Orit Karnieli-Miller - Academia.edu (original) (raw)
Papers by Orit Karnieli-Miller
Qualitative Health Research
People with mental illnesses face the dilemma of whether to disclose or conceal their diagnosis, ... more People with mental illnesses face the dilemma of whether to disclose or conceal their diagnosis, but this dilemma was scarcely researched. To gain in-depth understanding of this dilemma, we interviewed 29 individuals with mental illnesses: 16 with major depression/bipolar disorders and 13 with schizophrenia. Using a phenomenological design, we analyzed individuals’ experiences, decision-making processes, and views of gains and costs regarding concealment and disclosure of mental illness. We found that participants employed both positive and negative disclosure/concealment practices. Positive practices included enhancing personal recovery, community integration, and/or supporting others. Negative practices occurred in forced, uncontrolled situations. We also identified various influencing factors, including familial norms of sharing, accumulated experiences with disclosure, and ascribed meaning to diagnosis. Based on these findings, we deepen the understanding about decision-making p...
Journal of Youth Studies, 2017
The study examined at-risk youths' meaning making of their own significant life events and the co... more The study examined at-risk youths' meaning making of their own significant life events and the contribution of these events to changes in their lives. Narrative interviews with 14 Israeli at-risk youths (aged 16-18) revealed three themes: (a) the event as a powerful, emotional-awakening experience; (b) self-inquiry following the event, differentiating between life before and after, and (c) biographical changes in the youths' lives. Despite the diversity of the events, certain similarities were identified among them: they were perceived as surprising in their timing and intensity, as conveying a broader message, and as the cause of the youths' choice to take responsibility for themselves and their interactions with significant others. Use of narrative theories of personality provides insight into at-risk youths' meaning making of their difficult experiences. The deep exploration and construction of these experiences reveal the process in which difficult life events can lead to positive changes.
Nature Metabolism
Sexual dimorphisms are responsible for profound metabolic differences in health and behavior. Whe... more Sexual dimorphisms are responsible for profound metabolic differences in health and behavior. Whether males and females react differently to environmental cues, such as solar ultraviolet (UV) exposure, is unknown. Here we show that solar exposure induces food-seeking behavior, food intake, and food-seeking behavior and food intake in men, but not in women, through epidemiological evidence of approximately 3,000 individuals throughout the year. In mice, UVB exposure leads to increased food-seeking behavior, food intake and weight gain, with a sexual dimorphism towards males. In both mice and human males, increased appetite is correlated with elevated levels of circulating ghrelin. Specifically, UVB irradiation leads to p53 transcriptional activation of ghrelin in skin adipocytes, while a conditional p53-knockout in mice abolishes UVB-induced ghrelin expression and food-seeking behavior. In females, estrogen interferes with the p53–chromatin interaction on the ghrelin promoter, thus b...
Patient Education and Counseling
Physicians' roles include interpersonal professional encounters with patients, family members... more Physicians' roles include interpersonal professional encounters with patients, family members, and the healthcare team. The communication and relationship that develop from these encounters is central for high-quality care. Some encounters are challenging and potentially conflictual. Hence, physicians may need to apply assertive behavior/communication; namely, to share and protect their needs, rights, and values while addressing and preserving those of the other. Clinicians, researchers, and the public consider assertive communication style as a positive and necessary interpersonal communication skill. However, despite recognizing its importance to patients and nurses, the literature regarding physicians' needs and use of assertiveness is insufficient. The present scoping review protocol focuses on exploring and mapping the breadth of the literature focused on physicians' assertiveness from different career stages- senior MD's, residents, interns, and medical students.
Israel Journal of Health Policy Research
A recent paper has focused on residents' poor lifestyle habits and their potential negative i... more A recent paper has focused on residents' poor lifestyle habits and their potential negative impact on patients' lifestyles. This commentary argues that there are even greater reasons to be concerned about the health and well-being of residents and medical students and the resultant effects on patients throughout the careers of these learners. There is a “hidden curriculum”, i.e., customs, rituals and norms of behavior, in medical education and in the training at the healthcare setting, often contradicts the formal curriculum and include messages that neglect the basic needs of the learners as well as the patients. Due to the impact of these messages on the professional identity formation of learners, including a deterioration in their own wellbeing as well as impairment of their ability to empathize with and care for patients, we must align our formal and hidden curricula to show dignity and caring for learners, colleagues, and patients. To do this well, we need to change ou...
