Laura Vail

Hospital consultants breaking bad news with simulated patients: An analysis of communication using the Roter Interaction Analysis System

OBJECTIVE To explore how experienced clinicians from wide ranging specialities deliver bad news, and to investigate the relationship between physician characteristics and patient centredness. METHODS Consultations involving 46 hospital consultants from 22 different specialties were coded using the Roter Interaction Analysis System. RESULTS Consultants mainly focussed upon providing biomedical information and did not discuss lifestyle and psychosocial issues frequently. Doctor gender, age, place of qualification, and speciality were not significantly related to patient centredness. CONCLUSION Hospital consultants from wide ranging specialities tend to adopt a disease-centred approach when delivering bad news. Consultant characteristics had little impact upon patient centredness. Further large-scale studies are needed to examine the effect of doctor characteristics on behaviour during breaking bad news consultations. PRACTICE IMPLICATIONS It is possible to observe breaking bad news encounters by video-recording interactions between clinicians and simulated patients. Future training programmes should focus on increasing patient-centred behaviours which include actively involving patients in the consultation, initiating psychosocial discussion, and providing patients with opportunities to ask questions.

Healthcare assistants in general practice : a qualitative study of their experiences

AIM To explore the experiences of healthcare assistants (HCAs) working in general practice (GP). BACKGROUND HCAs increasingly play an important role in UK GP teams. The role is relatively new and little is known about how HCAs feel about their work in GP, and the challenges that they face. METHODS Semi-structured interviews were undertaken with 14 HCAs from two Primary Care Trusts in the West Midlands, United Kingdom. Transcriptions were analysed using the framework analysis approach. FINDINGS Overall, HCAs reported that they enjoyed their work, and particularly appreciated the patient contact and positive feedback gained. Attitudes to the role were affected by previous position, experience, and length of time working within the practice. The HCAs felt accepted and supported by GP team members and valued the support they were receiving. Key sources of frustration included the poor salary, the lack of initial clarity with regard to role definition, and the constraints of their scope of practice. Role boundaries between HCAs and practice nurses were experienced as well defined, and no perceptions of role ambiguity were reported. HCAs considered their work to be of relatively low status, with its main purpose being to ease the practice nurses workload. Although many had the desire to train as nurses, few saw it as a realistic possibility. CONCLUSIONS Although HCAs appear to be satisfied overall, the elements of dissatisfaction relate to status, pay, and career progression, which may limit the retention of individuals in this role. Practices should consider the importance of recognising and valuing the work of HCAs and of providing protected time and resources for mentorship and career progression.

Maintenance antipsychotic treatment versus discontinuation strategies following remission from first episode psychosis: systematic review

Background Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice. Method A systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP. Results Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis. Conclusions There is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies. Declaration of interest A.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals.