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Using mainly quantitative methods of evaluation, as well as patient comment assessment, this study evaluated whether changing the current informed consent process for labor epidural analgesia to a longer, more informational process resulted in a more satisfied patient. Satisfaction with the labor epidural informed consent process was evaluated using a questionnaire that was mailed and also available online. Half of the patient population was given a written labor epidural risk/benefit document at their 36-week obstetric check up. All patients received the standard informed consent. Survey responses were evaluated based on three independent variables dealing with the modality, timing, amount of informed consent information and one dependent variable, whether the patient's expectations of the epidural were met, which is equated with satisfaction. Patients in this study clearly indicated that they want detailed risk/benefit information on epidural analgesia earlier in their pregnancy. A meaningfully larger percentage of patients who received the written risk/benefit document were satisfied with the epidural process as compared to those who did not receive the document.

Made available in DSpace on 2015-03-05T18:11:56Z (GMT). No. of bitstreams: 0 Previous issue date: 19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este trabalho está vinculado a um projeto de pesquisa maior (OSTERMANN, 2005) que tem como objetivo analisar as interações entre médicos/as e pacientes que buscam atendimento ginecológico e obstétrico em um posto de saúde da região metropolitana de Porto Alegre, Brasil. A abordagem teórica e metodológica utilizada é a da Análise da Conversa (SACKS, 1992; WOOFFITT, 2005; HUTCHBY e WOOFFITT, 1998) e a da Sociolingüística Interacional (OSTERMANN, 2003; GUMPERZ, 1998; GOFFMAN, 1995), que propõem investigações de dados naturalísticos, os quais são, nesta pesquisa, 144 consultas médicas gravadas em áudio e transcritas de acordo com as convenções propostas por Jefferson (1984), além de anotações de observações sobre a instituição investigada. Este estudo investiga quais as identidades que emergem nas interações e como elas são negociadas pelos/as interagentes nos diferentes momentos das consultas (BUCHOLTZ, 1999; BUCHOLTZ e HALL, 2005; ECKERT e McCONNELL-GINET, 1992 e 2003; OSTERMANN, 2003 e 2006). Verificou-se que / This paper draws from a larger research project (OSTERMANN, 2005) that aims at investigating how doctors and patients, who seek gynecological and obstetrical consults in a public health center Southern Brazil interact. The theoretical and methodological approaches that underlie the research study are Conversation Analysis (SACKS, 1992; WOOFFITT, 2005; HUTCHBY e WOOFFITT, 1998) and Sociolinguistics (OSTERMANN, 2003; GUMPERZ, 1998; GOFFMAN, 1995), which propose investigations of naturalistic data. That data analyzed consists of 144 medical consultations recorded in audio and transcribed according to the conventions proposed by Jefferson (1984), as well as noted observations about the investigated institution. This study investigates which identities emerge in the interactions and how they are negotiated by the interactants during the different moments of the consultations (BUCHOLTZ, 1999; BUCHOLTZ e HALL, 2005; ECKERT e McCONNELL-GINET, 1992 e 2003; OSTERMANN, 2003 e 2006). It was verified that different identi

