Patient factors: |
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- Inadequately treated pain
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Clinician factors: |
- Relative lack of clinical experience
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- Less "psychological mindedness"
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- Inadequate training in communicating "bad news"
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- Difficulty expressing sensitivity when discussing prognosis and goals of care
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Health care system factors: |
- Increased complexity and fragmentation of care (eg, poor coordination of services, no one person in charge)
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- Long appointment waiting times and billing errors
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- Care delivery that is driven by health care system priorities rather than patient-centered principles
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