@Article{info:doi/10.2196/67947, author="Li, Qiwei and Zhou, Jie", title="Impact of News Portrayals of Physicians as Vulnerable on the Public's Evaluation and Trust in Physicians Under Different Involvement Levels: Quantitative Study", journal="J Med Internet Res", year="2025", month="Jul", day="9", volume="27", pages="e67947", keywords="vulnerable physicians", keywords="media portrayals", keywords="physician-patient trust", keywords="stereotype content model", keywords="involvement", abstract="Background: News portrayals of physicians, especially in China, often depict them as vulnerable---overworked, with inadequate compensation, or as victims of violence. These portrayals may send mixed signals to the public, yet their impact remains underexplored. Understanding their impact is essential for informing media strategies and improving physician-patient relationships. Objective: This study investigated how portrayals of physicians as vulnerable influence public evaluations of their competence, warmth, morality, and overall trust and considered the moderating effects of involvement (ie, hospital visit frequency). Methods: Four studies were conducted. Study 1 (N=492) examined the effects of daily exposure to vulnerable portrayals, and study 2 (N=710) experimentally exposed participants to vulnerable portrayals to directly investigate the causal relationship between exposure and evaluations with involvement as a hypothesized moderator. Study 3 (N=565) manipulated situational involvement using an imagination task, whereas study 4 (N=436) embedded involvement-enhancing content into news articles to improve ecological validity. Results: Study 1 revealed that among individuals with low or moderate involvement, greater exposure to vulnerable physician portrayals in everyday life predicted more favorable overall evaluations of physicians (low involvement: B=0.11 and P=.04; moderate involvement: B=0.20 and P<.001). No significant effect was found among high-involvement individuals (P>.68 in all cases), suggesting an inverted U-shaped moderating effect of involvement. Study 2 supported this pattern---vulnerable portrayals had no significant impact among individuals with low or high involvement (t702<0.49 in all cases; P>.15 in all cases) but had marginally positive effects on individuals with moderate involvement (t702=1.67; P=.10; d=0.26). Notably, individuals with superhigh involvement (ie, those in hospital settings) evaluated physicians more negatively following vulnerable portrayals (t702=2.49; P=.01; d=0.44). Given that nearly 80\% of the general population reports low to moderate hospital visits, which is the positive moderating effect range for involvement, studies 3 and 4 targeted this group and tested whether manipulated situational involvement could enhance the effects of vulnerable portrayals. In studies 3a and 3b, participants in the high--situational involvement condition evaluated physicians more positively in the vulnerable portrayal group than in the control group (3a: t401=2.71, P=.007, d=0.37; 3b: t154=3.48, P<.001, d=0.93), with no effects under low-involvement conditions. Study 4 confirmed that involvement-enhancing vulnerable portrayals elicited more favorable evaluations compared to the control group (t433=3.14; P=.002; d=0.37). Across all 4 studies, overall evaluation significantly predicted trust in the medical profession (B?0.38 in all cases; P<.001 in all cases), supporting the hypothesized mediation pathway. Conclusions: The findings reveal a complex relationship between news portrayals of vulnerable physicians and public perceptions moderated by involvement. These results have practical implications for leveraging media to increase public trust and improve physician-patient relationships. ", doi="10.2196/67947", url="https://www.jmir.org/2025/1/e67947" } @Article{info:doi/10.2196/69075, author="Sulaiman, Hafiz Muhammad and Muda, Nora and Abdul Razak, Fatimah", title="Analyzing Patient Complaints in Web-Based Reviews of Private Hospitals in Selangor, Malaysia, Using Large Language Model--Assisted Content Analysis: Mixed Methods Study", journal="JMIR Form Res", year="2025", month="Jun", day="27", volume="9", pages="e69075", keywords="large language model", keywords="hospital quality", keywords="patient satisfaction", keywords="big data", keywords="web-based review", abstract="Background: Large language model (LLM)--assisted content analysis (LACA) is a modification of traditional content analysis, leveraging the LLM to codevelop codebooks and automatically assign thematic codes to a web-based reviews dataset. Objective: This study aims to develop and validate the use of LACA for analyzing hospital web-based reviews and to identify themes of issues from web-based reviews using this method. Methods: Web-based reviews for 53 private hospitals in Selangor, Malaysia, were acquired. Fake reviews were filtered out using natural language processing and machine learning algorithms trained on yelp.com validated datasets. GPT-4o mini model application programming interface (API) was then applied to filter out reviews without any quality issues. In total, 200 of the remaining reviews were randomly extracted and fed into the GPT-4o mini model API to produce a codebook validated through parallel human-LLM coding to establish interrater reliability. The codebook was then used to code (label) all reviews in the dataset. The thematic codes were then summarized into themes using factor analysis to increase interpretability. Results: A total of 14,938 web-based reviews were acquired, of which 1121 (9.3\%) were fake, 1279 (12\%) contained negative sentiments, and 9635 (88\%) did not contain any negative sentiment. GPT-4o mini model subsequently inducted 41 thematic codes together with their definitions. Average human-GPT interrater reliability is perfect ($\kappa$=0.81). Factor analysis identified 6 interpretable latent factors: ``Service and Communication Effectiveness,'' ``Clinical Care and Patient Experience,'' ``Facilities and Amenities Quality,'' ``Appointment and Patient Flow,'' ``Financial and Insurance Management,'' and ``Patient Rights and Accessibility.'' The cumulative explained variance for the six factors is 0.74, and Cronbach $\alpha$ is between 0.88 and 0.97 (good and excellent) for all factors except factor 6 (0.61: questionable). The factors identified follow a global pattern of issues identified from the literature. Conclusions: A data collection and processing pipeline consisting of Python Selenium, the GPT-4o mini model API, and a factor analysis module can support valid and reliable thematic analysis. Despite the potential for collection and information bias in web-based reviews, LACA of web-based reviews is cost-effective, time-efficient, and can be performed in real time, helping hospital managers develop hypotheses for further investigations promptly. ", doi="10.2196/69075", url="https://formative.jmir.org/2025/1/e69075" } @Article{info:doi/10.2196/71186, author="Mart{\'i}nez-Mart{\'i}nez, H{\'e}ctor and Mart{\'i}nez-Alfonso, Julia and S{\'a}nchez-Rojo-Huertas, Bel{\'e}n and Reynolds-Cortez, Valeria and Tur{\'e}gano-Chumillas, Andrea and Meseguer-Ruiz, A. Victoria and Cekrezi, Shkelzen and Mart{\'i}nez-Vizca{\'i}no, Vicente", title="Perceptions of, Barriers to, and Facilitators of the Use of AI in Primary Care: Systematic Review of Qualitative Studies", journal="J Med Internet Res", year="2025", month="Jun", day="25", volume="27", pages="e71186", keywords="artificial intelligence", keywords="family practice", keywords="primary health care", keywords="general practice", keywords="physicians", keywords="systematic review", keywords="qualitative research", keywords="qualitative evidence synthesis", abstract="Background: Artificial intelligence (AI) has the potential to transform primary care by reducing the considerable bureaucratic burden. However, clinicians and patients share concerns regarding data privacy, security, and potential biases in AI algorithms. Objective: This study aimed to provide an in-depth understanding of primary care professionals' and patients' perceptions of, barriers to, and facilitators of the use of AI in primary care. Methods: We conducted a systematic review of qualitative studies using MEDLINE (via PubMed), Web of Science, and Scopus databases from inception to June 9, 2024. We used the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool to design the systematic search strategy for qualitative studies. Eligible studies included qualitative analyses---based on interviews, focus groups, or similar methods---of perceptions of, barriers to, and facilitators of the use of AI in primary care, involving primary care professionals