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Article ; Online: Collaborative Diagnostic Conversations Between Clinicians, Patients, and Their Families: A Way to Avoid Diagnostic Errors.

Espinoza Suarez, Nataly R / Hargraves, Ian / Singh Ospina, Naykky / Sivly, Angela / Majka, Andrew / Brito, Juan P

Mayo Clinic proceedings. Innovations, quality & outcomes

2023 Volume 7, Issue 4, Page(s) 291–300

Abstract: Objective: To identify the components of the collaborative diagnostic conversations between clinicians, patients, and their families and how deficiencies in these conversations can lead to diagnostic errors.: Patients and methods: We purposively ... ...

Abstract	Objective: To identify the components of the collaborative diagnostic conversations between clinicians, patients, and their families and how deficiencies in these conversations can lead to diagnostic errors. Patients and methods: We purposively selected 60 video recordings of clinical encounters that included diagnosis conversations. These videos were obtained from the internal medicine, and family medicine services at Mayo Clinic's campus in Rochester, Minnesota. These clinical encounters were recorded between November 2017, and December 2021, during the conduct of studies aiming at developing or testing shared decision-making interventions. We followed a critically reflective approach model for data analysis. Results: We identified 3 components of diagnostic conversations as follows: (1) recognizing diagnostic situations, (2) setting priorities, and (3) creating and reconciling a diagnostic plan. Deficiencies in diagnostic conversations could lead to framing issues in a way that sets diagnostic activities off in an incorrect or undesirable direction, incorrect prioritization of diagnostic concerns, and diagnostic plans of care that are not feasible, desirable, or productive. Conclusion: We identified 3 clinician-and-patient diagnostic conversation components and mapped them to potential diagnostic errors. This information may inform additional research to identify areas of intervention to decrease the frequency and harm associated with diagnostic errors in clinical practice.
Language	English
Publishing date	2023-07-07
Publishing country	Netherlands
Document type	Journal Article
ISSN	2542-4548
ISSN (online)	2542-4548
DOI	10.1016/j.mayocpiqo.2023.06.001
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Article ; Online: The role of time in involving patients with cancer in treatment decision making: A scoping review.

Wieringa, Thomas H / León-García, Montserrat / Espinoza Suárez, Nataly R / Hernández-Leal, María José / Jacome, Cristian Soto / Zisman-Ilani, Yaara / Otten, René H J / Montori, Victor M / Pieterse, Arwen H

Patient education and counseling

2024 Volume 125, Page(s) 108285

Abstract: Background: Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized.: Objective: This scoping review aimed to describe the role of ...

Abstract	Background: Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized. Objective: This scoping review aimed to describe the role of time in patient involvement, and identify strategies to overcome time-related barriers. Methods: Seven databases were searched for any publications on patient involvement in cancer treatment decisions, focusing on how time is used to involve patients, the association between time and patient involvement, and/or strategies to overcome time-related barriers. Reviewers worked independently and in duplicate to select publications and extract data. One coder thematically analyzed data, a second coder checked these analyses. Results: The analysis of 26 eligible publications revealed four themes. Time was a resource 1) to process the diagnosis, 2) to obtain/process/consider information, 3) for patients and clinicians to spend together, and 4) for patient involvement in making decisions. Discussion: Time is a resource throughout the treatment decision-making process, and generic strategies have been proposed to overcome time constraints. Practice value: Clinicians could co-create decision-making timelines with patients, spread decisions across several consultations, share written information with patients, and support healthcare redesigns that allocate the necessary time.
Language	English
Publishing date	2024-04-22
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	605590-4
ISSN	1873-5134 ; 0738-3991
ISSN (online)	1873-5134
ISSN	0738-3991
DOI	10.1016/j.pec.2024.108285
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Article ; Online: Developing and validating the Unhurried Conversations Assessment Tool (UCAT).

Mandhana, Dron M / Jacome, Cristian Soto / Ballard, Dawna I / Tesfai, Yohanna / Johnson, Sarah B / Gionfriddo, Michael R / Espinoza Suarez, Nataly R / Perneth, Sandra Algarin / Su, Lillian / Montori, Victor M

Patient education and counseling

2024 Volume 123, Page(s) 108237

Abstract: Objective: Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. ...

