Article

Factors affecting patient and clinician satisfaction with the clinical consultation: Can communication skills training for clinicians improve satisfaction?

September 2003
Psycho-Oncology 12(6):599-611

DOI:10.1002/pon.731

Source
PubMed

Authors:

Valerie Shilling

Brighton and Sussex Medical School, University of Sussex

Val A Jenkins

University of Sussex

Lesley Fallowfield

University of Sussex

The provision of adequate information in a clear and sensitive manner can improve cancer patients' experience of care. Satisfaction with the cancer consultation may impact on satisfaction with care in general and adjustment to the disease. This study aims to identify factors that influence patient and clinician satisfaction with the cancer consultation and whether satisfaction can be improved with communication skills training. 160 doctors from 34 UK cancer centres participated. Half were randomized to attend a communication skills training course. Patient satisfaction data are presented at baseline and following a communication skills course or in the case of the control doctors, three months after baseline. Clinicians also rated their satisfaction with the consultations. Overall patient satisfaction was not related to the speciality, seniority or sex of the clinician or patient, site of primary cancer or type of treatment. Satisfaction was related to patients' age, psychological morbidity and, most significantly, satisfaction with the length of wait in clinic. Clinician satisfaction was not related to age, sex or cancer site but clinicians were less satisfied following consultations with patients being treated palliatively. Communication skills training had a non-significant positive effect on patient satisfaction. The subtle benefits of improved communication may be overshadowed by practical problems such as waiting too long to see the doctor, which have an adverse effect on satisfaction.

Improving interns patient physician communication skills Application of self efficacy theory a pilot study

Article

Full-text available

Sep 2018

Abstract: Aim: This quasi-experimental study explored application of the selfefficacy theory in improving self-efficacy, communication skills and patient satisfaction among medical interns. Methods: This study was conducted among 70 medical intern students. Being selected by human judgment and homogenous sampling method, participants were assigned into control and intervention groups. Participants in the invention group received an e-book, two one-on-one training sessions and feedback on their shared experiences in group discussions by peers. The Kirkpatrick model was applied to evaluate the intervention. Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were assessed. Data from self and observational assessments were compared in and between groups at different time-points. Results: Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were improved significantly in the intervention group

Improving interns’ patient–physician communication skills: Application of self-efficacy theory, a pilot study

Article

Full-text available

Oct 2018

Aim: This quasi-experimental study explored application of the self-efficacy theory in improving self-efficacy, communication skills and patient satisfaction among medical interns. Methods: This study was conducted among 70 medical intern students. Being selected by human judgment and homogenous sampling method, participants were assigned into control and intervention groups. Participants in the invention group received an e-book, two one-on-one training sessions and feedback on their shared experiences in group discussions by peers. The Kirkpatrick model was applied to evaluate the intervention. Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were assessed. Data from self and observational assessments were compared in and between groups at different time-points. Results: Participants’ knowledge, self-efficacy and communication skills as well as their patients’ satisfaction were improved significantly in the intervention group compared to that of the control group. Correlation coefficient between interns’ self-efficacy and communication skills scores was 0.74 (P = 0.03). Conclusions: Application of self-efficacy theory could improve medical interns’ communication knowledge, self-efficacy and skills leading to patient satisfaction.

The validation and assessment of a curriculum based GAIT App used in teaching bachelor of physiotherapy students: a cross sectional study

Article

Full-text available

Sep 2024

Introduction There has been an advent in the use of Mobile Apps in the academic space. The pandemic hastened their usage, and forced us to rapidly innovate in order to meet the educational needs of our students. Also, Mobile Apps have been known to facilitate self-learning, make it enjoyable, and personalize the pace of learning of the individual. Given the level of skill-learning in Physiotherapy education, the use of Mobile Apps can pose a challenge, as well as offer an opportunity to explore its scope to enhance learning, and create innovative pedagogic strategies. There are a very few learning mobile apps that have been assessed in Physiotherapy education. Aim To develop, establish content validity and internal consistency of a curriculum based App on the kinesiology of normal Gait for bachelor of physiotherapy students, and to evaluate the App with regards to use, quality, engagement, and overall experience. Materials & methods In the first phase, a mobile app based on a bachelor of physiotherapy Gait curriculum was developed and validated using Delphi procedure, with 80% agreement criteria, by a group of experts. Subsequently, the App was rated by 200 users on: engagement, aesthetics, information, subjective quality. Results The content validity index following 2 rounds of Delphi was found to be 0.88. Also, therapists found the App easy to use, and 80% gave it a rating of > 3 stars. Conclusion Creating, designing, implementing, and evaluating the efficacy of a Gait App as a means to teaching the GAIT component to physiotherapy students was found to be appealing and beneficial.

