Analyzing Challenging Clinical Discussions in Orthopaedics

Duke University7 enrolled

Overview

The goal of this study is to analyze patient:provider communication surrounding the discussion of difficult clinical conversations such as knee replacement options. This study will also examine how using the teach-back communication technique can improve communication between patients and providers. Orthopedic residents, fellows, physician assistants, and attendings that agree to participate will be consented. Patients, who are likely to engage in a difficult clinical conversation, such as those who have a clinical indication for a Total Knee Replacement or a Partial Knee Replacement, will be recruited from participating providers clinical schedules. Patient:provider interactions will be recorded and then the providers will attend a 1 hour education lecture about how to use teach-back. After attending the lecture, additional patient:provider interactions will be recorded and analyzed via a qualitative approach. Additionally, providers will participate in a semi-structured interview to capture their perceptions of teach-back and what challenges and benefits they may derive from using it.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Teach-Back Communication Arthritis Knee Osteoarthritis

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria (Patient Participants): * Age 18 years and older * Clinical indication for multiple treatment options Exclusion Criteria (Patient Participants): * Non-English speaking * Minors or non-consenting other individuals (spouses, friends, family members, children) in the patient room during the clinical visit Inclusion Criteria (Provider Participants) * Age 18 years and older * A resident, fellow, physician assistant, or attending in the Duke Department of Orthopaedic Surgery Exclusion criterion (Provider Participants): • Non-English speaking

Outcomes

Primary Outcomes

Provider's uninterrupted utterances

We will assess this outcome directly from audio-recorded conversations. A coding scheme will then be developed that captures the average length of provider utterance without asking a question or an interruption from a patient

Time frame: End of discussion with patient, 20 minutes

Patient/provider talking ratio

This outcome will also be assessed from audio-recorded conversations. The transcript will be coded and the coding scheme will compare how often and how long patients talk compared to provider talking.

Time frame: End of discussion with patient, 20 minutes

Secondary Outcomes

Providers perceptions about teach-back

This outcome will be assessed via semi-structured interviews.

Time frame: End of semi-structured interview, one hour

Providers belief of future use of teach-back

This outcome will be assessed via the semi-structured interview