Trust, medical expertise and humaneness: A qualitative study on people with cancer' satisfaction with medical care.
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ABSTRACT: Background
Understanding peoples' evaluations of their health care is important to ensure appropriate health-care services.Objectives
To understand what factors influence peoples' satisfaction with care and how interpersonal trust is established between doctors and cancer patients in Germany.Design
A narrative interview study that included women with a diagnosis of breast cancer and men with a diagnosis of prostate cancer. A question-focused analysis was conducted.Setting and participants
Interviewees were sought across Germany through self-help organizations, clinics, rehabilitation facilities, physicians and other health-care professionals, in order to develop modules on experiencing cancer for the website krankheitserfahrungen.de (illness experiences.de).Results
Satisfaction was related to the perception of having a knowledgeable and trusted physician. Trust was developed through particular interactions in which 'medical expertise' and 'humaneness' were enacted by physicians. Humaneness represents the ability of physicians to personalize medical expertise and thereby to convey working in the individual's best interest and to treat the patient as an individual and unique human being. This was fostered through contextual and relational factors including among others setting, time, information transfer, respect, availability, profoundness, sensitivity and understanding.Conclusion
It was the ability to make oneself known to and know the patient in particular ways that allowed for satisfying care experiences by establishing interpersonal trust. This suggests the importance of conceptualizing the doctor-patient relationship as a fundamentally reciprocal human interaction of caregiving and care-receiving. At the core of the satisfying care experiences lies a doctor-patient relationship with a profoundly humane quality.
SUBMITTER: Blodt S
PROVIDER: S-EPMC8077133 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveDeteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers.MethodsWe adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships.FindingsAbout 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care.ConclusionAt the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.
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Project description:BACKGROUND:ACP enables individuals to define and discuss goals and preferences for future medical treatment and care with family and healthcare providers, and to record these goals and preferences if appropriate. Because general practitioners (GPs) often have long-lasting relationships with people with dementia, GPs seem most suited to initiate ACP. However, ACP with people with dementia in primary care is uncommon. Although several barriers and facilitators to ACP with people with dementia have already been identified in earlier research, evidence gaps still exist. We therefore aimed to further explore barriers and facilitators for ACP with community-dwelling people with dementia. METHODS:A qualitative design, involving all stakeholders in the care for community-dwelling people with dementia, was used. We conducted semi-structured interviews with community dwelling people with dementia and their family caregivers, semi structured interviews by telephone with GPs and a focus group meeting with practice nurses and case managers. Content analysis was used to define codes, categories and themes. RESULTS:Ten face to face interviews, 10 interviews by telephone and one focus group interview were conducted. From this data, three themes were derived: development of a trust-based relationship, characteristics of an ACP conversation and the primary care setting. ACP is facilitated by a therapeutic relationship between the person with dementia/family caregiver and the GP built on trust, preferably in the context of home visits. Addressing not only medical but also non-medical issues soon after the dementia diagnosis is given is an important facilitator during conversation. Key barriers were: the wish of some participants to postpone ACP until problems arise, GPs' time restraints, concerns about the documentation of ACP outcomes and concerns about the availability of these outcomes to other healthcare providers. CONCLUSIONS:ACP is facilitated by an open relationship based on trust between the GP, the person with dementia and his/her family caregiver, in which both medical and non-medical issues are addressed. GPs' availability and time restraints are barriers to ACP. Transferring ACP tasks to case managers or practice nurses may contribute to overcoming these barriers.
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Project description:OBJECTIVE:We explored parents' accounts of the parent-clinician relationship in childhood cancer to understand how parents who perceive threats to the relationship can be supported. METHODS:Multicentre longitudinal qualitative study, with 67 UK parents of children (aged 1-12 years) receiving treatment for acute lymphoblastic leukaemia. Analyses drew on the wider sample but focussed on 50 semistructured interviews with 20 parents and were informed by constant comparison. RESULTS:All 20 parents described problems with clinical care such as inadequate information or mistakes by staff but varied in how much the problems threatened their sense of relationship with clinicians. Some parents saw the problems as having no relevance to the parent-clinician relationship. Others saw the problems as threats to the clinical relationship but worked to "contain" the threat in ways that preserved a trusting relationship with at least one senior clinician. Parents' containment work protected the security they needed from the parent-clinician relationship, but containment was a tenuous process for some. A few parents were unable to contain the problems at all; lacking trust in clinicians, these parents suffered considerably. CONCLUSIONS:Given the complexity of childhood cancer care, problems with clinical care are inevitable. By engaging in containment work, parents met their needs to feel secure in the face of these problems, but the extent to which parents should have to do this work is debatable. Parents could benefit from support to seek help when problems arise which threaten their trust in clinicians. Attachment theory can guide clinicians in giving this support.
