PubMed Health⌕ Search

Biomedical subjects

Arnstein Finset

Publications and source records attributed to Arnstein Finset.

31 records · Page 2Linked to original sources
PubMed2003

Interaction analysis of physician-patient communication: the influence of trait anxiety on communication and outcome.

Little attention has been paid to how patients' personality traits interfere with the communication and the outcome of physician-patient interaction. We performed an experimental study with students with high and low trait anxiety as patients. One physician conducted a single consultation with 41 students applying two beforehand-specified consultation styles. Patients completed questionnaires concerning emotional state and satisfaction. The actual content of the consultations was analyzed by Roter interaction analysis system (RIAS). The physician gave more biomedical information to low-anxiety students than high-anxiety students. Students who provided a lot of biomedical information themselves were less tense after the consultation. However, students with high anxiety were more dependent on the physician actively asking biomedical questions for them to be able to deliver that same information. In contrast to low-anxiety students, those with high anxiety were less satisfied after consultations involving many psychosocial questions posed by the physician and a good deal of emotional talk on their own part. Compared to low-anxiety students, students with high anxiety were less satisfied and tenser after consultations with much positive emotional talk on the part of the physician. We conclude that physicians and educators should be aware that psychological and emotional communication may be experienced as intrusive and inappropriate by patients with high trait anxiety when they present minor somatic problems.

Adult↗
PubMed2003

Physician communication in different phases of a consultation at an oncology outpatient clinic related to patient satisfaction.

The aim of this study was to identify the relationship between content during the different phases of the consultation and overall patient satisfaction with regular follow-up consultations at a cancer outpatient clinic. Thirty-six consultations were analysed with Roter Interaction Analysis System (RIAS). In the statistical analysis, timed events of the RIAS categories were used. The regular follow-up consultations were rather short aiming at discussing medical and therapeutic aspects of the illness. There was a positive correlation between physician informal talk (IT) and patient satisfaction in the history-taking phase. Patients were found to be dissatisfied if the physician had focused on a great deal of psychosocial exchange (PE) during physical examination. Our study suggests that the physician should not initiate discussion of psychosocial topics during physical exam. This result should be studied further in other samples and designs.

Adult↗
PubMed2003

Effectiveness and cost-effectiveness of comprehensive rehabilitation programs.

Comprehensive rehabilitation involving multidisciplinary involvement of healthcare professionals is available to patients with rheumatic diseases. Studies were reviewed on the effectiveness of such programs for patients with chronic low back pain, widespread pain, and rheumatoid arthritis. When effects on the various outcome measures are demonstrated, improvements can only with difficulty be attributed to a specific component of a comprehensive program. Economic analyses for the effectiveness of comprehensive programs are scarce, but are needed by policy makers to allow optimal allocation of resources. Preferably the overall performance of comprehensive rehabilitation programs, not the individual components, should be evaluated.

Arthritis, Rheumatoid↗
PubMed2003

The effect of social network intervention for women with rheumatoid arthritis.

A partially-controlled intervention study was performed. Female patients with rheumatoid arthritis (RA) were allocated to three groups: the network intervention group (n = 104), the attention control group (n = 85), and the no-treatment control group (n = 75). The network intervention consisted of an assessment session and a network meeting. Patients were assessed at baseline and approximately 10 and 18 months after the intervention. The network intervention group reported an increase in network size. Daily emotional support increased for the intervention patients compared with patients in the attention control group. The degree of social dysfunction was reduced for patients in the intervention group compared to patients in the no-treatment control group. Furthermore, for single patients, the intervention significantly increased the social network size and improved both social functioning, and perceived overall health, compared to both control groups. The results suggest that the social needs of single patients should be given special attention in clinical settings.

Adult↗
PubMed2002

[Physician-patient relations in functional disorders].

The doctor-patient relationship is often problematic in relation to "functional disorders". A strictly biomedical understanding fails in two ways: first, because it does not incorporate psychosocial factors; second, because it does not take into account the body as a subject and carrier of meaning. A more integrated model would include a general understanding of the aetiology and presentation of symptoms (bio-psychosocial) as well as of symptoms and body as carrier of meaning (phenomenology). This way the patient's subjective experience, gender, social and cultural situation become medically valid information on par with biological parameters. This article describes how a bio-psychosocial and phenomenological understanding of symptoms can change the communication between physician and patient. We present some approaches that the physician may use when meeting patients with "functional disorders".

Communication↗
PubMed2002

Androgens and estrogens in relation to hot flushes during the menopausal transition.

In this paper, the association of hormones to vasomotor complaints during the menopausal transition is discussed. Fifty-seven regularly menstruating women without history of hormone replacement therapy (HRT) were selected for a longitudinal, prospective study around the menopausal transition. The mean age at the start of the study was 51.3 (+/-2.0) years. At intervals of 12 months all women went through a semi-structured interview and filled in questionnaires. Venous blood samples were collected every 12-month for analyses of estradiol (E2), testosterone, androstendione, dehydroepiandrosterone-sulphate (DHEA-S), follicle stimulating hormone (FSH), thyrotropin (TSH), and luteinizing hormone (LH). Vasomotor complaints were tested using questions about hot flushes and bouts of sweating in terms of occurrence, frequency and degree of distress. Forty-six percent of the subjects reported hot flushes and bouts of sweating before menopause, increasing to 67% during the first year after menopause and 49% in the second year postmenopause. Low levels of estradiol and high levels of FSH were associated with vasomotor complaints before menopause. During menopause high levels of TSH were related to vasomotor complaints. The first year after menopause, women, who at this point achieved hot flushes, were characterised by high levels of E2, but declining and low levels of FSH, but increasing. Postmenopausal, high levels of testosterone and DHEA-S seemed to protect against vasomotor symptoms. Our most important finding was, that among women who achieved hot flushes at the first assessment postmenopause, the high androgen levels was a significant predictor of recovery from hot flushes at the last assessment, 1 year later.

Androstenedione↗
PubMed2002

Analyzing medical dialogues: strength and weakness of Roter's interaction analysis system (RIAS).

Roter's interaction analysis system (RIAS) is analyzed in this article. Ground rules of linguistic interaction analysis, emphasizing meaning as a product of interaction and turn taking as a basic principle for the understanding of interaction are briefly introduced. Specific aspects of the application of RIAS are discussed and a number of adjustments and/or specifications suggested: (1) utterances should be defined in terms of content and turn taking criteria; (2) the recording system should allow for registering interruptions; (3) pauses or silences should be scored on the basis of functional criteria and not as demarcation in the communication; (4) clear distinctions should be made between the categories of "backchannel" and "agree"; (5) questions should be coded according to function rather than linguistic form; (6) some of the socioemotional categories may appear too narrow, others too wide; (7) crying should be included in the coding scheme as a separate category.

Communication↗
PubMed2002

The impact of disability and disease duration on social support of women with rheumatoid arthritis.

The objective was to investigate the impact of physical disability and disease duration on the amount of social support received by female patients with rheumatoid arthritis. Two hundred sixty-four patients were assessed in a cross-sectional study. Disease duration had a negative relationship to daily emotional support; the length of disease duration was related to less emotional support. A combination of long disease duration and high disability was related to a low degree of problem-oriented emotional support. High physical disability was associated with less social companionship. Patients with high disability and few friends and patients with high disability and few neighbours reported less social companionship than patients with high disability and four or more friends or three or more neighbours. The combination high disability and few friends were associated with less problem-oriented instrumental support. Number of friends, age, and personality type all contributed to the variance in social support.

Adult↗
PubMed2002

The final version of the Patient Perspective Survey (PPS): a new tool to improve consultation outcome and patient participation in general practice patients with complex health problems. Doctors' and patients' evaluation and guidelines for clinical use.

BACKGROUND: The Patient Perspective Survey (PPS) is a new clinical communication tool designed to stimulate patient involvement in the management of complex health problems in general practice and to improve patient and doctor satisfaction with the consultation. The development of this final 38-item version of the PPS has been described elsewhere. OBJECTIVE: The aims of this article are to present recommendations for clinical use and how GPs and patients have evaluated this new tool. METHODS: The study material included 159 patients (78% females) with a mean age of 45 years, mainly presenting with longstanding musculoskeletal and psychosocial disorders, selected by 32 GPs. After the PPS-based consultation, both doctor and patient were asked to fill in evaluation forms. RESULTS: In as many as 55-85% of the consultations' various aspects, it was perceived by the GPs that the use of the survey helped (to some extent, much or very much) in achieving improved clinical communication and a constructive consultation. The most important elements appeared to be stimulation of positive interaction/processes and obtaining new and relevant information. Similar results were found regarding patient evaluation. There was significantly more positive doctor evaluation if the doctor-patient relationship had lasted less than 1 year, and if the patient agreed to prepare a 'plan of action' for a follow-up consultation. Guidelines for clinical use are presented. CONCLUSION: We now regard the PPS to be completed for daily clinical use and believe that it has been shown to be a potent tool to improve consultation outcome in the large and challenging group of patients with complex health problems in general practice.