or patients. Exclusion criteria included studies on clinical decision support systems, reviews, commentaries, editorials, conference abstracts, and non-English or non-Spanish publications. Methodological quality was assessed using the Joanna Briggs Institute checklist. A thematic synthesis approach was used to structure the results, and the Grading of Recommendations Assessment, Development, and Evaluation--Confidence in the Evidence From Reviews of Qualitative Research (GRADE-CERQual) tool was used to assess the confidence in each finding. Results: We analyzed 316 participants, including primary care physicians, patients, and other health care professionals, from 13 studies across 6 countries selected from 942 screened records. We identified four analytical themes using thematic synthesis: (1) change in the physician-patient relationship, highlighting concerns about loss of empathy, connection, and trust; (2) AI as a partner for efficient time and information management, including its potential to improve workflow and decision-making, alongside skepticism about increased workload; (3) data as the cornerstone of AI development, reflecting concerns about data privacy, quality, bias, and corporate responsibility; and (4) barriers to and facilitators of AI in primary care, emphasizing equity, accessibility, and stakeholder co-design. The GRADE-CERQual assessment provided high confidence in all themes except theme 4, which was rated as moderate confidence. Conclusions: This meta-synthesis includes the perspectives of primary care physicians and patients, but further research is needed on the perspectives of other professionals. Moreover, there was heterogeneity in methods and sampling strategies. This first systematic review synthesizing qualitative evidence on AI perceptions in primary care provides a comprehensive understanding of related barriers and facilitators. The key themes identified suggest that AI may help address workload, decision-making, and data management, improving health care efficiency while ensuring ethical, patient-centered care. Trial Registration: PROSPERO CRD42024560048; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024560048 ", doi="10.2196/71186", url="https://www.jmir.org/2025/1/e71186", url="http://www.ncbi.nlm.nih.gov/pubmed/40560641" } @Article{info:doi/10.2196/62947, author="Gamble, Eoin and Heavin, Ciara and Linehan, Conor", title="Adaptation of Clinical Research Staff to Decentralized Clinical Trials and Impacts on the Patient-Centered Experience: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Jun", day="16", volume="27", pages="e62947", keywords="decentralized trials", keywords="decentralized clinical trial", keywords="DCT", keywords="remote trials", keywords="clinical research technology", keywords="site experience", keywords="patient centeredness", keywords="patient experience", keywords="participant-centric trials", keywords="human centered", abstract="Background: Industry stakeholders, academic experts, and regulatory bodies emphasize the importance of prioritizing a patient-centered experience in clinical trials to enhance retention, adherence, and trial participation. Concurrently, there has been a notable rise in the adoption of technology-mediated decentralized methodologies for conducting clinical trials. Nonetheless, is a truly patient-centric approach being achieved? The shift to decentralized approaches risks prioritizing operational efficiency and remote data collection over the nuanced and diverse needs of participants. This raises critical questions about whether the current implementation of decentralized clinical trials (DCTs) fully aligns with the principles of patient centeredness. Objective: Using a qualitative approach, our study aims to understand the perceptions of clinical research staff (CRS) of this transition and its impact on delivering a patient-centered experience. Methods: A total of 15 CRS with experience of facilitating DCTs were interviewed, and transcripts were analyzed. Results: Our findings reveal 1 superordinate theme---the quality and frequency of interactions with patients and CRS are limited---and six main themes: (1) increasing demands of the CRS role, (2) creating difficulties for patients, (3) knowing the patient and understanding their experience, (4) impacts on forming and maintaining CRS-patient relationship, (5) difficulty in delivering desired level of support and care, and (6) perceived affects to conduct of a trial. While DCTs offer advantages in improving accessibility, they introduce new complexities that can negatively impact patient engagement, retention, and the CRS-patient relationship. Conclusions: This study offers insights into the perspectives of CRS on delivering a patient-centered experience in DCTs. It highlights the benefits of DCTs alongside the challenges they present, emphasizing the need for additional support, training, streamlined technology, and resources to help CRS adapt to evolving trial dynamics. To fully realize the patient-centered potential of DCTs, technology and trial designers must recognize the complex interplay of factors shaping the patient experience. This requires collaboration with CRS and patients to address the diverse needs of all stakeholders, prioritizing the broader aspects of the patient experience beyond at-home convenience and data collection. ", doi="10.2196/62947", url="https://www.jmir.org/2025/1/e62947", url="http://www.ncbi.nlm.nih.gov/pubmed/40522722" } @Article{info:doi/10.2196/66221, author="Hayer, Rupinder and Tang, Joyce and Bisschops, Julia and Schneider, W. Gregory and Kirley, Kate and Khan, Tamkeen and Rieger, Erin and Walford, Eric and Anderson, Irsk and Press, Valerie and Williams, Brent", title="Implementing the H\&P 360 in Three Medical Institutions: Usability Study", journal="JMIR Med Educ", year="2025", month="Jun", day="5", volume="11", pages="e66221", keywords="history and physical", keywords="medical education", keywords="social drivers", keywords="social determinants of health", abstract="Background: The traditional history and physical (H\&P) provides the basis for physicians' data gathering, problem formulation, and care planning, yet it can miss relevant behavioral or social risk factors. The American Medical Association's ``H\&P 360,'' a modified H\&P, has been shown to foster information gathering and patient rapport in inpatient settings and objective structured clinical examinations. It prompts students to explore 7 domains, as appropriate to the clinical context: biomedical problems, psychosocial problems, patients' priorities and goals, behavioral history, relationships, living environment and resources, and functional status. Objective: This study aims to examine the perceived usability of the H\&P 360 outside standardized patient settings. Methods: The H\&P 360 was implemented in various clinical settings across 3 institutions. Of the 207 student participants, 18 were preclerkship, 126 were clerkship, and 63 were postclerkship; 3-8 months after implementation, we administered a student survey consisting of 14 Likert-type items (1=strongly disagree to 5=strongly agree) and 3 free-text response items to assess usability. Results: Of the 207 students, 61 responded to the survey (response rate was 29.5\%). Among all students, mean ratings on the 3 usability survey items ranged from 4.03 to 4.24. The 5 items assessing the impact on patient care had mean ratings ranging from 3.88 to 4.24. The mean ratings for the 2 student learning items were 4.10 and 4.16. Students' open-ended comments were generally positive, expressing a perceived value in obtaining a more complete contextual picture of patients' conditions and supporting the usability of the H\&P 360. Survey response patterns varied across institutions and learner levels. Conclusions: Our findings suggest that using the H\&P 360 may enhance information gathering critical for chronic disease management, particularly regarding social drivers of health. As a potential new standard, the H\&P 360 may have clinical usability for identifying and addressing health inequities. Future work should assess its effects on patient care and outcomes. ", doi="10.2196/66221", url="https://mededu.jmir.org/2025/1/e66221", url="http://www.ncbi.nlm.nih.gov/pubmed/40471655" } @Article{info:doi/10.2196/64160, author="Woo, Kyungmi and Min, Hee Se and Kim, Aeri and Choi, Subin and Alexander, L. Gregory and O'Malley, Terrence and Moen, D. Maria and Topaz, Maxim", title="Understanding Gender-Specific Daily Care Preferences: Topic Modeling Study", journal="J Med Internet Res", year="2025", month="May", day="29", volume="27", pages="e64160", keywords="care preference", keywords="patient-centered