Redesigning methods of psychosocial intervention 2 10 13James Coyne
This document discusses redesigning psychosocial services for cancer patients. It notes that international standards for cancer care may not be practical or appropriate for all cultural contexts. When developing new services, it is important to evaluate appropriateness, involve stakeholders, and monitor implementation. Screening all patients for distress may not be feasible and could identify needs without solutions. Alternatively, all patients should have opportunities to discuss their experiences and concerns without screening. The goals of psychosocial care should be better symptom management, access to support, and specialized services for high-risk patients.
This document provides information about discussing goals of care with family members of patients with dementia. It begins with an introduction and outlines the session goals. It then discusses the natural history and progression of Alzheimer's disease using the FAST scale. Data on the clinical course of advanced dementia is presented showing high rates of infections, eating problems, and burdensome interventions in the last months of life. Evidence is discussed regarding treating or not treating pneumonia and tube feeding. The role play provides an example case of a patient with advanced dementia to discuss goals of care.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
This document discusses self-harm and suicide among children and young people, and the role of primary care. It notes a 70% increase in under-14s attending A&E for self-harm and that 1 in 10 young people will self-harm at some point. It also discusses suicide rates among young women and those under 25 in England. The document proposes developing an electronic clinical decision support system (e-CDSS) to help GPs assess and manage suicide risk in young patients. Feedback from qualitative research with GPs, patients, and mental health experts was incorporated into the prototype e-CDSS to ensure it is clinically relevant, integrated with workflows, and provides actionable decision support.
The document discusses the benefits of group medical visits for patients, providers, and practices. It notes that group visits can enhance patient education, improve access to care, and increase practice productivity and revenue. Group visits allow for more time with patients to focus on lifestyle education and chronic disease management. They also provide social support from sharing experiences with other patients. The document outlines strategies for implementing group visits, including selecting topics, planning logistics, ensuring regulatory compliance, and billing insurance.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
Redesigning methods of psychosocial intervention 2 10 13James Coyne
This document discusses redesigning psychosocial services for cancer patients. It notes that international standards for cancer care may not be practical or appropriate for all cultural contexts. When developing new services, it is important to evaluate appropriateness, involve stakeholders, and monitor implementation. Screening all patients for distress may not be feasible and could identify needs without solutions. Alternatively, all patients should have opportunities to discuss their experiences and concerns without screening. The goals of psychosocial care should be better symptom management, access to support, and specialized services for high-risk patients.
This document provides information about discussing goals of care with family members of patients with dementia. It begins with an introduction and outlines the session goals. It then discusses the natural history and progression of Alzheimer's disease using the FAST scale. Data on the clinical course of advanced dementia is presented showing high rates of infections, eating problems, and burdensome interventions in the last months of life. Evidence is discussed regarding treating or not treating pneumonia and tube feeding. The role play provides an example case of a patient with advanced dementia to discuss goals of care.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
This document discusses self-harm and suicide among children and young people, and the role of primary care. It notes a 70% increase in under-14s attending A&E for self-harm and that 1 in 10 young people will self-harm at some point. It also discusses suicide rates among young women and those under 25 in England. The document proposes developing an electronic clinical decision support system (e-CDSS) to help GPs assess and manage suicide risk in young patients. Feedback from qualitative research with GPs, patients, and mental health experts was incorporated into the prototype e-CDSS to ensure it is clinically relevant, integrated with workflows, and provides actionable decision support.
The document discusses the benefits of group medical visits for patients, providers, and practices. It notes that group visits can enhance patient education, improve access to care, and increase practice productivity and revenue. Group visits allow for more time with patients to focus on lifestyle education and chronic disease management. They also provide social support from sharing experiences with other patients. The document outlines strategies for implementing group visits, including selecting topics, planning logistics, ensuring regulatory compliance, and billing insurance.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
Strategies to improve linkage to HIV care aim to increase the percentage of people who enter care after receiving a positive HIV test result from 65% to 85%. Studies show those who enter care early are more likely to start antiretroviral therapy, achieve viral suppression, and reduce risky sexual behaviors. The document discusses various strategies tested in studies and used by agencies to improve different aspects of the linkage process, including messaging at diagnosis, counseling approaches, active versus passive referrals, engagement strategies, and care team coordination. The goal is to establish a seamless system to immediately link people to continuous, coordinated, and high-quality HIV care.
This document discusses strategies for improving linkage to care for people who test HIV positive. It highlights the importance of immediately linking people to continuous care when they learn they are infected in order to improve health outcomes. Barriers to entering care include lack of insurance, not wanting to acknowledge being HIV positive, and lack of support services. Successful strategies discussed include providing comprehensive counseling and messaging about benefits of early care, using a trauma-informed and motivational interviewing approach, actively facilitating referrals and follow through, and care team coordination through linkage specialists.
