Effective physician-patient communication is primary to successful medical consultation and encourages a collaborative interactional process between patient and doctor. Collaborative communication, rather than one-way authoritarian, physician-led medical interview, is significant in navigating difficult circumstances such as delivering "bad news" to patients diagnosed with cancer. Additionally, the potential psychological effects of breaking bad news in an abrupt and insensitive manner can be devastating and long-lasting for both the patient and his or her family. The topic of delivering unfavorable news to patients is an issue that many medical professionals find to be challenging and is now getting the attention of medical professionals in many countries, including the former Soviet Union (FSU) republics. The limited literature on communication skills in oncology in the FSU republics supports that the physician-patient communication style is perceived as significantly physician-oriented rather than patient-oriented. More specifically, the Soviet medical education system, as well as post-graduate medical education, has placed little to no emphasis on physician-patient communication training. Physician-oriented communication leads to patients being less forthcoming and open regarding their own feelings about being diagnosed with cancer, which may exacerbate the overall communication problem. The purpose of this study was to investigate the effectiveness of the training program "Delivering Unfavorable News to Patients Diagnosed with Cancer" (Baile et al., 2000) conducted in Uzbekistan, one of the FSU republics. A total of 50 oncologists from the National Oncology Center of Uzbekistan (N = 50, n = 25 , n = 25 ) completed Self-Efficacy, Interpersonal skills (FIRO-B), Empathy (JSPE), and Physician Belief (PBS), and demographic instruments before, immediately after, and then two weeks after the training intervention. Results of MANOVA and bivariate statistical analyses revealed significant differences in self-efficacy, empathy, and PBS scores within the experimental group, but not within the control group, from pre-test to post-test. The follow-up data analysis suggested that participants maintained the level of change that occurred immediately after the training intervention.

This thesis comprises three chapters involving the analysis of the body mass index (BMI) in health economics. The first chapter evaluates two correction models that aim to address measurement error in self-reported (SR) BMI in survey data. This chapter is an addition to the literature as it utilizes two separate Canadian datasets to evaluate the transportability of these correction equations both over time and across different datasets. Our results indicate that the older method remains competitive and that when BMI is used as an independent variable, correction may even be unnecessary. The second chapter measures the relationship between long-term physician costs and BMI. The results show that obesity is associated with higher longterm physician costs only at older ages for males, but at all ages for females. We find that accounting for existing health conditions that are often associated with obesity does not explain the increase in long-term physician costs as BMI increases. This indicates that there is an underlying relationship between the two that we could not account for in our econometric models. Finally, the third chapter decomposes the differences in BMI distributions of Canada and the US. The results show that the differences between BMI levels, both over time and across countries, are increasing with BMI; meaning the highest difference is observed at the right tail of the two distributions. In analysis comparing two points in time, these differences are solely due to differences in the returns from attributes and the omitted variables that we cannot account for in our models. In cross-country analysis, there is evidence that the differences observed below the mean can be explained by the differences in characteristics of the two populations. The differences observed above the mean are again due to those in returns and the omitted variables. / Dissertation / Doctor of Philosophy (PhD)

Communication between the patient and the physician in clinical encounters has traditionally been considered a passive interaction on the side of the patient, whereby the healthcare provider examines the patient's condition and circumstances, evaluates the situation, and prescribes a certain treatment plan or procedural solution that will heal the patient's ailment. However, recent research and fundamental communications understanding strongly emphasizes that effective communication is a two-way endeavor that ideally should involve input and insight from both sides of the conversation. Treating all clinical interactions as a one-way didactic experience where a provider usually goes through a checklist of commonalities would seem to not approach the same level of patient satisfaction and understanding as active mutual participation employing common conversational and argumentative techniques by both sides of the patient-physician dyad. The Conversational Argument Coding Scheme, presented by Canary et al., was implemented in a slightly modified format to code transcripts of clinical encounters in a college setting. It was demonstrated that clinical encounters employing more forms of conversational argumentation did not statistically correlate to increased ratings of patient satisfaction/knowledge, but did not harm these ratings in a significant manner. This could be due to the limitation that the study was conducted with a patient population consisting entirely of enrolled college students on campus, implying a greater degree of health literacy and education level that highlights that a presence or lack of teach-back or other mutual participation would not significantly affect patient satisfaction/knowledge in the clinical encounter. Further research needs to be conducted to prove this correlation, but as of now, it would be in good practice and in good faith for healthcare providers to employ teach-back or to encourage mutual participation and conversation in their clinical encounters.

This research investigated the role religion plays in how individuals view euthanasia and physician-assisted suicide. One hundred participants from each of the three major monotheistic world religions were given a seven-question survey. The seven questions consisted of statements regarding the knowledge of their own religion, how the participants feel about terminally ill patients and those who have lost vital functions, and also whether or not they believe euthanasia is morally just. It was predicted that the participants who belong to Judaism and Islam viewed euthanasia as morally just and participants who belong to the Christianity viewed euthanasia as morally incorrect.

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The thesis refines the analytical categories of ‘refugee’ and ‘highly skilled migrant’ by exploring the experiences of non-European medical doctors who came to Sweden as refugees. As a narrative research study, the thesis is based on seven in-depth semi-structured interviews with refugee doctors who live in Sweden. By employing Van Hear’s concept of mixed migration and the notions of human, social and cultural capital, the thesis accounts for the interconnectedness of research participants’ migratory and professional trajectories. The analysis of the complex criss-crossing of their doctor and refugee identities makes use of Brubaker and Cooper’s concepts of identification and categorization, and self-understanding and social location which are further developed by Jenkins’ theory on social identity and Anthias’ concept of translocational positionality. The thesis concludes that these individuals’ migratory trajectories cannot be ranked as either forced or voluntary, but have to be conceptualized in terms of mixed migratory movements. In the same vein, the thesis points to the processual nature of identity which is always partly self-constructed and partly determined by the external categorizations, and hence pleads against the essentialization of migrants’ identities, be it that of a ‘refugee’ or ‘highly skilled migrant’.

This study examined patient behavior in the emergency department and trained physicians to respond to that behavior. It demonstrated that physicians can increase patient satisfaction by responding to the thoughts, feelings and actions which the patients are experiencing. The literature provided variables for patient satisfaction and physician counseling techniques. These variables provided the base for a Patient Satisfaction Inventory (PSI) and a training module for the physicians. Patient behavior was evaluated through the clinical Thinking, Feeling and Acting interview, given to patients, before and after each patient was seen by the physician. This information was then provided to the physicians. For half of the patients, physicians responded according to patients thinking. feeling and acting components of behavior. For the others, physicians received no information other than the generic summary card summarizing thoughts, feelings and actions of the patients as a group. The PSI was completed by all patients after discharge from the emergency department. Pre and post training scores were compared on the PSI to determine if there was a difference in patient satisfaction. An increase in patient satisfaction was experienced after the physicians were trained to purposefully respond to patient behavior. On the PSI, patients perceived greater compassion, understood and communicated with the physician better, and perceived more accurate diagnoses and treatments. These increases in patient satisfaction were significant (p < .01) regardless of whether the physician had the actual patient information from the clinical TF A interview or just the generic summary. The physicians seemed to become sensitized to the patients needs by organizing the data they already had about the patients. Implications for the counseling field and training physicians to better serve their patients were discussed. / Ed. D.