care", keywords="quality of life", keywords="data mining", keywords="topic modeling", keywords="gender differences", keywords="online platform", keywords="KNIME", abstract="Background: Daily preferences are a reflection of how adults wish to have their needs and values addressed, contributing to joy and satisfaction in their daily lives. Clinical settings often regard older adults as a uniform group, neglecting the diversity within this population, which results in a shortfall of person-centered care that overlooks their distinct daily care preferences. At the heart of person-centered care lies the imperative to comprehend and integrate these preferences into the care process. Recognizing and addressing gender differences in older adults is critical to customizing care plans, thereby optimizing quality of life and well-being for individuals. This study addresses the need to understand the diverse daily care preferences of adults, particularly among older populations, who represent a growing demographic with unique needs and interests. Objective: This study aims to identify and analyze the key themes and daily care preferences from unstructured adult text narratives with a focus on uncovering gender-specific variations. Methods: This study used 4350 deidentified, unstructured textual data from MyDirectives (MyDirectives, Inc), an interactive online platform. Advanced topic modeling techniques were used to extract meaningful themes, and gender-specific term frequency and distribution were examined to identify gender differences in these elements. Results: The study sample included 2883 women (mean age 63.02, SD 13.69 years) and 1467 men (mean age 67.07, SD 11.73 years). Our analysis identified six major themes: (1) ``entertainment'' (12.14\%, 528/4350), (2) ``music'' (10.39\%, 452/4350), (3) ``personal interests and memories'' (38.18\%, 1661/4350), (4) ``intimate relationships'' (14.92\%, 649/4350), (5) ``natural comforts'' (16.18\%, 704/4350), and (6) ``emotional, cultural, and spiritual foundations'' (8.18\%, 356/4350). Gender differences were evident: women were more likely to express preferences for ``personal interests and memories'' (40.7\% vs 33.3\%), ``natural comforts'' (18.4\% vs 11.9\%), and ``emotional and spiritual foundations'' (9.3\% vs 6.1\%) than men. Men expressed stronger preferences for ``entertainment'' (18.1\% vs 9.1\%) and ``music'' (16.8\% vs 7.2\%). Common terms across all participants included ``dog,'' ``love,'' ``friends,'' and ``book.'' Notably, the study revealed significant gender differences in daily care preferences, especially regarding familial relationships and entertainment choices. Conclusions: The findings underscore the importance of recognizing individual daily care preferences in person-centered care, particularly regarding gender. Understanding these preferences is crucial for improving care quality and patient satisfaction, thereby enhancing the overall quality of life for adults receiving care across our health care system. ", doi="10.2196/64160", url="https://www.jmir.org/2025/1/e64160" } @Article{info:doi/10.2196/59157, author="Flora, Parminder and Tobia, Angela and Verweel, Lee and Lau, Bernice and Campbell, Janet and Eshraghi, Arezoo and Dilkas, Steven and Goldstein, Roger and Raulino, Patricia and MacKay, Crystal", title="Exploring Compassionate Care in Virtual Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="May", day="22", volume="12", pages="e59157", keywords="compassion", keywords="rehabilitation", keywords="virtual care", keywords="virtual rehabilitation", keywords="limb loss", keywords="chronic obstructive pulmonary disease", keywords="qualitative interviews", abstract="Background: Virtually delivered health care services can offer numerous benefits, and the demand for virtual care continues to grow among subgroups facing mobility challenges. The experience of compassion in health care is linked to patient satisfaction and clinical outcomes; however, this link in virtual rehabilitation settings is underexplored. Objective: The objectives of this study were to explore what compassionate care means to rehabilitation patients in a virtual rehabilitation context and explore patients' experiences of how the technology associated with virtual rehabilitation impacted their experience of care. Methods: We conducted one-on-one semistructured qualitative interviews with patients with limb loss and chronic obstructive pulmonary disease. A reflexive thematic analysis approach was used to generate domain summaries and initial themes across the sample. Themes were generated following analytic work over a series of discussions within the research team. Results: Sixteen interviews were conducted. Four themes illustrating participants' perceptions of compassionate care were generated: (1) features of compassionate care include feeling valued, connected, and cared for by the health care provider; (2) threats to compassionate care in virtual rehabilitation; (3) facilitating compassion in virtual rehabilitation through preparation; and (4) benefits of virtual care. Conclusions: Patient perceptions of compassionate care in a virtual rehabilitation setting may be impacted by the behaviors and communication of providers. Provider training and preparation and the personal connections formed with their patients may impact compassionate care experiences. ", doi="10.2196/59157", url="https://rehab.jmir.org/2025/1/e59157" } @Article{info:doi/10.2196/64028, author="Schmieding, L. Malte and Kopka, Marvin and Bolanaki, Myrto and Napierala, Hendrik and Altendorf, B. Maria and Kuschick, Doreen and Piper, K. Sophie and Scatturin, Lennart and Schmidt, Konrad and Schorr, Claudia and Thissen, Alica and W{\"a}scher, Cornelia and Heintze, Christoph and M{\"o}ckel, Martin and Balzer, Felix and Slagman, Anna", title="Impact of a Symptom Checker App on Patient-Physician Interaction Among Self-Referred Walk-In Patients in the Emergency Department: Multicenter, Parallel-Group, Randomized, Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="2", volume="27", pages="e64028", keywords="digital health", keywords="triage", keywords="symptom checker", keywords="patient-centered care", keywords="eHealth apps", keywords="mobile phone", keywords="decision support systems", keywords="consumer health information", keywords="health literacy", keywords="randomized controlled trials", keywords="null results", keywords="emergency care", keywords="patient-physician-interaction", keywords="patient satisfaction", abstract="Background: Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs' impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce. Objective: This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients' anxiety and trust in the treating physician. Methods: This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients' satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients' satisfaction with care, their anxiety levels, and physicians' satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients' and physicians' perceptions of the SCA's utility and the frequency of patients questioning their physician's authority. Results: Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference --2.4, 95\% CI --6.3 to 1.1, P=.24). Secondary outcomes, including patients' and physicians' satisfaction with care and patient anxiety, showed no significant group differences (all P>.