Analyzing communication in medical consultations. Do behavioral measures correspond to patients' perceptions?
Institute for Health Care Evaluation, Texas A&M University, College Station 77843-4334. Medical Care
(Impact Factor: 3.23).
When analyzing relationships between physician-patient communication and medical outcomes, researchers typically rely on quantitative measures of behavior (e.g., frequencies or ratios) derived from observer-coding of transcripts, audiotapes, or videotapes. Interestingly, rarely have researchers assessed whether quantitative measures of communication (e.g., the physician's information giving) correspond to patients' perceptions of physicians' communication (e.g., informative). This investigation of 115 pediatric consultations examined this issue and yielded several notable findings. First, less satisfied parents received more directives and proportionally less patient-centered utterances from physicians than did more satisfied parents. Second, findings were mixed regarding the degree to which behavioral measures related to analogue measures of parents' perceptions. For example, the doctors' use of patient-centered statements was predictive of parents' perceptions of physicians' interpersonal sensitivity and partnership building, but the amount of information physicians provided parents was unrelated to judgments of the doctors' informativeness. Third, with some important exceptions, relationships between behavioral measures and parents' evaluations did not vary for parents differing in education and anxiety about the child's health. Finally, behavioral measures in the form of frequencies tended to be better predictors of parents' perceptions than were measures in the form of proportions. Implications are discussed.
Available from: Maria K Venetis
- "The present exploratory study responds to the National Academy of Sciences Institute of Medicine's report on ensuring quality cancer care (Institute of Medicine, 1999), which called for studies of the " reality " of breast-cancer care. This call stems largely from the fact that patients' reports of communication behaviors are rarely significantly correlated with their actual occurrences (Street, 1992) and the fact that there is virtually no research involving the relationship between observed (i.e., taped and coded) communication variables and breast-cancer patients' health outcomes, especially those other than satisfaction (Venetis et al., 2009). This pilot study examines the relationship between taped and coded participation behavior and pre–post consultation changes in patients' cancer coping. "
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ABSTRACT: In the context of breast-cancer care, there is extremely little research on the association between observed (i.e., taped and coded) communication behaviors and patients' health outcomes, especially those other than satisfaction. In the context of presurgical consultations between female breast cancer patients and a surgeon, the aim of this exploratory study was to test the association between communication-based participation behaviors and pre-post consultation changes in aspects of patients' mental adjustment to cancer (i.e., coping). Participants included 51 women newly diagnosed with breast cancer and a surgical oncologist from a National Cancer Institute (NCI)-designated cancer center in the northeastern United States. Outcomes were changes in patients' fighting spirit, helplessness/hopelessness, anxious preoccupation, cognitive avoidance, and fatalism (measured immediately before and after consultations via survey), and the main predictors were three communication-based participation behaviors coded from videotapes of consultations: patient question asking, patient assertion of treatment preferences, and surgeon solicitation of patient question/concern/opinion. Patients who more frequently asserted their treatment preferences experienced increases in their fighting spirit (p = .01) and decreases in their anxious preoccupation (p = .02). When companions (e.g., sister, spouse) asked more questions, patients experienced decreases in their anxious preoccupation (p = .05). These findings suggest that, in the present context, there may be specific, trainable communication behaviors, such as patients asserting their treatment preferences and companions asking questions, that may improve patients' psychosocial health outcomes.
Health Communication 08/2014; 30(1):1-7. DOI:10.1080/10410236.2014.943633 · 0.97 Impact Factor
Available from: Ian Fletcher
- "Inferences about whether specific utterances are elicited by preceding ones can be made when dialogue is coded  . But we are concerned here only with sequences that have statistical support. "
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ABSTRACT: To identify methods available for sequential analysis of dyadic verbal clinical communication and to review their methodological and conceptual differences.
Critical review, based on literature describing sequential analyses of clinical and other relevant social interaction.
Dominant approaches are based on analysis of communication according to its precise position in the series of utterances that constitute event-coded dialogue. For practical reasons, methods focus on very short-term processes, typically the influence of one party's speech on what the other says next. Studies of longer-term influences are rare. Some analyses have statistical limitations, particularly in disregarding heterogeneity between consultations, patients or practitioners. Additional techniques, including ones that can use information about timing and duration of speech from interval-coding are becoming available.
There is a danger that constraints of commonly used methods shape research questions and divert researchers from potentially important communication processes including ones that operate over a longer-term than one or two speech turns. Given that no one method can model the complexity of clinical communication, multiple methods, both quantitative and qualitative, are necessary.
Broadening the range of methods will allow the current emphasis on exploratory studies to be balanced by tests of hypotheses about clinically important communication processes.
Patient Education and Counseling 05/2009; 75(2):169-77. DOI:10.1016/j.pec.2008.10.006 · 2.20 Impact Factor
Available from: Ronald M Epstein
- "Further, different methods of measuring communication (e.g., self-report vs. observer coding) may generate very different assessment of the behavior . For example, even though an observer coding system indicated that the clinician provided treatment information, it may not have been understood by the patient, or perceived as having been informative . Similarly, patient reports of involvement in decision-making may not correspond with observers' judgments about whether participation had occurred . "
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ABSTRACT: Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions.
Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway.
Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.
Patient Education and Counseling 02/2009; 74(3):295-301. DOI:10.1016/j.pec.2008.11.015 · 2.20 Impact Factor
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