This document summarizes the benefits and services provided by ConciergeMDs, a company that helps doctors transition to a concierge medical practice model. ConciergeMDs offers ongoing operational support, marketing assistance to attract patients, and best practices for running the practice. They aim to help doctors focus on high-quality personalized care while still maintaining a profitable practice and better work-life balance. Converting to a ConciergeMDs concierge practice model allows doctors to practice medicine as they choose and directly care for fewer patients with more appointment time.
Communication Skills in Between Doctor and Patient and Breaking the bad news Orindom Shing Pulock
This document discusses communication skills, with a focus on patient counseling and breaking bad news. It covers several key topics:
- The importance of communication in the doctor-patient relationship for comprehensive treatment, patient satisfaction, and improved health outcomes.
- Effective communication involves listening to understand the patient, making sure they understand as well, and receiving feedback from their responses.
- Basic elements of counseling patients include explaining their disease and treatment plan, providing information materials, discussing lifestyle changes, and answering questions about medications and recovery.
- Examples show counseling patients pre- and post-operatively, including discussing diagnosis, treatment plans, diet and pain management, follow-up care and potential complications.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Clinical communication skills year 1 introductionReina Ramesh
This document provides an overview of teaching clinical communication skills to medical students. It discusses the Calgary-Cambridge Guide, which structures the medical interview into initiating the session, gathering information, and closing the session. Key aspects of each part are outlined, including establishing rapport, obtaining the patient's history, and ensuring shared understanding. The document also notes how communication is integrated into the curriculum, with emphasis on both medical and patient perspectives through activities like role-plays and feedback. Assessment involves OSCE exams focusing more on process than content in the first year.
The document discusses effective adherence to medical treatment regimens. It notes that non-adherence is a complex problem with many interrelated behavioral and psychological causes. It proposes that a comprehensive behavioral program using a customizable software platform can help address non-adherence by providing personalized support that targets the cognitive, emotional, behavioral, and environmental factors influencing each individual patient.
Presentation on DNAR Policy (From Acute Hospital Network, June 2014) [AHN 19]Irish Hospice Foundation
This document discusses DNAR (Do Not Attempt Resuscitation) policies and communication regarding end-of-life care. It notes that while DNAR policies aim to provide guidance, individual decision making is needed. DNAR decisions should be made through open discussions involving the patient and considering their prognosis, values and goals. However, communication challenges can arise from unrealistic expectations, denial, misunderstandings and conflicts. The document advocates clear documentation and communication of DNAR decisions across care settings to ensure patient wishes are followed.
IN THIS PRESENTATION I HAVE DESCRIBED ABOUT DOCTORS AND PATIENTS RELATIONSHIP . History of doctor-patient relationship. Models of doctor-patient relationship. Psychological types of doctors. Basic characters and skills of physician. Communication of doctors. Problems of contemporary healthcare system
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
Hippocrates viewed the physician as 'captain of the ship' and the patient as someone to take orders. Relationship between patients and doctors are often unstated, and thy are dynamic
As conditions change, the kind of relationship that works best for a patient may change. Doctors and patients should choose a “relationship fit” . Effectiveness of the patient-physician relationship directly relates to health outcomes.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
This study evaluated the causes of patients visiting multiple consultants or hospitals for the same chief complaint. 50 patients in Durgapur, India were surveyed. The results showed that 64% had unpleasant scheduling experiences, 88% lacked health insurance, 26% felt staff were not courteous, and 28% felt consultants did not fully answer questions. The study concluded that improving communication, listening skills, wait times, and ensuring questions are answered could increase patient satisfaction and reduce multiple visits. It is recommended that consultants foster respect, take time to listen actively, provide counseling, and incorporate patient feedback.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
The document discusses complex patient journeys and tools to impact them. It begins by defining key dimensions and inflection points of patient journeys. Dimensions include the healthcare, disease/therapy, and human journeys. Inflection points are moments where outcomes are predicted. Behavioral science and cognitive-behavioral therapy can be used to intervene at these points by addressing cognitive, emotional, and behavioral barriers. A case study examines using these tools to help appropriate diabetes patients initiate insulin injections by addressing a patient's needle anxiety through cognitive reframing and desensitization exercises.
