National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Events (2)
- Behavioral Health (1)
- Cancer (2)
- Cancer: Breast Cancer (1)
- Cancer: Lung Cancer (1)
- Care Coordination (2)
- Children/Adolescents (1)
- Chronic Conditions (2)
- (-) Clinician-Patient Communication (43)
- Communication (16)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Critical Care (1)
- Data (1)
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- Diagnostic Safety and Quality (3)
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- Disparities (3)
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- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (3)
- Electronic Health Records (EHRs) (5)
- Emergency Department (1)
- Evidence-Based Practice (1)
- Genetics (1)
- Guidelines (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (12)
- Health Literacy (2)
- Hospitalization (1)
- Human Immunodeficiency Virus (HIV) (3)
- Infectious Diseases (1)
- Medicaid (1)
- Medical Errors (2)
- Medical Expenditure Panel Survey (MEPS) (1)
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- Practice Patterns (1)
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- Provider (1)
- Provider: Pharmacist (1)
- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (6)
- Registries (1)
- Research Methodologies (1)
- Sexual Health (1)
- Shared Decision Making (10)
- Skin Conditions (1)
- Social Stigma (3)
- Surgery (1)
- Teams (1)
- Telehealth (1)
- Tools & Toolkits (3)
- Vaccination (1)
- Web-Based (3)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 43 Research Studies DisplayedAbraham J, Kannampallil TG, Patel VL
Impact of structured rounding tools on time allocation during multidisciplinary rounds: an observational study.
The aim of this study was to investigate whether disproportionate time allocation effects during multidisciplinary rounds (MDRs) persist with the use of structured rounding tools. It concluded that the use of structured rounding tools potentially mitigates disproportionate time allocation and communication breakdowns during rounds with the more structured system-based Handoff Intervention Tool (HAND-IT), almost completely eliminating such effects.
AHRQ-funded; HS017586.
Citation: Abraham J, Kannampallil TG, Patel VL .
Impact of structured rounding tools on time allocation during multidisciplinary rounds: an observational study.
JMIR Hum Factors 2016 Dec 09;3(2):e29. doi: 10.2196/humanfactors.6642.
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Keywords: Tools & Toolkits, Clinician-Patient Communication, Teams, Health Information Technology (HIT), Care Coordination
Gordon HS, Street RL
How physicians, patients, and observers compare on the use of qualitative and quantitative measures of physician-patient communication.
The purpose of this study was to compare several different measures of physician-patient communication. Communication was measured with rating scales completed by patients and physicians and by two groups of external observers who used rating scales or coded the frequency of communication behaviors. The findings highlight the potential for using observers' ratings as an alternate measure of communication to more labor intensive frequency measures.
AHRQ-funded; HS010876.
Citation: Gordon HS, Street RL .
How physicians, patients, and observers compare on the use of qualitative and quantitative measures of physician-patient communication.
Eval Health Prof 2016 Dec;39(4):496-511. doi: 10.1177/0163278715625737.
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Keywords: Communication, Shared Decision Making, Patient and Family Engagement, Clinician-Patient Communication
Gallagher TH, Etchegaray JM, Bergstedt B
Improving communication and resolution following adverse events using a patient-created simulation exercise.
The HealthPact Patient and Family Advisory Council (PFAC) created and led a five-stage simulation exercise to help stakeholders understand what patients experience following an adverse event. Take-homes from these exercises included the fact that the response to adverse events can be complex, siloed, and uncoordinated. Participating in this simulation exercise led stakeholders and patient advocates to express interest in continued collaboration.
AHRQ-funded; HS019531.
Citation: Gallagher TH, Etchegaray JM, Bergstedt B .
Improving communication and resolution following adverse events using a patient-created simulation exercise.
Health Serv Res 2016 Dec;51 Suppl 3:2537-49. doi: 10.1111/1475-6773.12601.
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Keywords: Adverse Events, Clinician-Patient Communication, Medical Errors, Medical Liability, Patient-Centered Healthcare, Patient Safety
Sulzer SH, Muenchow E, Potvin A
Improving patient-centered communication of the borderline personality disorder diagnosis.