Harefuah, 2021
INTRODUCTION The COVID-19 pandemic posed unique challenges to medical teams in general and in the... more INTRODUCTION The COVID-19 pandemic posed unique challenges to medical teams in general and in the field of obstetrics in particular, where the provision of medical services could not be postponed. Optimal care during the COVID-19 outburst required rapid adjustment to changes, ensuring staff and patients' safety while maintaining close and direct contact with patients. OBJECTIVES To explore obstetricians' experiences during the first outburst, focusing on their challenges, needs and ways of coping. METHODS Semi-structured in-depth interviews were conducted online with 13 senior physicians and residents (7 women, 6 men) from four hospitals, who worked in obstetrics. The interviews were analyzed using the Immersion/Crystallization method developed in medicine focused on their experiences. RESULTS The findings revealed that alongside the impressive mobilization of the teams during this period, physicians encountered various challenges. These included being overwhelmed with the e...
Medical Teacher
Breaking bad news (BBN) is a difficult task that requires multiple professional competencies. The... more Breaking bad news (BBN) is a difficult task that requires multiple professional competencies. The way it is managed has implications for all involved in the encounter: the patient, family members, and the news provider. Existing guidelines were developed mainly at the turn of the millennium and require updating based on identification of daily clinical needs and pedagogical challenges while teaching the current protocols. Furthermore, there is a need to provide an overview of BBN encounters as a process, rather than a subdivided event, to help practitioners adopt an approach that might serve them in their daily routines. This twelve tips article summarizes research and practical experience for handling BBN encounters, from their preparation, through delivering the news while attending patients and family members' needs, toward documenting the news, and critically reflecting on the interaction. The tips are structured and explained to serve both practitioners and medical educators.
Autism
The lockdown that was imposed by governments as part of the attempt to contain the COVID-19 pande... more The lockdown that was imposed by governments as part of the attempt to contain the COVID-19 pandemic included extreme measures, such as home confinement and the shutting down of special education systems. Our aim was to learn about the core experiences of parents of children with autism during this significant life disturbance. Thirty-one parents of 25 children with autism participated in semi-structured telephone interviews which were transcribed verbatim and underwent a qualitative, immersion/crystallization analysis. The analysis was conducted in an iterative consensus-building process to identify parents’ experiences, concerns, challenges, coping strategies, and perceived needs during the lockdown. The main themes that emerged related to the various parental concerns; the major difficulties encountered during this unique time, the functional, social, and behavioral implications the lockdown had on these children; and the manner in which the parents coped as an indication of thei...
Cell Reports
Summary Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via a... more Summary Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via an unknown mechanism. Here we discover that ultraviolet B (UVB) exposure enhances the levels of sex-steroid hormones and sexual behavior, which are mediated by the skin. In female mice, UVB exposure increases hypothalamus-pituitary-gonadal axis hormone levels, resulting in larger ovaries; extends estrus days; and increases anti-Mullerian hormone (AMH) expression. UVB exposure also enhances the sexual responsiveness and attractiveness of females and male-female interactions. Conditional knockout of p53 specifically in skin keratinocytes abolishes the effects of UVB. Thus, UVB triggers a skin-brain-gonadal axis through skin p53 activation. In humans, solar exposure enhances romantic passion in both genders and aggressiveness in men, as seen in analysis of individual questionaries, and positively correlates with testosterone level. Our findings suggest opportunities for treatment of sex-steroid-related dysfunctions.
Scientia Medica
Aims: clinical communication (CC) relates to health professionals’ interaction with patients/fami... more Aims: clinical communication (CC) relates to health professionals’ interaction with patients/families. CC is fundamental for the physicians’ role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC.Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC.Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship’s technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants’ needs. Therefore, teaching CC must go beyond asking the appropriate question or applying s...
