: Three lines of work. Qual Sociol. 1985;8(3):224-247.
Bury M. Chronic illness as biographical disruption. Sociol Health Illn. 1982;4(2):167-182.
Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. “You Get Reminded You’re a Sick Person”: personal data tracking and patients with multiple chronic conditions. J Med Internet Res. 2015;17(8):e202-202.
Gorman RK, Wellbeloved-Stone CA, Valdez RS. Uncovering the invisible patient work system through a case study of breast cancer self-management. Ergonomics. 2018;61(12):1575-1590.
Holden RJ, Cornet VP, Valdez RS. Patient ergonomics: 10-year mapping review of patient-centered human factors. Appl Ergon. 2020;82:102972.
Yin K, Jung J, Coiera E, et al. Patient work and their contexts: scoping review. J Med Internet Res. 2020;22(6):1-16.
Boehmer KR, Gionfriddo MR, Rodriguez-Gutierrez R, et al. Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis. BMC Fam Pract. 2016;17(1):127.
Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers. J Med Internet Res. 2015;17(6):e137.
Katzman ER, Kinsella EA. “It’s Like Having Another Job”: the invisible work of self-managing attendant services. Disabil Soc. 2018;33(9):1436-1459.
Lin WY. Illness trajectories and invisible work in peritoneal dialysis patients' practice. Taiwanese Sociol. 2009;17:1-59.
McCoy L. Time, self and the medication day: a closer look at the everyday work of adherence. Sociol Health Illn. 2009;31(1):128-146.
Oudshoorn N. Diagnosis at a distance: the invisible work of patients and healthcare professionals in cardiac telemonitoring technology. Sociol Health Illn. 2008;30(2):272-288.
Montori VM. Why We Revolt: A Patient Revolution for Careful and Kind Care / Victor Montori. Rochester, NY: The Patient Revolution; 2017.
Health Topics. Pew Research Centre. https://www.pewresearch.org/internet/2011/02/01/health-topics-4/. Published February 1, 2011. Accessed on March 02, 2021.
Adamski M, Truby H, M. Klassen K, Cowan S, Gibson S. Using the internet: nutrition information-seeking behaviours of lay people enrolled in a massive online nutrition course. Nutrients. 2020;12(3):750. https://doi.org/10.3390/nu12030750.
Mendes Á, Abreu L, Vilar-Correia MR, Borlido-Santos J. “That Should Be Left to Doctors, That’s What They are There For!”-exploring the reflexivity and trust of young adults when seeking health information. Health Commun. 2017;32(9):1076-1081. https://doi.org/10.1080/10410236.2016.1199081.
Rooks RN, Kapral CG, Mathis AL. Chronic conditions may be more important than race or ethnicity in relation to health information seeking and use. J Aging Health. 2019;31(4):611-630.
Greene JA, Choudhry NK, Kilabuk E, Shrank WH. Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook. J Gen Inter Med. 2011;26(3):287-292.
Hogan TP, Palmer CL. “Information work” and chronic illness: Interpreting results from a nationwide survey of people living with HIV/AIDS. Proc Am Soc Inform Sci Technol. 2005;42(1).
Kaziunas E, Ackerman MS, Veinot TCE. Localizing chronic disease management: Information work and health translations. Proc ASIST Annu Meet. 2013;50(1):1-10.
Hochschild AR. The Managed Heart: Commercialization of Human Feeling / Arlie Russell Hochschild. Berkeley, CA: University of California Press; 1983.
Laidsaar-Powell RC, Butow PN, Bu S, et al. Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Educ Couns. 2013;91(1):3-13.
Werner A, Malterud K. “It Is Hard Work Behaving as a Credible Patient": encounters between women with chronic pain and their doctors. Soc Sci Med. 1982;57(8):1409-1419.
Buchman DZ, Ho A, Goldberg DS. Investigating trust, expertise, and epistemic injustice in chronic pain. J Bioeth Inq. 2017;14(1):31-42.
Langberg EM, Dyhr L, Davidsen AS. Development of the concept of patient-centredness - a systematic review. Patient Educ Couns. 2019;102(7):1228-1236.
Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Inter Med. 2012;27(10):1361-1367.
Hong H, Oh HJ. The effects of patient-centered communication: exploring the mediating role of trust in healthcare providers. Health Commun. 2020;35(4):502-511.
de Groot E, Schönrock-Adema J, Zwart D, et al. Learning from patients about patient-centredness: a realist review: BEME Guide No. 60. Med Teach. 2020;42(4):380-392.

Myasthenia Gravis Foundation of America; Nurse Practitioners' Association of Ontario; Canadian Association of Neuroscience Nurses

Date Created: 20210512 Date Completed: 20211022 Latest Revision: 20211022

20221213

10.1111/medu.14561

33979015