Adult↗
PubMedDate not supplied

Long term benefits of communication skills training for cancer doctors.

OBJECTIVE: To assess satisfaction and learning accomplishments after communication skills training courses for cancer doctors in the Nordic countries. METHOD: 155 physicians from the five Nordic countries participated in a communication skills training course. Questionnaires were completed at baseline, at course completion and at follow-up after 2 to 6 years. RESULTS: 94% of the physicians indicated satisfaction with the course. Physicians who had participated in the whole course (as opposed to those who had participated only in parts of the course) and physicians from Denmark and Sweden were most satisfied with the course. Whereas physicians at baseline most frequently reported a need to learn specific aspects of communication, often with emphasis on psychiatric problems, at follow-up they most typically reported that they had learnt basic communication skills (i.e. to listen and to pose open-ended questions). The majority of the physicians reported at follow-up that they applied the learnt skills to patient-related work, in relation to colleagues and on a personal level. CONCLUSION: Communication skills courses for senior clinicians with no previous formal training in this field should emphasise basic communication skills as well as the handling of difficult situations in doctor-patient interaction.

Adult↗
PubMedDate not supplied

Exploring rare patient behaviour with sequential analysis: an illustration.

AIMS: To illustrate the application of sequence analysis to the study of rare patient behaviour in physician-patient dialogue. The rare behaviour in question here is patients' expression of emotional cues and concerns. We investigate which physician behaviours precede and follow such expressions. METHODS: Thirty-five cancer-patient consultations performed by four oncologists (two male and two female) were analysed. The consultations were coded with the Roter Interaction Analysis System (RIAS). Sequence analysis by means of Sequential Data Interchange Standard (SDIS) and the Generalized Sequential Querier (GSEQ) was applied to the coded data. Lag analysis (using RIAS categories) was applied to associate the given behaviour (patient 'concerns') with target behaviours (physician utterances). RESULTS: For female physicians the significantly associated behaviour before the patient's expression of concern was reassurance, while male physicians also applied facilitation behaviour. After patients' expression of concern both reassurance and facilitating behaviour were shown by physicians of both genders. CONCLUSIONS: Sequence analysis appears to be a clinically meaningful and statistically sound method for analysing are patient utterances and associated physician behaviour.

Communication↗
PubMedDate not supplied

Communicating with alexithymic and non-alexithymic patients: an experimental study of the effect of psychosocial communication and empathy on patient satisfaction.

BACKGROUND: Previous studies have shown that alexithymia is associated with a wide range of somatic and psychiatric conditions. The aim of this study was to investigate experimentally how psychosocial communication and empathic response from the physician affects satisfaction in alexithymic and non-alexithymic patients. METHOD: Seven physicians and 65 female patients from a fibromyalgia patient association participated in the study. The Toronto Alexithymia Scale (TAS-20) was used to categorise patients as alexithymic or non-alexithymic. Patients also completed questionnaires regarding trait anxiety and satisfaction with their consultation. Physicians were instructed to differentiate their communication in terms of both psychosocial matters and empathic response. The content of the consultation was analysed using the Roter Interactional Analysis System. RESULTS: Regression analyses revealed that alexithymic patients were significantly more satisfied when they received a greater empathic response from the physician. Non-alexithymic patients, however, were more satisfied when the consultation was of longer duration. Psychosocial communication did not have any statistically significant effect on satisfaction in either of the two subgroups. CONCLUSIONS: Verbalised empathic response from the physician may be crucial for the alexithymic patient's post-consultation satisfaction and may thereby become the basis for a solid treatment alliance. The validity of this hypothesis should be tested in different clinical settings and with different patient populations. Future research on alexithymic patients' response to psychosocial communication may benefit from determining to what extent this communication is concerned with general distress or more complex emotional phenomena.

Adult↗