Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial - Gross, S.; Becker, C.; Beck, K.; Memma, V.; Gaab, J.; Schutz, P.; Leuppi, J. D.; Schaefert, R.; Langewitz, W.; Trendelenburg, M.; Breidthardt, T.; Eckstein, J.; et al. (BMJ Open, 2023)
OBJECTIVE: Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care. DESIGN: Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups. SETTING: Three Swiss teaching hospitals. PARTICIPANTS: Adult patients hospitalised for medical care. INTERVENTIONS: We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes. RESULTS: Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (+/-14.6) vs 90.2 (+/-12.1), adjusted difference -2.5 (95% CI -4.28 to -0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient-physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002). CONCLUSIONS: A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients. TRIAL REGISTRATION NUMBER: NCT03210987.
Keywords: journalArticle; (Forschungsrat) of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) and; (Ref SNFS-160072 und -185592). JDL has also received unrestricted grant money; *Health Facilities; *Inpatients; 1500000083). PS has previously received unrestricted grant money unrelated to; 22.00094. RS received a speaker honorarium from Novartis. MT is recipient of a; Adult; Bangerter-Rhyner-Stiftung under projects no. PC 28/17 and PC 05/18, from the; Communication; Dissent and Disputes; Driver-Project - 2018DR108)) and the Swiss National Science Foundation (SNSF); Funds of the Argovia Professorship of the Medical University Clinic (FG; Gottfried Julia Bangerter-Rhyner Foundation (8472/HEG-DSV). PS has received; Hospitals, Teaching; Humans; K50001, and in the context of a Horizon Europe project from the Swiss State; Promotion Sante Suisse (Gesundheitsforderung Schweiz) under contract no. 18.191/; Science Foundation (SNSF) (Ref 10001C_192850/1 and 10531C_182422) and the; Secretariat for Education, Research and lnnovation (SERI) under contract number; Swiss Cancer League (Krebsliga Schweiz) under project no. KLS-4304-08-2017, from; Switzerland).; Switzerland, GSK AG Switzerland and Novartis AG Switzerland. RS received funding; and has research collaborations with Roche, Novartis and Idorsia (all; from the Stanley Thomas Johnson Stiftung & Gottfried und Julia; hospitalization; internal medicine; medical education & training; medical ethics; project grant of the Swiss National Science Foundation (grant No. 320030_200423); research team are supported by the Swiss Personalized Health Network (Ref; support from the SNF (SNSF Professorship, PP00P3_150531), the Research Committee; this project from Nestle Health Science and Abbott Nutrition. JDL and his; unrelated to the project from AstraZeneca AG Switzerland, Boehringer GmbH