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Project description:BackgroundA diagnosis of type 2 diabetes (T2D) results in widespread changes to a person's life and can be experienced as an assault on their sense of self. The resources available to an individual influence how the individual adapts to their diabetic identity and subsequently engages in self-care. Digital interventions can be viewed as a resource that people can draw on to adapt to the diagnosis. However, there is an indication that people from disadvantaged groups find digital health technologies more challenging to access and use, which may increase health inequalities.ObjectiveThis study aims to gain insights into how and why people with T2D use digital self-care technology and how experiences vary between individuals and social groups.MethodsA purposive sample of people who had used a digital intervention to help them self-care for their T2D were recruited for the study. Semistructured interviews were conducted, and data were analyzed thematically.ResultsA diverse sample of 21 participants were interviewed. Participants used digital interventions to help them to understand and feel more in control of their bodies. Digital interventions were used by participants to project their chosen identity to others. Participants selected technology that allowed them to confirm and enact their preferred positive identities, both by avoiding stigma and by becoming experts in their disease or treatment. Participants preferred using digital interventions that helped them conceal their diabetes, including by buying discrete blood glucose monitors. Some participants used technology to increase their sense of power in their interaction with clinicians, whereas others used technology to demonstrate their goodness.ConclusionsThe technology that people with T2D have access to shapes the way they are able to understand and control their bodies and support preferred social identities.
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Project description:IntroductionTrust between supervisors and trainees mediates trainee participation and learning. A resident (postgraduate) trainee's understanding of their supervisor's trust can affect their perceptions of their patient care responsibilities, opportunities for learning, and overall growth as physicians. While the supervisor perspective of trust has been well studied, less is known about how resident trainees recognize supervisor trust and how it affects them.MethodsIn this qualitative study, 21 pediatric residents were interviewed at a single institution. Questions addressed their experiences during their first post-graduate year (PGY-1) on inpatient wards. Each interviewee was asked to describe three different patient care scenarios in which they perceived optimal, under-, and over-trust from their resident supervisor. Data were analyzed using thematic analysis.ResultsResidents recognized and interpreted their supervisor's trust through four factors: supervisor, task, relationship, and context. Optimal trust was associated with supervision balancing supervisor availability and resident independence, tasks affording participation in decision-making, trusting relationships with supervisors, and a workplace fostering appropriate autonomy and team inclusivity. The effects of supervisor trust on residents fell into three themes: learning experiences, attitudes and self-confidence, and identities and roles. Optimal trust supported learning via tailored guidance, confidence and lessened vulnerability, and a sense of patient ownership and team belonging.DiscussionUnderstanding how trainees recognize supervisor trust can enhance interventions for improving the dialogue of trust between supervisors and trainees. It is important for supervisors to be cognizant of their trainees' interpretations of trust because it affects how trainees understand their patient care roles, perceive autonomy, and approach learning.
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Project description:BackgroundIt is widely accepted that patient generates overall satisfaction with medical service and sub satisfaction on the basis of response to patient's trust in medical service and response to patient's attitude towards health policy in China. This study aimed to investigate the correlations between patient's trust in medical service/patient's attitude towards health policy and patient's overall satisfaction with medical service/sub satisfaction in current medical experience and find inspiration for future reform of China's health delivery system on improving patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy.MethodsThis study collaborated with the National Bureau of Statistics to collect a sample of 3,424 residents from 17 provinces and municipalities in a 2008 China household survey on patient's trust in medical service, patient's attitude towards health policy, patient's overall satisfaction and sub satisfaction in current medical experience.ResultsPatient's overall satisfaction with medical service and most kinds of sub satisfaction in current medical experience were significantly influenced by both patient's trust in medical service and patient's attitude towards health policy; among all kinds of sub satisfaction in current medical experience, patient's trust in medical service/patient's attitude towards health policy had the largest influence on patient's satisfaction with medical costs, the influences of patient's trust in medical service/patient's attitude towards health policy on patient's satisfaction with doctor-patient interaction and satisfaction with treatment process were at medium-level, patient's trust in medical service/patient's attitude towards health policy had the smallest influence on patient's satisfaction with medical facilities and hospital environment, while patient's satisfaction with waiting time in hospital was not influenced by patient's trust in medical service/patient's attitude towards health policy.ConclusionIn order to improve patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy, both improving patient's interpersonal trust in medical service from individual's own medical experience/public trust in medical service and improving patient's attitude towards health policy were indirect but effective ways.