Abstract	Objective: Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. Methods: In the first two phases, the unhurried conversation dimensions were identified and transformed into an assessment tool. In the third phase, two independent raters used UCAT to evaluate the unhurriedness of 100 randomly selected consultations from 184 videos recorded for a large research trial. UCAT's psychometric properties were evaluated using this data. Results: UCAT demonstrates content validity based on the literature and expert review. EFA and reliability analyses confirm its construct validity and internal consistency. The seven formative dimensions account for 89.93% of the variance in unhurriedness, each displaying excellent internal consistency (α > 0.90). Inter-rater agreement for the overall assessment item was fair (ICC = 0.59), with individual dimension ICCs ranging from 0.26 (poor) to 0.95 (excellent). Conclusion: UCAT components comprehensively assess the unhurriedness of consultations. The tool exhibits content and construct validity and can be used reliably. Practice implications: UCAT's design and psychometric properties make it a practical and efficient tool. Clinicians can use it for self-evaluations and training to foster unhurried conversations.
MeSH term(s)	Humans ; Reproducibility of Results ; Educational Measurement/methods ; Communication ; Psychometrics ; Clinical Competence
Language	English
Publishing date	2024-03-02
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605590-4
ISSN	1873-5134 ; 0738-3991
ISSN (online)	1873-5134
ISSN	0738-3991
DOI	10.1016/j.pec.2024.108237
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Article ; Online: Impact of Cost Conversations During Clinical Encounters Aided by Shared Decision-Making Tools on Medication Adherence.

Espinoza Suarez, Nataly R / Urtecho, Meritxell / LaVecchia, Christina M / Fischer, Karen M / Kamath, Celia C / Brito, Juan P

Mayo Clinic proceedings. Innovations, quality & outcomes

2022 Volume 6, Issue 4, Page(s) 320–326

Abstract: Objective: To investigate the impact of cost conversations occurring with or without the use of encounter shared decision-making (SDM) tools in medication adherence.: Patients and methods: Using a coding scheme that included the occurrence and ... ...

Abstract	Objective: To investigate the impact of cost conversations occurring with or without the use of encounter shared decision-making (SDM) tools in medication adherence. Patients and methods: Using a coding scheme that included the occurrence and characteristics of cost conversation, we analyzed a randomly selected sample of 169 video recordings of clinical encounters. These videos were obtained during the conduct of practice-based randomized clinical trials comparing care with and without SDM tools for patients with diabetes, osteoporosis, and depression. Medication adherence was described in 2 ways: as a binary (yes/no) outcome, in which the patient met at least 80% adherence, or as a continuous variable, which was the percent of days that the patient adhered to their medication. The secondary analysis took place in 2018 from trials that ran between 2007 and 2015. Results: Most patients were White (155, 93.4%), educated (104, 63.4% completed college), middle-aged (mean age, 58 years), female (104, 61.5%), and from diabetes (86, 50.9%), depression (43, 25.4%), and osteoporosis (40, 23.7%) trials. Cost conversations occurred in 119 clinical encounters (70%) and were more frequent in those encounters in which SDM tools were used ( Conclusion: In this videographic analysis of SDM practice-based clinical trials, cost conversations were not associated with the general measures of medication adherence. Future studies should assess whether a tailored cost conversation intervention would impact the cost-related nonadherence among patients.
Language	English
Publishing date	2022-06-25
Publishing country	Netherlands
Document type	Journal Article
ISSN	2542-4548
ISSN (online)	2542-4548
DOI	10.1016/j.mayocpiqo.2022.05.005
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Article ; Online: ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters.

Espinoza Suarez, Nataly R / LaVecchia, Christina M / Morrow, Allison S / Fischer, Karen M / Kamath, Celia / Boehmer, Kasey R / Brito, Juan P

Patient education and counseling

2022 Volume 105, Issue 11, Page(s) 3249–3258

Abstract: Objective: To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them.: Methods: A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from ... ...

Abstract	Objective: To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. Methods: A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools. Results: Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. Conclusion: Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. Practice implications: We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
MeSH term(s)	Communication ; Humans ; Physician-Patient Relations ; Prospective Studies
Language	English
Publishing date	2022-07-25
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605590-4
ISSN	1873-5134 ; 0738-3991
ISSN (online)	1873-5134
ISSN	0738-3991
DOI	10.1016/j.pec.2022.07.016
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Jg. 1995 - 2021: Lesesall (1.OG)
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Article ; Online: Video-based observation research: A systematic review of studies in outpatient health care settings.