Frontiers in Psychiatry
We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore poten... more We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and...
Patient Education and Counseling
OBJECTIVES Assess associations between medical students' reflective ability demonstrated in w... more OBJECTIVES Assess associations between medical students' reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions. METHODS We analyzed 66 medical students' reflective ability, using 'REFLECT' rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. 'BAS' and 'SPIKES' questionnaires measured students' communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills. RESULTS Significant positive correlations between students' reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients' needs and address emotions. CONCLUSIONS High reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically. PRACTICE IMPLICATIONS Encourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients' reactions to them. This process may help students develop competency to share and tailor difficult information sensitively-a critical skill when communicating bad news.
Communication & Medicine
Tensions between nurses and physicians have been linked to differences in power, hierarchy, educa... more Tensions between nurses and physicians have been linked to differences in power, hierarchy, education, compensation and gender. Less attention has been paid to the underlying values on which these differences are predicated. Likewise, little is known about how frequently values conflicts are resolved, and the threats to patient safety unresolved conflicts pose. Our aim was to compare the values embedded in affirming and challenging narratives elicited from nurses and physicians from a large health system. We used thematic analysis and descriptive statistics to assess goodness-of-fit of observed differences in themes. Narratives were coded into eight values categories. Nurses felt affirmed by emotional investment, altruism, humanism, and being of service; for physicians, it was humanism and teamwork. Nurse challenges involved respect, altruism/kindness and emotional investment. For physicians it was also respect and, in addition, professionalism, being of service, humanism and teamwo...
Evidence Based Nursing
Implications for practice and research ► Disclosure and concealment dilemmas create significant c... more Implications for practice and research ► Disclosure and concealment dilemmas create significant challenges for parents of children with a mental illness. ► Healthcare professionals should empower parents by providing them information about mental illness to share with others to decrease stigma, advice about the best structure for disclosure about their child's illness and support them when they experience negative consequences of disclosure or concealment. ► Further research is needed about fathers’, children’s and adolescents’ experiences with disclosure and concealment.
Patient Education and Counseling
OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but resea... more OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.
Journal of Argumentation in Context
Recent research on medical communication discusses the role of argumentation in building physicia... more Recent research on medical communication discusses the role of argumentation in building physician-patient consensus to enhance shared decision-making. This paper focuses on the potential of using argumentation to establish the preliminary step of shared understanding of the diagnosis. This understanding is important in helping patients accept the disease and in increasing their involvement in care. We conducted an in-depth analysis of an observation of a medical encounter, triangulated with interviews with all participants, to illustrate how the lack of clear information and argumentation concerning the disease hindered the patient’s understanding and acceptance of it. This in turn led to difficulties in building a trusting relationship and in reaching treatment decisions. We discuss how using argumentation focused on the disease can allow a fruitful patient-centered discussion about the medical condition and treatment options.
Health communication, Jan 23, 2017
Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challengi... more Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challenging. The present study assessed an innovative course focused on enhancing ICS and humor based on the Four Habits Model and theater concepts. Medical students enrolled in the course (the study group) were assessed pre- and post-intervention, as well as compared with their peers (the control group) using quantitative methods to measure attitudes, self-efficacy, and behaviors. Qualitative methods were used to learn about students' change in perceptions related to ICS and humor following the course, as well as their experiences of developing these skills during the course. Post-intervention study group participants scored significantly higher on all ICS measurements and on humor behavior compared with pre-intervention, and significantly higher on all humor measurements compared with control group participants. Interviews indicated students' increased understanding and difficulties in ...