This document discusses the importance of soft skills for doctors. It notes that while doctors require hard skills for their medical specialization, they also need soft skills for interacting with patients and stakeholders. These include empathy, communication, attitude and relationship management. The document argues that soft skills can be learned and provides tips for doctors to acquire them, such as having a learning mindset, networking, and self-improvement. It also presents examples of when poor soft skills can negatively impact patient experiences.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
The document discusses key aspects of implementing a disease management program including:
1. Encouraging early detection of diseases through various forms of advertising and utilizing guidelines from organizations like the CDC and WHO.
2. Providing incentives for patients to proactively manage their health like lower costs, support groups, and easy access to their medical records.
3. Addressing factors like ensuring quality of care through measurements, making facilities accessible, and emphasizing the importance of prescription management.
The document discusses key aspects of implementing an effective disease management program, including encouraging early detection of diseases, providing patient incentives, establishing physician incentives, selecting appropriate facilities, measuring quality of care, managing prescription benefits, and using case management strategies. It emphasizes preventing disease through screening, education, and lifestyle changes can improve patients' health while lowering overall healthcare costs. Future directions include increased use of electronic medical records and data analytics to track outcomes and continuously improve programs.
Strategies to improve linkage to HIV care aim to increase the percentage of people who enter care after receiving a positive HIV test result from 65% to 85%. Studies show those who enter care early are more likely to start antiretroviral therapy, achieve viral suppression, and reduce risky sexual behaviors. The document discusses various strategies tested in studies and used by agencies to improve different aspects of the linkage process, including messaging at diagnosis, counseling approaches, active versus passive referrals, engagement strategies, and care team coordination. The goal is to establish a seamless system to immediately link people to continuous, coordinated, and high-quality HIV care.
This document discusses strategies for improving linkage to care for people who test HIV positive. It highlights the importance of immediately linking people to continuous care when they learn they are infected in order to improve health outcomes. Barriers to entering care include lack of insurance, not wanting to acknowledge being HIV positive, and lack of support services. Successful strategies discussed include providing comprehensive counseling and messaging about benefits of early care, using a trauma-informed and motivational interviewing approach, actively facilitating referrals and follow through, and care team coordination through linkage specialists.
This document summarizes the benefits and services provided by ConciergeMDs, a company that helps doctors transition to a concierge medical practice model. ConciergeMDs offers ongoing operational support, marketing assistance to attract patients, and best practices for running the practice. They aim to help doctors focus on high-quality personalized care while still maintaining a profitable practice and better work-life balance. Converting to a ConciergeMDs concierge practice model allows doctors to practice medicine as they choose and directly care for fewer patients with more appointment time.
Communication Skills in Between Doctor and Patient and Breaking the bad news Orindom Shing Pulock
This document discusses communication skills, with a focus on patient counseling and breaking bad news. It covers several key topics:
- The importance of communication in the doctor-patient relationship for comprehensive treatment, patient satisfaction, and improved health outcomes.
- Effective communication involves listening to understand the patient, making sure they understand as well, and receiving feedback from their responses.
- Basic elements of counseling patients include explaining their disease and treatment plan, providing information materials, discussing lifestyle changes, and answering questions about medications and recovery.
- Examples show counseling patients pre- and post-operatively, including discussing diagnosis, treatment plans, diet and pain management, follow-up care and potential complications.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Clinical communication skills year 1 introductionReina Ramesh
This document provides an overview of teaching clinical communication skills to medical students. It discusses the Calgary-Cambridge Guide, which structures the medical interview into initiating the session, gathering information, and closing the session. Key aspects of each part are outlined, including establishing rapport, obtaining the patient's history, and ensuring shared understanding. The document also notes how communication is integrated into the curriculum, with emphasis on both medical and patient perspectives through activities like role-plays and feedback. Assessment involves OSCE exams focusing more on process than content in the first year.
The document discusses effective adherence to medical treatment regimens. It notes that non-adherence is a complex problem with many interrelated behavioral and psychological causes. It proposes that a comprehensive behavioral program using a customizable software platform can help address non-adherence by providing personalized support that targets the cognitive, emotional, behavioral, and environmental factors influencing each individual patient.
Presentation on DNAR Policy (From Acute Hospital Network, June 2014) [AHN 19]Irish Hospice Foundation
This document discusses DNAR (Do Not Attempt Resuscitation) policies and communication regarding end-of-life care. It notes that while DNAR policies aim to provide guidance, individual decision making is needed. DNAR decisions should be made through open discussions involving the patient and considering their prognosis, values and goals. However, communication challenges can arise from unrealistic expectations, denial, misunderstandings and conflicts. The document advocates clear documentation and communication of DNAR decisions across care settings to ensure patient wishes are followed.
