Yukiko Seki

Physician-patient communication and patient satisfaction in Japanese cancer consultations

Over the past few decades, physician-patient communication has been intensively studied in western countries, because of its importance for the physician-patient relationship and patient health outcomes. Although various concepts and models of this relationship have recently been introduced in Japan, there are few studies on Japanese physician-patient interaction. The purpose of this study is to describe characteristics of physician-patient communication in a Japanese cancer consultation, and to examine the relation of this interaction with patient satisfaction. One hundred and forty cancer outpatients and twelve physicians were included. The Roter Interaction Analysis System (RIAS), one of the most frequently used systems for analyzing physician-patient interaction, was applied, physicians made more utterances directing the interaction than patients did, and their discussion was largely focused on biomedical topics. It can be concluded that the structure of the physician-patient interaction in our study was basically similar to those in previous western studies, although some differences were also found. The relation between physician-patient communication and patient satisfaction was generally consistent with previous studies. Patients were more satisfied with consultations in which the physician used more open-ended questions. On the other hand, physician direction and encouragement was negatively associated with patient satisfaction. Also, patients who asked more questions were less satisfied with the consultation.

The interaction between physician and patient communication behaviors in Japanese cancer consultations and the influence of personal and consultation characteristics.

The communications of physician and patient vary with the characteristics of patient and consultation, as well as the communications of the counterpart. The purpose of this study is to explore the interaction between physician and patient communications in Japanese cancer consultation in view of the influence of patient and consultation characteristics. One hundred and forty cancer outpatients and 12 physicians were included in this study. The Roter Interaction Analysis System (RIAS) was used to analyze the physician-patient interaction. Patient information giving was positively related to physician facilitation, while patient question asking and emotional expression were associated with the warm and empathetic attitude of the physician. On the other hand, the encouraging statements of the physician were greater in shorter consultations, which implies physicians might have interrupted patients with encouragement before thoroughly listening to the patients concern. Further investigation is needed to confirm the causal relationships of these interactions.

Sexual activities and social relationships of people with HIV in Japan.

Sixty-one Japanese with sexually transmitted HIV were investigated to clarify the state of, and difficulties in, their sexual activities and social relationships. The study revealed the following difficulties in social relationships due to HIV infection. Thirty-one per cent had experienced discrimination or breach of confidentiality. Self-restriction due to anxiety over discrimination was observed in approximately 90%, and the self-restriction score tended to be higher in those who were not employed, those with economic problems, those who were in a relatively poor state of health, those who had developed AIDS and those who had previously experienced discrimination or breach of confidentiality. The experience of discrimination or breach of confidentiality, and the experience of receiving negative support tended to increase as the respondents had a wider emotional support network. About 60% were dissatisfied with their sex lives, and the degree of satisfaction was significantly lower in those who had fewer sexual contacts and those who had a suppressive attitude toward sexual contacts. A low degree of satisfaction with sex life was found to be an important factor that escalates the level of depression or anxiety.

Working Condition Factors Associated with Time Pressure of Nurses in Japanese Hospitals

Working Condition Factors Associated with Time Pressure of Nurses in Japanese Hospitals: Yukiko Seki. Faculty of Education, Saitama University—In Japan, the most common reason for medical errors is a lack of cross‐checking. To prevent errors, efforts to strengthen cross‐checking behaviors are being adopted. However, time pressures also lead to errors, and increasing cross‐checking activities leads to an increased workload and even greater time pressures. The purpose of this study was to identify working conditions that lead to time pressure for nurses, and to find ways to reduce time pressure and prevent subsequent errors. Self‐reporting questionnaires were distributed over 10 days to 416 nurses working in 17 wards at two hospitals; 357 nurses (85.8%) responded anonymously, providing data on 2,150 person‐days. In multivariate analyses, medical support services and the number of nurse calls answered were associated with subjective assessments of time pressures and nursing service delays due to busyness. Moreover, working the “evening‐day shift” (when a nurse works a day shift after working the evening shift with no days off in between) led to a high level of fatigue before work and was associated with nursing service delays due to busyness. Reducing time pressures and preventing errors requires an adequate number of nurses, shift plans that consider rest periods and order of rotation, increased task discretion for nurses, and the prevention of chronic fatigue.