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2\%) rather than a detrimental (3/164, 1.8\%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9\%). Similar patterns were observed regarding the SCA's perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1\%; control: 4/184, 2.2\%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter. Conclusions: We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA's impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals. Trial Registration: German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06688-w ", doi="10.2196/64028", url="https://www.jmir.org/2025/1/e64028" } @Article{info:doi/10.2196/62670, author="Heaney-Huls, Krysta and Shams, Rida and Nwefo, Ruth and Kane, Rachel and Gordon, Janna and Laffan, M. Alison and Stare, Scott and Dullabh, Prashila", title="Electronic Health Record Data Collection Practices to Advance Standardization and Interoperability of Patient Preferences for Interpretation Services: Qualitative Study", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e62670", keywords="health information exchange", keywords="interoperability", keywords="electronic health records", keywords="interpreter", keywords="limited English proficiency", keywords="communication barriers", abstract="Background: Poor health outcomes are well documented among patients with a non-English language preference (NELP). The use of interpreters can improve the quality of care for patients with NELP. Despite a growing and unmet need for interpretation services in the US health care system, rates of interpreter use in the care setting are consistently low. Standardized collection and exchange of patient interpretation needs can improve access to appropriate language assistance services. Objective: This study aims to examine current practices for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter in the electronic health record (EHR) and the implementation maturity and adoption level of available data standards. The paper identifies standards implementation; data collection workflows; use cases for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter; challenges to data collection and use; and opportunities to advance standardization of the interpreter needed data element to facilitate patient-centered care. Methods: We conducted a narrative review to describe the availability of terminology standards to facilitate health care organization documentation of a patient's self-reported preference for an interpreter in the EHR. Key informant discussions with EHR developers, health systems, clinicians, a practice-based research organization, a national standards collaborative, a professional health care association, and Federal agency representatives filled in gaps from the narrative review. Results: The findings indicate that health care organizations value standardized collection and exchange of patient language assistance service needs and preferences. Informants identified three use cases for collecting, documenting, and exchanging information on a patient's self-reported preference for an interpreter, which are (1) person-centered care, (2) transitions of care, and (3) health care administration. The discussions revealed that EHR developers provide a data field for documenting interpreter needed data, which are routinely collected across health care organizations through commonly used data collection workflows. However, this data element is not mapped to standard terminologies, such as Logical Observation Identifiers Names and Codes (LOINC) or Systematized Medical Nomenclature for Medicine--Clinical Terminology (SNOMED-CT), consequently limiting the opportunities to electronically share these data between health systems and community-based organizations. The narrative review and key informant discussions identified three potential challenges to using information on a patient's self-reported preference for an interpreter for person-centered care and quality improvement, which are (1) lack of adoption of available data standards, (2) limited electronic exchange, and (3) patient mistrust. Conclusions: Collecting and documenting patient's self-reported interpreter preferences can improve the quality of services provided, patient care experiences, and equitable health care delivery without invoking a significant burden on the health care system. Although there is routine collection and documentation of patient interpretation needs, the lack of standardization limits the exchange of this information among health care and community-based organizations. ", doi="10.2196/62670", url="https://www.jmir.org/2025/1/e62670", url="http://www.ncbi.nlm.nih.gov/pubmed/39888652" } @Article{info:doi/10.2196/64993, author="Biro, Joshua and Handley, L. Jessica and Cobb, K. Nathan and Kottamasu, Varsha and Collins, Jeffrey and Krevat, Seth and Ratwani, M. Raj", title="Accuracy and Safety of AI-Enabled Scribe Technology: Instrument Validation Study", journal="J Med Internet Res", year="2025", month="Jan", day="27", volume="27", pages="e64993", keywords="artificial intelligence", keywords="AI", keywords="patient safety", keywords="ambient digital scribe", keywords="AI-enabled scribe technology", keywords="AI scribe technology", keywords="scribe technology", keywords="accuracy", keywords="safety", keywords="ambient scribe", keywords="digital scribe", keywords="patient-clinician", keywords="patient-clinician communication", keywords="doctor-patient relationship", keywords="doctor-patient communication", keywords="patient engagement", keywords="dialogue script", keywords="scribe", doi="10.2196/64993", url="https://www.jmir.org/2025/1/e64993" } @Article{info:doi/10.2196/46390, author="Guhan, Pooja and Awasthi, Naman and McDonald, Kathryn and Bussell, Kristin and Reeves, Gloria and Manocha, Dinesh and Bera, Aniket", title="Developing a Machine Learning--Based Automated Patient Engagement Estimator for Telehealth: Algorithm Development and Validation Study", journal="JMIR Form Res", year="2025", month="Jan", day="20", volume="9", pages="e46390", keywords="machine learning", keywords="mental health", keywords="telehealth", keywords="engagement detection", keywords="patient engagement", abstract="Background: Patient engagement is a critical but challenging public health priority in behavioral health care. During telehealth sessions, health care providers need to rely predominantly on verbal strategies rather than typical nonverbal cues to effectively engage patients. Hence, the typical patient engagement behaviors are now different, and health care provider training on telehealth patient engagement is unavailable or quite limited. Therefore, we explore the application of machine learning for estimating patient engagement. This can assist psychotherapists in the development of a therapeutic relationship with the patient and enhance patient engagement in the treatment of mental health conditions during tele--mental health sessions. Objective: This study aimed to examine the ability of machine learning models to estimate patient engagement levels during a tele--mental health session and understand whether the machine learning approach could support therapeutic engagement between the client and psychotherapist. Methods: We proposed a multimodal learning-based approach. We uniquely leveraged latent vectors corresponding to affective and cognitive features frequently used in psychology literature to understand a person's level of engagement. Given the labeled data constraints that exist in health care, we explored a semisupervised learning solution. To support the development of similar technologies for telehealth, we also plan to release a dataset called Multimodal Engagement Detection in Clinical Analysis (MEDICA). This dataset includes 1229 video clips, each lasting 3 seconds. In addition, we present experiments conducted on this dataset, along with real-world tests that demonstrate the effectiveness of our method. Results: Our algorithm reports a 40\% improvement in root mean square error over state-of-the-art methods for engagement estimation. In our real-world tests on 438 video clips from psychotherapy sessions with 20 patients, in comparison to prior methods, positive correlations were observed between psychotherapists' Working Alliance Inventory scores and our mean and median engagement level estimates. This indicates the potential of the proposed model to present patient engagement estimations that align well with the engagement measures used by psychotherapists. Conclusions: Patient engagement has been identified as being important to improve therapeutic alliance. However, limited research has been conducted to measure this in a telehealth setting, where the therapist lacks conventional cues to make a confident assessment. The algorithm developed is an attempt to model person-oriented engagement modeling theories within machine learning frameworks to estimate the level of engagement of the patient accurately and reliably in telehealth. The results are encouraging and emphasize the value of combining psychology and machine learning to understand patient engagement. Further testing in the real-world setting is necessary to fully assess its usefulness in helping therapists gauge patient engagement during online sessions. However, the proposed approach and the creation of the new dataset, MEDICA, open avenues for future research and the development of impactful tools for telehealth. ", doi="10.2196/46390", url="https://formative.jmir.org/2025/1/e46390" } @Article{info:doi/10.2196/68046, author="Lachman, Peter and Fitzsimons, John", title="Transforming Medical Education to Make Patient Safety Part of the Genome of a Modern Health Care Worker", journal="JMIR Med Educ", year="2025", month="Jan", day="17", volume="11", pages="e68046", keywords="patient safety", keywords="psychological safety", keywords="medical curriculum", keywords="professional competence", keywords="clinical