IN THIS PRESENTATION I HAVE DESCRIBED ABOUT DOCTORS AND PATIENTS RELATIONSHIP . History of doctor-patient relationship. Models of doctor-patient relationship. Psychological types of doctors. Basic characters and skills of physician. Communication of doctors. Problems of contemporary healthcare system
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
Hippocrates viewed the physician as 'captain of the ship' and the patient as someone to take orders. Relationship between patients and doctors are often unstated, and thy are dynamic
As conditions change, the kind of relationship that works best for a patient may change. Doctors and patients should choose a “relationship fit” . Effectiveness of the patient-physician relationship directly relates to health outcomes.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
This study evaluated the causes of patients visiting multiple consultants or hospitals for the same chief complaint. 50 patients in Durgapur, India were surveyed. The results showed that 64% had unpleasant scheduling experiences, 88% lacked health insurance, 26% felt staff were not courteous, and 28% felt consultants did not fully answer questions. The study concluded that improving communication, listening skills, wait times, and ensuring questions are answered could increase patient satisfaction and reduce multiple visits. It is recommended that consultants foster respect, take time to listen actively, provide counseling, and incorporate patient feedback.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
The document discusses complex patient journeys and tools to impact them. It begins by defining key dimensions and inflection points of patient journeys. Dimensions include the healthcare, disease/therapy, and human journeys. Inflection points are moments where outcomes are predicted. Behavioral science and cognitive-behavioral therapy can be used to intervene at these points by addressing cognitive, emotional, and behavioral barriers. A case study examines using these tools to help appropriate diabetes patients initiate insulin injections by addressing a patient's needle anxiety through cognitive reframing and desensitization exercises.
This document discusses the importance of soft skills for doctors. It notes that while doctors require hard skills for their medical specialization, they also need soft skills for interacting with patients and stakeholders. These include empathy, communication, attitude and relationship management. The document argues that soft skills can be learned and provides tips for doctors to acquire them, such as having a learning mindset, networking, and self-improvement. It also presents examples of when poor soft skills can negatively impact patient experiences.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
The document discusses key aspects of implementing a disease management program including:
1. Encouraging early detection of diseases through various forms of advertising and utilizing guidelines from organizations like the CDC and WHO.
2. Providing incentives for patients to proactively manage their health like lower costs, support groups, and easy access to their medical records.
3. Addressing factors like ensuring quality of care through measurements, making facilities accessible, and emphasizing the importance of prescription management.
The document discusses key aspects of implementing an effective disease management program, including encouraging early detection of diseases, providing patient incentives, establishing physician incentives, selecting appropriate facilities, measuring quality of care, managing prescription benefits, and using case management strategies. It emphasizes preventing disease through screening, education, and lifestyle changes can improve patients' health while lowering overall healthcare costs. Future directions include increased use of electronic medical records and data analytics to track outcomes and continuously improve programs.
Healthcare -- putting prevention into practiceZafar Hasan
This slidedeck is submitted by Zafar Hasan because one of the trends in medicine for the last 20 years isa focus on prevention and this deck is an outstanding practice primer.
The document summarizes the introductory meeting of the Trauma Informed Care Network (TICN) held on March 14, 2014 in Salt Lake City, Utah. TICN was formed in 2013 by mental health and medical professionals to increase collaboration and education around trauma-informed care. The meeting discussed the impacts of trauma, goals to increase awareness and access to treatment, and potential initiatives for the network such as establishing a speakers bureau and website. Attendees were asked to sign up for the network and its provider list.
Why screeing cancer patients for distress will increase disparities in psycho...James Coyne
Keynote address
Implementing screening of cancer patients for distress will not improve patient outcomes and may aggravate existing biases in who get psychosocial services.
Study and survey results indicate that digital can best be deployed by healthcare and life sciences/pharmaceuticals practitioners and companies to offer "warm" treatment that encourages and empowers patients in order to yield excellent health outcomes and operational efficiencies.
Becoming Better Advocates for Your HealthBest Doctors
A leader and innovator in research on patient-centered care, Dr. Leana Wen will share her perspectives on what patients and providers can do to work more effectively together to achieve their shared goal – better health and outcomes. She will be joined by Sonia Millsom, VP of Best Doctors, who will discuss how optimizing care and controlling costs are within reach for today’s patient. The presenters will finish with live questions from the audience.
This document provides best practices for independent oncology practices to increase referrals from hospital-affiliated physicians. It outlines a four-pronged strategy of excellent service, outreach, convenience, and cost considerations. Excellent service includes outstanding patient care, quick turnaround times, and communication with referrers. Outreach involves hospital presence, referrer meetings, community involvement, and promotion. Convenience recommends a one-stop shop, proximity to patients, and multiple locations. Regarding cost, the document suggests accepting more insurance plans and staying attractive to payers to compete with hospitals. Data analysis tools can help implement these strategies effectively.
