BACKGROUND: This study aimed to examine whether online interactive communication education using video materials was as effective as face-to-face education among healthcare college students.
METHODS: The participants were healthcare college students who were enrolled in study programs to obtain national medical licenses. They participated in lectures and exercises on healthcare communication, both online (n = 139) and face-to-face (n = 132). Listening skills, understanding, and confidence in healthcare communication were assessed using a self-assessed tool.
RESULTS: From the two-way ANOVA result, the interaction effects between group (online, face-to-face) and time (Time 1, Time 2, Time 3) were not statistically significant. The main effect of time increased significantly from Time1 to Time 3 on understanding of communication with patients (Hedges\'g = 0.51, 95%CI 0.27-0.75), confidence in communication with patients (g = 0.40, 95%CI 0.16-0.64), and confidence in clinical practice (g = 0.49, 95%CI 0.25, 0.73), while the score of listening skills had no significant change (Hedges\'g = 0.09, 95%CI - 0.03 to 0.45).
CONCLUSIONS: The results show that online communication education with video materials and active exercises is as effective in improving students\' confidence as face-to-face. It will be necessary to modify the content of this educational program to improve skills as well as confidence in communication.
BACKGROUND: Not Applicable.

OBJECTIVE: To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice.
METHODS: This study comprised a qualitative, case-study design within a constructivist paradigm using convenience sampling.
METHODS: Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses\' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus-group sessions. The data were transcribed and analysed inductively.
RESULTS: In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information.
CONCLUSIONS: Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information.
UNASSIGNED: It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans.
CONCLUSIONS: Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients\' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing.
UNASSIGNED: We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method.
UNASSIGNED: No patient or public contribution.

Background: Preventive cardiology aims to educate patients about risk factors and the importance of mitigating them through lifestyle adjustments and medications. However, long-term adherence to recommended interventions remains a significant challenge. This study explores how physician counselling contributes to successful behavior changes in various aspects of lifestyle. Methods: A cross-sectional study conducted in Greece in 2022-2023 included 1988 participants. Validated questionnaires assessed patients\' characteristics, dietary habits, and lifestyle choices. Results: The findings revealed that patients who received lifestyle advice from physicians demonstrated increased compliance with the Mediterranean diet and a higher involvement in physical activity. Notably, they were also less likely to be non-smokers. Importantly, physicians\' recommendations had a more pronounced association with adherence level to the Mediterranean diet compared to other lifestyle behaviors. Additionally, specific dietary components like cereal, legume, and red meat consumption were significantly associated with physicians\' guidance. Conclusions: This study highlights the complex relationship between patients\' cardiometabolic health, lifestyle decisions, and healthcare professionals\' guidance. The substantial influence of physicians on Mediterranean diet adherence underscores the necessity for a multidisciplinary healthcare approach. Collaborative efforts involving physicians, dietitians, and fitness experts can offer comprehensive support to patients in navigating the intricate landscape of cardiometabolic health.

OBJECTIVE: Uncertainty is unavoidable in the context of painful medical procedures. It is important to investigate the impact of different ways of communicating uncertainty on upcoming pain.
METHODS: In our exploratory study, healthy participants (n = 30) were repeatedly presented with three highly uncertain pain predictions communicated by a hypothetical doctor. A direct statement of high uncertainty (\"I don\'t know\") was compared to more indirect predictions (social prediction: \"It varies widely among people\"; range prediction: \"… not painful at all to very highly painful\"), followed by individually calibrated electrical stimuli of non-, moderately, or very highly painful intensity.
RESULTS: The direct expression of uncertainty led to the most intense pain sensation (for moderately painful stimuli only), lowest and most certain pain expectations, lowest trust in the hypothetical doctor, and lowest feeling of being well-informed, especially as compared to the social prediction. No differential effects on anxiety were observed.
CONCLUSIONS: Expressing high uncertainty indirectly, with reference to the common experiences of others, may be beneficial for optimizing pain experiences and enhancing patients\' trust in a medical professional.
CONCLUSIONS: Our findings inform on how high uncertainty about upcoming pain may impact patient and health outcomes, pointing to some advantages of indirect communication.

Poor medical information transfer across healthcare visits and providers poses a potential threat to patient safety. Patient-held health records (PHRs) may be used to facilitate informational continuity, handover communication and patient self-management. However, there are conflicting opinions on the effectiveness of PHRs, other than in maternal and child care. Moreover, the experiences of users of PHRs in low- and middle-income countries are critical in policy decisions but have rarely been researched.
This study aimed to explore similarities and differences in the perspectives of patients, carers and healthcare providers (HCPs) on the current PHRs for diabetes and hypertension in Kerala.
A qualitative design was used comprising semistructured interviews with patients with diabetes/hypertension (n = 20), carers (n = 15) and HCPs (n = 17) in Kerala, India. Data were analysed using thematic analysis.
Themes generated regarding the experiences with PHRs from each user group were compared and contrasted. The themes that arose were organized under three headings: use of PHRs in everyday practice; the perceived value of PHR and where practice and value conflict. We found that in the use of PHRs in everyday practice, multiple PHRs posed challenges for patients carrying records and for HCPs locating relevant information. Most carers carried all patients\' past PHRs, while patients made decisions on which PHR to take along based on the purpose of the healthcare visit. HCPs appreciated having PHRs but documented limited details in them. The perceived value of PHRs by each group for themselves was different. While HCPs placed value on PHRs for enabling better clinical decision-making, preventing errors and patient safety, patients perceived them as transactional tools for diabetes and hypertension medications; carers highlighted their value during emergencies.
Our findings suggest that users find a variety of values for PHRs. However, these perceived values are different for each user group, suggesting minimal functioning of PHRs for informational continuity, handover communication and self-management.
Patients and carers were involved during the pilot testing of topic guides, consent and study information sheets. Patients and carers gave their feedback on the materials to ensure clarity and appropriateness within the context.