competence", doi="10.2196/68046", url="https://mededu.jmir.org/2025/1/e68046" } @Article{info:doi/10.2196/60352, author="Gamper, Jo Mary and Singer Cohen, Rebecca and Esperanza Razaz, Maryam and Parrillo, Elaina and Thornton, P. Clifton and Wec, Aleksandra and McDonald, Kathryn and Gleason, T. Kelly", title="Electronic Communication Between Children's Caregivers and Health Care Teams: Scoping Review on Parental Caregiver's Perceptions and Experience", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="13", volume="7", pages="e60352", keywords="electronic communication", keywords="patient portal", keywords="provider-patient relations", keywords="parental caregiver", keywords="relational coordination theory", keywords="patient-clinician relationship", keywords="mobile phone", abstract="Background: Asynchronous communication via electronic modes (e-communication), including patient portals, secure messaging services, SMS text messaging, and email, is increasingly used to supplement synchronous face-to-face medical visits; however, little is known about its quality in pediatric settings. Objective: This review aimed to summarize contemporary literature on pediatric caregivers' experiences with and perspectives of e-communication with their child's health care team to identify how e-communication has been optimized to improve patient care. Methods: A scoping review following the Arksey and O'Malley methodological framework searched PubMed, CINAHL, Embase, and Web of Science using terms such as ``Electronic Health Records'' and ``Communication'' from 2013 to 2023 that discussed caregiver experiences and perspectives of e-communication with their child's health care provider. Studies were excluded if they were abstracts, non-English papers, nonscientific papers, systematic reviews, or quality improvement initiatives, or pertained to synchronous telemedicine. We conducted a two-step screening process by scanning the title and abstract and reviewing the full text by two independent screeners to confirm eligibility. From an initial 903 articles identified via the database search, 23 articles fulfilled all the inclusion criteria and are included in this review. Results: Of the 23 articles meeting the inclusion criteria, 11 used quantitative methods, 7 used qualitative methods, and 5 used mixed methods. The caregiver sample sizes ranged from 51 to 3339 in the quantitative studies and 8 to 36 in the qualitative and mixed methods studies. A majority (n=17) used the patient portal that was self-categorized by the study. Secure messaging through a portal or other mobile health app was used in 26\% (n=6) of the studies, while nonsecure messaging outside of the portal was used 17\% (n=4) of the time and email was used 33.3\% (n=8) of the time. In 19 of the studies, parents reported positive experiences with and a desire for e-communication methods. Conclusions: The literature overwhelmingly supported caregiver satisfaction with and desire for e-communication in health care, but no literature intentionally studied how to improve the quality of e-communication, which is a critical gap to address. ", doi="10.2196/60352", url="https://pediatrics.jmir.org/2024/1/e60352" } @Article{info:doi/10.2196/57884, author="Park, Yuyi and ?Kim, Hyungsin and Kim, Hakkyun", title="Visualizing Empathy in Patient-Practitioner Interactions Using Eye-Tracking Technology: Proof-of-Concept Study", journal="JMIR Form Res", year="2024", month="Dec", day="11", volume="8", pages="e57884", keywords="clinical empathy", keywords="eye tracking", keywords="medical communication", keywords="nonverbal behavior", keywords="doctor-patient encounters", abstract="Background: Communication between medical practitioners and patients in health care settings is essential for positive patient health outcomes. Nonetheless, researchers have paid scant attention to the significance of clinical empathy in these interactions as a practical skill. Objective: This study aims to understand clinical empathy during practitioner-patient encounters by examining practitioners' and patients' verbal and nonverbal behaviors. Using eye-tracking techniques, we focused on the relationship between traditionally assessed clinical empathy and practitioners' actual gaze behavior. Methods: We used mixed methods to understand clinical encounters by comparing 3 quantitative measures: eye-tracking data, scores from the Korean version of the Jefferson Scale of Empathy--Health Professional, and Consultation and Relational Empathy survey scores. We also conducted qualitative interviews with patients regarding their encounters. Results: One practitioner and 6 patients were involved in the experiment. Perceived empathy on the part of the practitioner was notably higher when the practitioner focused on a patient's mouth area during the consultation, as indicated by gaze patterns that focused on a patient's face. Furthermore, an analysis of areas of interest revealed different patterns in interactions with new as opposed to returning patients. Postconsultation interviews suggested that task-oriented and socially oriented empathy are critical in aligning with patients' expectations of empathetic communication. Conclusions: This proof-of-concept study advocates a multidimensional approach to clinical empathy, revealing that a combination of verbal and nonverbal behaviors significantly reinforces perceived empathy from health care workers. This evolved paradigm of empathy underscores the profound consequences for medical education and the quality of health care delivery. ", doi="10.2196/57884", url="https://formative.jmir.org/2024/1/e57884" } @Article{info:doi/10.2196/59904, author="Su, Jingyuan and Shen, Ning Kathy and Guo, Xitong", title="Impact of Reverse Empowerment and Proactive Motivations on Physicians' Online Knowledge Sharing in Digital Platforms: Survey Study", journal="J Med Internet Res", year="2024", month="Nov", day="29", volume="26", pages="e59904", keywords="physician behavior", keywords="online knowledge sharing", keywords="proactivity", keywords="patient empowerment", keywords="digital platforms", keywords="health communication", abstract="Background: Digital platforms offer a venue for patients and physicians to exchange health information and provide health care services outside traditional organizational contexts. Previous studies have seldom focused on the factors that drive the proactivity of physicians' online behavior. Additionally, there is limited research exploring the influence of patients on physicians' online behavior, particularly from the perspective of patients possessing power. Objective: This study aims to investigate the effect of patient-empowering behaviors on physicians' online knowledge sharing and uncover the potential mechanisms of proactivity. Based on the proactive motivational model and empowerment theory, we propose the existence of a reverse empowerment process, where empowerment flows from patients to physicians. We suggest that patient-empowering behaviors may drive physicians' online knowledge sharing as a form of proactivity. Specifically, 3 proactive motivational states---knowledge-sharing self-efficacy, sharing meaning, and positive professional affect---mediate this relationship. Additionally, platform extrinsic rewards, as a contextual factor, have a moderating effect. Methods: To validate our proposed research model, we conducted a survey in China using the WJX platform, targeting physicians engaged in online knowledge sharing. The measurement instrument utilizes validated items adapted from prior research, using a 5-point Likert scale. We collected 257 valid responses, ensuring that participation was both anonymous and voluntary. Data analysis was performed in 2 stages. The first stage assessed the measurement model for reliability and validity, using the Harman 1-factor test and confirmatory factor analysis. The second stage used partial least squares-structural equation modeling to examine the direct, moderation, and mediation effects among the constructs, with bootstrapping used for significance testing. This comprehensive approach ensures a robust analysis of the proposed hypotheses and contributes to the overall validity of our research model. Results: Perceived patient-empowering behaviors significantly and positively influence physicians' online knowledge sharing ($\beta$=0.27, P<.001). Knowledge-sharing self-efficacy (effect=0.06, P=.04), sharing meaning (effect=0.12, P<.001), and positive professional affect (effect=0.10, P=.003) each partially mediate the effect of patient-empowering behaviors on physicians' online knowledge sharing. The overall proactive motivational states play a complete mediation role, meaning the entire indirect effect