Céline Bourquin

Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center

OBJECTIVE This study aimed to analyze complaints of patients, their relatives, and friends who consulted a complaints center based (Espace Patients & Proches (EPP)) in a hospital so as to better understand the reasons that motivated them and their underlying expectations. METHODS This study was based on the analysis of written accounts of the 253 situations that occurred during the first year of operation of the EPP. The accounts were analyzed qualitatively using an inductive, thematic analytic approach. RESULTS We identified 372 different types of complaints and 28 main analytic themes. Five clustered themes emerged from the analysis of the interconnections among the core themes: (1) interpersonal relationship (N=160-the number of accounts including a complaint related to this general theme); (2) technical aspects of care (N=106); (3) health-care institution (N=69); (4) billing and insurance; (5) access to information (N=13). CONCLUSION The main reason for patients, their relatives, and friends going to EPP was related to the quality of the interpersonal relationship with health-care professionals. Such complaints were markedly more frequent than those concerning technical aspects of care. PRACTICE IMPLICATIONS These results raise important questions concerning changing patient expectations as well as how hospitals integrate complaints into the process of quality health care.

Working alliance in communication skills training for oncology clinicians: A controlled trial

OBJECTIVE The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance. METHODS Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N=56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N=57) who did not benefit from CST. The patient-clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory - Short Revised Form. RESULTS While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patients questions diminished alliance. CONCLUSION Patient-clinician alliance is related to specific verbal communication behaviors. PRACTICE IMPLICATIONS Working alliance is a key element of patient-physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.

Medical Students’ Skills and Needs for Training in Breaking Bad News

This study assessed medical students’ perception of individual vs. group training in breaking bad news (BBN) and explored training needs in BBN. Master-level students (N = 124) were randomised to group training (GT)—where only one or two students per group conducted a simulated patient (SP) interview, which was discussed collectively with the faculty—or individual training (IT)—where each student conducted an SP interview, which was discussed during individual supervision. Training evaluation was based on questionnaires, and the videotaped interviews were rated using the Roter Interaction Analysis System. Students were globally satisfied with the training. Still, there were noticeable differences between students performing an interview (GT/IT) and students observing interviews (GT). The analysis of the interviews showed significant differences according to scenarios and to gender. Active involvement through SP interviews seems required for students to feel able to reach training objectives. The evaluation of communication skills, revealing a baseline heterogeneity, supports individualised training.

Mandatory communication skills training for oncologists: enforcement does not substantially impact satisfaction

PurposeEven though there is evidence that both patients and oncology clinicians are affected by the quality of communication and that communication skills can be effectively trained, so-called Communication Skills Trainings (CSTs) remain heterogeneously implemented.MethodsA systematic evaluation of the level of satisfaction of oncologists with the Swiss CST before (2000–2005) and after (2006–2012) it became mandatory.ResultsLevels of satisfaction with the CST were high, and satisfaction of physicians participating on a voluntary or mandatory basis did not significantly differ for the majority of the items.ConclusionsThe evaluation of physicians’ satisfaction over the years and after introduction of mandatory training supports recommendations for generalized implementation of CST and mandatory training for medical oncologists.

Individual training at the undergraduate level to promote competence in breaking bad news in oncology.

Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one‐to‐one simulated patient (SP) training with individual feedback (intervention group) vs small‐group SP training with collective feedback (comparison group).

Losing the “Person” in Personalized Medicine

it remains to be demonstrated how this fundamental aspect of the individual can be apprehended, and thereafter transformed into data to be integrated with biological information [3] . Finally, their suggestion that biography (which they do not really define) is “in the mind” is problematic. Biography, as a human experience, is embodied and social: it is “in” the body and “in” the environment as much as “in” the mind [4] . The claim that this “new way of conducting clinical research” will “conform more closely to clinical practice” seems unrealistic and thus contributes to the flow of discourses promising major scientific breakthroughs. Indeed, the attempt to characterize the individual patient by means of such a collection of data paradoxically leads to losing the person. It is also striking that, in this “new era of individualized patient care,” another person seems to be altogether missing: the one providing the very care, here the physician [5] . As the authors, quoting Sir William Osler, remind us, “Variability is the law of life and [...] no two faces are the same.” This applies to the physician every bit as much as to the patient and should be taken into account by clinicians and researchers. In a recent editorial, Horwitz et al. [1] thoughtfully summarized the history of medical sciences, addressing the shortcomings of randomized controlled trials to guide treatment decisions, and reviewing the potential benefits of “precision medicine.” To individualize patient care, they outlined an agenda for research that complements biological data with social and behavioral information about individuals and their environment (which they call “psychosocial features”). They concluded with the statement that “advances can only occur with a new understanding of the unity of mind (biography) and body (biology) that are reflected in the goals of psychosomatic medicine.” Although we applaud the authors’ efforts to broaden the scope of personalized medicine, we would like to make some cautionary remarks. Their research agenda assumes that the individual and collective human experiences can be reasonably reduced to a collection of data. However, it is far from clear how they envision to measure these “psychosocial features.” First, to capture biography, even with “detailed and repeated measures over time of each subject,” seems an impossible endeavor, because of its elusive, constantly evolving and kaleidoscopic nature [2] . Second, even if some aspects of the patient’s “psychosocial features,” such as place of birth, income, or formal psychiatric diagnoses, can be measured, their actual clinical relevance is mediated by personal experience; Received: February 27, 2017 Accepted after revision: March 14, 2017 Published online: September 14, 2017