Submitted by Maicon Juliano Schmidt (maicons) on 2015-05-26T14:11:20Z No. of bitstreams: 1 Joseane de Souza.pdf: 968658 bytes, checksum: 829b2d7efae01f53c4f417cbdf44f8eb (MD5) / Made available in DSpace on 2015-05-26T14:11:20Z (GMT). No. of bitstreams: 1 Joseane de Souza.pdf: 968658 bytes, checksum: 829b2d7efae01f53c4f417cbdf44f8eb (MD5) Previous issue date: 2015-03-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta tese provém de uma pesquisa de doutorado em Linguística Aplicada que visa a entender como se dão as interações entre oncologistas e mulheres com câncer de mama em consultas de acompanhamento ao longo de seus tratamentos ou de revisão. O foco do estudo foi em atendimentos que não consistiam em comunicação de más notícias (uma vez que as pacientes já haviam passado pelo diagnóstico de câncer) nem em tratamento de pacientes terminais. A literatura a respeito da relação médico-paciente no câncer tem englobado largamente esses dois pontos. Entretanto, a preocupação com a interação em consultas mais rotineiras, durante os tratamentos e nas revisões periódicas, em que nenhum diagnóstico ou prognóstico negativo é de fato entregue pelo médico, ainda é escassa. A metodologia utilizada advém da abordagem teórico-metodológica da Análise da Conversa ou Fala-em-Interação (SACKS, 1992; OSTERMANN; MENEGHEL, 2012). Seu foco é a observação, gravação em áudio (podendo ser também em vídeo) e posterior descrição das interações, das características das ações que os participantes ali produzem e de como as ações de um interagente afetam o outro, que irá produzir suas ações em resposta. Os dados (24 consultas gravadas em áudio) foram coletados em um hospital da região sul do Brasil que possui um centro para tratamento de câncer, transcritos segundo convenções próprias da área (JEFFERSON, 1984) e então analisados. A partir das análises, são descritas ações recorrentes realizadas por oncologistas e pacientes, tais como solicitações de avaliação; avaliações do próprio estado emocional; avaliações de estado físico; recomendações e avaliações prognósticas com justificativas e argumentação; accounts. Essas ações interacionais revelam que os participantes estão a lidar com a impossibilidade da certeza em vários aspectos nas consultas; por exemplo: a impossibilidade de uma avaliação prognóstica absolutamente certa, a impossibilidade de certeza sobre estar-se livre de recidivas, a impossibilidade de certeza de que determinados testes realmente servirão de base para as tomadas de decisão necessárias, etc. Além disso, algumas ações dos médicos (avaliações positivas, recomendações e avaliações prognósticas com justificativas e argumentação e accounts) possuem um potencial de tranquilização da paciente ao poderem diminuir incertezas por meio da construção de uma maior assertividade. Ao final, a contribuição do estudo pode consistir no aprimoramento de um dos eixos básicos da relação médico-paciente: como humanizar a relação oncologista-paciente de câncer de mama por meio de um aparato comunicacional – as práticas interacionais de gerenciamento da certeza. / The present dissertation derives from doctoral research in Applied Linguistics that aims at understanding how interactions between oncologists and women with breast cancer play out in long-term treatment consultations and/or follow-up ones. The focus of the study was neither on consultations where bad news was delivered (since the patients had already been diagnosed with the illness) nor on those with terminally ill patients. Literature on the doctor-patient relationship in cancer has largely covered these issues. However, concern about verbal interaction in routine consultations during treatment and in periodic revisions, during which no diagnosis or negative prognosis is actually delivered by the doctor, has been scarce. The methodology used originates in the theoretical-methodological approach of Conversation Analysis or talk-in-interaction (SACKS, 1992; OSTERMANN; MENEGHEL, 2012). Its goal is the observation, audio (or video) recording and latter description of the interactions, the characteristics of the actions the participants produce therein and how one party’s actions affect the other, who will, in turn, produce his/her action in response. The data (24 audio recordings) were collected in a hospital in southern Brazil which is equipped with a cancer treatment center, then transcribed in accordance with conventions used in the field (JEFFERSON, 1984), then analyzed. From the analyses, recurring actions performed by doctors and their patients are described, such as requests for assessments; self-assessments of a patient’s emotional state; physical assessments; recommendations and prognostic evaluations with justifications and argumentation; accounts. These interactional actions show that the participants are dealing with a situation in which certainty is impossible in various aspects of the consultations, for instance: the impossibility of an absolutely certain prognostic evaluation, the impossibility of being sure about not having a relapse, the impossibility of certainty with regard to whether certain tests will actually serve as a basis for making necessary decisions, etc. Furthermore, some of these actions by the doctor (positive assessments, recommendations and prognostic assessments with justifications and argumentation, and accounts) have the potential to reassure the patient as they can reduce uncertainty by means of the construction of assertiveness. Ultimately, the contribution of this study may lie in the improvement of one of the basic axes of the relationship between doctors and their patients: how to humanize the oncologist-breast cancer patient relationship by means of a communicational apparatus – the interactional practices of certainty management.

