OBJECTIVES:Contextualization of care has been well documented as an important process for optimizing health care outcomes. Yet there has been little research on attention to patient life context in care planning in the setting of life-threatening disease. We sought to explore how care is contextualized during medical visits in advanced lung cancer treatment in Norway. METHODS:We conducted an exploratory observational study using data from physician-patient dialogues about treatment decisions. The material consisted of consultations with patients receiving treatment for advanced lung cancer from several hospitals in Western Norway. Transcripts and audio recordings were analyzed using the Content Coding for Contextualization of Care (4 C) system. Physician attention to patient context was defined by whether clinicians (a) probed contextual red flags to elicit contextual factors and (b) incorporated contextual factors into care plans. Contextual factors were categorized into their twelve domains. RESULTS:Across 17 medical encounters, clinicians probed 19 of 30 contextual red flags (63%) and formulated contextualized care plans for 21 of 29 contextual factors, a contextualizing care rate of 72%. The most common contextual domains were Skills, Abilities and Knowledge (10 contextual domain assignments), followed by Access to Care (4) and Social Support (4). One contextual factor was assigned to two domains, yielding 30 contextual domain assignments across 29 contextual factors. CONCLUSION:This exploratory observational study suggests that inattention to contextual factors may hinder effective care for patients with advanced lung cancer. PRACTICE IMPLICATIONS:The findings support greater emphasis on contextualization of care in clinical training, assessment, and care planning.
OBJECTIVES:Patient narratives (PNs), documented patient stories in the medical record, are associated with improved communication, enhanced patient-clinician understanding, and greater clinician meaning and purpose. Because the clinical pace of the emergency department (ED) can make it difficult to establish meaningful patient-clinician relationships, we sought to evaluate the feasibility of implementing a PN program in the ED, explore clinicians' perceptions of its impact, and identify the content of ED PNs. METHODS:We conducted a convergent parallel mixed methods study in a tertiary care ED. Patient eligibility determination (clinically stable with anticipated admission), enrollment, and interview were completed by physicians. Participant narratives were collected at bedside and developed into a narrative note. ED clinicians completed surveys after reading PNs, and narratives underwent content analysis. RESULTS:Twenty-six patients completed PNs and 43 clinicians completed the survey (78%). Clinicians tended to be female (63%), white (91%), and an attending physician (40%) or nurse (30%). The majority perceived the PNs to be therapeutically validating (84%), a good use of clinical time (79%), and helpful in providing emergency care (72%). Clinicians reported that PNs also fostered clinician empathy (84%) and an improved understanding of patients' physical conditions (84%) and perspectives (96%), without inducing emotional stress (75%). The most frequent PN topic was family and friends (32%), followed by health care experience (20%) and career (14%). CONCLUSIONS:ED clinicians perceived that PNs enhanced their understanding of patients' lives, values, and perspectives within the context of illness, fostering empathy and supporting more humanistic, patient-centered care. PRACTICE IMPLICATIONS:Embedding brief PNs into ED workflows may support patient-clinician communication and clinician experience without disrupting clinical care.
OBJECTIVES:To reconceptualise motivational interviewing (MI) as a clinical decision-support skill for time-limited healthcare encounters and to clarify how this framing assists clinicians in navigating behaviour change without extending consultation time or compromising therapeutic relationships. METHODS:This discussion paper uses a narrative and conceptual synthesis approach integrating foundational motivational interviewing theory, systematic reviews and meta-analyses in healthcare settings, and implementation and fidelity literature relevant to routine clinical practice. Literature was identified through iterative searches of PubMed and reference lists of key publications, including targeted retrieval of fidelity and implementation research. The objective was not exhaustive evidence synthesis, but clarification of how motivational interviewing may function operationally within time-limited clinical workflows and behavioural decision-making. RESULTS:Motivational interviewing is associated with modest but clinically meaningful improvements across selected behavioural domains, including medication adherence, lifestyle modification, substance use risk reduction, and engagement with mental health treatment. Effects vary according to clinical context, clinician skill, fidelity to motivational interviewing principles, and implementation conditions. Beyond effect size estimates, reframing motivational interviewing as a readiness-calibrated clinical decision-support skill highlights its practical contribution to communication processes in time-constrained settings. Conceptually, motivational interviewing provides a structured framework for engaging patients, clarifying focus, eliciting intrinsic motivation, and planning next steps when readiness is present. CONCLUSIONS:Motivational interviewing should not be regarded as a substitute for guideline-directed care, pharmacological treatment, psychotherapy, or structural interventions. Rather, it functions as a complementary clinical skill that supports patient engagement, preserves autonomy, and aligns care with readiness within time-limited encounters. PRACTICE IMPLICATIONS:When conceptualised as a decision-support approach rather than a counselling technique, motivational interviewing offers clinicians a pragmatic method for determining whether to pursue action, explore ambivalence, or defer change. This framing has implications for postgraduate training and continuing professional development in patient-facing disciplines where behaviour change is central to care.