This document discusses key concepts for patient assessment and communication in medical imaging. It emphasizes the importance of critical thinking, problem solving, cultural awareness and establishing effective communication. The radiographer must collect subjective and objective data on the patient, analyze the data to develop a customized care plan, implement the plan and evaluate the results. Nonverbal communication, gender factors and other variables that could impact the patient experience are also addressed.
This document discusses key concepts for patient assessment and communication in medical imaging. It emphasizes the importance of critical thinking, problem solving, cultural awareness and establishing rapport when interacting with patients. Effective communication involves both verbal and nonverbal elements, with factors like gender, disabilities and grief needing consideration. The goals are to obtain necessary medical histories, explain procedures, ensure patient comfort and provide education to support patient rights and self determination.
This document discusses key concepts for patient assessment and communication in medical imaging. It emphasizes the importance of critical thinking, problem solving, cultural awareness and establishing rapport when interacting with patients. The radiographer must collect both subjective and objective data about the patient, analyze the information to develop an individualized care plan, implement the plan and evaluate the results. Nonverbal communication, gender factors and other variables that could impact the patient experience are also addressed.
This document discusses key concepts for patient assessment and communication in medical imaging. It emphasizes the importance of critical thinking, problem solving, cultural awareness and establishing rapport when interacting with patients. The radiographer must collect both subjective and objective data about the patient, analyze the information to develop an individualized care plan, implement the plan and evaluate the results. Non-verbal communication, gender factors and other variables that could impact the patient experience are also addressed.
The document discusses three ways to increase patient loyalty in healthcare: (1) provide quality service by listening to patient needs and being consistent, (2) personalize medical care through a team-based approach centered around the patient rather than symptoms, and (3) utilize effective medical teams where all members work together to focus on the patient through mutual monitoring and backup. The goal is to shift from reactive treatment to preventative care in order to strengthen long-term patient loyalty and relevance of healthcare groups.
The document discusses clinical decision support systems (CDSS) which are electronic tools that assist clinicians in making clinical decisions for patients. CDSS helps clinicians focus more on interacting with patients by providing clinical guidelines, recommendations, and diagnostic and prescribing support. While these systems can help with continuity of care, implementing them can also lead to confusion and lack of communication if not done properly. The aim is to compare the design and implementation of CDSS to assess diagnostic accuracy before and after its use in patient care.
This document outlines steps for effective breast cancer navigation using the nursing process theory. It discusses the role of a navigator, identifying barriers patients face, and developing strategies to address them. A case study example illustrates how to assess an elderly patient's physical, emotional, support system, knowledge, financial, and healthcare barriers. Attendees then brainstormed ways for navigators to reduce different barriers. The presentation emphasizes that navigators cannot work alone and need a multidisciplinary team including non-clinical navigators, financial counselors, dietitians, and social workers to best support patients.
This document discusses ethical issues surrounding disclosure of diagnoses, specifically Alzheimer's disease, to patients and their families. It provides guidance on assessing a patient's understanding and desire to know their diagnosis before disclosure. When disclosing Alzheimer's, it is important to arrange a joint meeting with family, allow time for questions, discuss disease progression and care plans, and involve caregivers going forward. The case study describes one family's experience where the husband decided to disclose the wife's Alzheimer's diagnosis to her in the doctor's office, but she initially reacted with disbelief and later developed aggressive behaviors towards her husband caregiver.
Genetic counseling involves assessing risk factors for genetic disorders, constructing pedigrees, estimating disease risk, providing information to clients, and helping them make decisions. It aims to educate clients, provide support, and allow for informed reproductive choices. Genetic counselors are specially trained to communicate complex genetic information in a caring, non-directive manner. They work with clients in a variety of settings to address legal, ethical and psychosocial issues surrounding genetic testing and diagnosis. Nurses play an important supporting role by recognizing genetic conditions, assisting with testing and counseling, and providing ongoing education and support.
Are Most Positive Findings False? Confirmatory Bias in the Evaluation of Psyc...James Coyne
I was tired of this 2007 presentation being plagiarized and so i am making it available. The time stamp for the file on a hard drive for it is 3.20.2007. An old cv I retrieved indicates that I gave a talk at Catholic University of America and at University of Gronigen with this title in 2007. I recycled some of the slides since and slides 48-50 have been quite popular as seen in some persons using them in publications without appropriate attribution.
Regardless, you should be amazed how prescient this presentation now seems, over a decade later, and how much things have not changed.
