Over the past few years, the rate of elective interventions in pregnancy in the United States, including elective inductions of labor and elective cesarean deliveries, has increased dramatically. While scholars attribute some of the increase in elective interventions to the female patients who request elective procedures from obstetricians, some literature contradicts that notion and suggests physicians are actually the primary perpetuators of the growth in elective procedures. Although pregnant women may seek elective interventions because of desired convenience, physicians can also claim the benefit of convenience in scheduling deliveries. In addition, elective procedures provide physicians greater monetary compensation than labor and deliveries which evolve without intervention. The current dissertation investigates the communicative role of obstetricians in women’s delivery decisions through in-depth interviews with obstetricians practicing in the state of Kentucky (N=28). Guided by the framework of Message Convergence, the study assesses how obstetricians manage uncertainty surrounding patient care and make clinical decisions in the midst of either unclear evidence or competing messages. The study also reveals the ways that physicians utilize their medical expertise to engage in decision-making with patients. In addition, specific scenarios of decision-making regarding delivery are discussed, including patients’ requests and physicians’ provisions of requests; patients’ requests and physicians’ refusals of requests; and physicians’ recommendations for treatment and patients’ refusals of recommendations for treatment. Finally, the internal tensions and conflicts experienced by physicians in the decision-making process with patients are also examined.

Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings:  Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.

abstract: Chronic illness can be a stressful experience that requires coping and support. In the last twenty years, Shared Medical Appointments (SMAs) were developed in U.S. healthcare as a response to the rising rates and challenges of chronic disease management. Due to the infancy of the SMA model, however, little is known or understood about the benefits of group medical care for patients. To date, scholars have not explored or systematically observed the communicative aspects of the SMA model. Communal coping, a theoretical framework that foregrounds group interaction and communication, offers a pragmatic lens for exploring how patients collectively cope with the stressors of chronic illness in the context of SMAs. Using qualitative methods, I conducted participant observation of SMAs at a Veterans Affairs hospital to analyze the communicative, transactional nature of communal coping as it unfolded among heart failure patients, family members, and providers in context. I also conducted interviews with SMA attendees. Analysis is based on 56 hours of fieldwork and 14 hours of interviews. Findings of this dissertation revealed group members who attended heart failure SMAs engaged in communal coping to manage the stressors of chronic illness. Group members moved through four primary phases of the communal coping process: (1) establish a communal coping orientation; (2) discuss shared stressors; (3) engage in cooperative action; and (4) practice communal reflexivity. Findings suggest patients become empowered by group interaction during SMAs as they move through each phase of the communal coping process. This dissertation also highlights various communicative strategies providers' use during SMAs to facilitate communal coping and group interaction. Theoretically, this dissertation expands upon existing knowledge of communal coping by exploring how individuals embody and socially construct the communal coping process. Specifically, this dissertation extends past models of communal coping with the addition of the communal reflexivity phase and through conceptualizing communal coping as a facilitated process of empowerment. Pragmatically, this research also offers insight to the benefits patients derive from attending SMAs, such as reduced feelings of stigma and isolation and improved motivation. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2015

The goals of this project are twofold. The first goal is to articulate my sense making of reproductive health for Women of color in the United States as a postcolonial condition; one that I trace back to the logics of elimination of settler colonialism (Wolfe, 2006) and frame as maintained through the colonial institutions, or racial projects (Omi & Winant, 2015), of the Prison Industrial Complex, the welfare system, and the health care system which create and perpetuate dominant cultural narratives of “the welfare queen”, “the negligent Black mother”, and “the wily patient”. I show how these narratives colonize the minds of health care providers and contribute to the current stratification of health care. My second goal with this project is to show how postcolonial interpretive ethnography can be used as a narrative medicine educational intervention for providers. Currently, Narrative Medicine asks providers to read themselves, their patients, and their interactions as literature to emphasize the personal and interpersonal tensions that are often lost in the fast paced biomedical world (Charon, 2001). With this project I aim to expand the field of Narrative Medicine to consider the ways patient-provider interactions are postcolonial, and how analyses of these interactions can be a method of decolonization. I do so by analyzing three interpretive ethnographic narratives that I have created which story my interactions with three Women of color: Tiffany, Rose, and Jane. I then analyze each of these interactions for colonizing and decolonizing sense making.

