Jeffrey Silver Humanism in Healthcare Research Roundup – November-December 2021

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.

Attitudes, experiences, and safety behaviours of adolescents and young adults who read visit notes: Opportunities to engage patients early in their care. Lam BD, Bourgeois F, DesRoches CM, Dong Z, Bell SK. Future Healthc J. 2021 Nov;8(3):e585-e592. doi: 10.7861/fhj.2021-0118. PMID: 34888446; PMCID: PMC8651326   Free full text Dr. Sigall K. Bell, a Gold Professor, has been a Gold Foundation grantee.
With the passage of the Cures Act, there has been a dramatic expansion in “open notes” – that is, clinical documentation that can be access electronically by patients. This includes patients who are adolescents and young adults (AYA), defined as those 13 to 25 years of age. To understand how AYA interact with open notes, Dr. Barbara Lam and colleagues surveyed 6,914 adults and 332 AYA. Survey questions sought to understand (1) participant perceptions about the importance of notes in engaging with their care, (2) the effect of reading notes on the patient-practitioner relationship, and (3) effect of reading notes on safety knowledge and behaviors. They found that the vast majority of AYA read notes (88%, compared to 95% of adults) and rated them as extremely important for understanding why tests were ordered (70% of AYA, compared to 74% of adults) and for identifying errors (97% of AYA, compared to 98% of adults). However, compared to adults, AYA were less likely to report feeling very comfortable reporting a serious mistake if they found one in the future (65%, compared to 79%). Overall, these results suggest that open notes can be an important tool for patient engagement and safety for a population transitioning from pediatric to adult care.

An Innovative Approach for Integrating Mandatory, Longitudinal Spirituality Training Into the Medical School Curriculum. Fleenor DW, Atkinson HG, Karani R, Lerner S, Leisman S, Marin D. Acad Med. 2021 Nov 2. doi: 10.1097/ACM.0000000000004494. Epub ahead of print. PMID: 34732656 Dr. Reena Karani has been a Gold Foundation grantee.
Spirituality and religion are important aspects of American life, with over 54% of American indicating that they are religious and another 27% reporting being spiritual but not religious. Yet physicians report feeling uncomfortable discussing such topics. To help bridge this gap, David Fleenor and colleagues introduced a mandatory, longitudinal 4-year medical school curriculum for spirituality training at Icahn School of Medicine at Mt. Sinai in New York. Between 2014 and 2020, they surveyed medical students and obtained qualitative feedback to evaluate the program. Though varying by the exact course, the investigators determined overall that the courses were relevant, quality of content was above average, and that medical students felt more confident about being an intern. The investigators credited the interprofessional nature of the team, iterative process of curriculum design, and integration of curriculum into existing courses as key factors in their success. Looking prospectively, they plan on continuing to refine the curriculum, pursue long-term assessments of students, and expand the program to other settings and populations.

Contribution of a positive psychology-based conceptual framework in reducing physician burnout and improving well-being: a systematic review. Bazargan-Hejazi S, Shirazi A, Wang A, Shlobin NA, Karunungan K, Shulman J, Marzio R, Ebrahim G, Shay W, Slavin S. BMC Med Educ. 2021 Nov 25;21(1):593. doi: 10.1186/s12909-021-03021-y. PMID: 34823509; PMCID: PMC8620251   Free full text Dr. Stuart Slavin has been a member of the Gold Humanism Honor Society Advisory Council.
Physician burnout continues to be a major problem for the healthcare workforce, leading to greater medication errors, lower patient satisfaction, physician turnover, and increased healthcare costs, among other negative outcomes. To counter burnout and better understand what allows physicians to thrive, advocates of positive psychology have proposed the PERMA framework (Positive emotion, Engagement, Relationships, Meaning, and Accomplishments). But what is the evidence base to support the PERMA Framework in improving physician well-being?  Dr. Shahrzad Bazargan-Hejazi and colleagues conducted a scoping review of four electronic bibliographic databases. Out of 1,723 results, they identified 21 studies that addressed physician burnout, stress, or well-being through positive psychology interventions. Ten used strategies that resonated with PERMA components and only 1 used the PERMA model. While studies did show some favorable outcomes, including increased satisfaction with one’s job, finding meaning in one’s job, staying engaged while at work, experiencing work-life balance, decreased emotional exhaustion, positive attitude, and improved coping and communication skills, the authors note that absence of studies specifically on PERMA highlights the need for further research.