The scandal of the £5m PACE chronic fatigue trialJames Coyne
Talk delivered to patients with chronic fatigue/myalgic
encephalomyelitis Belfast Castle February 7, 2016 about trial of psychotherapy that failed to demonstrate effectiveness, despite claims to the contrary
The scandal of the £5m pace trial for myalgic encephalomyelitisJames Coyne
This document summarizes James Coyne's involvement in criticizing the PACE trial for chronic fatigue syndrome. It discusses how Coyne initially published a critique of the trial findings in Lancet Psychiatry. When the PACE investigators refused to share trial data upon request, as they had promised, it became an internationally watched standoff. Coyne aims to obtain and reanalyze the data or get the paper retracted. He also wants to stop the abuse and stigmatization of CFS patients and recognize them as scientists.
Understanding Psychosis and Schizophrenia Royal EdinburghJames Coyne
Offers evidence that group of UK clinical psychologists offer misinformation to persons seeking information about services for serious mental problems.
Researchers face pressure to publish exciting findings that will garner media attention, but must take care not to exaggerate or distort their results. While promotion of their work is necessary, researchers should use appropriate causal language, recognize limitations of their studies, and remain transparent in reporting associations and rationale. Responsible reporting practices help ensure research accurately informs public health policies and recommendations.
Screening for depression in medical settings 2015 updateJames Coyne
This document summarizes a presentation on screening for depression in medical settings. The presenter expresses skepticism about screening and notes controversies should be resolved by evidence. Screening is meant to detect untreated depressed patients but success requires identifying many such patients and engaging them in effective treatment. However, evidence shows recognition alone does not improve outcomes and benefits of screening depend on the quality of routine care available. Overall, the presenter argues the evidence does not clearly support widespread screening and identifies potential harms such as high false positive rates and risks of overdiagnosis.
Maximizng the power of good scientific writingJames Coyne
Presentation at UMCG Central Medical Library, University of Groningen Symposium "How to Write a World-class Paper“ November 14th, 2014
A highly cited author discusses how differently he is now writing and promoting his articles compared to his first ones.
Negative emotions and health: Why do we keep stalking bears.ehpsJames Coyne
This document discusses the tendency of researchers to make spurious claims linking negative emotions to health outcomes. For over 50 years, researchers have claimed to find a modifiable connection between negative emotion and morbidity/mortality, but these claims often lead to embarrassment after being disconfirmed. The document argues that many studies actually find only uninformative risk markers rather than true modifiable risk factors. It warns against continuing to make premature or exaggerated claims without ruling out alternative explanations like residual confounding.
Are most positive findings in psychology false or exaggerated? An activist's ...James Coyne
This document summarizes a presentation given by James Coyne on issues with reliability and bias in positive psychology findings. Some key points:
- John Ioannidis and others have shown that many positive findings in biomedical research do not replicate and are exaggerated or false due to biases.
- Similar issues exist in psychology due to confirmatory bias, flexible data analysis and chasing statistical significance.
- Reforms are needed like pre-registering studies, transparent reporting standards, and making data available for independent analysis.
- However, challenges remain as journals prefer positive results and organizations have conflicts of interest that uphold certain findings. Overall, skepticism is needed regarding many claimed research findings.
“Evidenced based” behavioral medicine as bad as bad pharmaJames Coyne
Introduction to symposium held at International Congress of Behavioral Medicine, Groningen, August 2014. Discusses the shortcomings of evidence-based behavioral medicine in light of efforts to reform the shortcomings of the Pharma literature.
Groningen defeating dissertation blues 2104James Coyne
Invited talk to the Groningen Students in Medical Science PhD Council, May 2014. Presents practical strategies for PhD students to combat the blues while writing their theses.
Negative emotion and health why do we keep stalking bears, when we only find ...James Coyne
Describes the frustrating search for a link between specific negative emotions and health and why the search often fails. Integrates epidemiology and psychology.
The folly of believing positive findings from underpowered intervention studiesJames Coyne
Presented at the European Health Psychology Conference, July 13, 2013, This slideshow shows the folly of accepting positive findings from underpowered studies. Much of the "evidence" in health psychology comes from such unreliable studies.
Advice to junior researchers: High or low road to success?James Coyne
A presentation from the International Psycho-Oncology Society Conference in Rotterdam invited by the IPOS Early Career Professionals Special Interest Group.