Qualitative Health Research
People with mental illnesses face the dilemma of whether to disclose or conceal their diagnosis, ... more People with mental illnesses face the dilemma of whether to disclose or conceal their diagnosis, but this dilemma was scarcely researched. To gain in-depth understanding of this dilemma, we interviewed 29 individuals with mental illnesses: 16 with major depression/bipolar disorders and 13 with schizophrenia. Using a phenomenological design, we analyzed individuals’ experiences, decision-making processes, and views of gains and costs regarding concealment and disclosure of mental illness. We found that participants employed both positive and negative disclosure/concealment practices. Positive practices included enhancing personal recovery, community integration, and/or supporting others. Negative practices occurred in forced, uncontrolled situations. We also identified various influencing factors, including familial norms of sharing, accumulated experiences with disclosure, and ascribed meaning to diagnosis. Based on these findings, we deepen the understanding about decision-making p...
Journal of Youth Studies, 2017
The study examined at-risk youths' meaning making of their own significant life events and the co... more The study examined at-risk youths' meaning making of their own significant life events and the contribution of these events to changes in their lives. Narrative interviews with 14 Israeli at-risk youths (aged 16-18) revealed three themes: (a) the event as a powerful, emotional-awakening experience; (b) self-inquiry following the event, differentiating between life before and after, and (c) biographical changes in the youths' lives. Despite the diversity of the events, certain similarities were identified among them: they were perceived as surprising in their timing and intensity, as conveying a broader message, and as the cause of the youths' choice to take responsibility for themselves and their interactions with significant others. Use of narrative theories of personality provides insight into at-risk youths' meaning making of their difficult experiences. The deep exploration and construction of these experiences reveal the process in which difficult life events can lead to positive changes.
Nature Metabolism
Sexual dimorphisms are responsible for profound metabolic differences in health and behavior. Whe... more Sexual dimorphisms are responsible for profound metabolic differences in health and behavior. Whether males and females react differently to environmental cues, such as solar ultraviolet (UV) exposure, is unknown. Here we show that solar exposure induces food-seeking behavior, food intake, and food-seeking behavior and food intake in men, but not in women, through epidemiological evidence of approximately 3,000 individuals throughout the year. In mice, UVB exposure leads to increased food-seeking behavior, food intake and weight gain, with a sexual dimorphism towards males. In both mice and human males, increased appetite is correlated with elevated levels of circulating ghrelin. Specifically, UVB irradiation leads to p53 transcriptional activation of ghrelin in skin adipocytes, while a conditional p53-knockout in mice abolishes UVB-induced ghrelin expression and food-seeking behavior. In females, estrogen interferes with the p53–chromatin interaction on the ghrelin promoter, thus b...
Patient Education and Counseling
Physicians' roles include interpersonal professional encounters with patients, family members... more Physicians' roles include interpersonal professional encounters with patients, family members, and the healthcare team. The communication and relationship that develop from these encounters is central for high-quality care. Some encounters are challenging and potentially conflictual. Hence, physicians may need to apply assertive behavior/communication; namely, to share and protect their needs, rights, and values while addressing and preserving those of the other. Clinicians, researchers, and the public consider assertive communication style as a positive and necessary interpersonal communication skill. However, despite recognizing its importance to patients and nurses, the literature regarding physicians' needs and use of assertiveness is insufficient. The present scoping review protocol focuses on exploring and mapping the breadth of the literature focused on physicians' assertiveness from different career stages- senior MD's, residents, interns, and medical students.
Israel Journal of Health Policy Research
A recent paper has focused on residents' poor lifestyle habits and their potential negative i... more A recent paper has focused on residents' poor lifestyle habits and their potential negative impact on patients' lifestyles. This commentary argues that there are even greater reasons to be concerned about the health and well-being of residents and medical students and the resultant effects on patients throughout the careers of these learners. There is a “hidden curriculum”, i.e., customs, rituals and norms of behavior, in medical education and in the training at the healthcare setting, often contradicts the formal curriculum and include messages that neglect the basic needs of the learners as well as the patients. Due to the impact of these messages on the professional identity formation of learners, including a deterioration in their own wellbeing as well as impairment of their ability to empathize with and care for patients, we must align our formal and hidden curricula to show dignity and caring for learners, colleagues, and patients. To do this well, we need to change ou...
