Physician-patient interactions & communication with conscious patients during simulated cath-lab procedures: An exploratory study
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.
Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.
Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient.
Conclusions Our findings indicate underlying patient assumptions about physicians’ experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.
Methods In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.
Results While independent ratings of physician–patient communications demonstrated few discernible differences according to physicians’ experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient’s anxiety scores were differentiable according to operators’ experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient.
Conclusions Our findings indicate underlying patient assumptions about physicians’ experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.
Date Issued
2019-11-29
Date Acceptance
2018-02-06
Citation
BMJ Simulation & Technology Enhanced Learning, 2019, 5 (1)
ISSN
2056-6697
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Simulation & Technology Enhanced Learning
Volume
5
Issue
1
Copyright Statement
© BMJ Publishing Group Ltd. This article has been accepted for publication in BMJ Simulation && Technology Enhanced Learning, 2019 following
peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/bmjstel-2017-000249.
peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/bmjstel-2017-000249.
Sponsor
St Mary's Coronary Flow Trust
Imperial College Healthcare NHS Trust
Engineering & Physical Science Research Council (E
London Deanery
Wellcome Trust
Health Education North West London
Medical Research Council (MRC)
Grant Number
CFT/15/4003
RDOTH 79560
EP/F059221/1
LSHA ref: XXEMEJIA
095330/Z/11/Z
Funder to provide
MR/M018369/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
communication
immersive simulation
simulated patients
patient perspectives
OBSERVATIONAL TEAMWORK ASSESSMENT
PATIENTS FEARS
ANXIETY
SURGERY
INTERVENTION
DEPRESSION
REFINEMENT
SKILLS
OTAS
Publication Status
Published
Date Publish Online
2018-03-14