Should We Tell the Truth? Why Families in Japan Chose to Tell Their Loved Ones They Were Victims of Iatrogenic HIV Infection

Japanese families traditionally avoid disclosing diagnoses of terminal illnesses to patients, seeking to protect the patient from emotional pain and shock. Using awareness theory, in this study we aimed to investigate the attitudes toward disclosure among bereaved families of Japanese hemophiliacs with iatrogenic HIV/AIDS. Semistructured interviews were conducted with 34 bereaved family members. Qualitative content analysis centered around three main issues: (a) family attitudes toward physician nondisclosure of HIV diagnosis; (b) family attitudes regarding the consequences of nondisclosure; and (c) family attitudes regarding the impact of nondisclosure on patient—family relationships. Our findings suggest that families favored disclosure because they felt that knowledge of the iatrogenic HIV infection would benefit the patient.

A considerate care robot able to serve in multi-party settings

This paper introduces a service robot that provides assisted-care, such as serving tea to the elderly in care facilities. In multi-party settings, a robot is required to be able to deal with requests from multiple individuals simultaneously. In particular, when the service robot is concentrating on taking care of a specific person, other people who want to initiate interaction may feel frustrated with the robot. To a considerable extent this may be caused by the robots behavior, which does not indicate any response to subsequent requests while preoccupied with the first. Therefore, we developed a robot that can project the order of service in a socially acceptable manner to each person who wishes to initiate interaction. In this paper we focus on the task of tea-serving, and introduce a robot able to bring tea to multiple users while accepting multiple requests. The robot can detect a person raising their hand to make a request, and move around people using its mobile functions while avoiding obstacles. When the robot detects a persons request while already serving tea to another person, it projects that it has received the order by indicating “you are next” through a nonverbal action, such as turning its gaze to the person. Because it can project the order of service and indicate its acknowledgement of their requests socially, people will likely feel more satisfied with the robot even when it cannot immediately address their needs. We confirmed the effectiveness of this capability through an experiment in which the robot distributed snacks to participants.

Care robot able to show the order of service provision through bodily actions in multi-party settings

Service robots, such as tea-serving robots, should be designed to show the order of service provision in multi-party settings. An ethnographic study we conducted at an elderly care center revealed that the gaze and bodily actions of care workers can serve this function. To test this, we developed a robot system able to utilize its gaze and other gestures in this way. Experimental results demonstrated that the robot could effectively display the order of service provision using this method, and highlighted the benefits of employing the gaze for robots working in multi-party settings.

Assisted-care robot dealing with multiple requests in multi-party settings

This paper presents our ongoing work developing service robots that provide assisted-care, such as serving tea to the elderly in care facilities. In multi-party settings, a robot is required to be able to deal with requests from multiple individuals simultaneously. In particular, when the service robot is concentrating on taking care of a specific person, other people who want to initiate interaction may feel frustrated with the robot. To a considerable extent this may be caused by the robots behavior, which does not indicate any response to subsequent requests while preoccupied with the first. Therefore, we developed a robot that can display acknowledgement, in a socially acceptable manner, to each person who wants to initiate interaction. In this paper we focus on the task of tea-serving, and introduce a robot able to bring tea to multiple users while accepting multiple requests. The robot can detect a persons request (raising their hand) and move around people using its localization system. When the robot detects a persons request while serving tea to another person, it displays its acknowledgement by indicating “Please wait” through a nonverbal action. Because it can indicate its acknowledgement of their requests socially, people will likely feel more satisfied with the robot even when it cannot immediately address their needs.

How families in Japan view the disclosure of terminal illness: a study of iatrogenic HIV infection

Abstract Physicians in Japan typically do not disclose diagnoses of terminal illnesses to patients, in deference to the wishes of family members. Nonetheless, some evidence indicates that relatives of patients with iatrogenic HIV infection would prefer patient disclosure. We collected survey data from 314 family members in 225 households of hemophiliac patients who died from illnesses related to iatrogenic HIV infection in order to examine current attitudes toward patient disclosure in Japan. Family members reported that the diagnosis of iatrogenic HIV infection was disclosed to the patient by the primary physician in 32.8% of cases, by the family in 8.3% of cases, and not disclosed in 26.4% of cases. The majority of families indicated that the timing of the physicians disclosure occurred too late. Multivariate analysis indicated that families wished that patients had been informed of the diagnosis, despite the stigma associated with HIV in Japan. Furthermore, many families blamed the physician for the infection and fatality in those cases in which the physician did not convey feelings of regret. These results have important clinical ramifications to the practice of disclosing terminal diagnoses in Japan.