An undergraduate medical curriculum framework for providing care to transgender and gender diverse patients: A modified Delphi study. Ellaway RH, Thompson NL, Temple-Oberle C, Pacaud D, Frecker H, Jablonski TJ, Demers J, Mattatall F, Raiche J, Hull A, Jalil R. Perspect Med Educ. 2021 Nov 18:1–9. doi: 10.1007/s40037-021-00692-7. Epub ahead of print. PMID: 34792753; PMCID: PMC8600495   Free full text Dr. Rachel Ellaway has been a Gold Foundation grantee.
TGD (Transgender and gender diverse) people have unique healthcare needs and face many health disparities. Yet undergraduate medical school curricula often overlook TGD. To help develop a curriculum framework for providing care for TGD patients, Dr. Ellaway and colleagues conducted a modified Delphi study to generate a framework. The Delphi process included 71 panel members, including content experts, generalist physicians, teaching faculty, and medical students, and 56 community members. Through four rounds of surveys, they identified core values for teaching – including inclusivity, safety in practice, and safety in teaching – within a larger framework that encompasses terminology, epidemiology, medical and surgical treatment, mental health, sexual and reproductive health, and routine primary care. These insights may help in the customization of curricula based on setting and practical implementation within larger undergraduate medical education curricula.

Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain? Fiscella K, Epstein RM, Griggs JJ, Marshall MM, Shields CG. PLoS One. 2021 Oct 27;16(10):e0257794. doi: 10.1371/journal.pone.0257794. PMID: 34705826; PMCID: PMC8550362   Free full text Dr. Ronald Epstein, co-founder of Mindful Practice, has been a Gold Foundation grantee.
Implicit racial bias by physicians is associated with lower quality of care for minority patients, lower patient ratings of patient-centered care, shorter visits, and physician verbal dominance. But how does this implicit racial bias impact prescription of pain medications?  Dr. Kevin Fiscella and colleagues conducted a randomized field experiment between 2012 and 2016 using standardized patients (SP) who reported uncontrolled bone pain from metastatic lung cancer. 96 primary care physicians and oncologists saw these patients and completed a version of the Implicit Association Test. Through coded transcripts and covert audiotapes of the unannounced office visits, the investigators assessed how implicit bias impacted clinical care and communication. They found that, among physicians with greater implicit bias, there were significant differences in how the white SPs were treated compared to Black SPs. Black SPs had fewer renewals for an indicated opioid prescription and less patient-centered pain communication, although they had comparable rates of routine pain assessment, prognostic communication, and verbal dominance. These results suggest a need for larger systems-based strategies to monitor and mitigate racial disparities.

Health Humanities curriculum and evaluation in health professions education: a scoping review. Carr SE, Noya F, Phillips B, Harris A, Scott K, Hooker C, Mavaddat N, Ani-Amponsah M, Vuillermin DM, Reid S, Brett-MacLean P. BMC Med Educ. 2021 Nov 10;21(1):568. doi: 10.1186/s12909-021-03002-1. PMID: 34753482; PMCID: PMC8579562   Free full text Dr. Pamela Brett Maclean has been a Gold Foundation grantee.
The humanities are being increasingly incorporated into health professions education as a way of promoting humanistic medicine. Prior literature suggests that incorporation of the humanities improves the quality of education, but how do these programs align with desired learning outcomes?  Dr. Sandra Carr and colleagues conducted a scoping review of four databases, finding 8,621 publications; 24 articles were included for review. Overall, they found that there is a lack of consistent framework for health humanities learning, teaching, and assessment, which makes it difficult to systematically evaluate within or across curricula. Learning outcomes focused largely on developing reflexivity, capacity for self-reflection, and person-centeredness. Even then, most studies focused on process and content rather than evaluating changes in behavior. According to the authors, these results underscore the importance of articulating a set of core capacities so that there is a greater ability to compare between programs and to evaluate whether learning outcomes are being achieved.