Clinical communication: don't forget the physician!

Editor – In their critical review of the literature on clinical communication in cancer care, Salmon and Young argue convincingly that the current paradigm, which emphasises patients’ concurrent needs for autonomous decision making and emotional support, and conceives physicians’ training in communication as the acquisition of skills, is poorly supported by empirical evidence and undermined by the results of inductive qualitative studies. The new paradigm they propose is grounded in attachment theory because of the vulnerability of patients, their need for physicians’ expertise and authority, and the paradoxically relational nature of true autonomy. Moreover, it recognises that physicians are ‘goaldirected’ practitioners, sensitive to the context of the relational dyad, and not simply ‘communication technicians’. We find a new paradigm based on these fundamentals attractive, but at the same time we suggest that the focus on what should be taught and learned with regard to clinical communication could be broadened.

Individual Supervision to Enhance Reflexivity and the Practice of Patient-Centered Care: Experience at the Undergraduate Level

This article reports on what is at work during individual supervision of medical students in the context of teaching breaking bad news (BBN). Surprisingly, there is a relative lack of research and report on the topic of supervision, even though it is regularly used in medical training. Building on our research and teaching experience on BBN at the undergraduate level, as well as interviews of supervisors, the following key elements have been identified: learning objectives (e.g., raising student awareness of structural elements of the interview, emotion (patients and students) handling), pedagogical approach (being centered on student’s needs and supportive to promote already existing competences), essentials (e.g., discussing skills and examples from the clinical practice), and enhancing reflexivity while discussing specific issues (e.g., confusion between the needs of the patient and those of the student). Individual supervision has been identified as crucial and most satisfactory by students to provide guidance and to foster a reflexive stance enabling them to critically apprehend their communication style. Ultimately, the challenge is to teach medical students to not only connect with the patient but also with themselves.

Undergraduate training for medical students on breaking bad news in oncology: A continuation study exploring the patient perspective

This continuation study evaluates from the patient perspective the effectiveness of an individualized training in Breaking Bad News (BBN) in undergraduate medical education. Our previous study showed that medical students benefited from a simulated patient (SP) encounter, followed by an individual supervision based on the filmed SP encounter, with a significant increase of their communication performance in BBN post-training as rated by experts. This continuation study aims to (i) explore the patient perspective on students’ improved communication behaviour and (ii) better understand the benefits of such trainings.

Core components of Communication Skills Training in oncology: A synthesis of the literature contrasted with consensual recommendations

This systematic review synthesises the literature on Communication Skills Training (CST) programmes for oncology professionals to identify their core components and compare them with the recommendations formulated in a position paper based on a European expert consensus meeting. A systematic literature search was conducted using MEDLINE (OVID and PUBMED), CINAHL, EMBASE, PSYCHINFO, Web of Science and the Cochrane Library. The analytic approach relied on an a priori framework based on the position papers recommendations, generating several themes. Forty-nine articles were included. The CST programmes reported between 2010 and 2016 were heterogeneous. Some recommendations, especially those regarding content and pedagogic tools, were followed by most providers, while others, such as setting, objectives and participants, were not. This synthesis raises questions on how CST programmes are conceived and how they could or should be conceived in future. While medicine, especially clinical communication, is socially and culturally embedded, some recommendations regarding CST programmes seem to be universally valuable, contributing to ensure quality and enhanced credibility, and thus endorsement and sustained implementation, of CST programmes in the oncology setting.