OBJECTIVES:Self-management interventions in chronic disease are frequently communicated as general wellness advice. Horne's Necessity-Concerns Framework showed adherence tracks perceived necessity (OR = 1.742) and ameliorated concerns (OR = 0.504); Miller found health literacy correlates more strongly with adherence for non-medication regimens (r = 0.20) than medication regimens (r = 0.09). Neither addresses the authority signals prescriptions carry and self-management advice lacks. METHODS:Discussion paper grounded in conceptual analysis, integrating Horne's NCF, Miller's health literacy work, Leventhal's CSM, and Witte's EPPM. Choroideremia serves as the illustrative case, and the author has lived with CHM since age 15. RESULTS:The Therapeutic Mechanism-Trajectories Principle (TMTP) specifies what disease-specific information clinician-patient communication should include, rather than how the conversation should be conducted. Mechanism grounds an intervention's necessity in its disease-specific biomolecular basis, including dosing and risk profile; what must transfer is that a mechanism exists and is this patient's. Trajectories communicates the outcomes varying adherence produces over time, conceived through the Geodesic Concept as a curve from the patient's present position, shaped by adherence and routing around barriers. TMTP specifies what content is owed; how much and in what form is clinician judgment stated with its basis and uncertainty. Applied to choroideremia, it reframes UV-blocking sunglasses, antioxidant supplementation, and omega-3/DHA through their biomolecular basis. CONCLUSIONS:Reference literature must supply mechanism, trajectory, and dosing content, including a plain statement where dosing evidence does not exist, as a precondition to effective clinician-patient communication. TMTP applies wherever a disease-specific mechanism can be communicated, with the greatest gain where self-management is the only option; implementation cost is unknown and requires study. PRACTICE IMPLICATIONS:Reference literature should integrate the biomolecular basis and dosing guidance into self-management recommendations. Clinicians should communicate that basis at a calibrated level, present the outcomes different adherence levels produce, and surface barriers to adherence.
OBJECTIVES:Oncology healthcare professionals (HCPs) consistently report low knowledge and confidence in caring for LGBTIQ+ patients, contributing to inequities in cancer care. This study developed and evaluated the Australian Cancer LGBTIQ+ Inclusivity Toolkit (CanLIT) comprising training modules, inclusion strategies and information resources for working with LGBTIQ+ cancer patients and carers. METHODS:CanLIT was based on the findings of the Out with Cancer Study, co-designed with key stakeholders, and evaluated against national panel consensus recommendations for LGBTIQ+ cultural competency training standards, encompassing learner knowledge, attitudes, intention to change, and training acceptability. RESULTS:One hundred and forty-one learners completed four online training modules and pre-post surveys. Eleven participants were interviewed. Participants demonstrated significant (p < .001) gains in knowledge, confidence, support for LGBTIQ+ inclusivity, and intention to engage in inclusive practice, alongside reduced anti-inclusion beliefs. While overall comfort with LGBTIQ+ patients did not change significantly, likely due to high baselines, comfort increased for treating sexuality-diverse (LGBQ) and intersex patients. Participants endorsed CanLIT as relevant, high quality, and easy to understand, and would recommend it to colleagues. Participants identified implementation barriers, including IT and administrative systems blocking SOGI data collection and preferred names, and fear of causing offence and uncertainty about language. CONCLUSION:CanLIT is a promising, evidence-based training package associated with increased knowledge, confidence, and support for LGBTIQ+ inclusion in cancer care. Following minor modifications, CanLIT is freely available nationally through the Cancer Institute NSW EviQ Education platform. PRACTICE IMPLICATIONS:LGBTIQ+ inclusivity training should be a core component of professional development for all cancer healthcare workers. Training should be supplemented with supervised practice such as simulation and role play to build clinical comfort. Health services need to invest in information infrastructure accommodating preferred names, pronouns, and SOGI data collection. Sustaining change requires ongoing organisational support, including refresher education, peer mentoring, and visible leadership commitment.
