Gregory Makoul

• UConn Health Center

Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increas...

Aim : To develop two versions of the Communication Assessment Tool (CAT) skilled for the setting of community pharmacy and to pilot test it on a selected sample. Materials : Development of two versions of CAT-tool for community pharmacists. Validity and reliability assessments were required to determine the psychometric properties of developed tool...

Objective Use the RE-AIM framework to examine the implementation of a patient contextual data (PCD) Tool designed to share patients’ needs, values, and preferences with care teams ahead of clinical encounters. Materials & Methods Observational study that follows initial PCD Tool scaling across primary care at a Midwestern academic health network....

Background Effective communication strategies in health care help to enhance patient empowerment and improve clinical outcomes. Objective Adapt the original Communication Assessment (CAT) instrument for the pharmacist profession (CAT-Pharm) and to test its validity and reliability in two different settings. Setting Five hospital pharmacies in Ita...

Objective The Communication Assessment Tool (CAT) has previously been translated and adapted to the Italian context. This national study aimed to validate the CAT and evaluate communication skills of practicing surgeons from the patient perspective. Methods CAT consists of 14 items associated with a 5-point scale (5 = excellent); results are repor...

Background: Patient contextual data (PCD) are often missing from electronic health records, limiting the opportunity to incorporate preferences and life circumstances into care. Engaging patients through tools that collect and summarize such data may improve communication and patient activation. However, differential tool adoption by race might wi...

Background and Objective: Adequate communication skills are the core competency of healthcare providers for optimal patient interaction and relationships based on mutual trust. Unfortunately, there are still few publications assessing the type and effectiveness of therapeutic communication, and there are no tools to facilitate the standard, regular...

Background: Effective communication is integral to patient-centered care, yet external pressures can impede the ability to discuss important topics. One strategy to facilitate communication is pre-visit collection and sharing of patient contextual data (PCD), including life circumstances such as their beliefs, needs, and concerns. Objective: To...

Background: Ethiopia has experienced tremendous growth in medical education beginning in the early 2000s. Research shows a need for emphasis on empathy and compassionate care in this setting. In the United States, the Communication Assessment Tool (CAT) is a widely used, validated survey measuring provider-patient interactions. Objective: The go...

BACKGROUND Over the past several decades, health care has been shifting to a care model that more fully values patient engagement. Recently, there has been increased attention on the role of health information technology that enables patients to collaborate with clinicians through the sharing of patient-generated contextual data. We implemented the...

Objective To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda. Methods After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed. Results Identification and adaptation: The 14-item Communication Asses...

Background and objectives: Interpersonal communication is essential to providing excellent patient care and requires ongoing development. Although aspects of medical student interpersonal communication may degrade throughout career progression, it is unknown what specific elements pose challenges. We aimed to characterize clerkship students' persp...

Objective: We tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing. Methods: Patients (N=141) receiving a new prescription at one internal medicine clinic were recruited into a 2-arm physician-randomized study. We leveraged an EHR...

Background: The aim of the study is to translate and cross-culturally adapt, for use in the Italian context, the Communication Assessment Tool (CAT) developed by Makoul and colleagues. Methods: The study was performed in the out-patient clinic of the Surgical Department of Cardarelli Hospital in Naples, Italy. It involved a systematic, standardi...

Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted...

Over the past 50 years, a confluence of research evidence and teaching practice has positioned effective communication as the linchpin of doctor?patient relationships. This chapter examines the fundamental question underlying the connection between communication and outcomes: what is effective communication? Put even more simply: what works, and ho...

Objective: To undertake a pilot study and examine whether the communication assessment tool (CAT) is useful in assessing patient perceptions of dentists' interpersonal skills. Design: Cross-sectional questionnaire study. Setting: Three speciality dental clinics in a University teaching hospital in the United Kingdom. PARTICIPANTS, MATERIALS AN...

Background: There is increased emphasis on practicing humanism in medicine but explicit methods for faculty development in humanism are rare. Objective: We sought to demonstrate improved faculty teaching and role modeling of humanistic and professional values by participants in a multi-institutional faculty development program as rated by their...

Background: Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication. Objectives: The objective of this study was to determine patients' perceptions of their ED team's communication skills. Methods: This was a cross-sectional study i...

To describe the development and refinement of a scheme, detail of essential elements and participants in shared decision making (DEEP-SDM), for coding shared decision making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer. The evidence-based patient choice instrument was modified to re...

Evaluate the evidence regarding the relative effectiveness of multimedia and print as modes of dissemination for patient education materials; examine whether development of these materials addressed health literacy. A structured literature review utilizing Medline, PsycInfo, and the Cumulative Index to the Nursing and Allied Health Literature (CINA...

