Medical communication and technology: a video-based process study of the use of decision aids in primary care

Background: much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial.Methods: a video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour.Results: median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19–26) minutes to work through compared to 31 (16–41) minutes for the implicit tool; and 44 (39–55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58–66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversationConclusion: irrespective of the arm of the trial, both patients' and GPs' behaviour showed that they were reciprocally engaged in these consultations. However, even in consultations aimed at promoting shared decision-making, GPs' were verbally dominant, and they worked primarily as information providers for patients. In addition, computer-based decision aids significantly prolonged the consultations, particularly the later phases. These data suggest that decision aids may not lead to more 'sharing' in treatment decision-making and that, in their current form, they may take too long to negotiate for use in routine primary car

Nurse-patient interaction and communication: a systematic literature review

Aim: The purpose of this review is to describe the use and definitions of the concepts of nurse-patient interaction and nurse-patient communication in nursing literature. Furthermore, empirical findings of nurse-patient communication research will be presented, and applied theories will be shown. Method: An integrative literature search was executed. The total number of relevant citations found was 97. The search results were reviewed, and key points were extracted in a standardized form. Extracts were then qualitatively summarized according to relevant aspects and categories for the review. Results: The relation of interaction and communication is not clearly defined in nursing literature. Often the terms are used interchangeably or synonymously, and a clear theoretical definition is avoided or rather implicit. Symbolic interactionism and classic sender-receiver models were by far the most referred to models. Compared to the use of theories of adjacent sciences, the use of original nursing theories related to communication is rather infrequent. The articles that try to clarify the relation of both concepts see communication as a special or subtype of interaction. Conclusion: The included citations all conclude that communication skills can be learned to a certain degree. Involvement of patients and their role in communication often is neglected by authors. Considering the mutual nature of communication, patients’ share in conversation should be taken more into consideration than it has been until now. Nursing science has to integrate its own theories of nursing care with theories of communication and interaction from other scientific disciplines like sociology

Against Dedicated Methods:Relational Expertise in Participatory Design with People with Dementia

This chapter narrates the search for ways to involve people with dementia in the design process based on insights from three projects, several workshops and an educational module involving people with dementia and their network of caregivers and family. This six year-trajectory was part of a Ph.D. project and started ambitiously with the endeavor to find a dedicated method for involvement, inspired by those developed to involve children or people with aphasia. The aim was to develop a set of design guidelines for (successfully) involving people with dementia in the design process. It became clear that using a set of guidelines as a universal, dedicated, or passe-partout way of working for every person with dementia, would not work. We argue that the foundations for a more suitable individualized approach lie in the build-up of a personal relationship between the person with dementia and the designer. Based on such a personal relationship, ways to facilitate involvement of a person with dementia can be defined and design decisions can be collaboratively taken. Person-Centered Care is seen as a guide in the build-up of the relational expertise that a designer needs in order to collaborate with a person with dementia and that enables designers to value and articulate shared decision making

An investigation of responses to robot-initiated touch in a nursing context

© The Author(s) 2013. This article is published with open access at Springerlink.comDOI: 10.1007/s12369-013-0215-xPhysical human-robot interaction has the potential to be useful in a number of domains, but this will depend on how people respond to the robot’s actions. For some domains, such as healthcare, a robot is likely to initiate physical contact with a person’s body. In order to investigate how people respond to this type of interaction, we conducted an experiment with 56 people in which a robotic nurse autonomously touched and wiped each participant’s forearm. On average, participants had a favorable response to the first time the robot touched them. However, we found that the perceived intent of the robot significantly influenced people’s responses. If people believed that the robot intended to clean their arms, the participants tended to respond more favorably than if they believed the robot intended to comfort them, even though the robot’s manipulation behavior was the same. Our results suggest that roboticists should consider this social factor in addition to the mechanics of physical interaction. Surprisingly, we found that participants in our study responded less favorably when given a verbal warning prior to the robot’s actions. In addition to these main results, we present post-hoc analyses of participants’ galvanic skin responses (GSR), open-ended responses, attitudes towards robots, and responses to a second trial