Harefuah, 2021
INTRODUCTION The COVID-19 pandemic posed unique challenges to medical teams in general and in the... more INTRODUCTION The COVID-19 pandemic posed unique challenges to medical teams in general and in the field of obstetrics in particular, where the provision of medical services could not be postponed. Optimal care during the COVID-19 outburst required rapid adjustment to changes, ensuring staff and patients' safety while maintaining close and direct contact with patients. OBJECTIVES To explore obstetricians' experiences during the first outburst, focusing on their challenges, needs and ways of coping. METHODS Semi-structured in-depth interviews were conducted online with 13 senior physicians and residents (7 women, 6 men) from four hospitals, who worked in obstetrics. The interviews were analyzed using the Immersion/Crystallization method developed in medicine focused on their experiences. RESULTS The findings revealed that alongside the impressive mobilization of the teams during this period, physicians encountered various challenges. These included being overwhelmed with the e...
Medical Teacher
Breaking bad news (BBN) is a difficult task that requires multiple professional competencies. The... more Breaking bad news (BBN) is a difficult task that requires multiple professional competencies. The way it is managed has implications for all involved in the encounter: the patient, family members, and the news provider. Existing guidelines were developed mainly at the turn of the millennium and require updating based on identification of daily clinical needs and pedagogical challenges while teaching the current protocols. Furthermore, there is a need to provide an overview of BBN encounters as a process, rather than a subdivided event, to help practitioners adopt an approach that might serve them in their daily routines. This twelve tips article summarizes research and practical experience for handling BBN encounters, from their preparation, through delivering the news while attending patients and family members' needs, toward documenting the news, and critically reflecting on the interaction. The tips are structured and explained to serve both practitioners and medical educators.
Autism
The lockdown that was imposed by governments as part of the attempt to contain the COVID-19 pande... more The lockdown that was imposed by governments as part of the attempt to contain the COVID-19 pandemic included extreme measures, such as home confinement and the shutting down of special education systems. Our aim was to learn about the core experiences of parents of children with autism during this significant life disturbance. Thirty-one parents of 25 children with autism participated in semi-structured telephone interviews which were transcribed verbatim and underwent a qualitative, immersion/crystallization analysis. The analysis was conducted in an iterative consensus-building process to identify parents’ experiences, concerns, challenges, coping strategies, and perceived needs during the lockdown. The main themes that emerged related to the various parental concerns; the major difficulties encountered during this unique time, the functional, social, and behavioral implications the lockdown had on these children; and the manner in which the parents coped as an indication of thei...
Cell Reports
Summary Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via a... more Summary Ultraviolet (UV) light affects endocrinological and behavioral aspects of sexuality via an unknown mechanism. Here we discover that ultraviolet B (UVB) exposure enhances the levels of sex-steroid hormones and sexual behavior, which are mediated by the skin. In female mice, UVB exposure increases hypothalamus-pituitary-gonadal axis hormone levels, resulting in larger ovaries; extends estrus days; and increases anti-Mullerian hormone (AMH) expression. UVB exposure also enhances the sexual responsiveness and attractiveness of females and male-female interactions. Conditional knockout of p53 specifically in skin keratinocytes abolishes the effects of UVB. Thus, UVB triggers a skin-brain-gonadal axis through skin p53 activation. In humans, solar exposure enhances romantic passion in both genders and aggressiveness in men, as seen in analysis of individual questionaries, and positively correlates with testosterone level. Our findings suggest opportunities for treatment of sex-steroid-related dysfunctions.
Scientia Medica
Aims: clinical communication (CC) relates to health professionals’ interaction with patients/fami... more Aims: clinical communication (CC) relates to health professionals’ interaction with patients/families. CC is fundamental for the physicians’ role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC.Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC.Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship’s technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants’ needs. Therefore, teaching CC must go beyond asking the appropriate question or applying s...
Frontiers in Psychiatry
We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore poten... more We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and...