Little is known about how best to target cardiovascular health promotion messages to minorities. This study describes key lessons that emerged from a community and culture-centered approach to developing a multimedia, coronary heart disease (CHD) patient education program (PEP) for medically underserved South Asian immigrants. The prototype PEP int...

Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients' role preferences across measures, time and patient population. Five databases were searched from January 1980 to December 2007 (1980-2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and...

To identify concepts of health and disease as part of a study on designing culturally-targeted heart disease prevention messages for South Asians. We conducted qualitative, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at a community center for South Asian immigrants in Chicag...

To the Editors:–Street and Haidet appropriately position physician understanding of patient health beliefs as a key feature of patient-centered care (How well do doctors know their patients? Factors affecting physician understanding of patients’ health beliefs).1 They make a compelling argument for the value of shared understanding, and provide evi...

To present pilot data from an ongoing electronic health record (EHR) quality improvement study to improve medication management using patient previsit review of the EHR medication list and a plain-language new medication information sheet to provide with every new EHR prescription. Postvisit survey of 191 patients at an academic general internal me...

METHODS: We conducted qualitative interviews in Winter 2009-2010 to explore African American physicians' attitude toward and experience with clinical research. Research included a range from clinical trials to health services research. Inclusion criteria: AA provider of clinical care in minority communities in greater Hartford, CT. Exclusion criter...

This study investigated South Asians' explanatory models (EM) of CHD and compared them to the biomedical model as part of an effort to inform the development of culturally targeted CHD prevention messages. We conducted in-depth, semi-structured interviews in English, Hindi and Urdu with 75 respondents from a federally qualified health center and at...

Hospitalists care for an increasing percentage of hospitalized patients, yet evaluations of patient perceptions of hospitalists' communication skills are lacking. Assess hospitalist communication skills using the Communication Assessment Tool (CAT). A cross-sectional study of patients, age 18 or older, admitted to the hospital medicine service at a...

This study introduces, profiles, and tests the explanatory value of reliance, a construct that emerged from, and is expected to illuminate, consideration of perceived control in medical encounters. The investigation also links communication science with the truly interactive perspective of reciprocal determinism, highlighting the impact of personal...

To investigate provider and patient views about communication regarding cervical cancer screening follow-up. Using qualitative analysis, we interviewed 20 providers and 10 patients from two urban clinics that serve low-income African American and Hispanic women. Semi-structured interviews and focus groups assessed familiarity with National Cancer I...

We examined the effects of presentation medium on immediate and delayed recall of information and assessed the effect of giving patients take-home materials after initial presentations. Primary-care patients received video-based, print-based or no asthma education about asthma symptoms and triggers and then answered knowledge-based questions. Print...

The Communication Assessment Tool (CAT), developed by Makoul et al assesses patient perceptions of physicians' interpersonal and communication skills. The objective of this study was to gather initial benchmarking data for the use of the CAT in family medicine residency programs. Data were collected from patients seeing 127 residents from six famil...

Interventions to mitigate the impact of low literacy on patients' recall of information by simplifying language have had limited success. The current study examines the extent to which cognition explains the relationship between literacy and retention of health information. Primary care patients aged 40 to 85 years watched a video about colorectal...

Although South Asians are at higher risk for coronary heart disease (CHD) than most other U.S. racial/ethnic groups, very little research has addressed this disparity. As a first step in developing culturally targeted CHD prevention messages for this rapidly growing community, this study examined South Asians' knowledge and beliefs about CHD. Analy...

We test an initiative with the staff-based participatory research (SBPR) method to elicit communication barriers and engage staff in identifying strategies to improve communication within our emergency department (ED). ED staff at an urban hospital with 85,000 ED visits per year participated in a 3.5-hour multidisciplinary workshop. The workshop wa...

Communication is increasingly understood to be a fundamental clinical skill. It is critical to effective diagnosis and management, as well as to connecting with patients on a cognitive and emotional level. In addition, communication skills themselves have been linked with patient outcomes, including satisfaction, adherence, and decreased malpractic...

Evidence suggests that patients with low health literacy and type 2 diabetes mellitus (DM) may not be fully benefiting from DM education. In a needs assessment of diabetics at a federally qualified health center, we found that 47% of diabetics were unable to tell us what diabetes is, despite having received diabetes education. Most DM education mat...

Coding transcripts of focus groups is considered standard practice, but transcription is labor intensive and often expensive. In the context of coding answers to specific questions, we compared the feasibility and reliability of reviewing videos and transcripts of focus group discussions. Two teams, each composed of one faculty member and two exper...

Medical students encounter many challenging communication situations during the clinical clerkships. We created the Difficult Conversations Online Forum (DC Forum) to give students an opportunity to reflect, debrief, and respond to one another about their experiences. The DC Forum is a web-based application with structured templates for student pos...