In 2017, approximately 8.5% of pregnant women nationwide used illicit substances during their pregnancies, up from 6.3% just one year prior (NSDUH, 2017). The trends associated with substance misuse and pregnancy are alarming given the risks to both the mother and her child (Behnke et al., 2013). Pregnant women with substance use disorders (SUDs) are thus in critical need of support during the prenatal period (American Society of Addiction Medicine, 2011). However, they also contend with stigma and the possibility of punitive responses (Terplan et al, 2015), which can result in avoidance of treatment. Prenatal care and positive patient-provider relationships are essential to improved health outcomes (Lori et al, 2011). Yet, little is known about the patient-provider relationship for pregnant women with SUDs and what facilitates trust and women’s willingness to engage in care. Informed by recognition theory and intersectionality, this qualitative study aims to fill that gap, emphasizing the ways patients and providers develop and maintain their relationships, as well as their perceptions of each other. Semi-structured interviews were conducted with N=19 postpartum women with SUDs and N=10 prenatal care providers (not matched pairs). Using a two-layered thematic analytical approach – both data- and theory-driven – this research offers a comprehensive examination of prenatal care in the context of SUDs. Women entered into prenatal care feeling ambivalent about their pregnancy, with co-existing emotions such as guilt and excitement. They were also newly motivated to protect their child, and in need of clear medical information that was free of moral judgment. Women and providers identified provider traits that facilitated trust and connection in the patient-provider relationship, such as being nonjudgmental and supportive. Women also emphasized the value of being fully acknowledged as having worth and dignity. Finally, providers discussed the challenges of working with pregnant patients with SUDs, including the limits of their compassion, as well as the limitations of the health care system. Cumulatively, these findings highlight critical needs in prenatal care for women with SUDs, such as acknowledging women’s dignity, and supporting providers with comprehensive training and a health care system better suited to meet their patients’ needs.

Indiana University-Purdue University Indianapolis (IUPUI) / Purpose The experience of surgical patient decision-making for amputation, rotationplasty, or limb salvage surgery for the lower extremity was explored with osteosarcoma survivors and parents. Issues and patient concerns were examined prospectively in Facebook posts and retrospectively in personal interviews. Recommendations were sought for the development of a decision aid. Methods A qualitative inquiry was conducted in two studies: 1) a content analysis of 15 Facebook posts on the Osteosarcoma and Ewing’s Sarcoma Support Group about the surgical decision, and 2) a narrative analysis of 20 interviews with survivors and parents about their lived experience. The interview guide was informed by a knowledge translation theoretical model. In-person or video interviews included 29 parents or adolescent-young adults between the ages of 14-71 across 15 states. Results Participants were concerned about making the best decision for themselves or their child. Having little time to make the decision contributes to feeling overwhelmed and uninformed. The lack of information about options, potential limitations, prosthetic needs, and long-term functional outcomes impacts the decision-making process. Resources for finding information are limited. Shared decision-making approaches were preferred though many decisions were made by the surgeon. Patients felt unprepared for complications encountered after limb salvage. Conclusions Limb salvage surgery remains the gold standard for most providers; participants felt there was a bias on the surgeon’s part for salvage. Potential complications and uncertainties of each option were largely omitted in consultations; information about living with a prosthesis is an unmet need for decision-making. The decision affected their quality of life in ways they did not anticipate, resulting in additional decisions. Implications The findings of this study can be used in medical education for orthopedic surgeons to understand the long-term outcomes of limb salvage surgery. Patient preferences matter in the decision and patients who are involved in the decision are more satisfied if they are prepared for the unknown and potential complications. Recommendations for a decision aid include an online format, content that includes a discussion of uncertainties as well as complications of each option, patient stories for long-term outcomes, and resources for psychosocial support.