This study aimed to understand how clinicians communicate the diagnosis of borderline personality disorder (BPD) with patients, and compare these practices with patient communication preferences. It found that the majority of clinicians sampled did not actively share the BPD diagnosis with their patients, while the majority of patients wanted to be told that they had the disorder, as well as have their providers discuss the stigma they would face.
AHRQ-funded; HS000032.
Citation: Sulzer SH, Muenchow E, Potvin A .
Improving patient-centered communication of the borderline personality disorder diagnosis.
J Ment Health 2016;25(1):5-9. doi: 10.3109/09638237.2015.1022253.
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Keywords: Communication, Diagnostic Safety and Quality, Behavioral Health, Clinician-Patient Communication, Social Stigma
Traino HM, Siminoff LA
Keep it going: maintaining health conversations using relational and instrumental approaches.
The researchers examined how elements of relational and instrumental communication occurring within the first five minutes of the request impacted the length of the discussion. Sixteen U.S. tissue banking organizations and their staff making telephone requests for donation to families of tissue-donation eligible patients agreed to participate in the research. The researchers concluded that aspects of both relational and instrumental communication were associated with discussion length.
AHRQ-funded; HS013152.
Citation: Traino HM, Siminoff LA .
Keep it going: maintaining health conversations using relational and instrumental approaches.
Health Commun 2016;31(3):308-19. doi: 10.1080/10410236.2014.950020.
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Keywords: Communication, Patient and Family Engagement, Clinician-Patient Communication
Lee JL, Beach MC, Berger ZD
A qualitative exploration of favorite patients in primary care.
This study ascertained whether physicians have favorite patients, their experiences with such patients, and how such relationships may influence patients and physicians. It found that most participants (22/25) reported having favorite patients. For many physicians, favorite patients were not necessarily the most compliant patients, or those most similar to them. Instead, favorite patients were often very sick patients and/or those who have known their physicians for a long time.
AHRQ-funded; HS000029.
Citation: Lee JL, Beach MC, Berger ZD .
A qualitative exploration of favorite patients in primary care.
Patient Educ Couns 2016 Nov;99(11):1888-93. doi: 10.1016/j.pec.2016.06.023.
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Keywords: Patient Experience, Patient and Family Engagement, Primary Care, Clinician-Patient Communication
Toomey SL, Elliott MN, Schwebel DC
Relationship between adolescent report of patient-centered care and of quality of primary care.
This study investigated whether adolescent self-report of patient-centered care (PCC) varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. It found that adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. The study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
AHRQ-funded; HS020513.
Citation: Toomey SL, Elliott MN, Schwebel DC .
Relationship between adolescent report of patient-centered care and of quality of primary care.
Acad Pediatr 2016 Nov - Dec;16(8):770-76. doi: 10.1016/j.acap.2016.01.006.
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Keywords: Children/Adolescents, Primary Care, Clinician-Patient Communication, Quality of Care, Access to Care
Prochaska MT, Press VG, Meltzer DO
Patient perceptions of wearable face-mounted computing technology and the effect on the doctor-patient relationship.
The authors aimed to determine patients' perception of and their privacy concerns with Google Glass. They found that the majority, 64% of respondents, appeared open to and would want their doctor to use face-mounted wearable computers such as Google Glass, even when they were unfamiliar with this technology. Although some patients expressed concerns about privacy, the authors found that patients were much less concerned about wearable technologies affecting the trust they have in their physician.
AHRQ-funded; HS023007.
Citation: Prochaska MT, Press VG, Meltzer DO .
Patient perceptions of wearable face-mounted computing technology and the effect on the doctor-patient relationship.
Appl Clin Inform 2016 Oct 12;7(4):946-53. doi: 10.4338/aci-2016-06-le-0094.
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Keywords: Health Information Technology (HIT), Hospitalization, Patient-Centered Healthcare, Patient Experience, Clinician-Patient Communication
Lyles CR, Allen JY, Poole D
"I want to keep the personal relationship with my doctor": Understanding barriers to portal use among African Americans and Latinos.
The investigators sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade. Their findings suggest that uniform adoption of portal use across diverse patient groups requires more usable, more personalized websites, which may be particularly important for reducing health care disparities.
AHRQ-funded; HS022408.
Citation: Lyles CR, Allen JY, Poole D .
