Journal of general internal medicine
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Comparative Study
Providers' perceptions of relationships and professional roles when caring for patients who leave the hospital against medical advice.
Patients who leave hospitals against medical advice (AMA) may be at risk for adverse health outcomes. Their decision to leave may not be clearly understood by providers. This study explored providers' experiences with and attitudes toward patients who leave the hospital AMA. ⋯ Our study revealed that patients who leave AMA influence providers' perceptions of their patients' insight, and their own patient-provider communication, empathy for patients, and professional roles and obligations. Future research should investigate educational interventions to optimize patient-centered communication and support providers in their decisional conflicts when these challenging patient-provider discussions occur.
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Multicenter Study Comparative Study
Physician burnout and patient-physician communication during primary care encounters.
Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors. ⋯ Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.
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Comparative Study
Using the experiences of bereaved caregivers to inform patient- and caregiver-centered advance care planning.
Traditional approaches to advance care planning (ACP) have many limitations; new approaches are being developed with the goal of improving end-of-life care. ⋯ The experiences of older patients at the end of life and their caregivers support a form of ACP that includes a broader set of issues than treatment decision-making alone, recognizes the dynamic nature of preferences, and focuses on addressing barriers to patient-caregiver communication.
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Comparative Study
Older patients perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries.
Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure. ⋯ When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients' perceptions regarding the need for these services.
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Randomized Controlled Trial Comparative Study
The impact of consumer-directed health plans and patient socioeconomic status on physician recommendations for colorectal cancer screening.
Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. ⋯ Patient SES and deductible-level affect physician recommendations for preventive care. Coverage of preventive services and funds in medical savings accounts may help to mitigate the impact of high-deductibles and SES on inappropriate recommendations.