Families, Family Interaction and Health 2009 NIMH PresentionJames Coyne
The document summarizes critiques of past studies that claimed to find direct physiological links between family interactions and health outcomes like diabetes control or mortality. Some key criticisms included small sample sizes, overanalyzed data, ignoring obvious behavioral explanations like medication adherence, and findings that did not replicate or pass common sense tests. Later work found marital quality predicted survival through more plausible mechanisms like supporting complex medical regimens rather than direct physiological pathways. The takeaway is to be cautious of strong claims from weak evidence and avoid distractions from testable hypotheses about behavioral pathways.
Evaluates a meta analysis of family therapy interventions for families facing physical illness.
The slide presentation and article is discussed in greater detail at http://jcoynester.wordpress.com/2013/08/12/interventions-for-the-family-in-chronic-illness-a-meta-analysis-i-like/
When cherished beliefs clash with evidenceJames Coyne
The document summarizes challenges faced when scientific evidence contradicts widely held beliefs. It discusses how storylines become entrenched and shape how evidence is perceived, often in a biased way that favors confirming existing beliefs. Even well-conducted studies showing no effect of psychosocial interventions on cancer outcomes have been misrepresented or ignored. The document calls for more transparent and honest reporting of results to establish a climate where null findings are valued rather than hyped results.
Chronology of distress, anxiety, and depression in older cancer aa 2 5 13
Screening for Distress versus Providing Supportive Care: Avoiding a Conflict
1. Screening for Distress versus
Providing Supportive Care: Avoiding
a Conflict
4e Nationaal Congres Palliatieve Zorg
Lunteren, NL 14-16 Nov 2012
James C. Coyne, Ph.D.
Department of Psychiatry, University of
Pennsylvania
Health Psychology Program, University
of Groningen
2. We would all like patients
with advanced cancer to
feel that they can talk to a
healthcare professional
about their concerns without
feeling guilty about taking
up the professional’s time.
3. We would all like patients with advanced
cancer to have better management of their
symptoms and better understanding of
what is possible in their personal
circumstances.
4.
5. Advanced cancer patients are not receiving
the help they need.
Large proportions of patients were burdened
by symptoms/problems.
Of those who had received help, many
viewed it as inadequate.
Better symptom/problem
identification and
management is warranted
for advanced cancer
patients.
6. Efforts to marshal the resources and
personnel to address the needs of cancer
patients can have unintended
consequences, particularly when they are
undertaken in dysfunctional systems with
perverse incentives.
8. An American woman Susan Krantz,
received national news attention when she
complained about her physician charging
her $50 for her having asked questions
during her annual physical.
9. Her insurance company paid her physician
for the physical, but not for answering her
questions.
She had not been warned of the extra
charge ahead of time.
11. Talking to patients as a (billable) procedure.
Conversations with the meter running.
“We’re not paid to solve
patients’ problems, we are
paid to do procedures.”
12. American healthcare system staffed by
professionals financed by fees for service,
not guaranteed salaries.
Professionals are paid for doing procedures,
not engage in cognitive processes like
having conversations and solving problems.
14. Monitoring screening for distress with
quality indicators.
Pfizer gives $10 million grant to American
psychologist to develop quality indicators to
monitor oncologists’ screening for distress.
15. Oncologists cannot close their medical records
without indicating whether they have asked a
patient about distress.
Oncologists must indicate what action was taken if
a patient report being distressed.
Oncologists can comply with quality indicators by
asking simply “you feeling depressed?” and
prescribing antidepressants to patients who
answer “yes” without formal diagnosis, patient
education, or follow-up.
16. A significant proportion of breast
cancer patients in the United
States are prescribed an
antidepressant without ever
having a two weeks mood
disturbance in their life.
17. NonMDs 1
Other MDS 2
Psychiatrists 3
Oncologists 4
God 5
19. “To screen or not to screen?”
The answer is complex, and depends on the
goals, existing resources in a setting, and the
readiness of that setting to accommodate the
effects of introducing screening, intended and
unintended.
20. Promise of screening
Cheap, quick.
With touch screen, can be integrated into routine
care in almost mechanical fashion.
Identifies distress and depression that would
otherwise be undetected.
Uncovers unmet needs.
Gives voice to otherwise silent or unheard
persons in need.
21. Promise of screening
Scores are ambiguous as to what needs to be done.
Requires follow up to resolve positive screens, involving
staff and patient time and resources.
Many needs that are identified will not have standard or
ready solutions.
Clinical need is not equivalent to interest in or readiness to
accept services.
22. Implementation of screening
Has not been shown to improve patient
outcomes.
Involves reworking of pathways from patients
to psychosocial services.
Involves reconceptualization of provision of
support in terms of billable procedures or
“sessions” with professionals.
Has unintended consequences including
forcing the cancer experience into the mold
of a mental health issue.
23.
