OCHER

A joint call for health services research proposals from all Norwegian health enterprises, administered by the Norwegian Research Council, led OCHER to submit its most ambitious proposal till now. With collaborating partners in five hospitals we aim to observe challenging encounters involving seriously or chronically ill patients, in order to come closer to an understanding of the connection between specific behaviours and patient understanding and involvement in decisions. The proposal, named Processes of information exchange and decision making in challenging clinical encounters (PIECE): Uncovering practices that affect patient safety and quality of care, will, if it succeeds, employ several PhD students and postdoctorals in the period 2015-2020.

Two papers from OCHER members have just been published in the Patient Education and Counseling special issue on the top papers from the International Conference on Communication in Healthcare conference that took place in September 2013 in Montreal, Canada. Jennifer Gerwing (currently a postdoc at Ahus) and Anne Marie Dalby (currently a PhD student at Ahus) explores the semantic functions of physician gestures. Pål Gulbrandsen, with the same two authors and Eirik Ofstad (also a current PhD student at Ahus/Nordlandssykehuset) describes in detail two encounters which illustrate the far from optimal shared decision making in encounters even when physicians really exhibit strong efforts. The papers have been added on the publication list.

We now have keynote speakers/discussants for our research workshop in January 14-16 confirmed. We are happy to present important contributors from diverse fields, covering qualitative and quantitative approaches. Here are the names: professor Marla Clayman, American Institutes for Research and Northwestern University, Chicago, professor Anssi Peräkylä, University of Helsinki, and professor Jan C. Frich, University of Oslo. The program will be ready by the end of August.

Following a series of articles in the Norwegian major newspaper Aftenposten about a fatal case at Molde hospital , Pål Gulbrandsen explains in an essay published [in Norwegian] June 25 why such cases are handled so clumsily. Major points are 1) risks are not sufficiently communicated up front, 2) “average” doctors are shamed by superiors, 3) debriefings lack or are not performed adequately, and 4) due to the former, patients and relatives are not given timely and serious apologies.

The symposium aims to inform health care personnel in all areas who meet cancer patients and has two international key lectures by Angela Coulter, University of Oxford and Pål Gulbrandsen, University of Oslo. See program here.

Previous studies indicating that female physicians do not get sufficient credit for being patient-centered were conducted in experimental settings only. The large Ahus dataset comprising 497 physician-patient encounters in a general hospital were analysed by Judy Hall and others to see if this is also true in the real world. The analysis demonstrated a more complex picture. Read the paper here.

In a narrative published in Patient Education and Counseling, “A matter of the heart”, Pål Gulbrandsen reflects on two very different patients with chest pain he met in clinical practice. In addition to highlighting four important virtues of a physician, curiosity, compassion, clarity, and courage, the paper demonstrates how the way we practice medicine these days teaches people that more examinations always are good, and hence reinforces the burden on healthcare costs. Read the paper here.

Today we added seven new 2-day courses in the Norwegian version of the Four Habits – 4 gode vaner – to our calendar and courses. These courses build on the development of the Four Habits Approach to Effective Clinical Communication in Kaiser Permanente, California, USA since 1989. Following their important contribution and a pilot in Oslo in August 2006, we developed an adjusted Norwegian version that was tested in a randomised controlled trial in 2007-08. We found that a condensed 20-hour training over two days was effective and changed physician behavior. Also, more than three years after the course, 60% of the physicians stated that the course had changed their practice ever after. Later, the approach has been used in Sweden and Germany, and research projects are launched in Cologne and drafted in Uppsala. Akershus University Hospital and the University of Oslo currently invest in the development of a teach-the-teachers program in order to foster a higher capacity for post-graduate teaching and supervision.

The health services research group at Akershus University Hospital, in which Pål Gulbrandsen’s communication research group is embedded, has launched a call for 2-3 researchers. These positions are not locked to communication research, the quality of the applications will guide who will get the positions. But this is definitely an opportunity for researchers in the field of communication. We are continuously building a stronger group, now comprising three PhD students with background in medicine, linguistics, and professional ethics, as well as a senior anthropologist and a postdoctoral Canadian psychologist. We will focus our studies on the details of information exchange and shared decision making. Deadline for the application is March 23, 2014. Unfortunately the call is not available in English. We will probably give priority to Scandinavian speaking applicants (Norwegian, Swedish, Danish), but are open for discussions with others. See call stillingsannonse_seniorforskere-våren 2014.

Of the 497 originally collected videotapes of doctor-patient encounters from Akershus University Hospital 2007-08, 194 are now transcribed and tagged by the Institute of Nordic and Linguistic Studies at the University of Oslo, thus forming the Lege-pasient-korpuset (Doctor-Patient Corpus). All information in the dialogues that could identify any of the speakers has been anonymised. The Regional Ethics Committee has accepted publication to make these dialogues available for researchers everywhere (though as they are in Norwegian, use outside of Scandinavia is hardly likely). By allowing this, Arnstein Finset, Pål Gulbrandsen, and Bård Fossli Jensen, the researchers behind the original study, hope to achieve that several research groups in Scandinavia will profit on their work. The only requirement is that they want to be informed about use of the corpus, and asked to participate in the research if the study subject requires medical or psychological expertise. The ultimate goal is to create more insight in how doctors and patients talk together, in order to improve the teaching of doctors. A news story about the corpus was published on the website for Norwegian research news today at forskning.no (in Norwegian).