OBJECTIVE:This study aimed to explore the relationship between digital health literacy (DHL) and shared decision-making (SDM) among Chinese individuals with hypertension and to examine whether self-efficacy and patient activation (PA) sequentially mediated the association between DHL and SDM. METHODS:A cross-sectional questionnaire survey was conducted among individuals with hypertension in Changzhou City, Jiangsu Province. All participants completed a structured questionnaire, including demographic information, DHL, self-efficacy, PA, and SDM. Pearson correlation analysis was used to examine the relationships among DHL, self-efficacy, PA, and SDM. Multivariate linear regression analysis was performed to identify factors associated with SDM. Mediation analysis based on the Bootstrap method was applied to test the sequential mediating effects of self-efficacy and PA in the relationship between DHL and SDM. RESULTS:This cross-sectional study included 662 individuals with hypertension. DHL, self-efficacy, and PA were all significantly and positively correlated with SDM (r = 0.385-0.538, P < 0.01). Regression analysis showed that DHL was significantly associated with SDM. Mediation analysis suggested that the association between DHL and SDM may be partially explained by the sequential mediation of self-efficacy and PA. CONCLUSIONS:DHL was positively associated with SDM among individuals with hypertension, and this association may be partly explained by self-efficacy and PA. PRACTICE IMPLICATIONS:In clinical practice, interventions targeting DHL, self-efficacy, and PA may support patients' participation in SDM.
Trust is one of the most essential elements in our overall human existence. It is a critical part of our human experience, one that reaches well beyond the boundaries of healthcare. Trust is the element that holds society together. It emerges in the relationship of one human being connecting with another human being, and it reaches to the engagements people have with organizations, institutions, and systems as well. Trust, while hard to hold, is ever present. It is a powerful force that guides our way of being, our interactions, our choices, even if we ourselves are not directly conscious of it. With that, it stands firmly as a cornerstone of experience excellence overall and is why a commitment to human experience matters. Ultimately, a commitment to human experience matters in our conversation specifically here, as it is an essential driver of trust itself. It is not trust that creates experience, but rather it is trust that is fostered by it. And trust provides a path of us to achieve that outcomes we aspired to and that all people deserve.
This study investigates how communication and service quality in Patient Relationship Management impact patient satisfaction through trust. The literature in this field is predominantly in developed countries, whereas it is scarce in sub-Saharan Africa. Combining bibliometric analysis and structural equation modelling, the study highlights emerging research trends and provides empirical evidence to guide healthcare practitioners, policymakers, and researchers in improving patient care. To strengthen its theoretical foundation, the study integrates the Social Exchange Theory and Expectancy–Disconfirmation Theory to explain the model. The study retrieved quantitative data from the Scopus database for bibliometric analysis. A questionnaire was used to collect data from 310 patients for SEM analysis using purposive sampling. Bibliometric findings revealed that while ``patient satisfaction'' is widely studied, key relational constructs such as trust, communication, and service quality are underutilized, with lower keyword occurrences and limited co-citation networks. This indicates a gap in the literature and highlights the need for empirical investigation of these dimensions. The result of the structural equation modelling revealed that communication and trust had significant direct effects on satisfaction. Service quality had an insignificant direct effect on satisfaction. Trust was found to have a significant mediation effect on the link between communication, service quality, and satisfaction. Patient level of education had a significant moderating effect on the association between perceived service quality, communication, and satisfaction. The study explores provider-patient interaction dynamics within healthcare institutions using a mixed-methods framework, contributing to scholarly discussions and benefiting lawmakers and managers.