24. Raffle, A and Gray, M. (2007). Screening:
Evidence and Practice. Oxford Press.
Screening must be delivered in a well functioning
total system if it is to achieve the best chance of
maximum benefit and minimum harm. The system
needs to include everything from the identification of
those to be invited right through to follow-up after
intervention for those found to have a problem.
25. Current Dutch practices do not comply
with proposed international guidelines for
mandated screening.
26. Detection of Need for Care Guideline:
Discussions following completion of the
Lastmeter
27. Viva les Dutch!
The last time I checked, the Dutch were
still talking to every patient who wished to
talk, even those who were not distressed.
28. What screening is not
Definition excludes settings in which patients
complete screening items or questionnaires
and their responses are then used to structure
discussions with professionals or peer
counselors, regardless of whether the patients
meet pre-established thresholds for distress.
Definition excludes situations in which a
questionnaire is used to facilitate a
conversation independent of patients’ level of
distress.
29. The basic comparative evaluation
of screening:
All patients screened for distress. Patients
screening positive according to some set criteria
receive a follow up interview, in which nature of
distress is evaluated, and a service is provided or a
referral is made.
versus
Patients are informed about same services and
have ready access to them by self-referral or
clinician referral without regard to level of distress.
30. The Basic Comparative Evaluation of
Screening
All patients screened for distress. Patients
screening positive according to some set criteria
receive a follow up interview, in which nature of
distress is evaluated, and a service is provided or
a referral is made.
Versus
Patients are informed about same services and
have ready access to them by self-referral or
clinician referral without regard to level of distress.
31. No study has ever shown that patients
screened for distressed have better
outcomes than patients having the
same access to discussions with staff
and services without being screened.
32. Screening for distress
should be cautiously
recommended for well
resourced settings, not
mandated!
Be prepared for on
intended consequences.
33. Alternatives to screening
Enhanced support, access to services, and follow
up for patients already known to be distressed or
socially disadvantaged.
Provide ready access for patients to discuss
unmet needs with professional and peer
counselors regardless of level of distress.
Increase resources for addressing health
disparities in access to psychosocial services.
34. Alternatives to screening
Give patients time to talk and listen to them, don't
let screening for distress get in the way.
Don't require cancer patients to interact through
computer touch screen assessments.
Do give them the opportunity to talk about their
experiences, their needs, their concerns, and their
preferences regardless of their level of distress.
35. Implementing screening for distress
involves adopting a distress paradigm
for supportive services that will have
unintended consequences.
36. Should the services we provide to cancer
patients be required to be evidence-
based?
37. Of course.
We need to ensure quality
services that will improve
patient outcomes.
Patients with advanced cancer
are often dissatisfied with the
effectiveness of services they
receive.
38. Of course not.
Many patients seeking services
are not distressed and so
cannot register an
improvement.
Many patients do not seek
services in order to resolve
distress.
39. Compared to what?
Almost all claims of being “evidence-based”
services are based on comparisons to wait list
and no treatment.
Providing evidence-based treatments requires
training, credentialing, and billing.
The unanswered question whether most patients
need more than focused attention, support, and
feedback.
40. Should patients have free
access to yoga?
Should patients have
access to yoga if it is not
shown to reduce their
distress?
42. Should psychiatrists conduct that spiritual
histories?
Should psychiatrists bill for doing meaning-
centered, spiritually oriented
psychotherapy?
Should pastoral counselors talk about
spiritual issues without mental health
credentialing?
43. Many patient concerns can be addressed
with information, support and attention, and
follow up.
Fewer patients need more specialized
services, but they should have access to
them, and the services should be evidence
based.
44. Resolution
We need to distinguish between patients
getting the routine supportive services they
need and getting more specialized, intensive
treatments that should
beevidence-based.
45. Rogers A, Karlsen S, Addington-Hall J 'All the
services were excellent. It is when the human
element comes in that things go wrong':
Dissatisfaction with hospital care in the last year
of life. J Advanced Nursing 31 (4): 768-774 2000
Examined causes of dissatisfaction with hospital-based
care. At least one negative comment was made by 59% of
those making any comment. Qualitative analysis of
responses to open questions suggest that expressions of
dissatisfaction arise from a sense of being 'devalued',
'dehumanized' or 'disempowered' and from situations in
which the 'rules' governing the expected health
professional-patient relationships were broken.
46. Alternatives to screening
• Enhanced support, access to services, and
follow up for patients already known to be
distressed or socially disadvantaged.
• Provide ready access for patients to discuss
unmet needs with professional and peer
counselors regardless of level of distress.
• Increase resources for addressing health
disparities in access to psychosocial services.