Patients identify cultural factors that affect their health care encounters
Anna Nápoles‐Springer and her colleagues convened 19 focus groups of African‐American, Latino and non‐Latino white living in the San Francisco Bay Area of the USA. They asked people to discuss what ‘culture’ meant to them and how what their doctors did or did not understand about their culture affected their medical consultations. The views they elicited confirmed the importance of several aspects of cultural competence that are currently included in the frameworks used to develop and assess health care providers. They also identified several other aspects and implications of culture that warrant attention in health care contexts.
Purchasing spectacles: what matters to clients?
Fiona Fylan and her colleagues surveyed 158 people who had attended one of 14 optometry practices with age‐related changes in vision. They identified four main clusters of issues in relation to the purchase of spectacles: style, vision (and eye health), information about technical details (e.g. about different lens types) and practical difficulties (e.g. in visiting the optician and affording spectacles). The authors suggest that opticians could usefully think about offering information relating to each of the first three clusters, prioritizing those aspects which individual clients consider most relevant.
What happens in consultations? The differing accounts of doctors and patients
Richard Hooper and his colleagues asked members of the British armed forces and their doctors to indicate on a questionnaire what actions were taken as a result of a particular consultation. They also asked the patients whether they thought particular actions should have been taken. They found varying degrees of agreement between patients and doctors about whether particular types of action were taken. The proportion of patients for whom what was done did not accord with what patients thought should have been done was higher when doctors’ (rather than patients’) reports were used to assess what was done.
Assessment of doctors' facilitation of shared decision making
Glyn Elwyn and his colleagues present a revised version of the OPTION instrument, which was designed to allow observers to make structured assessments of the extent to which doctors act to involve patients in decision making. When two trained observers applied the instrument to 186 primary care consultations, they achieved good levels of agreement for the overall OPTION scores. Neither of the raters assigned a score higher than the mid‐point to any of the consultations for any of the behaviours of interest. The authors suggest this reflects the fact that doctors who have not been trained in shared decision making achieve low levels of patient involvement in routine practice.
Doctors' views about patients arriving with specific requests
Hanna Toiviainen and her colleagues report on a national survey of Finnish physicians. Over half of the respondents said they ‘often’ or ‘very often’ saw patients who arrived at their appointments with specific requests for particular laboratory tests, examinations, or surgical or other procedures. Three quarters of the physicians thought there had been an increase in such requests in recent years. Only a quarter of them thought these situations had positive implications for patient care and physician–patient interaction. They gave a range of reasons for regarding patients’ requests as having positive or negative implications. Some differences of opinion apparently reflected different judgements about how well informed patients were and how well‐founded their requests were.
The experiences of people with multiple chronic illnesses
Polly Noël and her colleagues held focus group discussions with 60 people, from four regions of the USA, who had two or more chronic health conditions. They asked people to discuss the problems they experienced in caring for multiple illnesses, their communication with health care providers and learning needs for self‐management. They identified a number of issues, particularly relating to medications. Although most patients wanted to be active partners in their own care, they sometimes had difficulty in making this happen. The authors, however, were confident that health care could be organized to meet the complex needs of people with multiple morbidities.
A tool for evaluating community involvement
Jane South and her colleagues report on the development of a self‐assessment tool that organizations can use to consider how well they are doing in relation to community involvement, and to identify areas for improvement. The ‘Well Connected’ tool encourages consideration of: diversity within the organization, whether organizational procedures facilitate participation, communication, support for staff to engage with communities, opportunities for community involvement in decision making and community access to resources.
Families’ and health professionals’ perspectives on family centred care
Gail MacKean and her colleagues present the findings of interviews conducted with parents of children with developmental problems and the health care providers who worked with them. They found that, while health care providers valued parents who were able to play lead roles in the design and implementation of care plans, and to advocate strongly for their children, parents valued health care providers who had good relational competencies, care about them, recognised their uniqueness, and engaged in collaborative relationships in which respective roles were agreed by negotiation. The authors suggest that current trends to devolve responsibility for care to parents are not furthering the implementation of family centred care as families envisage it.