Patient Education and Counseling
OBJECTIVES Assess associations between medical students' reflective ability demonstrated in w... more OBJECTIVES Assess associations between medical students' reflective ability demonstrated in written narratives, and communication skills demonstrated later in simulated-patient breaking bad news interactions. METHODS We analyzed 66 medical students' reflective ability, using 'REFLECT' rubric and four newly developed parameters: Noticing Explanations provided to patients, Noticing Emotions, Remoteness/Connectedness in their writing, and mentioning Self-Emotions. 'BAS' and 'SPIKES' questionnaires measured students' communication skills. Spearman and Chi-square tests examined correlations among all variables. Multiple regressions examined associations between reflective ability and demographic variables with communication skills. RESULTS Significant positive correlations between students' reflective ability, measured by REFLECT and three of the new parameters, and global communication skill scores. Reflective ability of Noticing Explanations in writing was associated with ability to tailoring information to patients' needs and address emotions. CONCLUSIONS High reflective ability may improve communication skills. Specifically, ability to notice explanations to patients may enhance later capability to tailor information to patients and address emotions empathically. PRACTICE IMPLICATIONS Encourage educational interventions enhancing reflective ability; specifically observation and detailed writing about how explanations are given to patients and patients' reactions to them. This process may help students develop competency to share and tailor difficult information sensitively-a critical skill when communicating bad news.
Communication & Medicine
Tensions between nurses and physicians have been linked to differences in power, hierarchy, educa... more Tensions between nurses and physicians have been linked to differences in power, hierarchy, education, compensation and gender. Less attention has been paid to the underlying values on which these differences are predicated. Likewise, little is known about how frequently values conflicts are resolved, and the threats to patient safety unresolved conflicts pose. Our aim was to compare the values embedded in affirming and challenging narratives elicited from nurses and physicians from a large health system. We used thematic analysis and descriptive statistics to assess goodness-of-fit of observed differences in themes. Narratives were coded into eight values categories. Nurses felt affirmed by emotional investment, altruism, humanism, and being of service; for physicians, it was humanism and teamwork. Nurse challenges involved respect, altruism/kindness and emotional investment. For physicians it was also respect and, in addition, professionalism, being of service, humanism and teamwo...
Evidence Based Nursing
Implications for practice and research ► Disclosure and concealment dilemmas create significant c... more Implications for practice and research ► Disclosure and concealment dilemmas create significant challenges for parents of children with a mental illness. ► Healthcare professionals should empower parents by providing them information about mental illness to share with others to decrease stigma, advice about the best structure for disclosure about their child's illness and support them when they experience negative consequences of disclosure or concealment. ► Further research is needed about fathers’, children’s and adolescents’ experiences with disclosure and concealment.
Patient Education and Counseling
OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but resea... more OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.
Journal of Argumentation in Context
Recent research on medical communication discusses the role of argumentation in building physicia... more Recent research on medical communication discusses the role of argumentation in building physician-patient consensus to enhance shared decision-making. This paper focuses on the potential of using argumentation to establish the preliminary step of shared understanding of the diagnosis. This understanding is important in helping patients accept the disease and in increasing their involvement in care. We conducted an in-depth analysis of an observation of a medical encounter, triangulated with interviews with all participants, to illustrate how the lack of clear information and argumentation concerning the disease hindered the patient’s understanding and acceptance of it. This in turn led to difficulties in building a trusting relationship and in reaching treatment decisions. We discuss how using argumentation focused on the disease can allow a fruitful patient-centered discussion about the medical condition and treatment options.
Health communication, Jan 23, 2017
Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challengi... more Teaching and applying interpersonal communication skills (ICS) and humor in medicine is challenging. The present study assessed an innovative course focused on enhancing ICS and humor based on the Four Habits Model and theater concepts. Medical students enrolled in the course (the study group) were assessed pre- and post-intervention, as well as compared with their peers (the control group) using quantitative methods to measure attitudes, self-efficacy, and behaviors. Qualitative methods were used to learn about students' change in perceptions related to ICS and humor following the course, as well as their experiences of developing these skills during the course. Post-intervention study group participants scored significantly higher on all ICS measurements and on humor behavior compared with pre-intervention, and significantly higher on all humor measurements compared with control group participants. Interviews indicated students' increased understanding and difficulties in ...