April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: From the Doctor’s Point-of-View: Motivations for Reducing Uncertainty and Sharing Bad News
Most comparative studies of health narratives aim to modify patient behavior, with little regard for the health provider (Meisel et al, 2016), despite the fact that doctors’ decisions directly impact how disease is diagnosed and treated. This formative research aims to address this gap by investigating doctors’ motivations to reduce their own uncertainty even when doing so requires that they share bad news with patients. In a series of semi-structured qualitative interviews with eye doctors (N = 17), we investigated motivations to utilize a diagnostic device that can detect age-related macular degeneration (AMD) up to three years before it becomes clinically evident (Owsley, 2016). AMD is a chronic, progressive, potentially-blinding disease for which there is currently no cure (Pennington & DeAngelis, 2016). In the United States, it is the leading cause of irreversible blindness in adults over 50 years old and it is the number one cause of visual disability throughout the industrialized world. In short, an AMD diagnosis can be devastating to patients and, as such, represents a potential barrier to eye care providers who are tasked with sharing this bad news. Doctors’ self-efficacy may be further compromised by the fact that the only available pharmaceutical treatment for AMD involves repeat ocular injections, which are currently only approved for use in patients with advanced disease (Schmier, 2012). However, early diagnosis is not without merit. Earlier intervention in the form of increased monitoring, an improved diet and lifestyle modification is likely to have substantial benefits for patients’ well-being in the short- and long-term (Parfitt et al., 2019; Takahashi et al., 2015). Traditional subjective methods for detecting AMD have been shown to result in missed diagnoses about 25% of the time (Neely et al., 2017). Alternatively, clinicians can perform dark adaptation testing to diagnose AMD with 90% accuracy (Jackson et al., 2014). Therefore, in the current study, researchers sought to identify how eye doctors who currently use dark adaptation reconcile what they perceive as the benefits of early diagnosis with the increased likelihood that they will be obligated to deliver potentially devastating news earlier and with greater frequency. Participants identified three beneficiaries: themselves, patients and society at large (i.e., the public health system). Thematic coding revealed that benefits to doctors include better clinical decision-making, fewer medical errors, improved doctor/patient relationships and revenue growth. Physicians perceive that patients benefit on three levels: clinically, emotionally, and with respect to quality of life. Finally, participants said that the public health system can benefit from reduced costs associated with injection therapy and vision loss, while promoting improved standards of care. A future direction for this emerging line of research involves utilizing insights gleaned from doctors who are currently performing desired behaviors in order to generate narrative-based interventions that will lead to universal adoption of best practices.