"I want to keep the personal relationship with my doctor": Understanding barriers to portal use among African Americans and Latinos.
J Med Internet Res 2016 Oct 3;18(10):e263. doi: 10.2196/jmir.5910.
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Keywords: Disparities, Electronic Health Records (EHRs), Clinician-Patient Communication, Racial and Ethnic Minorities, Web-Based
Kantor R, Thyssen JP, Paller AS
Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.
The authors sought to determine the most commonly-used terms for atopic dermatitis. They found that atopic dermatitis was the most commonly-used term in studies across almost all publication types, languages, and journals and appears to be increasing in popularity. They concluded by suggesting the use of the term atopic dermatitis in publications, healthcare clinician training, and patient education.
AHRQ-funded; HS023011.
Citation: Kantor R, Thyssen JP, Paller AS .
Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.
Allergy 2016 Oct;71(10):1480-5. doi: 10.1111/all.12982.
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Keywords: Education: Patient and Caregiver, Diagnostic Safety and Quality, Patient-Centered Healthcare, Clinician-Patient Communication, Skin Conditions
Krouss M, Croft L, Morgan DJ
Physician understanding and ability to communicate harms and benefits of common medical treatments.
The researchers evaluated physician understanding of harms and benefits of common tests and therapies. They found that most clinicians overestimate harms and benefits for most treatments. Likewise, most of the clinicians in our study reported rarely or never using statistical terms to explain treatment options to patients. However, they were interested in resources to improve understanding of treatment effect size.
AHRQ-funded; HS018111.
Citation: Krouss M, Croft L, Morgan DJ .
Physician understanding and ability to communicate harms and benefits of common medical treatments.
JAMA Intern Med 2016 Oct;176(10):1565-67. doi: 10.1001/jamainternmed.2016.5027.
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Keywords: Adverse Events, Communication, Education: Patient and Caregiver, Patient Safety, Clinician-Patient Communication
Tan JY, Xu LJ, Lopez FY
Shared decision making among clinicians and Asian American and Pacific Islander sexual and gender minorities: an intersectional approach to address a critical care gap.
The authors illustrated how issues at the intersection of Asian American and Pacific Islander (AAPI) and sexual and gender minorities (SGM) identities affect shared decision making processes and health outcomes. They discussed experiences of AAPI SGM that are affected by AAPI heterogeneity, SGM stigma, multiple minority group identities, and sources of discrimination.
AHRQ-funded; HS022433.
Citation: Tan JY, Xu LJ, Lopez FY .
Shared decision making among clinicians and Asian American and Pacific Islander sexual and gender minorities: an intersectional approach to address a critical care gap.
LGBT Health 2016 Oct;3(5):327-34. doi: 10.1089/lgbt.2015.0143.
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Keywords: Shared Decision Making, Disparities, Racial and Ethnic Minorities, Clinician-Patient Communication, Social Stigma
Shay LA, Street RL, Jr., Baldwin AS
Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: a pilot study.
The researchers developed a tool to describe strength and content of provider HPV vaccination recommendations. The tool showed how providers undercut their recommendations through qualifications or support them with a rationale. The authors recommended that providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.
AHRQ-funded; HS022418.
Citation: Shay LA, Street RL, Jr., Baldwin AS .
Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: a pilot study.
Patient Educ Couns 2016 Sep;99(9):1452-60. doi: 10.1016/j.pec.2016.06.027.
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Keywords: Practice Patterns, Vaccination, Infectious Diseases, Sexual Health, Clinician-Patient Communication, Guidelines, Evidence-Based Practice, Communication
Gulbrandsen P, Clayman ML, Beach MC
Shared decision-making as an existential journey: aiming for restored autonomous capacity.
The researchers described the different ways in which illness represents an existential problem, and its implications for shared decision-making. They found that the fundamental uncertainty, state of vulnerability, and lack of power of the ill patient, imbue shared decision-making with a deeper existential significance and call for greater attention to the emotional and relational dimensions of care. They propose that the aim of shared decision-making should be restoration of the patient's autonomous capacity.
AHRQ-funded; HS022932.
Citation: Gulbrandsen P, Clayman ML, Beach MC .
