Patient-centered communication: Do patients really prefer it?

Program in Medical Ethics, Division of General Internal Medicine, University of California San Francisco, CA 94143-0320, USA.
Journal of General Internal Medicine (Impact Factor: 3.45). 11/2004; 19(11):1069-79. DOI: 10.1111/j.1525-1497.2004.30384.x
Source: PubMed


To investigate patient preferences for a patient-centered or a biomedical communication style.
Randomized study.
Urgent care and ambulatory medicine clinics in an academic medical center.
We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention.
Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements.
Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82% [51/62] for age < 30; 68% [100/148] for ages 30-59; 55% [21/38] for age > 59; P < .03), more educated (76% [54/71] for postcollege education; 73% [94/128] for some college; 49% [23/47] for high school only; P= .003), use CAM (75% [140/188] vs. 55% [33/60] for nonusers; P= .006), and have a patient-centered physician (88% [74/84] vs. 30% [16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a "doctor's interest in you as a person" as "very important."
Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication.

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    • "An expectation for extensive receipt of information is contrary to a finding suggesting that a significant proportion of patients prefer the traditional, biomedical communication style (Swenson, Buell, et al. 2004), a focused and " efficient " type of health communication model that only requires short questions and answers. Others have also shown that most patients prefer patient centeredness (Epstein, Franks, et al. 2005). "
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    • "Female physicians spend more time with patients than male physicians do (Roter et al., 2002), and they have more humanistic and patient-centered attitudes about patient care (Krupat et al., 2000). Furthermore, patients generally prefer a patient-centered style (Swenson et al., 2004). However, female physicians do not receive much higher satisfaction ratings from patients—usually, not at all higher—according to a meta-analysis (Hall, Blanch- Hartigan, & Roter, 2011). "
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    • "More unambiguous are reports from observational studies, indicating that the doctor-centered approach is tenacious and that patients still have a limited degree of participation in decision making (Braddock et al., 1999; Campion et al., 2002). Studies also indicate that preferences for being informed and participating in decision making vary amongst patients (de Haes, 2006; Degner and Sloan, 1992; Swenson et al., 2004), and Elwyn et al. (2012, p. 1363) note that: ''Some patients initially decline decisional responsibility role, and are wary about participating''. de Haes (2006) takes a step further by pointing out that patient-centeredness, understood as ''paying attention to psychosocial issues, to stimulate "
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    ABSTRACT: Shared decision making has become an ideal in contemporary clinical practice, and guidelines recommend exploring patients’ preferences and providing them with options so they can make informed decisions. This paper examines how the ideal of sharedness is maintained and negotiated through epistemic and deontic resources in secondary care consultations where patients are given a choice between invasive and non-invasive treatment options. The analysis suggests that the physician's presentation of treatment options is often tilted in favor of one proposal over the other, yet giving the patient the right to make the final decision. The patients on the other hand regularly resist this responsibility by claiming lack of epistemic authority (e.g. I know nothing about it) or by making the decision contingent on the physician taking a stronger deontic stance (e.g. if you think so). This may be characterized as an inverted use of deontic authority from both parties: Physicians give patients deontic rights in their pursuit of independent commitment to their preferred option, while patients orient to physicians’ epistemic and deontic rights as a way to resist committing to the physicians’ propositions. These conflicting orientations to epistemic and deontic authority counteract the ideal of shared decision making.
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