BACKGROUND: Research focused on understanding what enables or hinders health professionals to speak up about a safety concern has been to date predominately atheoretical and speaker focused. However, the role the receiver of the message plays in these often-difficult encounters is highly influential. To date, speaking up programs have created conversational mnemonics that technically should respectfully engage the receiver, yet speaking up remains challenging. This paper utilises Communication Accommodation Theory to explore the impact the communication behaviour and speaker characteristics has on the receiver of a speaking up message, and if these impacts differ between receiver groups (clinical disciplines).
METHODS: Clinicians (N = 208) from varying disciplines responded to two hypothetical speaking up vignettes, where participants were the receivers of speaking up messages. Analysis of variance was used to explore any potential differences between receiver groups.
RESULTS: Findings indicated that the level of perceived accommodation and group membership, whether defined by speaker discipline or seniority, collectively influenced how the receiver of a speaking up message evaluated the interaction, which influenced their anticipated response to the speaker.
CONCLUSIONS: The receiver\'s perceptions and evaluations of the message, their own professional identity and the presence of others, influenced receivers\' anticipated responses. This has direct implications on healthcare speaking up training and provision of care, as the varying clinical disciplines received and responded to the same messages differently.

BACKGROUND: Instant messaging applications and texting are useful for educating and communicating with medical students; however, they present patient privacy concerns and do not address the challenge of student inclusion in patient care communication. EMR-integrated secure messaging offers an opportunity to include students on team communication, enhance their medical education, and ensure patient privacy.
METHODS: Between July 2019 through March 2020, we performed a mixed method study to evaluate use of EPIC® Secure Chat as a means of enhancing student education and team communication. We promoted use of secure messaging in orientation, performed a pre- and post-rotation survey to assess perceptions of Secure Chat effect on communication, and directly reviewed and categorized messages.
RESULTS: Twenty-four 3rd and 4th year students completed the pre-rotation survey, and 22 completed the post-rotation survey. Twelve (50%) students reported the quality of communication with faculty was either good or very good prior to internal medicine rotation, while 20 (91%) reported this post-rotation (p-value 0.001). There was a similar improvement in communication with ancillary staff. Nineteen (86%) students felt that secure messaging improved their communication with faculty. On message review, threads were frequently logistical, but also often included discussions of patient management.
CONCLUSIONS: Students viewed Secure Chat as having a favorable effect on their communication with team members and reported communication on internal medicine to be improved compared to prior rotations. Messages included students on important patient care conversations. Secure messaging offers a novel medium to improve team communication, enhance student education, and maintain patient privacy.

OBJECTIVE: Anxiety is commonly observed in oncology patients but infrequently screened, assessed or addressed. According to psychosocial guidelines, all healthcare professionals, including radiation therapists, are responsible for the psychosocial care of patients. Radiation therapists (RTs) interact with patients daily throughout treatment; however, little research exists to evaluate RTs\' ability to identify and manage patients\' psychosocial needs. This study aimed to determine if RTs can detect and manage patient anxiety.
METHODS: A cross-sectional, mixed-methods survey containing two clinically relevant vignettes was developed. Two fictitious patients were presented to elicit responses reflective of RTs\' experiences and judgements in the recognition and management of anxiety. Surveys were distributed via email in Australia, New Zealand and Canada. Ethical approval was obtained from the University of Sydney (2016/227) and informed consent was obtained from participants.
RESULTS: Eligible and complete surveys were received from 582 respondents (240 (41.2%) from Australia; 78 (13.4%) New Zealand; 264 (45.4%) Canada). Almost all respondents endorsed a relevant descriptor of anxiety (vignette 1, 577 (99.1%); vignette 2, 579 (99.5%)). For both vignettes, the most frequently endorsed management strategy was to acknowledge the patients\' feelings and encourage them to express their concerns (vignette 1, 548 (94.2%); vignette 2, 455 (78.2%)).
CONCLUSIONS: RTs in Australia, New Zealand and Canada are able to detect anxiety and endorse a strategy to manage patients experiencing anxiety depicted in written vignettes. Exploring RTs\' abilities to detect and manage patient anxiety whilst in the high-pressure clinical environment is an important next step.

As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.

Although healthcare professionals often consider body weight a sensitive and difficult topic to discuss with children, a contextualized and comprehensive understanding of youth perspectives on weight-related words used in healthcare has yet to be established. This qualitative study aims to explore perspectives of Dutch children on the terminology healthcare professionals use when discussing weight.
Fourteen interviews and one focus group discussion were held with children (age 8-16) who were in care because of their weight. A toolkit with customizable interview techniques was used in order to facilitate reflection and tailor the interview to each respondent. A narrative content analysis was conducted.
Respondents attached both clear and subtle differences in meanings to (certain) weight-related words. Their perspectives were not unanimous for any single word. Moreover, at times, respondents framed certain words in positive or negative ways or used a word they disliked to describe themselves. This illustrates that meanings of weight-related words are not fixed but context and situation specific.
This study revealed that meanings children assign to weight-related words are shaped by their experiences in the broader social context, especially at school, as well as with (previous) healthcare professionals. It pointed towards the importance of bedside manner, acquaintanceship, and support. Healthcare professionals treating children because of their body weight are advised to invest in a good patient-caregiver relationship, pay attention to children\'s previous (negative) social weight-related experiences, and reflect critically on their own preconceptions about body weight and the impact these preconceptions might have on their patient-caregiver relationships.