Use of Messaging Principles to Design a Facebook Ad Promoting Public Engagement in Serious Illness Care for National Healthcare Decisions Day. Back AL, Warner MR, Beard KM, Goodnow MH, Constans LA, McCabe PJ. J Palliat Med. 2021 Dec;24(12):1762-1765. doi: 10.1089/jpm.2021.0346. Epub 2021 Oct 20. PMID: 34668792 Dr. Anthony Back has been a Gold Foundation grantee.
While advance care planning is an important priority in end-of-life care, there is great hesitation in the general public toward articulating one’s own plans for palliative care. Public engagement through messaging on social media is one possible approach to address this issue. To that end, Dr. Anthony Back and colleagues designed one 60-second Facebook video and derived three, smaller 10-second Facebook ads, each of which had a slightly different message. They then examined how users interacted with the videos. They used five messaging principles: (1) talk up the benefits, (2) present choices, (3) use stories, (4) invite dialogue, and (5) invoke a new team. In the week that the videos were promoted, the 60-second video was viewed 67,650 times and the three 10-second ads were viewed 253,087 times. The most desirable message was “What matters to me is being near my family,” followed by “I don’t want to go out on a machine” and “I’ve heard so many medical horror stories.”  Moreover, the click-through rate was 1.57%, higher than the average Facebook click-through rate of 0.90%. This high rate means that the cost per click was $0.74 (compared to the Facebook average of $1.72) and cost of sponsoring the full-length video was $0.02 per click. The authors conclude that the utilization of social media ad campaigns can be a cost-effective way to reach wide audiences and deliver important healthcare messages.

Increasing medical student confidence in gender and sexual health through a student-initiated lecture series. Mahabamunuge J, Morel K, Budrow J, Tounkel I, Hart C, Briskin C, Kasoff M, Spiegel S, Risucci D, Koestler J. J Adv Med Educ Prof. 2021 Oct;9(4):189-196. doi: 10.30476/JAMP.2021.90099.1398. PMID: 34692856; PMCID: PMC8521215   Free full text Dr. Jennifer Koestler has been a Gold Foundation grantee.
National surveys consistently demonstrate that medical students perceive that they receive insufficient training on gender and sexual health topics. This gap in training may be linked to a perceived lack of competence in treating patients from gender and sexual minority (GSM) groups. Dr. Jasmin Mahabamunuge and colleagues designed a student-initiated lecture series on topics related to gender and sexual health, and evaluated whether this lecture series led to greater student comfort with discussing topics related to sexual health. 14 lectures were delivered over 2 years. Among the 152 students who attended, 105 completed both pre- and post-lecture series surveys.  Results showed that students had statistically significant greater self-reported comfort with discussing topics related to (1) sexuality with gender, (2) sexual minority patients, (3) HIV prevention counseling, (4) female genital cutting, and (5) intimate partner violence. Qualitative analysis of free-text responses also suggest that lectures were effective and that they should be integrated into the required medical school curriculum. The authors acknowledge that the voluntary nature of the lecture series may skew results since participants were initially more interested in these topics. However, the preliminary results nevertheless suggest that student-initiated lectures may be helpful in addressing this unmet need.