The national recommendations for use of the prostate specific antigen (PSA) test for prostate cancer screening have been modified over the years as scientific evidence emerged. Current screening recommendations discourage widespread PSA screening for men at low to average risk, but provide specific guidelines for shared-decision making between men and their health providers about the benefits and risks of PSA testing. This study was an examination of relationships between men’s assessment of the quality of their care and communication with their health providers, the extent to which providers engage men in recommended discussions about PSA testing, and factors associated with shared-decision making and PSA testing. Secondary data from the U.S. Health Information National Trends Survey 4, Cycle 2 that included men with no history of prostate cancer and in the recommended age ranges for prostate cancer screening were analyzed (N=777). Non-Hispanic white men rated their quality of care higher than men of other races (c2 (49, n=635) = 7.23, p = 0.0098), whereas Hispanic men gave the lowest ratings compared to other men (c2 (49, n=635) = 5.42, p = 0.024). Previous PSA testing was reported by 64% of the men, 56% of whom stated that they discussed screening with their provider and 80% reported that they were asked if they wanted to have the test done. However, only 21% - 39% reported having ever discussed the pros and cons of PSA testing. Discussing PSA testing with a provider was the strongest predictor of obtaining the test (OR=69.5, CI = 23.6 – 204.6) but the effect was significantly modified when providers and patients engaged in the shared-decision making process (OR = 47.42, CI = 14.91 – 150.74). Age, education level and perceived quality of care were consistent, positive predictors of PSA testing. These results indicate there is a gap in provider-patient discussions about PSA screening and suggest that health providers may not be following the recommended guidelines for the content of the discussions needed to facilitate shared-decision making. Effective provider-based interventions to increase shared-decision-making about PSA testing are needed if the national objectives for prostate cancer screening are to be met.

Thesis (Ph.D.)--University of Wollongong, 2006. / Typescript. Includes bibliographical references: leaf 343-380.

This work is focused on communication improvement in tracheostomized and laryngektomized patients. I have chosen the topic because, according to my opinion, communication between people is very important. If there is an obstacle on communication, it brings about a lot of problems in human life which is very stressful indeed. By tracheostomy and laryngectomy performing, a barrier in spoken verbal communication arises and therefore it is important to address this issue and focus ourselves on the help to these patients. After tracheostomy the function of vocal cords is disabled and laryngectomy means a surgical removal of the larynx. In these clients, either temporarily or permanently, disruption in spoken verbal communication occurs. There are several ways how to compensate the spoken verbal communication. As a substitute, however, the most frequently used is the written verbal communication. According to my opinion it would be appropriate to include pictograms into the care of these patients. Pictograms are cards with pictures. When they are used for communication in hospital, they are supplemented with words or short phrases that clearly express the particular notion or feeling. The cards are supposed to help a client who has problems with verbal communication, but also health care workers. Therefore we set a goal to create pictograms and bring them into practice, then to determine whether the use of pictograms in practice contribute to a better communication between nurses and a tracheostomized or a laryngectomized patient and to find out whether the use of pictograms has an influence on cooperation between the family of a tracheostomized or laryngectomized patient and members of the health care team. We also wondered if patients and nurses would recommend or would not recommend the continued use of pictograms in practice.

The health care industry is currently experiencing many changes. Managed care is altering the way health care is delivered through advances in technology and new approaches in financing. As part of this transition, importance will be placed on patients becoming better consumers and participants in determining their health care service needs. The focus of this study is on the non-compliant patient and the many factors that revolve around this topic.

