Jeffrey Silver Humanism in Healthcare Research Roundup – February 2019

The Jeffrey Silver Humanism in Healthcare Research Roundup features summaries of recently published studies on humanism in healthcare. To receive email notification of new studies once per month, enter your information here and select “Jeffrey Silver Research Roundup” from the checkboxes at the bottom. See previous posts in this series.

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Publications from Gold Foundation-Affiliated Authors

Bringing narratives from physicians, patients and caregivers together: A scoping review of published research Moniz T, Costella J, Golafshani M, Watling C, Lingard L. Med Humanit. 2019 Feb 8.
This study was supported by a Mapping the Landscape grant from the Gold Foundation.
Physicians, patients, and caregivers all have different perspectives and stories to tell about illness. Understanding how and why stories differ helps support patient-centered care. Do studies that examine first-person narratives look at the differences among groups to glean insights? In this scoping review, 22 studies were included (13 from patients and caregivers; 7 by patients, caregivers, and physicians; and 2 by patients and physicians). Thirteen studies combined the different groups’ narratives in their analysis. Most studies used descriptive content analysis to draw out themes, but did not look at how groups’ perspectives varied and why. The authors see this as a missed opportunity and urge further comparative research to better understand how differences in the narratives impact the healthcare experience.

The power of the group: comparison of interviews and group concept mapping for identifying patient-important outcomes of care Free full text Rising KL, LaNoue M, Gentsch AT, Doty AMB, Cunningham A, Carr BG, Hollander JE, Latimer L, Loebell L, Weingarten G, White N, Mills G. BMC Med Res Methodol. 2019 Jan 8;19(1):7.
Dr. Marianna LaNoue is a Mapping the Landscape grantee.
What is the most efficient and effective way to identify patient-important outcomes (PIOs)? No formal guidance exists for research. This study compares the comprehensiveness and efficiency of individual interviews to group concept mapping (GCM) for identifying patient goals. GCM draws on group participation to create a concept map that sorts related ideas into clusters. This study used a mixed methods and participatory approach with 89 participant interviews and 52 GCM participants, all of whom had diabetes mellitus that was moderately to poorly controlled. Results show that the first phase of GCM, the GCM brainstorming phase, was effective in identifying PIOs, and that additionally, the brainstorming sessions resulted in a more comprehensive list of PIOs than individual interviews.  The researchers conclude that while there are benefits to both individual interviews and the full GCM process, the brainstorming phase offers an “accessible and powerful tool” in identifying PIOs.

Beyond burnout: A physician wellness hierarchy designed to prioritize interventions at the systems level      Shapiro DE, Duquette C, Abbott LM, Babineau T, Pearl A, Haidet P. Am J Med. 2018 Dec 13. pii: S0002-9343(18)31155-0.
Drs. Daniel Shapiro and Paul Haidet are Mapping the Landscape grantees. Dr. Shapiro is also a Gold professor and Dr. Haidet is a Picker-Gold grantee.
Burnout is a serious issue, and there are many interventions available in the literature but little guidance on how to prioritize these. This article offers a model, the Health Professional Wellness Hierarchy, based on Maslow’s hierarchy of needs to prioritize systems-level interventions related to the prevention of burnout.  The authors posit that interventions should begin at the lowest level, Level 1, in which healthcare professionals must have their basic physical and mental health needs met first, such as food, sleep, and mental health wellness. Next, the model prioritizes patient and physician physical safety. Only after these levels are addressed should leaders turn their energy to intervening at higher-order needs. Level 3 is Respect; Level 4 is Appreciation and Connection; and the top, Level 5, is Healing Patients and Contributing at the Fullest of One’s Ability.

The Jefferson Scale of Empathy: a nationwide study of measurement properties, underlying components, latent variable structure, and national norms in medical students     Free full text Hojat M, DeSantis J, Shannon SC, Mortensen LH, Speicher MR, Bragan L, LaNoue M, Calabrese LH. Adv Health Sci Educ Theory Pract. 2018 Dec;23(5):899-920.
Dr. Marianna LaNoue is a Mapping the Landscape grantee.
Empathy is a personality attribute that promotes humanism. The Jefferson Scale of Empathy (JSE) is a widely used tool to measure empathy. The tool has shown to have strong psychometric properties in tests of various groups of students and clinicians but has not been tested among osteopathic medical students. Using a sample of 6,009 osteopathic medical students, the JSE was administered to establish norms in medical students nationwide. Item-total scores (scores between each item and the total score on the scale) were statistically significant and reliability was reported at 0.82. There were significant gender differences reported, favoring women in the sample. The findings of this study support the use of the JSE among osteopathic medical students. The authors also developed a new nationwide norm table which can be used to assess students’ JSE scores against national data.