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Project description:The study examines the meaning of good-quality social care for people with Parkinson's disease and their carers. It identifies, from their perspective, the impact of good-quality social care on health and well-being.Qualitative case study methodology, interview and framework analysis techniques were used.community locations in the north and midlands of England.Data were collected from 43 participants including individual interviews with people with Parkinson's disease (n=4), formal and informal social care providers (n=13), 2 focus groups, 1 with people with Parkinson's disease and their carers (n=17), and 1 with professionals (n=8), plus a telephone interview with a former commissioner.Good-quality social care, delivered in a timely fashion, was reported to have a positive impact on health. Furthermore, there is an indication that good-quality social care can prevent untoward events, such as infections, symptom deterioration and deterioration in mental health. The concept of the 'Impact Gap' developed from the findings, illustrates how the costs of care may be reduced by delivering good-quality social care. Control, choice and maintaining independence emerged as indicators of good-quality social care, irrespective of clinical condition. Participants identified characteristics indicative of good-quality social care specific to Parkinson's disease, including understanding Parkinson's disease, appropriate administration of medication, timing of care and reassessment. 'Parkinson's aware' social care was seen to generate psychological, physical and social benefits that were inter-related.The findings indicate how maximising quality in social care delivery for people with Parkinson's disease can impact on health and well-being. Long-term or short-term benefits may result in prevented events and reductions in health and social care resource. Health professionals can be instrumental in early detection of and signposting to social care.
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Project description:This study aimed to determine the factors that influence patient satisfaction with ecdemic medical care.Eight hundred and forty-four face-to-face interviews were conducted between October and November 2017 in two high-profile hospitals in Nanchang, China. Patient satisfaction was divided into lowest and highest satisfaction groups according the 80/20 rule. Demographic factors associated with patient satisfaction were identified by logistic regression models.Respondents' main reasons for choosing a non-local hospital were "high level of medical treatment" (581/844), "good reputation of the hospital" (533/844), and "advanced medical equipment" (417/844). The top three items that dissatisfied the ecdemic patients were "long time to wait for treatment" (553/844), "complicated formalities" (307/844), and "poor overall service attitude" (288/844). Fewer female patients (adjusted odds ratio [AOR] =1.47, 95% confidence interval [CI] =1.03-2.11), patients with a family per-capita monthly income (FPMI) between 3,001 and 5,000 CNY (AOR =1.40, 95% CI =1.01-2.17), inpatients (AOR =1.46, 95% CI =1.01-2.13), and more patients with an FPMI >7,000 CNY (AOR =0.43, 95% CI =0.20-0.92) were detected in the lowest satisfaction group. Fewer patients with an associate's or bachelor's degree (AOR =2.40, 95% CI =1.37-4.20) and patients with an FPMI >7,000 CNY (AOR =3.02, 95% CI =1.10-8.33) were detected in the highest satisfaction group. Moreover, more inpatients (AOR =0.70, 95% CI =0.54-0.97) and those aged 46-65 years (AOR =0.63, 95% CI =0.33-0.98) were detected in the highest satisfaction group.Findings suggested that managers of the medical facilities should note the importance of increasing their publicity through a rapidly developing media, as well as the necessity of creating a more patient-friendly medical care experience. Hospitals should also focus on the medical care experience of patients with relatively lower and higher income levels, male ecdemic patients, and ecdemic outpatients.
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Project description:In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as "access to adequate health care for all at an affordable price". Despite this, an estimated 90% of Somalia's largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people's trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country.A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis.Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country's citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging - including the widespread practice of further appointments for follow-up - which inflates the costs. The study also found poor patient-provider relationship and widespread distrust of the private health care system.The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor-patient relationship has been - and remains - a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with dignity and respect. The education system, particularly the syllabus used by medical faculties, should be reviewed and improved to provide medical students with necessary knowledge, skills and attitudes to maintain patient dignity and rights.
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