Farmaceuter är den yrkesgrupp med bäst insyn i alla läkemedel en patient tar i öppenvården. En bra kommunikation är oftast avgörande för en bra behandling och kan bidra till att förebygga biverkningar av medicinering och påverka individuella och samhällsenliga beslut som förbättrar hälsan. Specialister bör hjälpa patienter att komplettera sina kunskaper om sjukdomar och läkemedel. Detta förhindrar användning av förvirrande, otydlig och osannolik information som utgör ett hot mot patientens hälsa och till och med livet. I denna litteraturstudie granskades fyra artiklar från databasen OneSearch. Syftet var att undersöka vikten av aktivt lyssnande och dess betydelse vid kommunikation. Resultatet visar att aktivt lyssnande är en viktig komponent i initiala interaktioner och ökar mottagarens uppfattning om att känna sig förstådd, ge större konversationstillfredsställelse och gör samtalspartnern mer socialt attraktiv. Dessutom kan det påverka och vara en bidragande faktor till ökad kompetens inom andra områden inom kommunikation, såsom själveffektivitet och känsla av delaktighet. Det har också påvisats att parafrasering, en teknik inom aktivt lyssnande ger en ökning av den sociala attraktionen för intervjuaren, då en lyssnare som parafraserar erhållet budskap visar större intresse och skapar känsla av sammanhang med en samtalspartner. Aktivt lyssnande kan vara en bidragande faktor till att kunna kommunicera på ett effektivt sätt vilket är nödvändigt för att kunna erbjuda en högkvalitativ rådgivning och sjukvård på apoteket. Slutsatsen är att kommunikation har en meriterande och avgörande roll i farmaceutens arbete. En god kommunikationsförmåga samt lyssnarförmåga, vilka bygger på fullständig uppmärksamhet på vad en person säger. Att lyssna noga samtidigt som intresse visas och inte avbryta är avgörande för att förstå patienten, förmedla information kring läkemedel på ett tydligt och begripligt sätt. Dessutom förbättras patientens följsamhet till läkemedelsbehandling. Studier som använts i litteratursarbetet kan dock inte jämföras fullt ut med varandra, då samma mätmetoder inte har använts. / Pharmacists are the professionals, which have the best insight into all of the drugs a patient takes in outpatient care. They also see more patients in one day than other health care professions. Good communication is often crucial for good treatment and can help prevent the side effects of medication and have an influence on individual and societal decisions thus promoting health. Specialists should help patients supplement their knowledge of diseases and medicines, which prevents the use of confusing, unclear, and improbable information that poses a threat to the patient's health and even life. In this literature study, four articles from the OneSearch database were reviewed. The purpose was to investigate the importance of active listening and its influence on communication. The results showed that active listening is an important component in initial interactions and increases the recipient's perception of feeling understood. Furthermore, active listening leads to greater conversational satisfaction and makes the conversation partner more socially attractive. It can influence and be a contributing factor to increasing other areas of communication such as self-efficacy, and a sense of participation. It was also shown that paraphrasing, a technique in active listening, increases the social attraction for the interviewer, as a listener who paraphrases the received message shows greater interest and creates a sense of connection with the conversation partner. Active listening can be a contributing factor to being able to communicate effectively, which is necessary to be able to offer high-quality advice and medical care at the pharmacy. The conclusion is that communication has a meritorious role in the pharmacist's work. Good communication ability and listening skills that are based on full attention to what a person says and listening carefully while showing interest without interruption are crucial to understand the patient. It helps with conveying information about drugs in a clear and comprehensible way and improve the patient's adherence to drug treatment. Studies used in this literature work can, however, not be fully compared with each other, as different measurement methods have been used.

This study examined women's health messages found on ten endometriosis websites. Qualitative research methods were used to investigate messages available via Internet media about causes and treatments of endometriosis, particularly as they relate to the suggestion that hysterectomy and pregnancy are effective treatments. Messages about infertility, physician-patient communication, and accessibility were also examined. Findings indicate that the websites provided similar messages regarding the symptoms, causes, and treatments of endometriosis; results pertaining to infertility were mixed. Little information was available on methods of improving physician-patient communication. Most websites provided additional low-cost information while requiring minimal technological competency or additional software of site patrons. The results of this study have implications for future research in medical science and communication and reflect the importance of research on women's health communication. A detailed discussion of findings and suggestions for further research are offered. The author's own experiences with endometriosis are incorporated into the analysis.