Mental illness affects 1.2 million children and youth in Canada. Female adolescents, in particular, suffer significant consequences associated with this. While family physicians are often the first line of contact for a health-related concern, little is known about how the promotion of lifestyle medicine to enhance the mental wellbeing of female adolescents is being communicated. Using a qualitative content analysis approach, a survey about counseling on lifestyle medicine was completed by 126 Hamilton Family Physicians giving a response rate of 25.2%. Key informants discussed with the highest agreement the following three themes: lifestyle medicine factors, barriers, and improvements for communication to female adolescent patients. The global prevalence of female adolescent mental health issues in combination with the use of screening tools was showcased within this study population. Results indicated that Hamilton family physicians integrate global recommendations into their line of care with patient-centered dialogue, awareness of patient needs, and lifestyle medicine education. / Thesis / Master of Science (MSc)

The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting. Routine oncology out-patient consultations from two different hospitals were audio-recorded. After the consultations, patients and oncologists perceptions of the content and quality of the communication were assessed using a self-report questionnaire. A nation-wide survey was performed to assess oncologists’ perceived barriers against psychosocial communication. Finally, the audio-recorded consultations were used for evaluating inter-rater reliability and feasibility of two different communication analysis instruments. Patient-physician consultations in oncology care are focused on the physical aspects of disease and treatment, both in terms of how often these issues were discussed and in terms of the amount of time spent on discussing them. Psychosocial issues, such as the disease’s effects on patients’ emotional or social functioning, are not always discussed during consultations, and the time spent on such discussions is limited. When psychosocial issues are discussed during the medical consultations, they are most often patient-initiated. Reasons for why psychosocial aspects are seldom discussed during the medical consultations can be the barriers concerning this kind of communication perceived by a large majority (93%) of the oncologists. Barriers against psychosocial communication were identified at organizational levels (including guidelines, routines, and resources) and individual levels (including physicians’ knowledge and attitudes). Furthermore, this thesis shows that there are methods with high feasibility and reliability for evaluating the content of patient-physician communication, in large study samples in oncology care. The method (observation/self-report) and perspective (patient, physician, and observer) used when evaluating communication affects the results. This needs to be considered when choosing evaluation methods in intervention studies. There are reasons to continue to evaluate, promote and implement promising ways of achieving better communication in clinical practice. Research should focus on how to overcome barriers against psychosocial communication.

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京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13327号 / 論医博第2195号 / 新制||医||1044(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 伊達 洋至, 教授 佐藤 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

OBJETIVOS Valorar la Implicación del Paciente en la Toma de Decisiones (IPTD) en las consultas de Atención Primaria (AP). MATERIAL Y MÉTODOS Estudio observacional de tipo descriptivo y multicéntrico realizado en Centros de Salud de AP. Un observador validado y entrenado en la escala CICAA-D analizó las videograbaciones de las consultas. RESULTADOS Se analizaron 638 encuentros clínicos; en 387(61%) no se apreció una IPTD. En 251(39%), se detectaron distintos grados de IPTD, de los cuales 161(64%) fueron etiquetados como "toma de decisiones participada" y en el resto 90(36%) como "toma de decisiones compartida". CONCLUSIÓN En la práctica observamos que la IPTD puede tener lugar a diferentes niveles: el "participado" (limitado a la discusión de una única opción de tratamiento) y el "compartido" (suele haber más de una opción). Las habilidades comunicativas que el médico emplea son mayores dependiendo del grado de implicación que tenga lugar en la consulta. / OBJECTIVES To explore patient participation in primary health care consultations. DESIGN Cross-sectional study. Setting. 97 general practices (GP). Patients. 658 patients attending their doctors for unselected reasons. Measurements. All the encounters were video-recorded, and were assessed by a rater using the CICAA-D instrument. After the consultation, GPs completed a questionnaire about biomedical and relational information. RESULTS Encounters were successfully video-recorded: 638. Out of these, only 90 interviews clearly showed patient participation. In other 161 interviews patient participation was considered possible. Consultations were less participatory when GPs declared they were more certain about the evolution of the problem and the usefulness of the tests prescribed to reach a diagnosis. CONCLUSIONS GPs ask patients for their opinion and promote discussion about the suggested plan very infrequently. Doctors should bear this in mind and should at least invite their patients to contribute their opinions when suggesting any action plans.