of the model is significant (effect=0.29, P<.001), while the direct effect in the model is nonsignificant (effect=0.07, P=.26). Additionally, platform extrinsic rewards significantly and negatively moderate the effect of sharing meaning on physicians' online knowledge sharing ($\beta$=--0.13, P=.001). Conclusions: This study is the first to recognize and examine proactivity as an alternative mediating mechanism for physicians' online knowledge sharing, highlighting the active role of patients in empowering physicians. It makes a significant contribution to the existing literature on empowerment, eHealth, and proactive behavior. Additionally, the findings offer valuable guidance for designing and managing digital platforms to ensure service sustainability. ", doi="10.2196/59904", url="https://www.jmir.org/2024/1/e59904" } @Article{info:doi/10.2196/60670, author="Wooldridge, S. Jennalee and Soriano, C. Emily and Chu, Gage and Shirazi, Anaheed and Shapiro, Desiree and Patterson, Marta and Kim, Hyun-Chung and Herbert, S. Matthew", title="Optimizing Compassion Training in Medical Trainees Using an Adjunct mHealth App: A Preliminary Single-Arm Feasibility and Acceptability Study", journal="JMIR Form Res", year="2024", month="Nov", day="26", volume="8", pages="e60670", keywords="mobile phone", keywords="compassion", keywords="empathy", keywords="mHealth", keywords="mobile health", keywords="medical student", keywords="medical resident", keywords="mHealth app", keywords="app", keywords="medical trainee", keywords="training", keywords="feasibility", keywords="acceptability", keywords="pilot", keywords="mindfulness", keywords="self-compassion", keywords="smartphone app", keywords="applicability", abstract="Background: While structured compassion training programs have shown promise for increasing compassion among medical trainees, a major challenge is applying the concepts and practices taught during the program into the complex, dynamic, time-pressured, and often hectic hospital workplace. Objective: The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of Compassion Coach, a mobile health (mHealth) smartphone app designed to bolster a 6-week mindfulness and self-compassion training program for medical trainees. Methods: In Compassion Coach, notifications to remind, encourage, and measure the perceived impact of informal mindfulness and compassion practices taught during the program were delivered at 7 AM, 12 PM, and 7 PM, respectively, 3 times per week over the course of the training program. The app also contained a library of guided audio formal mindfulness and compassion practices to allow quick and easy access. In this pilot study, we collected data from 29 medical students and residents who downloaded Compassion Coach and completed surveys assessing perceived effectiveness and acceptability. Engagement with the Compassion Coach app was passively tracked through notification response rate and library resource access over time. Results: The average response rate to notifications was 58\% (SD 29\%; range 12\%-98\%), with a significant decline over time (P=.009; odds ratio 0.98, 95\% CI 0.96-0.99). Across all participants and occasions, the majority agreed the informal practices prompted by Compassion Coach helped them feel grounded and centered (110/150, 73\%), improved compassion (29/41, 71\%), reduced burnout (106/191, 56\%), and improved their mood (133/191, 70\%). In total, 16 (55\%) of the 29 participants accessed guided audio recordings on average 3 (SD 3.4) times throughout the program. At the posttreatment time point, most participants (13/18, 72\%) indicated that Compassion Coach helped them engage in compassion practices in daily life, and half (9/18, 50\%) indicated that Compassion Coach helped improve interactions with patients. Conclusions: Overall, preliminary results of Compassion Coach are encouraging and suggest the integration of a smartphone app with an ongoing mindfulness and self-compassion training program may bolster the effects of the program on medical trainees. However, there was variability in engagement with Compassion Coach and perceived helpfulness. Additional research is indicated to optimize this novel mHealth approach and conduct a study powered to formally evaluate effects. ", doi="10.2196/60670", url="https://formative.jmir.org/2024/1/e60670", url="http://www.ncbi.nlm.nih.gov/pubmed/39589766" } @Article{info:doi/10.2196/63814, author="Gordon, P. Nancy and Yin, Chelsea and Lo, C. Joan", title="Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study", journal="JMIR Aging", year="2024", month="Nov", day="7", volume="7", pages="e63814", keywords="patient portal use", keywords="video visit use", keywords="older adults", keywords="racial and ethnic differences", keywords="telehealth", keywords="mobile phone", abstract="Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ?1 message to a clinician in 2019 or 2020 and viewing ?1 laboratory test result in 2020), and having ?1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults' use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. ", doi="10.2196/63814", url="https://aging.jmir.org/2024/1/e63814" } @Article{info:doi/10.2196/57611, author="Fischer, Lena and Scheibler, F{\"u}l{\"o}p and Schaefer, Corinna and Karge, Torsten and Langer, Thomas and Schewe, Vincent Leon and Florez, D. Ivan and Hutchinson, Andrew and Li, Sheyu and Maes-Carballo, Marta and Munn, Zachary and Perestelo-Perez, Lilisbeth and Puljak, Livia and Stiggelbout, Anne and Pieper, Dawid", title="Fostering Shared Decision-Making Between Patients and Health Care Professionals in Clinical Practice Guidelines: Protocol for a Project to Develop and Test a Tool for Guideline Developers", journal="JMIR Res Protoc", year="2024", month="Nov", day="4", volume="13", pages="e57611", keywords="shared decision-making", keywords="practice guidelines as topic", keywords="decision support techniques", keywords="support", keywords="decision-making", keywords="decisions", keywords="tool", keywords="testing tool", keywords="protocol", keywords="medical decision-making", keywords="patient decision aid", keywords="decision aid", keywords="tool development", abstract="Background: Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking. Objective: The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation. Methods: The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs. Results: The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026. Conclusions: The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice. International Registered Report Identifier (IRRID): DERR1-10.2196/57611 ", doi="10.2196/57611", url="https://www.researchprotocols.org/2024/1/e57611", url="http://www.ncbi.nlm.nih.gov/pubmed/39495553" } @Article{info:doi/10.2196/58096, author="Kennedy, Blair Ann and Harb, Tarasidis Anna and Schockling, Chloe and Ray, Jackson Lauren and Palomo, Jennifer and Russ-Sellers, Rebecca", title="Understanding the Values, Qualities, and Preferences of Patients in Their Relationships With Obstetrics and Gynecology Providers: Cross-Sectional Survey With a Mixed Methods Approach", journal="J Particip Med", year="2024", month="Oct", day="16", volume="16", pages="e58096", keywords="communication", keywords="obstetrics", keywords="gynecology", keywords="trust", keywords="barriers to care", keywords="patient-provider relationships", abstract="Background: The patient-provider relationship in obstetrics and gynecology (OBGYN) is uniquely complex due to the sensitive nature of examinations and topics. Patients often prefer health care providers who share similar racial, ethnic, gender, or linguistic backgrounds, particularly in sensitive health care situations, to improve communication and comfort, though historically, specific gender preferences for OBGYNs have not been evident. Objective: This study aims to describe the values, qualities, and preferences of patients in their relationships with OBGYN providers. Methods: This cross-sectional survey, conducted from October 2019 to December 2019, involved 1039 US OBGYN patients and used a mixed methods approach, integrating quantitative responses and qualitative insights from open-ended questions. Recruitment was facilitated through targeted social media campaigns, and the survey aimed to capture detailed patient preferences and barriers to care by assessing responses on provider traits, patient experiences, and demographic factors. The study's rigorous data collection and analysis were designed to fill gaps identified in previous research on patient-provider relationships in OBGYN care. Results: The findings underscore the paramount importance of trust and comfort, with listening skills identified as