Golembiewski, Elizabeth H / Espinoza Suarez, Nataly R / Maraboto Escarria, Andrea P / Yang, Andrew X / Kunneman, Marleen / Hassett, Leslie C / Montori, Victor M

Patient education and counseling

2022 Volume 106, Page(s) 42–67

Abstract: Objective: To examine the use of video-based observation research in outpatient health care encounter research.: Methods: We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for ... ...

Abstract	Objective: To examine the use of video-based observation research in outpatient health care encounter research. Methods: We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. Results: 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. Conclusion: Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. Practice implications: Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
MeSH term(s)	Humans ; Outpatients ; Ambulatory Care ; Delivery of Health Care ; Health Services Research ; Research Design
Language	English
Publishing date	2022-10-02
Publishing country	Ireland
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	605590-4
ISSN	1873-5134 ; 0738-3991
ISSN (online)	1873-5134
ISSN	0738-3991
DOI	10.1016/j.pec.2022.09.017
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Article: Comparing Complication Rates of Midline Catheter vs Peripherally Inserted Central Catheter. A Systematic Review and Meta-analysis.

Urtecho, Meritxell / Torres Roldan, Victor D / Nayfeh, Tarek / Espinoza Suarez, Nataly R / Ranganath, Nischal / Sampathkumar, Priya / Chopra, Vineet / Safdar, Nasia / Prokop, Larry J / O'Horo, John C

Open forum infectious diseases

2023 Volume 10, Issue 2, Page(s) ofad024

Abstract: Background: Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of ... ...

Abstract	Background: Peripherally inserted central catheters (PICCs) and midlines are commonly used devices for reliable vascular access. Infection and thrombosis are the main adverse effects of these catheters. We aimed to evaluate the relative risk of complications from midlines and PICCs. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies. The primary outcomes were catheter-related bloodstream infection (CRBSI) and thrombosis. Secondary outcomes evaluated included mortality, failure to complete therapy, catheter occlusion, phlebitis, and catheter fracture. The certainty of evidence was assessed using the GRADE approach. Results: Of 8368 citations identified, 20 studies met the eligibility criteria, including 1 RCT and 19 observational studies. Midline use was associated with fewer patients with CRBSI compared with PICCs (odds ratio [OR], 0.24; 95% CI, 0.15-0.38). This association was not observed when we evaluated risk per catheter. No significant association was found between catheters when evaluating risk of localized thrombosis and pulmonary embolism. A subgroup analysis based on location of thrombosis showed higher rates of superficial venous thrombosis in patients using midlines (OR, 2.30; 95% CI, 1.48-3.57). We did not identify any significant difference between midlines and PICCs for the secondary outcomes. Conclusions: Our findings suggest that patients who use midlines might experience fewer CRBSIs than those who use PICCs. However, the use of midline catheters was associated with greater risk of superficial vein thrombosis. These findings can help guide future cost-benefit analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs vs midline catheters.
Language	English
Publishing date	2023-01-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad024
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Article ; Online: Impact of Cost Conversation on Decision-Making Outcomes.

Espinoza Suarez, Nataly R / LaVecchia, Christina M / Fischer, Karen M / Kamath, Celia C / Brito, Juan P

Mayo Clinic proceedings. Innovations, quality & outcomes

2021 Volume 5, Issue 4, Page(s) 802–810

Abstract: Objective: To understand the impact of cost conversations on the following decision-making outcomes: patients' knowledge about their conditions and treatment options, decisional conflict, and patient involvement.: Patients and methods: In 2020 we ... ...

Abstract	Objective: To understand the impact of cost conversations on the following decision-making outcomes: patients' knowledge about their conditions and treatment options, decisional conflict, and patient involvement. Patients and methods: In 2020 we performed a secondary analysis of a randomly selected set of 220 video recordings of clinical encounters from trials run between 2007 and 2015. Videos were obtained from eight practice-based randomized trials and one pre-post-prospective study comparing care with and without shared decision-making (SDM) tools. Results: The majority of trial participants were female (61%) and White (86%), with a mean age of 56, some college education (68%), and an income greater than or equal to $40,000 per year (75%), and who did not participate in an encounter aided by an SDM tool (52%). Cost conversations occurred in 106 encounters (48%). In encounters with SDM tools, having a cost conversation lead to lower uncertainty scores (2.1 vs 2.6, Conclusion: Cost conversations have a minimal but favorable impact on decision-making outcomes in clinical encounters, particularly when they occurred in encounters aided by an SDM tool that raises cost as an issue.
Language	English
Publishing date	2021-06-12
Publishing country	Netherlands
Document type	Journal Article
ISSN	2542-4548
ISSN (online)	2542-4548
DOI	10.1016/j.mayocpiqo.2021.05.006
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Article ; Online: Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review.