Shared decision-making as an existential journey: aiming for restored autonomous capacity.
Patient Educ Couns 2016 Sep;99(9):1505-10. doi: 10.1016/j.pec.2016.07.014.
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Keywords: Communication, Shared Decision Making, Patient-Centered Healthcare, Patient and Family Engagement, Clinician-Patient Communication
Mabachi NM, Cifuentes M, Barnard J
AHRQ Author: Brach C
Demonstration of the Health Literacy Universal Precautions Toolkit: lessons for quality improvement.
AHRQ’s Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support.
AHRQ-authored.
Citation: Mabachi NM, Cifuentes M, Barnard J .
Demonstration of the Health Literacy Universal Precautions Toolkit: lessons for quality improvement.
J Ambul Care Manage 2016 Jul-Sep;39(3):199-208. doi: 10.1097/jac.0000000000000102..
Keywords: Health Literacy, Quality Improvement, Tools & Toolkits, Primary Care, Clinician-Patient Communication
Cato KD, Bockting W, Larson E
Did I tell you that? Ethical issues related to using computational methods to discover non-disclosed patient characteristics.
Using the Belmont Report's principles of respect for persons, beneficence, and justice as a framework, the authors examined the ethical issues posed by electronic phenotyping. Ethical issues identified include the ability of the patient to consent for the use of their information, the ability to suppress pediatric information, and ensuring that the potential benefits justify the risks of harm to patients.
AHRQ-funded; HS022961.
Citation: Cato KD, Bockting W, Larson E .
Did I tell you that? Ethical issues related to using computational methods to discover non-disclosed patient characteristics.
J Empir Res Hum Res Ethics 2016 Jul;11(3):214-9. doi: 10.1177/1556264616661611.
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Keywords: Clinician-Patient Communication, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Outcomes Research, Registries, Research Methodologies
Khan A, Rogers JE, Forster CS
Communication and shared understanding between parents and resident-physicians at night.
The researchers studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan. After conducting a prospective cohort study of 286 parents and 37 night-team senior residents, they found that parents and residents reported that they shared an understanding with one another about care plans in 86.0percent and 73.1 percent of cases, respectively.
AHRQ-funded; HS022986; HS000063.
Citation: Khan A, Rogers JE, Forster CS .
Communication and shared understanding between parents and resident-physicians at night.
Hosp Pediatr 2016 Jun;6(6):319-29. doi: 10.1542/hpeds.2015-0224.
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Keywords: Care Coordination, Healthcare Delivery, Communication, Patient and Family Engagement, Clinician-Patient Communication
Nathan AG, Marshall IM, Cooper JM
Use of decision aids with minority patients: a systematic review.
The authors conducted a systematic review to characterize the application and effectiveness of decision aids (DA) in racial, ethnic, sexual, and gender minorities. ical decisions. They concluded that DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities.
AHRQ-funded; HS023050.
Citation: Nathan AG, Marshall IM, Cooper JM .
Use of decision aids with minority patients: a systematic review.
J Gen Intern Med 2016 Jun;31(6):663-76. doi: 10.1007/s11606-016-3609-2.
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Keywords: Shared Decision Making, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Clinician-Patient Communication
Roberts MC, Bryson A, Weinberger M
Patient-centered communication for discussing oncotype DX testing.
The researchers identified patient-centered communication strategies/gaps for discussing Oncotype DX testing (ODX) results. They applied a patient-centered communication framework to analyze qualitative interviews with oncologists about how they communicate about ODX with patients. Overall, providers discussed four patient-centered communication domains: exchanging information, assessing uncertainty, making decisions and cross-cutting themes.
AHRQ-funded; HS019468; HS022189.
Citation: Roberts MC, Bryson A, Weinberger M .
Patient-centered communication for discussing oncotype DX testing.
Cancer Invest 2016 May 27;34(5):205-12. doi: 10.3109/07357907.2016.1172637.
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Keywords: Cancer, Cancer: Breast Cancer, Communication, Clinician-Patient Communication, Shared Decision Making, Genetics, Patient and Family Engagement, Patient-Centered Healthcare, Women
Robinson JD, Tate A, Heritage J
Agenda-setting revisited: when and how do primary-care physicians solicit patients' additional concerns?
