Silence in physician clinical practice: a scoping review protocol

and aims What was the objective and aims of the study?

What methods (e.g. qualitative, quantitative, mixed methods) were used? How were patients and/or physicians engaged in the design process? Population Who were the participants, sample size? Concept What type of data concerning silence was included? In what manner is silence described, and characterized including the terms used, such as invitational, hostile, etc.? What, if any factors influence engaging with silence Context In what setting did the employment of silence take place? . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 11, 2024. ; https://doi.org/10.1101/2024.07.10.24310250doi: medRxiv preprint Page 12 of 19 Findings/results What are the roles, purposes, or functions of silence? Any challenges/limitations reported? 169 170 171 Before the extraction process, the team will collaborate to pilot five of the included studies to 172 confirm accuracy, ensure mutual comprehension, and assess the suitability of the data extraction 173 form. Modifications to the data extraction form will be made as necessary and additional 174 categories may be identified during data extraction. Any modifications made to the tool will be 175 carefully noted and disclosed as part of our audit trail. In instances where essential data for 176 extraction is not readily available within the published paper, authors of the respective 177 publications will be contacted for clarification. 178 179 Stage 5: Collating, summarizing and reporting the results 180 Scoping reviews, differing from systematic reviews, generally do not evaluate the 181 methodological quality or bias risk of the studies included, nor do they perform data synthesis 182 like meta-analyses. Instead, they offer a descriptive overview of the studies encompassed.20 Our 183 approach involves both numerical and narrative summarization of various aspects of the included 184 studies. These aspects include the year of publication, geographical location, clinical setting, 185 participants, and study design. This analysis aims to map how silence is described in clinical 186 interactions between patients and physicians. 187 Qualitative data will be analyzed using thematic analysis.27This will involve coding extracted 188 data and grouping it iteratively to identify patterns of shared meaning in the data extracted. This 189 will be complimented by drawing on our experiences as author group of family physicians (MK, . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 11, 2024. ; https://doi.org/10.1101/2024.07.10.24310250doi: medRxiv preprint Page 13 of 19 190 CS, DB), palliative care doctors (SM, EmL) and medical educationalists (MB) working across 191 different health contexts. We anticipate the need for regular team meetings to facilitate data 192 charting and analysis.24 193 194 Stage 6: Consultation 195 In line with Levac et al.'s recommendation, we will integrate consultation as a component of our 196 planned scoping review.24 The outcomes of this review will be shared through presentations to 197 palliative care physicians, ensuring a comprehensive exploration and understanding of silence's 198 role in clinical healthcare settings. This consultation phase will gather insights into our initial 199 findings and their significance, explore potential applications and dissemination strategies, and 200 identify areas requiring further research. Through this collaborative approach, we will facilitate 201 discussions on implications and practical insights e.g. to improve communication skills training. 202 Engaging in conversations with physicians will offer valuable insights into the practical 203 implications of the research, enriching our skill set by incorporating diverse perspectives into the 204 research process. 205 206 Limitations 207 Whilst we will do our best to identify all relevant literature, it may be that our search strategy 208 may miss some studies. Additionally, our search is restricted to English language studies across 5 209 databases. This protocol is restricted to physicians and physicians in training. Whilst 210 understanding silence across health care professionals would be informative, the decision to 211 restrict our search to physicians is based on a mix of pragmatic limitations and to focus our . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 11, 2024. ; https://doi.org/10.1101/2024.07.10.24310250doi: medRxiv preprint Page 14 of 19 212 findings relative to our expertise in medical education. We anticipate study heterogeneity, which 213 may limit the type of analysis possible. 214 215 Discussion 216 This protocol presents the methodological framework and approach we will employ to identify 217 and map the existing evidence regarding the experiences of physicians with silence in clinical 218 settings. By identifying, analyzing, and synthesizing existing literature on this topic, the review 219 will offer insights into the various roles and functions of silence in physician-patient interactions. 220 The review will help recognize the diverse roles that silence plays in clinical consultations. 221 These roles encompass diverse aspects such as invitational silence, emotional acknowledgment, 222 non-productive silence, and hostile silence, among others. Understanding these roles holds the 223 potential to enhance the communication skills of healthcare professionals, enriching patient care 224 experiences, improving their quality of life, and fostering a safe and comfortable environment 225 within healthcare settings. Such insights can inform the development of tailored educational 226 initiatives aimed at augmenting physicians' proficiency in communication. Through 227 dissemination via peer-reviewed presentations and publications, the findings of this scoping 228 review will contribute to ongoing dialogues on optimizing doctor-patient communication and 229 refining healthcare delivery practices. 230 231 Authors’ contributions: Conceptualization: MK, SR, MB, CS, Methodology: all, Writing: MK 232 and SR wrote the initial draft, this was reviewed and edited by all members of the team, who 233 approved submission of the final protocol. 234 . CC-BY 4.0 International licenseIt is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 11, 2024. ; https://doi.org/10.1101/2024.07.10.24310250doi: medRxiv preprint Page 15 of 19 235 Supporting Information: PRISMA-P 236 237 Data Availability Statement: No datasets were generated or analyzed during the current study. 238 All relevant data from this study will be made available upon study completion. 239 240 Funding: The authors received no specific funding for this research. 241 242 Competing interests: The authors have declared that no competing interests exist. 243 244 References 245 1. Kenny C. The Power of Silence: Silent Communication in Daily Life. Abingdon, Oxon: 246 Routledge; 2011. 247 2. Ruiz-Moral R, de Leonardo CG, Martínez FC, Martín DM. Medical students’ perceptions 248 towards learning communication skills: a qualitative study following the 2-year training 249 programme. Int J Med Educ. 2019;10:90. 250 3. Association of American Medical Colleges. 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