An Interprofessional Group Intervention to Promote Faculty Well-Being: A Randomized Clinical Trial. Hata SR, Berkowitz LR, James K, Simpkin AL. J Contin Educ Health Prof. 2021 Nov 17. doi: 10.1097/CEH.0000000000000404. Epub ahead of print. PMID: 34799518 Dr. Arabella Simpkin has been a Gold Foundation grantee.
Burnout among healthcare professionals has important negative consequences on patient safety, practitioner well-being, and healthcare costs, among other outcomes. Addressing burnout in a way that is practical and sustainable is an important priority. Dr. Susan Hata and colleagues conducted a randomized control trial to evaluate whether a series of interprofessional self-facilitated dinner meetings could help reduce burnout. 25 physicians, nurse practitioners, and certified nurse midwives were enrolled and participated in three monthly self-facilitated groups for faculty. The intervention group had a one-page guide while the placebo group had none. The investigators used questions from the Physicians’ Reaction to Uncertainty Scale, Maslach Burnout Inventory, and Utrecht Work Engagement Scale to operationalize depersonalization, emotional exhaustion, burnout, empowerment, reaction to uncertainty, sense of connection and community at work, and perception that the department is committed to faculty well-being. After three months, there was a comparable reduction in burnout and increased sense of community and connection at work in both groups. The authors highlight that because the benefit appears to be related to better relationships among colleagues rather than specific assigned curricular content, this may be an effective and sustainable approach to maintaining well-being.

Leveraging Podcasts to Introduce Medical Students to the Broader Community of Health Care Professionals. Miller KA, Keeney T, Fialkowski A, Srinivasan S, Singh TA, Kesselheim J, Farrell S, Cooper C, Royce CS. MedEdPORTAL. 2021 Oct 25;17:11191. doi: 10.15766/mep_2374-8265.11191. PMID: 34754938; PMCID: PMC8542682 Dr. Jennifer Kesselheim has been a Gold Professor
Interprofessional education (IPE) has been identified as a way to increase collaboration in health care, reduce diagnostic errors, and lower rates of preventable mortality and morbidity. Yet limited financial resources and administrative support, rigid curricula, and high student workload are barriers for implementation. Dr. Kelsey Miller and colleagues sought to reduce these barriers through creating a podcast series for 135 preclinical medical students preparing to transition to clinical rotations. Four podcast episodes were recorded, focusing on the distinct educational paths, roles, and responsibilities of healthcare team members as well as covering effective communication techniques and learning from interprofessional team members. These podcasts were coupled with an hour-long interactive videoconference with podcast interviewees. There were 197 unique downloads of the podcasts by 80 students, and 95 students signed in to the interactive session. Pre- and post-intervention surveys, based on the IPEC Competency Self-Assessment, showed an improvement in domain scores for both interprofessional interaction and interprofessional values. The authors conclude by noting that podcasts and other virtual tools can be important tools for asynchronous learning.

LGBTQIA+ invisibility in nursing anatomy/physiology textbooks. Ray King K, Fuselier L, Sirvisetty H. J Prof Nurs. 2021 Sep-Oct;37(5):816-827. doi: 10.1016/j.profnurs.2021.06.004. Epub 2021 Jun 17. PMID: 34742510
Despite increasing recognition, there remain considerable health disparities faced by members of the LGBTQIA+ community. Delivering culturally competent care is important in addressing these issues, but classroom materials often fail to represent LGBTQIA+ issues fairly. Dr. Katherine Ray King and colleagues conducted a content analysis of four nursing anatomy/physiology textbooks used in four leading nursing programs to identify such representations. Two researchers methodically coded the texts and compared their findings. They identified four themes: (1) heteronormativity, (2) sex/gender binary, (3) androcentrism, and (4) gender norms. According to authors, the absence of representation and frequent misrepresentation of LGBTQIA+ do not support professional values of ethical nursing. They suggest structural changes to promote inclusivity such as increased use of sidebars, case studies, as well as the removal of pathologizing language and content.

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Bharat Kumar, MD

Humanism in Research Assistant Editor

Updates the staff, databases, and social media about new studies around humanism in healthcare; curates and compiles the monthly Jeffrey Silver Humanism in Healthcare Research Roundup.