Late-breaking update: A new study was published in the Mayo Clinic Proceedings on Feb. 22, 2019, as we were wrapping up this month’s Research Roundup: “Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017” Free full text from Tait D. Shanafelt; Colin P. West; Christine Sinsky; Mickey Trockel; Michael Tutty; Daniel V. Satele; Lindsey E. Carlasare; Lotte N. Dyrbye. This survey of U.S. physicians is an update to the team’s 2011 and 2014 studies. The researchers found that burnout improved between 2014 and 2017, returning to near 2011 levels, though physicians are still at higher risk of burnout than professionals in other fields. Symptoms of depression among physicians have worsened. Drs. Shanafelt, West and Dyrbye are Mapping the Landscape grantees.

Other Publications

Providing end-of-life care: Increased empathy and self-efficacy among student caregivers in residential homes for the dying      Weisse CS, Melekis K, Hutchins B. Am J Hosp Palliat Care. 2018 Dec 25:1049909118820844.
The lack of sufficient training in end-of-life care among healthcare professionals as the aging population continues to increase has been called a public health crisis. This study examines the effects of a program designed to improve skills of caring for people who are dying in community-run, residential homes. A total of 18 undergraduate health profession students completed the 8-week Community Action, Research, and Education program (CARE), spending 30 hours a week as caregivers for hospice patients with a prognosis of 3 months or less. The Jefferson Scale of Empathy-Health Professions and a self-efficacy scale were used. Both empathy and self-efficacy increased after the end-of-life care intervention. Journals were also used for qualitative analysis related to knowledge, skill, and value development. A common theme among participants was the development of communication skills. The authors note that almost 80 residential homes for the dying exist in America, offering opportunities for educational initiatives to partner and enable healthcare professionals to gain critical experience and skills in caring for patients at the end of life.

Physician assurance reduces patient symptoms in US adults: An experimental study Free full text Leibowitz KA, Hardebeck EJ, Goyer JP, Crum AJ. J Gen Intern Med. 2018 Dec;33(12):2051-2052.
What is the healing power of assurance from a healthcare provider? As time demands increase for physicians, primary care visits that don’t have a medication component may nonetheless have a significant value that can be quantified. The benefit of primary care provider visits with positive words and affirmations to their patients has mixed results in the literature. This study examines the effects of a physician who reassured patients that their symptoms would soon diminish. 36 patients were in the intervention group (with one sentence of reassurance from a clinician) and 41 patients were in the control group. Participants rated their itchiness before a histamine skin prick and after at 3, 9, 12, 15, and 18 minutes. After assurance, itchiness decreased significantly faster in the intervention group. This study demonstrates that reassurance by providers may assist in improving their symptoms.

Unmet Needs: Hearing the Challenges of Chronic Patients with Artificial Intelligence Free full text Tewarie B, Bailey V, Rebarber M, Xu J. NEJM Catalyst. 2019 Jan 30.
Understanding what it is like to live with a chronic illness can be difficult. This study uses natural language processing and machine learning to draw out unmet patient needs in more than 500,000 de-identified and anonymous comments in online forums during 2010-2018. The study focused on patients living with one of 10 chronic illnesses, which included Alzheimer’s, Crohn’s epilepsy and diabetes, and found patterns of increasing positivity or negativity in patients with certain diseases. Unmet needs were classified into medical needs and emotional needs; six of the top eight unmet needs were emotional and the top two unmet needs focused on how to live with the disease. Six pain points involving physicians were identified, all of which involved unsatisfying interactions, such as lack of communication and discomfort or distrust. The findings underscore the importance of helping patients with chronic diseases beyond short-term medical interventions.

Use of text messaging to improve patient experience and communication with pediatric tonsillectomy patients     Newton L, Sulman C. Int J Pediatr Otorhinolaryngol. 2018 Oct;113:213-217.
Text messages are a low-cost way to communicate with patients, and studies have found benefits to using text messages in the medical arena, such as engaging patients in smoking cessation interventions and adherence to therapy. The purpose of this study was to examine the effects of a text-messaging service received preoperatively and postoperatively with pediatric tonsillectomy patients. The “Patient Journey” application provided education and information to the parents of pediatric patients starting 14 days before surgery and ending 9 days after surgery. In this study, 85 patients participated in the program and none had canceled procedures or visits to the emergency department. 25% of participants called the nurse line for concerns postoperatively, largely for pain management questions. Participants reported that they found the information helpful and easy to understand and that it helped to decrease anxiety levels. This study demonstrates how text-messaging can be a useful, easy way to facilitate patient/family education for surgical procedures.

Tresa Kaur

Research Roundup Editor

Disseminates current issues, trends, and research on humanism and healthcare.