León-García, Montserrat / Wieringa, Thomas H / Espinoza Suárez, Nataly R / Hernández-Leal, María José / Villanueva, Gemma / Singh Ospina, Naykky / Hidalgo, Jessica / Prokop, Larry J / Rocha Calderón, Claudio / LeBlanc, Annie / Zeballos-Palacios, Claudia / Brito, Juan Pablo / Montori, Victor M

BMJ open quality

2023 Volume 12, Issue 4

Abstract: Background: The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.: Methods: We included experimental studies manipulating the length of ... ...

Abstract	Background: The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare. Methods: We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction). Information sources: Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023. Risk of bias: Cochrane Risk of Bias instrument. Data synthesis: Narrative synthesis. Results: 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK's general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice. Conclusion: Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed. Trial registration number: OSF Registration DOI:10.17605/OSF.IO/EUDK8.
MeSH term(s)	Adult ; Humans ; Family Practice ; Health Facilities ; Quality of Health Care ; Referral and Consultation
Language	English
Publishing date	2023-10-23
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Systematic Review
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2023-002311
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Article ; Online: Decisional Regret Surrounding Dialysis Initiation: A Comparative Analysis.

Pawar, Aditya S / Thorsteinsdottir, Bjorg / Whitman, Sam / Pine, Katherine / Lee, Alexander / Espinoza Suarez, Nataly R / Organick Lee, Paige / Thota, Anjali / Lorenz, Elizabeth / Beck, Annika / Albright, Robert / Feely, Molly / Williams, Amy / Behnken, Emma / Boehmer, Kasey R

Kidney medicine

2023 Volume 6, Issue 3, Page(s) 100785

Abstract: Rationale & objective: Dialysis comes with a substantial treatment burden, so patients must select care plans that align with their preferences. We aimed to deepen the understanding of decisional regret with dialysis choices.: Study design: This ... ...

Abstract	Rationale & objective: Dialysis comes with a substantial treatment burden, so patients must select care plans that align with their preferences. We aimed to deepen the understanding of decisional regret with dialysis choices. Study design: This study had a mixed-methods explanatory sequential design. Setting & participants: All patients from a single academic medical center prescribed maintenance in-center hemodialysis or presenting for home hemodialysis or peritoneal dialysis check-up during 3 weeks were approached for survey. A total of 78 patients agreed to participate. Patients with the highest (15 patients) and lowest decisional regret (20 patients) were invited to semistructured interviews. Predictors: Decisional regret scale and illness intrusiveness scale were used in this study. Analytical approach: Quantitatively, we examined correlations between the decision regret scale and illness intrusiveness scale and sorted patients into the highest and lowest decision regret scale quartiles for further interviews; then, we compared patient characteristics between those that consented to interview in high and low decisional regret. Qualitatively, we used an adapted grounded theory approach to examine differences between interviewed patients with high and low decisional regret. Results: Of patients invited to participate in the interviews, 21 patients (8 high regret, 13 low regret) agreed. We observed that patients with high decisional regret displayed resignation toward dialysis, disruption of their sense of self and social roles, and self-blame, whereas patients with low decisional regret demonstrated positivity, integration of dialysis into their identity, and self-compassion. Limitations: Patients with the highest levels of decisional regret may have already withdrawn from dialysis. Patients could complete interviews in any location (eg, home, dialysis unit, and clinical office), which may have influenced patient disclosure. Conclusions: Although all patients experienced disruption after dialysis initiation, patients' approach to adversity differs between patients experiencing high versus low regret. This study identifies emotional responses to dialysis that may be modifiable through patient-support interventions.
Language	English
Publishing date	2023-12-20
Publishing country	United States
Document type	Journal Article
ISSN	2590-0595
ISSN (online)	2590-0595
DOI	10.1016/j.xkme.2023.100785
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