crucial. A notable finding is the marked preference for same-gender providers, observed in 80.7\% (545/675) of participants. Primary barriers to seeking care reported included daily commitments, highlighting the need for accessible and flexible care options. Conclusions: The study highlights a significant shift from previous scientific findings in patient preferences toward gender concordance and trust in OBGYN settings, diverging from previous research. These results emphasize the need for patient-centered care and tailored communication strategies to enhance patient experiences and outcomes. Future research should focus on diverse populations to broaden the findings' applicability and explore the impact of recent shifts in health care policies. ", doi="10.2196/58096", url="https://jopm.jmir.org/2024/1/e58096", url="http://www.ncbi.nlm.nih.gov/pubmed/39412870" } @Article{info:doi/10.2196/50236, author="Madanay, Farrah and Tu, Karissa and Campagna, Ada and Davis, Kelly J. and Doerstling, S. Steven and Chen, Felicia and Ubel, A. Peter", title="Classification of Patients' Judgments of Their Physicians in Web-Based Written Reviews Using Natural Language Processing: Algorithm Development and Validation", journal="J Med Internet Res", year="2024", month="Aug", day="1", volume="26", pages="e50236", keywords="web-based physician reviews", keywords="patient judgments", keywords="RoBERTa", keywords="natural language processing", keywords="text classification", keywords="machine learning", keywords="patient experience", keywords="patient-authored reviews", keywords="healthcare quality", keywords="patient care", keywords="psychology", abstract="Background: Patients increasingly rely on web-based physician reviews to choose a physician and share their experiences. However, the unstructured text of these written reviews presents a challenge for researchers seeking to make inferences about patients' judgments. Methods previously used to identify patient judgments within reviews, such as hand-coding and dictionary-based approaches, have posed limitations to sample size and classification accuracy. Advanced natural language processing methods can help overcome these limitations and promote further analysis of physician reviews on these popular platforms. Objective: This study aims to train, test, and validate an advanced natural language processing algorithm for classifying the presence and valence of 2 dimensions of patient judgments in web-based physician reviews: interpersonal manner and technical competence. Methods: We sampled 345,053 reviews for 167,150 physicians across the United States from Healthgrades.com, a commercial web-based physician rating and review website. We hand-coded 2000 written reviews and used those reviews to train and test a transformer classification algorithm called the Robustly Optimized BERT (Bidirectional Encoder Representations from Transformers) Pretraining Approach (RoBERTa). The 2 fine-tuned models coded the reviews for the presence and positive or negative valence of patients' interpersonal manner or technical competence judgments of their physicians. We evaluated the performance of the 2 models against 200 hand-coded reviews and validated the models using the full sample of 345,053 RoBERTa-coded reviews. Results: The interpersonal manner model was 90\% accurate with precision of 0.89, recall of 0.90, and weighted F1-score of 0.89. The technical competence model was 90\% accurate with precision of 0.91, recall of 0.90, and weighted F1-score of 0.90. Positive-valence judgments were associated with higher review star ratings whereas negative-valence judgments were associated with lower star ratings. Analysis of the data by review rating and physician gender corresponded with findings in prior literature. Conclusions: Our 2 classification models coded interpersonal manner and technical competence judgments with high precision, recall, and accuracy. These models were validated using review star ratings and results from previous research. RoBERTa can accurately classify unstructured, web-based review text at scale. Future work could explore the use of this algorithm with other textual data, such as social media posts and electronic health records. ", doi="10.2196/50236", url="https://www.jmir.org/2024/1/e50236", url="http://www.ncbi.nlm.nih.gov/pubmed/39088259" } @Article{info:doi/10.2196/53203, author="Hartford, Anna and Stein, J. Dan", title="The Machine Speaks: Conversational AI and the Importance of Effort to Relationships of Meaning", journal="JMIR Ment Health", year="2024", month="Jun", day="18", volume="11", pages="e53203", keywords="artificial intelligence", keywords="AI", keywords="conversational AIs", keywords="generative AI", keywords="intimacy", keywords="human-machine interaction", keywords="interpersonal relationships", keywords="effort", keywords="psychotherapy", keywords="conversation", doi="10.2196/53203", url="https://mental.jmir.org/2024/1/e53203", url="http://www.ncbi.nlm.nih.gov/pubmed/38889401" } @Article{info:doi/10.2196/46300, author="Thomas, Claire Donna and Litherland, Frances Eva and Masso, Sarah and Raymundo, Gianina and Keep, Melanie", title="Clinicians' Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health", journal="JMIR Form Res", year="2024", month="Jun", day="7", volume="8", pages="e46300", keywords="telehealth", keywords="pediatric", keywords="allied health", keywords="focus group", keywords="decision-making", keywords="community-based", keywords="counseling", keywords="speech pathology", keywords="occupational therapy", keywords="clinical services", abstract="Background: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. Objective: The aim of this study is to explore clinicians' decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians' perceptions of telehealth utility beyond COVID-19 lockdowns. Methods: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community--based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. Results: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: ``flexible telehealth use,'' ``telehealth can be superior to in-person therapy,'' and ``fear that in-person services may be replaced.'' Conclusions: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience. ", doi="10.2196/46300", url="https://formative.jmir.org/2024/1/e46300", url="http://www.ncbi.nlm.nih.gov/pubmed/38848121" } @Article{info:doi/10.2196/49262, author="Larsen, Maria and Holde, Eirin Gro and Johnsen, Kolset Jan-Are", title="Investigating Patient Satisfaction Through Web-Based Reviews of Norwegian Dentists: Quantitative Study Using the Meaning Extraction Method", journal="J Particip Med", year="2024", month="May", day="3", volume="16", pages="e49262", keywords="internet use", keywords="Linguistic Inquiry and Word Count", keywords="LIWC", keywords="patient satisfaction", keywords="patient preference", keywords="challenging encounters", keywords="preventive dentistry", keywords="population surveillance", abstract="Background: Challenging encounters in health care professions, including in dentistry, are relatively common. Challenging encounters can be defined as stressful or emotional situations involving patients that could impact both treatment outcomes and patients' experiences. Through written web-based reviews, patients can share their experiences with health care providers, and these posts can be a useful source for investigating patient satisfaction and their experiences of challenging encounters. Objective: This study aims to identify dominant themes from patient-written, web-based reviews of dentists and investigate how these themes are related to patient satisfaction with dental treatment. Methods: The study data consisted of 11,764 reviews written by dental patients, which included 1- to 5-star ratings on overall satisfaction and free-text comments. The free-text comments were analyzed using Linguistic Inquiry and Word Count software, and the meaning extraction method was used to group words into thematic categories. These themes were used as variables in a multilevel logistic regression analysis to predict patient satisfaction. Results: Eight themes emerged from the analyses, of which 6 (75\%)---explanation (odds ratio [OR] 2.56, 95\% CI 2.16-3.04; P<.001), assurance (OR 3.61, 95\% CI 2.57-5.06; P<.001), performance assessment (OR 2.17, 95\% CI 1.84-2.55; P<.001), professional advice (OR 1.81, 95\% CI 1.55-2.13; P<.001), facilities (OR 1.78, 95\% CI 1.08-2.91; P=.02), and recommendation (OR 1.31, 95\% CI 1.12-1.53; P<.001)---increased the odds of high patient satisfaction. The remaining themes (2/8, 25\%)---consequences of treatment need (OR 0.24, 95\% CI 0.20-0.29; P<.001) and patient-centered care (OR 