Rising financial pressures and the need to revitalize culture prompted a renewed emphasis on patient experience at Billings Clinic. This case study describes the impact of redefining patient experience as a measure of trust and a set of care processes. It presents an alternative to the more traditional view of patient experience as an outcome metric based on meeting patient expectations. Billings Clinic chose the patient survey question likelihood of recommending as an organizational goal or key performance indicator (KPI). Under the direction of executive leadership, the patient experience team developed a new strategic framework aimed at driving improvement for this metric. Key features of this framework include reframing likelihood to recommend as a measure of trust, creating strong executive and departmental leadership connections, engaging directly with care teams, developing a patient experience tactic library, sharing patient survey data transparently and utilizing industry developed patient survey goal setting and improvement tools. In all service lines where goals were set, there was an increase in the likelihood of recommending scores. The increase also outpaced the national average increase in several service lines. Patient experience metrics were viewed as a reflection of process consistency rather than individual performance. Overall, this approach created a more focused, collaborative, and actionable way to improve patient experience. By simplifying data, refining communication, and connecting insights to daily workflows, teams were better able to understand their impact and take meaningful action.
Healthcare professionals are often taught that empathy, defined as imagining oneself in the emotional experience of another, is essential to providing excellent care. Yet in high-stress, high-stakes clinical environments, the very tool given to increase patient and employee connection can contribute to disengagement, burnout, and diminished resiliency. This research review article examines the longstanding conflation of empathy and compassion in healthcare and argues that the distinction between the two is not merely semantic but critical to provider well-being and patient outcomes. Drawing on research from neuroscience, psychology, and communication studies, the piece outlines how emotional, perspective-taking empathy activates the brain's pain and stress centers, increasing emotional load for clinicians who are already working in environments defined by high emotion and low control. In contrast, compassion, defined as recognizing another's suffering paired with a desire to help, engages neural pathways associated with regulation, problem-solving, and connection. Compassion-based approaches have been associated with improved resilience, enhanced patient satisfaction, and increased provider engagement. By separating these concepts and examining their distinct impacts, this article highlights why ``compassion fatigue'' may be a misnomer for what is actually empathy-driven overload. The intended takeaway is a reframing of how caring connections are taught and practiced in healthcare: shifting from empathy as emotional immersion to compassion as a sustainable, action-oriented tool that protects providers while still strengthening the quality of connection at the heart of the patient experience.
Trust in the healthcare system is an important driver of public health, but is sometimes lacking among individuals and communities. Patient and family engagement in research and service development is one proposed means of influencing trust. Patients and families can be engaged authentically and meaningfully as partners in the conduct of research and the development of healthcare services. When engagement is conducted following best practices, patients and families have the opportunity to build strong mutual relationships with project leads, hold a share of the power in the discipline, and exercise choice to influence the research and service development agenda. These mechanisms might increase trust in researchers and clinicians, potentially extending to institutions and entire systems of care. However, if conducted poorly, patient and family engagement may erode trust, creating frustration, skepticism, and retraumatization. When engagement goes wrong, the utmost care must be taken to building shared solutions to challenges, with the goal of rebuilding trust that has been lost. Importantly, no amount of high-quality engagement can be expected to erase the substantial historical and current harms that have been done to patients and communities within the healthcare system. In order for patient and family engagement to increase trust in the healthcare system, it is incumbent on project leads to be worthy of the trust they seek, while always maintaining the context of a historical backdrop that was not.
Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants completed the Trust in Physicians Scale (TPS) and the Philadelphia ACE Survey assessing conventional ACEs (cACEs: abuse, neglect, household challenges) and expanded ACEs (eACEs: neighborhood/community adversity). Descriptive statistics characterized the cohort, and multivariable linear regression examined associations between ACE exposure and TPS scores adjusting for demographic covariates. To contextualize quantitative findings, we conducted in-depth semi-structured interviews with 10 patients with high cACEs; transcripts were analyzed using thematic analysis. Results: The mean cACE score was 3.0 (out of 15) and 40.7% reported ≥ 3 ACEs. After adjustment for race, age, gender, and ethnicity, higher cACEs were associated with higher physician trust (β = 0.49, 95% CI [0.01–0.96]; p = 0.04). Qualitative interviews (mean cACE 7.8/15) demonstrated that trauma-informed, relational communication—including listening, transparency, and collaborative decision-making—strengthened trust during hospitalization. Conclusion: Trauma-informed relational care represents an actionable strategy to strengthen patient trust in inpatient physicians among individuals with high ACEs.