Objective: To test a multimedia patient education program on colorectal cancer (CRC) screening that was designed specifically for the Hispanic/Latino community, and developed with input from community members. Methods: A total of 270 Hispanic/Latino adults, age 50-80 years, participated in Spanish for all phases of this pretest-posttest design....

African American seniors (65 and older) are less likely to be vaccinated against influenza than are non-Hispanic White seniors. There is a clear need for targeted messages and interventions to address this disparity. As a first step, 6 focus groups of African American seniors (N = 48) were conducted to identify current perceptions about influenza a...

Although professionalism has always been a core value in medicine, it has received increasingly explicit attention over the past several years. Unfortunately, the terms used to explain this competency have been rather abstract. This study was designed to identify and prioritize behaviorally based signs of medical professionalism that are relevant t...

Multimedia diabetes education programs (MDEP) have the potential to improve communication and education of those with low health literacy. We examined the effect of a MDEP targeted to patients with low literacy on knowledge and assessed the association between literacy and knowledge improvement. We showed the MDEP to 190 patients recruited from cli...

Our objective was to determine how large, random samples of Americans define health. Two questions were used to ascertain concepts of health: Are you healthy? and How do you know? (What does health mean to you?) These questions were added to omnibus telephone surveys conducted with two random samples of adults from the 48 contiguous United States:...

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 comm...

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines a "handoff" as a contemporaneous, interactive process of passing patient-specific information from one caregiver to another for the purpose of ensuring the continuity and safety of patient care. The purpose of this study was to conduct a comprehensive investigation on...

Objective: Determine if a short multimedia program that provides information about colorectal cancer (CRC) and related screening options could be implemented in a busy clinical practice. Methods: Eligible patients were 50-80 years old, had not been screened for CRC, and were scheduled to see one of 10 study physicians. Patients were asked to view a...

Objective: This study examined whether or not differences in knowledge and attitudes explained racial differences in influenza vaccination rates. Methods: Telephone interviews were conducted with a random sample of 500 Black and 500 White adults age 65 and older who live in Cook County, IL. We used multiple logistic regression to adjust the likelih...

Background: This study tested a multimedia education program designed to encourage influenza vaccination among African American seniors (65 and older), as they are significantly less likely to be vaccinated than are Caucasians. Methods: The multimedia program was developed using information gained through four waves of focus groups. Two versions of...

Approximately 7000 deaths occur yearly in the United States as a result of medication errors, and 1.5 million people are harmed by adverse drug events at a cost of $3.5 billion per year. Computerized order entry has been shown to decrease the number of medication errors by 55% to 80 % in the hospital. This has led many to advocate the use of electr...

Patient surveys such as the Communication Assessment Tool (CAT) are recommended to assess physicians. Optimal methods to select judges and set a minimum passing standard (MPS) for a patient survey are unknown. Fifty-eight judges in five groups provided item-based (Angoff) and group-based (Hofstee) judgments for the CAT on two occasions. Judges were...

Develop a patient education program that provides accurate and easy-to-understand information for newly diagnosed breast cancer patients. To inform development of the patient education program, we conducted a longitudinal series of semi-structured interviews with 30 breast cancer patients as well as one-time interviews with 22 healthcare providers....

Effective communication is an essential aspect of high-quality patient care and a core competency for physicians. To date, assessment of communication skills in team-based settings has not been well established. We sought to tailor a psychometrically validated instrument, the Communication Assessment Tool, for use in Team settings (CAT-T), and test...

Background: Coding from transcripts of focus groups is considered standard practice, but transcribing is labor-intensive. Objective: To compare the reliability and validity of coding videotapes vs. transcripts of focus group discussion. Methods: Two teams, each composed of one faculty member and two staff members, completed the coding. Both teams a...

Despite the documented benefits of colorectal cancer screening, patient participation rates remain low. Physician recommendation has been identified as a significant predictor of screening completion. The aim of this study is to investigate how primary care physicians perceive colorectal cancer screening communication tasks, as well as to explore t...

Interpersonal and communication skills are a core area of competency for medical students, residents, and practicing physicians. As reflection and self-assessment are essential components of skill-building, we examined the content of medical students' assessments of their own developing communication skills. Between 2000 and 2003, a total of 674 fi...

The Hispanic/Latino population has been documented as having the lowest colorectal cancer (CRC) screening rates in the United States, putting this group at-risk for late-stage presentation of disease. We assessed knowledge, attitudes, and behavior regarding CRC screening to inform the development of messages that promote screening among Hispanic/La...

Research published in the late 1960s by Korsch et al1,2 is widely considered the foundation for contemporary inquiry into the patient-physician relationship. In a diverse set of studies since then, effective communication has been linked with increases in patient and physician satisfaction, better adherence to treatment plans, more appropriate medi...