0.62, 95\% CI 0.52-0.74; P<.001)---reduced the odds of high patient satisfaction. Conclusions: The meaning extraction method is an interesting approach to explore patients' written accounts of encounters with dental health professionals. The experiences described by patients provide insight into key elements related to patient satisfaction that can be used in the education of dental health professionals and to improve the provision of dental health services. ", doi="10.2196/49262", url="https://jopm.jmir.org/2024/1/e49262", url="http://www.ncbi.nlm.nih.gov/pubmed/38700933" } @Article{info:doi/10.2196/13924, author="Gordon, Deborah and Ford, Anna and Triedman, Natalie and Hart, Kamber and Perlis, Roy", title="Health Care Consumer Shopping Behaviors and Sentiment: Qualitative Study", journal="J Participat Med", year="2020", month="Jun", day="16", volume="12", number="2", pages="e13924", keywords="decision making", keywords="choice behavior", keywords="mental processes", keywords="behavioral economics", keywords="health costs", keywords="health care costs", keywords="treatment costs", keywords="cost sharing", keywords="health expenditures", keywords="out-of-pocket costs", abstract="Background: Although some health care market reforms seek to better engage consumers in purchasing health care services, health consumer behavior remains poorly understood. Objective: This study aimed to characterize the behaviors and sentiment of consumers who attempt to shop for health care services. Methods: We used a semistructured interview guide based on grounded theory and standard qualitative research methods to examine components of a typical shopping process in a sample size of 54 insured adults. All interviews were systematically coded to capture consumer behaviors, barriers to shopping behavior, and sentiments associated with these experiences. Results: Participants most commonly described determining and evaluating options, seeking value, and assessing or evaluating value. In total, 83\% (45/54) of participants described engaging in negotiations regarding health care purchasing. The degree of positive sentiment expressed in the interview was positively correlated with identifying and determining the health plan, provider, or treatment options; making the decision to purchase; and evaluating the decision to purchase. Conversely, negative sentiment was correlated with seeking value and making the decision to buy. Conclusions: Consumer shopping behaviors are prevalent in health care purchasing and can be mapped to established consumer behavior models. ", doi="10.2196/13924", url="http://jopm.jmir.org/2020/2/e13924/" } @Article{info:doi/10.2196/16511, author="Masi, Domitilla and Gomez-Rexrode, Elvira Amalia and Bardin, Rina and Seidman, Joshua", title="The ``Preparation for Shared Decision-Making'' Tool for Women With Advanced Breast Cancer: Qualitative Validation Study", journal="J Participat Med", year="2019", month="Dec", day="20", volume="11", number="4", pages="e16511", keywords="shared decision making", keywords="clinical decision making", keywords="patient preferences", keywords="cancer", keywords="breast cancer", keywords="human-centered design", keywords="patient care planning", abstract="Background: The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. Objective: Avalere Health developed the Preparation for Shared Decision-Making (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. Methods: We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. Results: Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. Conclusions: This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool's implementation in the clinical workflow and its impact on patient outcomes. ", doi="10.2196/16511", url="http://jopm.jmir.org/2019/4/e16511/" } @Article{info:doi/10.2196/12105, author="Schlaudecker, D. Jeffrey and Goodnow, Keesha and Goroncy, Anna and Hartmann, Reid and Regan, Saundra and Rich, Megan and Butler, Adam and White, Christopher", title="Meaningful Partnerships: Stages of Development of a Patient and Family Advisory Council at a Family Medicine Residency Clinic", journal="J Participat Med", year="2019", month="Mar", day="20", volume="11", number="1", pages="e12105", keywords="advisory committee", keywords="patient-centered care", keywords="patient engagement", keywords="graduate medical education", abstract="Background: Partnering with patients and families is a crucial step in optimizing health. A patient and family advisory council (PFAC) is a group of patients and family members working together collaboratively with providers and staff to improve health care. Objective: This study aimed to describe the creation of a PFAC within a family medicine residency clinic. To understand the successful development of a PFAC, challenges, potential barriers, and positive outcomes of a meaningful partnership will be reported. Methods: The stages of PFAC development include leadership team formation and initial training, PFAC member recruitment, and meeting launch. Following a description of each stage, outcomes are outlined and lessons learned are discussed. PFAC members completed an open-ended survey and participated in a focus group interview at the completion of the first year. Interviewees provided feedback regarding (1) favorite aspects or experiences, (2) PFAC impact on a family medicine clinic, and (3) future projects to improve care. Common themes will be presented. Results: The composition of the PFAC consisted of 18 advisors, including 8 patient and family advisors, 4 staff advisors, 4 resident physician advisors, and 2 faculty physician advisors. The average meeting attendance was 12 members over 11 meetings in the span of the first year. A total of 13 out of 13 (100\%) surveyed participants were satisfied with their experience serving on the PFAC. Conclusions: PFACs provide a platform for patient engagement and an opportunity to drive home key concepts around collaboration within a residency training program. A framework for the creation of a PFAC, along with lessons learned, can be utilized to advise other residency programs in developing and evaluating meaningful PFACs. ", doi="10.2196/12105", url="http://jopm.jmir.org/2019/1/e12105/" } @Article{info:doi/10.2196/10782, author="Benham-Hutchins, Marge and Brown, A. Sharon and Donovan, E. Erin and Guevara, Henry and Johnson, H. Alisha", title="Spanish-Speaking Hispanic Patients' Information-Sharing Preferences During Hospitalization: An Exploratory Pilot Study", journal="J Participat Med", year="2018", month="Dec", day="06", volume="10", number="4", pages="e10782", keywords="cancer", keywords="chronic disease", keywords="diabetes", keywords="Hispanic", keywords="self-management", abstract="Background: Self-management of chronic conditions, such as cancer or diabetes, requires the coordination of care across multiple care settings. Current patient-centered, hospital-based care initiatives, including bedside nursing handoff and multidisciplinary rounds, often focus on provider information exchange and roles but fall short of the goals of participatory medicine, which recognize the right of patients to partner in their own care and play an active role in self-management. Objective: This study aimed to elicit Spanish-speaking Hispanic patients' perspectives on the exchange and sharing of information during hospitalization. Methods: This exploratory pilot study incorporated a qualitative descriptive approach by using Spanish language focus groups, posthospitalization, to determine patient-identified information needs during hospitalization. Results: Participants preferred paper-based Spanish language medical information. Doctors and nurses were key information providers and communicated with participants verbally, usually with the assistance of a translator. Participants expressed a desire to be informed about medication and treatments, including side effects and why there were changes in medication during hospitalization. In addition, they expressed interest in knowing about the progress of their condition and when they could expect to go home. Emotional readiness to receive information about their condition and prognosis was identified as an individual barrier to asking questions and seeking additional information about their condition(s). Conclusions: Overall, participants shared positive experiences with providers during hospitalization and the usefulness of self-care instructions. Language was not recognized as a barrier by any of the participants. Nevertheless, future research on the influence of emotional readiness on the timing of medical information is needed. ", doi="10.2196/10782", url="http://jopm.jmir.org/2018/4/e10782/" }