TY - JOUR
T1 - Rethinking the Difficult Patient
T2 - Formative Qualitative Study Using Participatory Theater to Improve Physician-Patient Communication in Rheumatology
AU - Leung, Jerik
AU - Som, Avira
AU - McMorrow, Lily
AU - Zickuhr, Lisa
AU - Wolbers, John
AU - Bain, Karen
AU - Flood, Julia
AU - Baker, Elizabeth A.
N1 - Funding Information:
The authors would like to acknowledge the actors from the Metro Theater Company for their role and dedication in delivering this educational session. JL was supported by the Rheumatology Research Foundation (Lawren H Daltroy Health Professional Prereceptorship).
Publisher Copyright:
©Jerik Leung, Avira Som, Lily McMorrow, Lisa Zickuhr, John Wolbers, Karen Bain, Julia Flood, Elizabeth A Baker.
PY - 2023
Y1 - 2023
N2 - Background: Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients’ actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency. Objective: The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus. Methods: We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules. Results: Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants’ learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies. Conclusions: Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content.
AB - Background: Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients’ actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency. Objective: The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus. Methods: We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules. Results: Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants’ learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies. Conclusions: Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content.
KW - arts-based education
KW - communication
KW - concordance
KW - health equity
KW - interactivity
KW - participatory theater
KW - physician education
KW - physician-patient communication
KW - rheumatology
KW - social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85151396207&partnerID=8YFLogxK
U2 - 10.2196/40573
DO - 10.2196/40573
M3 - Article
C2 - 36877547
AN - SCOPUS:85151396207
SN - 2561-326X
VL - 7
JO - JMIR Formative Research
JF - JMIR Formative Research
M1 - e40573
ER -