No description available.

Background: Much research consistently shows that there are disparities in healthcare delivery. Healthcare disparities affect individuals across a broad range of demographics such as gender, race or ethnicity, and it is also related to socioeconomic factors such as income levels, access to health benefits and insurance, and health literacy. Recent immigrants to Canada encounter a different and unfamiliar healthcare system. This situation presents challenges to the practice of health care delivery. Therefore, it is crucial that innovative strategies be identified to reduce disparities in health care to promote the overall quality of care and public health services. Purpose: The purpose of this dissertation research was two-fold: (1) to examine cultural competence strategies, if any, that are used by healthcare organizations to improve interaction and communication between healthcare providers and their immigrant patients with the purpose to reduce healthcare disparities; and specifically, (2) to explore the use of Information and Communications Technologies (ICTs) to improve communication between healthcare providers and immigrant patients with the objective of reducing healthcare disparities. Methods: This dissertation research employed a mixed methods approach for data collection and analysis. The research was carried out in three phases. In the first phase, a series of focus group discussions with a sample of recent immigrants was conducted. In the second phase, an online survey was conducted to gain insights from healthcare providers regarding the role of ICTs in improving communication with immigrant patients to help reduce healthcare disparities. In the third phase, healthcare providers who participated in the survey were invited to participate in face-to-face, in-depth semi-structured interviews to further reflect on and extend the survey responses. Campinha-Bacote's Cultural Competence Model and Unified Theory of Acceptance and Use of Technology were employed for this dissertation research as its theoretical framework. Results: The findings indicated that the absence of effective communication as well as cultural and language barriers were major issues related to communication between healthcare providers and immigrant patients. The findings also indicated that immigrant patients might need to improve their digital and health literacy skills in order to improve their communication with their healthcare providers. Further, the findings indicated that it was important for healthcare providers to have access to more demographic data on immigrant patients because such data will allow healthcare providers to be better informed on how to most effectively tailor their healthcare services to this population group. Conclusion: Findings obtained from this dissertation research shed light on cross cultural communication issues related to working with immigrant patients that may lead to disparities in health care. Healthcare organizations may use these findings to better inform their decision making with regard to effective patient-provider communication. Finally, the findings bear important implications for the line of research that examines patient-provider communication from immigrant patients' perspectives. They can inform the design of cultural competence strategies for healthcare organizations.

Effective patient-provider communication (PPC) involves conveying sufficient information to a patient such that the treatment is agreed upon and implemented accurately. Furthermore, a patient must feel adequately involved in the treatment process. With the advent of the COVID-19 pandemic, many clinical visits were shifted online. Although telemedicine was successful in meeting pandemic-specific goals, such as lowering personal contact, it changes the communicative context. Both patients and providers get less input from body language (nonverbal communication) and rely more on verbal communication. Furthermore, the number of telemedicine visits conducted remains elevated over pre-pandemic levels. Much of what is known about effective PPC is derived from studies in in-person contexts, with little information available in virtual contexts. Given that even occasional lapses in optimal PPC can have severe effects on patient outcomes, it is essential to understand PPC in various settings to optimize patient outcomes in the long run. This study was a secondary data analysis of the UCF Student Health Services Patient Satisfaction Questionnaire. A total of 6645 survey results from January 2021 to November 2022 were analyzed to compare patient perceptions of PPC variables and overall satisfaction with the clinical visit. The results indicated that there was no statistically significant difference in overall satisfaction and PPC variables between telemedicine and in-person visits. However, the results revealed that different PPC variables contributed to overall satisfaction with telemedicine and in-person visits. Keywords: patient-provider communication, telemedicine, telehealth, COVID-19, patient satisfaction, college

No description available.