Colorectal cancer screening rates remain low, especially among low-income and racial/ethnic minority groups. We pilot-tested a physician-directed strategy aimed at improving rates of recommendation and patient colorectal cancer screening completion at 1 federally qualified health center serving low-income, African-American and Hispanic patients. Co...

Interpersonal and communication skills have been identified as a core competency that must be demonstrated by physicians. We developed and tested a tool that can be used by patients to assess the interpersonal and communication skills of physicians-in-training and physicians-in-practice. We began by engaging in a systematic scale development proces...

To develop medical students' skills in interacting with individuals who have limited health literacy. Described are 2 novel approaches to health literacy curriculum design. Efforts at both schools have been implemented to improve medical student awareness of health literacy, as well as specific skills in clear communication and strategies that ensu...

Widely used models for teaching and assessing communication skills highlight the importance of greeting patients appropriately, but there is little evidence regarding what constitutes an appropriate greeting. To obtain data on patient expectations for greetings, we asked closed-ended questions about preferences for shaking hands, use of patient nam...

We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients rece...

As behavioral health risks account for the major causes of preventable morbidity and mortality in the United States, national guidelines recommend that physicians routinely screen patients for risk factors, and counsel as appropriate. To assess the scope of health risk screening and characterize the communication content of counseling for health be...

The Viewpoint article in this issue by Drs. Michael Hanna and Joseph Fins, "Power and Communication: Why Simulation Training Ought to Be Complemented by Experiential and Humanist Learning," is provocative on several levels. This Commentary focuses on three interrelated questions that emerge from the article's consideration of power dynamics in enco...

Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December...

We sought to develop a reliable and valid measure of patient self-efficacy within the context of productive communication and positive attitude for cancer patients. A set of 19 potential items for the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer) was pilot tested with 50 cancer patients. Based on the pilot test, item va...

Educators, researchers, clinicians, and patients often advocate empathy in the physician-patient relationship. However, little research has systematically examined how patients present opportunities for physicians to communicate empathically and how physicians respond to such opportunities. The Empathic Communication Coding System was used to inves...

Attention to providers' communication skills is likely to increase, given the confluence of forces that have highlighted the importance of communication in healthcare. In the United States, interpersonal and communication skills have been explicitly identified as a priority throughout the continuum of medical education and practice. Ideally, theory...

Although empathy in the physician-patient relationship is often advocated, a theoretically based and empirically derived measure of a physician's empathic communication to a patient has been missing. This paper describes the development and initial validation of such a measure, the Empathic Communication Coding System (ECCS), which includes a metho...

To provide first-year medical students with a non-threatening, standardized, clinical-skills assessment at the end of the first year (M1CSA), and provide resources to help them build on their strengths and address any weaknesses before starting the second year. Implemented for the first time in April 2001, the M1CSA was designed to help first-year...

The following transcript is from a video program that is part of the Patient Narrative Series, produced by the Program in Communication and Medicine at the Feinberg School of Medicine at Northwestern University and partly funded by The Arthur Vining Foundations. Patients are given video cameras, shown how to use them, and asked to share their thoug...

The following transcript is from a video program that is part of the Patient Narrative Series, produced by the Program in Communication and Medicine at the Feinberg School of Medicine at Northwestern University and partly funded by The Arthur Vining Foundations. Patients are given video cameras, shown how to use them, and asked to share their thoug...

Evaluate the effectiveness of a rehabilitation-specific communication skills training program for physicians. Three groups of rehabilitation patients were interviewed 3 mo after discharge, one group before and two groups after implementation of a communication skills training program. The setting was a free-standing rehabilitation hospital with a r...

Sliwa JA, Makoul G, Betts H: Rehabilitation-specific communication skills training: Improving the physician-patient relationship. Am J Phys Med Rehabil 2002;81:126–132. Objective: Evaluate the effectiveness of a rehabilitation-specific communication skills training program for physicians. Design: Three groups of rehabilitation patients were intervi...

To assess physician-patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies. An exploratory, observational study involving analysis of videotaped physician-patient encounters, questionnaires, and medical-record reviews. General in...

This article examines uses and characteristics of the SEGUE Framework, a research-based checklist of medical communication tasks. A recent survey of US and Canadian medical schools indicates that the SEGUE Framework is the most widely used structure for communication skills teaching and assessment in North America. Student and faculty response to t...

In May 1999, 21 leaders and representatives from major medical education and professional organizations attended an invitational conference jointly sponsored by the Bayer Institute for Health Care Communication and the Fetzer INSTITUTE: The participants focused on delineating a coherent set of essential elements in physician-patient communication t...

The importance of communication between doctors and patients has been well established, and there is growing acceptance of the need to teach and assess communication skills in medical schools. Faculty meeting at a consensus workshop during the International Conference on Teaching Communication in Medicine (Oxford, July 1996) generated a series of r...