The authors assessed the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. They found that physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits. Further, those that were formatted so as to allow for 'concerns' were significantly more likely to generate some type of agenda item.
AHRQ-funded; HS010922; HS013343.
Citation: Robinson JD, Tate A, Heritage J .
Agenda-setting revisited: when and how do primary-care physicians solicit patients' additional concerns?
Patient Educ Couns 2016 May;99(5):718-23. doi: 10.1016/j.pec.2015.12.009.
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Keywords: Communication, Primary Care, Patient-Centered Healthcare, Patient Safety, Clinician-Patient Communication
Bae J, Encinosa WE
AHRQ Author: Encinosa WE
National estimates of the impact of electronic health records on the workload of primary care physicians.
This study examines whether electronic health records (EHR) is associated with increases in face time with the patient per visit and increases in the physician's patient volume per week. It found that among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size.
AHRQ-authored.
Citation: Bae J, Encinosa WE .
National estimates of the impact of electronic health records on the workload of primary care physicians.
BMC Health Serv Res 2016 May 10;16(1):172. doi: 10.1186/s12913-016-1422-6.
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Keywords: Primary Care, Electronic Health Records (EHRs), Clinician-Patient Communication, Health Information Technology (HIT)
Spatz ES, Krumholz HM, Moulton BW
The new era of informed consent: getting to a reasonable-patient standard through shared decision making.
The authors discuss a range of issues associated with shared decision making. They see it as a collaborative communication process between clinicians and patients that integrates the best evidence available with the patients’ values and preferences, to promote high-quality health care decisions.
AHRQ-funded; HS023000.
Citation: Spatz ES, Krumholz HM, Moulton BW .
The new era of informed consent: getting to a reasonable-patient standard through shared decision making.
JAMA 2016 May 17;315(19):2063-4. doi: 10.1001/jama.2016.3070..
Keywords: Clinician-Patient Communication, Communication, Shared Decision Making, Education: Patient and Caregiver, Patient and Family Engagement, Patient-Centered Healthcare
Medford-Davis L, Park E, Shlamovitz G
Diagnostic errors related to acute abdominal pain in the emergency department.
This study reviewed a selected high-risk cohort of patients presenting to the ED with abdominal pain to evaluate for possible diagnostic errors and associated process breakdowns. Diagnostic errors occurred in 35 of 100 high-risk cases. Over two-thirds had breakdowns involving the patient-provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results).
AHRQ-funded; HS022087.
Citation: Medford-Davis L, Park E, Shlamovitz G .
Diagnostic errors related to acute abdominal pain in the emergency department.
Emerg Med J 2016 Apr;33(4):253-9. doi: 10.1136/emermed-2015-204754.
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Keywords: Pain, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Clinician-Patient Communication
Flieger SP
Implementing the patient-centered medical home in complex adaptive systems: becoming a relationship-centered patient-centered medical home.
The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the patient-centered medical homes (PCMH) model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. It found that becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration.
AHRQ-funded; HS021385.
Citation: Flieger SP .
Implementing the patient-centered medical home in complex adaptive systems: becoming a relationship-centered patient-centered medical home.
Health Care Manage Rev 2016 Apr/Jun;42(2):112-21. doi: 10.1097/hmr.0000000000000100.
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Keywords: Patient-Centered Healthcare, Primary Care, Clinician-Patient Communication
Sulzer SH, Feinstein NW, Wendland CL
Assessing empathy development in medical education: a systematic review.
The authors examined how researchers define the central construct of empathy and what they choose to measure. They found that the majority of studies were characterised by internal inconsistencies and vagueness in both the conceptualization and operationalization of empathy, constraining the validity and usefulness of the research. They suggested that future research follow the lead of basic scientific research that conceptualizes empathy as relational rather than as a personal quality that may be modified wholesale through appropriate training.
AHRQ-funded; HS000032.
Citation: Sulzer SH, Feinstein NW, Wendland CL .
Assessing empathy development in medical education: a systematic review.
Med Educ 2016 Mar;50(3):300-10. doi: 10.1111/medu.12806.
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Keywords: Education: Academic, Education: Continuing Medical Education, Patient-Centered Healthcare, Clinician-Patient Communication