Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs

Derksen, Frans; Hartman, Tim olde; Bensing, J.M.; Lagro-Janssen, Antoine L. M.

doi:10.3399/bjgp16x687565

Cited by 39 publications

(31 citation statements)

References 33 publications

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“…Our results showed that patients wanted confirmation from their GP during the encounter. On the other hand, Derksen et al [38] report in their interview study that GPs sometimes perceive that protocol driven care is a barrier for being empathic towards patients during encounters. Hence, adherence to guidelines such as CPPs might influence GPs provision of confirmation.…”

Section: Discussionmentioning

confidence: 99%

Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

Hultstrand

Coe

Lilja

et al. 2020

BMC Health Serv Res

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Background: How interactions during patient-provider encounters in Swedish primary care construct access to further care is rarely explored. This is especially relevant nowadays since Standardized Cancer Patient Pathways have been implemented as an organizational tool for standardizing the diagnostic process and increase equity in access. Most patients with symptoms indicating serious illness as cancer initially start their diagnostic trajectory in primary care. Furthermore, cancer symptoms are diverse and puts high demands on general practitioners (GPs). Hence, we aim to explore how presentation of bodily sensations were constructed and legitimized in primary care encounters within the context of Standardized Cancer Patient Pathways (CPPs). Methods: Participant observations of patient-provider encounters (n = 18, on 18 unique patients and 13 GPs) were carried out at primary healthcare centres in one county in northern Sweden. Participants were consecutively sampled and inclusion criteria were i) patients (≥18 years) seeking care for sensations/symptoms that could indicate cancer, or had worries about cancer, Swedish speaking and with no cognitive disabilities, and ii) GPs who met with these patients during the encounter. A constructivist approach of grounded theory method guided the data collection and was used as a method for analysis, and the COREQ-checklist for qualitative studies (Equator guidelines) were employed. Results: One conceptual model emerged from the analysis, consisting of one core category Negotiating bodily sensations to legitimize access, and four categories i) Justifying care-seeking, ii) Transmitting credibility, iii) Seeking and giving recognition, and iv) Balancing expectations with needs. We interpret the four categories as social processes that the patient and GP constructed interactively using different strategies to negotiate. Combined, these four processes illuminate how access was legitimized by negotiating bodily sensations. Conclusions: Patients and GPs seem to be mutually dependent on each other and both patients' expertise and GPs' medical expertise need to be reconciled during the encounter. The four social processes reported in this study acknowledge the challenging task which both patients and primary healthcare face. Namely, negotiating sensations signaling possible cancer and further identifying and matching them with the best pathway for investigations corresponding as well to patients' needs as to standardized routines as CPPs.

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Section: Discussionmentioning

confidence: 99%

Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

Hultstrand

Coe

Lilja

et al. 2020

BMC Health Serv Res

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“…Consequently, public health interventions that operate solely at the GP level may risk falling short as targeted individuals tend not to be susceptible to prevention in this context. FA Derksen, TC Olde Hartman, JM Bensing and AL Lagro-Janssen [47] propose that longer consultations could influence whether attention is paid to prevention in the clinical encounter. Our findings, however, do not support this suggestion, given that patients in the health dialogues brought up other medical health problems despite the intended focus on prevention.…”

Section: Discussionmentioning

confidence: 99%

‘Motivational work’: a qualitative study of preventive health dialogues in general practice

Broholm-Jørgensen

Langkilde

Tjørnhøj‐Thomsen

et al. 2019

Preprint

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Background While treatment plays an important role in general practice, primary and secondary prevention of so-called health behavior diseases has become an urgent issue of health politics as well as an important task in general practice. Through an analytical lens of ‘motivational work’, we explore how preventive health dialogues unfold in Danish general practices, with the purpose of understanding the social interactions and temporal complexities embedded in preventive health dialogues. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues and 18 semi-structured interviews with patients and general practitioners. The TOF pilot study in 2016 made it possible to explore preventive health dialogues between GPs and patients in general practice. The intervention addressed early detection and prevention in general practice through an approach of population-based risk stratification. Results We found that both GPs and patients—in an interplay—affected motivational work in the health dialogues to occur as one-way communication characterized by biomedically based guidance, information, suggestions, and advice on risk factors. Our findings illustrate a tendency among GPs to do motivational work without facilitating dialogue, concerning neither the underlying social causes of the behavior nor the patients’ possibilities to change their health behavior. We furthermore found that patients took part in reproducing the biomedical and treatment-oriented focus in the clinical encounter. Patients’ perspectives and expectations with regard to the structure and content of the health dialogues influenced whether and how GPs sought to promote and awaken patients’ motivation to change health behavior. Conclusion Overall, our findings point to a discrepancy between a biomedical action perspective and the temporality of prevention, with the former lessening the dialogue and interaction between GP and patient.

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“…To overcome barriers to communication, healthcare personnel should develop the ability to express empathy, closeness and solidarity with patients' emotions, and also possess active listening skills -in areas such as paying careful attention and manifesting availability to help -together with self-assuredness, transmitting a sense of security on the basis of well-grounded opinions [3,39,42,43].…”

Section: Discussionmentioning

confidence: 99%

“…However, despite this considerable progress, there is often a profound lack of interest in interpersonal communication. The ability to communicate with patients has been erroneously viewed as a lesser skill, compared to technical aspects of healthcare [2,3], when in fact it is an essential element in the relationship between healthcare personnel and their patients, based on mutual recognition and shared decision making [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Breaking bad news to antenatal patients with strategies to lessen the pain: a qualitative study

et al. 2018

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Background: To consider the thoughts and actions of healthcare personnel in situations when an adverse prenatal diagnosis must be communicated, including appropriate strategies and skills to respond to information needs and to manage the emotional responses of patients. Methods: Descriptive qualitative study using non-participant observation and semi-structured interviews to analyse the discourses of physicians, midwives, nurses and nursing assistants who provide healthcare to obstetric patients. Results: There may be barriers to effective communication between healthcare personnel and patients, depending on the characteristics of the persons involved, the organisation of healthcare, biotechnological progress and cultural factors. Conclusions: The human quality of healthcare has deteriorated due to excessive workloads and to the growing role played by technology. In order to improve communication, more attention should be paid to human and spiritual dimensions, prioritising empathy, authenticity and non-judgmental listening. An appropriate model of clinical relationship should be based on shared decision making, clarifying the functions of the multidisciplinary team to alleviate a mother's suffering when a pregnancy is interrupted. To do so, protocols should be implemented to ensure the provision of comprehensive care, not only addressing biological issues but also providing psychosocial attention. Finally, training should be provided to healthcare staff to enhance their social skills and cultural competence. This study identifies potential improvements in the interventions made by healthcare personnel and in the organisation of the institution, concerning the attention provided to pregnant women when an adverse prenatal diagnosis must be communicated.

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Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs

Cited by 39 publications

References 33 publications

Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

Negotiating bodily sensations between patients and GPs in the context of standardized cancer patient pathways – an observational study in primary care

‘Motivational work’: a qualitative study of preventive health dialogues in general practice

Breaking bad news to antenatal patients with strategies to lessen the pain: a qualitative study

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