Thesis (M.A.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Nov. 30, 2009). Includes bibliographical references (p. 100-104).

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)

Few interpersonal and organizational communication studies examine the professional and organizational aspects of career satisfaction among minority physicians. Due to the underrepresenation of minority physicians, most studies resort to comparing aggregate groups of minority physicians in juxtaposition to non-minority physicians. These studies fail to uncover possible communication differences, which originate from cultural dissimilarities between disaggregate racial/ethnic groups. Even fewer studies examine physicians' written communication to open-ended survey questions about career satisfaction/dissatisfaction between disaggregate racial/ethnic minority groups and non-minorities. This study specifically examines written responses to two open-ended survey questions about professional and organizational dissatisfaction and compares responses from disaggregate minority physician and non-minority physicians. Participants were divided into five response-driven categories of race/ethnicity as follows: Asian/Pacific Islander, Black/African American, Indian/Pakistani, Hispanic, and White/Non-Hispanic. The population consists of 1849 members of the medical staff roster of a Southeastern, U.S., not-for-profit hospital group. Primary findings indicate the presence of recurrent themes among disaggregate minority physician racial/ethnic groups' responses. Significant variation exists between responses from disaggregate minority physician racial/ethnic groups and non-minority physicians. Results imply that open-ended methods of data collection are essential to gaining knowledge about ways cultural dissimilarities between disaggregate minority racial/ethnic groups affect communication and satisfaction. Understanding more about cultural dissimilarities is necessary for: improving data collection quality; recruiting and retaining minority physicians; and reducing healthcare disparities among minorities.

Abstract This quasi-experimental design study compared two small samples of Emergency medicine residents after one group had an educational intervention on death notification skills and the other did not. Comparisons were made on residents’ confidence in their communication, interpersonal skills and level of compassion fatigue/satisfaction and EM Residents’ level of Secondary Traumatic Stress after an event of patient death and subsequent notification of Secondary Patients. Residents were interviewed to gather recommendations for designing death notification curriculum. Over an eight month period, forty emergency medicine residents at two sites, control and intervention, completed surveys designed to provide quantitative data on self-confidence and stress related to recent patient deaths. Residents who participated in a death notification event completed the Secondary Traumatic Stress Scale. Interviews were conducted to gather information on the impact of the notification and recommend changes in curriculum at the experimental site. The data infer that an educational intervention on death notification skills increased residents’ confidence in their ability to give compassionate death notification to families as compared with the control group. Residents in the intervention and control group had no significant differences in their potential for compassion satisfaction. Residents who had the educational intervention showed less Secondary Traumatic Stress symptoms than their non-intervention counterparts. The intervention group showed less risk for burnout (although it would only be significant at p < 0.10). The overall conclusion is that there is some evidence for a positive effect of the intervention. However, due to the small sample size the conclusion is tentative and more research is needed to evaluate the training.

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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<p><strong>OBJECTIVE: </strong>The aim of this study was to explore an alternative method of secure data exchange of patient information among physicians using their existing email.<strong></strong></p> <p><strong>METHODS: </strong>A four-step framework was designed to effectively conduct the research. It involved designing a prototype of a web-based system called ST-SecRx to simulate secure communication between physicians while exchanging sensitive patient data through email. The simulation achieved through the system was meant to determine and measure response of physicians to the use of secure email or similar communication tools for exchanging patient data. Physicians were invited to use ST-SecRx and subsequently participate in a survey to determine its acceptability and their perceptions about the usefulness of the software. Finally, the data collected from the survey were analyzed.</p> <p><strong>RESULTS:</strong> Data were collected from 22 physicians from various healthcare facilities in the province of Ontario, Canada. Eliminating questionnaires with no response resulted in 19 valid responses. Results revealed that 57.9% used email support provided by their organization for exchanging patient data. Over 70% acknowledged that factors such as: ease of use, not having to use an email different from the one provided by their employer, not having to create and remember new password every three to six months, and data transfer complying with privacy regulations would facilitate their use of ST-SecRx. More than 50% of the physicians felt that the simulated system as demonstrated to them was more secure and easier to use when compared to previously used methods of patient data exchange through email. The majority of the physicians (from 57.9% to 73.7%) agreed with all the six questions on behavioral intention to use ST-SecRx. Overall 42% were willing to pay between $5 and $20 per month for ST-SecRx. Additional analysis of data by age, sex and discipline did not reveal any substantial differences in their enthusiasm to use the system.</p> <p><strong>CONCLUSION: </strong>The current research was successful providing data on what is important to clinicians who want to exchange data on patients with other clinicians. Use of systems similar to the prototype ST-SecRx could be an improvement over conventional email, provided that they would ensure security using encrypted technology under public key infrastructure methods and systems. Overall the physicians were satisfied with ST-SexRx and found it simple, fast, easy to use, and secure, and they indicated that they intended to use it if it were made available and it conformed to privacy and security standards. Also, such a secure system would have the potential to reduce the overall cost of healthcare by reducing duplication of diagnostic tests and making patient- specific information exchange faster. More research needs to be conducted with a larger sample size to validate the findings of this study. The limitations, dissatisfaction, and concerns expressed by the physicians who used ST-SecRx could direct future research. Future studies could include other healthcare professionals in the exchange of sensitive clinical data.</p> / Master of Science (MSc)

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