Challenges of the Calgary–Cambridge Consultation Guide in Veterinary Multicultural and Multilingual Scenarios and the Role of Veterinary Translators

Article

Full-text available

Aug 2024

Simple Summary The success and the satisfaction of clinicians in practice relies heavily on how consultations, communication, and relationships are built with clients. Very knowledgeable and competent veterinarians might not be able to provide their services if the client declines their services based on misperceptions or lack of understanding, potentially resulting in lack of treatments of pets in need. The Calgary–Cambridge Guide for consultations and communication is an important tool taught in most veterinary colleges to help future clinicians improve their communication skills, ultimately benefiting the veterinary profession, clients, and the welfare of their pets. In this commentary we describe challenges in applying these guidelines in multilingual and multicultural scenarios such as Hong Kong. In these scenarios clinicians and clients often need an interpreter, adding complexity to the interaction and communication. Non-verbal communication, where body language plays an important role in showing expressions, empathy, and concerns is not effective or is altered if there is not even eye contact or a translator is not accurately interpreting all these emotions. This commentary analyses the challenges encountered by veterinarians during consultations in multicultural and multilingual centres. Abstract The Calgary–Cambridge Guide is a widely recognised framework for teaching communication skills to healthcare professionals that has become a cornerstone of communication training programs in medicine and other healthcare fields. In the context of veterinary medicine, its integration into communication training programs has become an asset improving communication, education, interaction, and quality of service, enhancing the veterinary–client–patient relationship (VCPR). In veterinary medicine, however, a more challenging consultation dynamic involves the veterinarian, the owner, and the animal. The addition of a veterinary assistant that acts as an interpreter or translator is common in Hong Kong where the native language (Cantonese) coexists with English when consultations are led by non-native language speakers. This addition converts this commonly dyadic model into a triadic communication model. The addition of an assistant interpreter influences the way consultations are conducted, how information is conveyed, and how interpersonal cues and empathy are delivered. In this report we depict challenges applying the Calgary–Cambridge Guide in multicultural and multilingual veterinary medical centres in Hong Kong and highlight the role of veterinary supporting staff in these scenarios, specifically veterinary assistant interpreters.

A quasi-experimental study to improve health service quality: implementing communication and self-efficacy skills training to primary healthcare workers in two counties in Iran

Article

Full-text available

Jul 2021
BMC Med Educ

Background Service satisfaction ratings from clients are a good indicator of service quality. The present study aimed to investigate the impact of communication skills and self-efficacy training for healthcare workers on clients’ satisfaction. Methods A quasi-experimental study was conducted in health centers of Saveh University of Medical Science in Iran. Primary Healthcare (PHC; N = 105) workers and service recipients (N = 364) were randomly assigned to intervention and control groups. The intervention group received four 90-min training sessions consisting of lecture, film screening, role-playing, and discussion group. Before and 3 months after the intervention, a multi-part questionnaire (including demographics, self-efficacy and communication skills in PHC workers; and satisfaction questionnaire in service recipients) was completed by participants in both intervention and control groups. Results PHC worker mean scores of self-efficacy and communication skills after the educational program were increased in the intervention group compared to the control group (p < 0.05). Also, mean satisfaction scores for service recipients of the intervention group (PHC workers) generally significantly increased compared to the control group (p < 0.001). Conclusions The educational program improved the self-efficacy, and communication skills in health workers and improved client satisfaction overall. Our results support the application of self-efficacy and communication skills training for other medical groups who wish to improve clients satisfaction as an important health services outcome.

STUDNETS' PERCEPTION ON THE DETERMINANTS OF DOCTOR-PATIENTS CONCORDANCE IN TERTIARY INSTITUTIONS IN BAYELSA STATE, NIGERIA

Article

Full-text available

Jun 2019

The doctor-patient relationship is an important aspect of health care that has been overlooked over time. This study examined the socio-demographic determinants of patients' concordance with doctors using undergraduates in two Nigerian institutions located in Bayelsa State as a case study. This survey study conducted among 150 undergraduates in two Nigerian universities is built on the Szasz and Hollender three basic model. The study utilised the questionnaire as the instrument of data collection based on the objectives of the study. Descriptive statistics such as percentages, mean, and standard deviation, and inferential statistics like multiple regression, chi-square cross-tabulations, one sample t-test and Analysis of Variance (ANOVA) were utilised in testing of associated between variables. Findings from the study revealed that more male (53.3%) than female (46.7%) participated in the study. While only socio-demographic variables such as being single (P< 0.039), and belonging to the college of health sciences (P<0.028), significantly predicted undergraduates students' understanding with the doctor. Also, faculty of students; college of health sciences (P<0.012), ethnic group (P<0.047), and year of study (P<0.013), had a relationship with patients' satisfaction with doctor's explanation of the nature of their illness. Thus, the study concluded that Physician-Patients concordance is generally low, therefore, there is need to build a better relationship between patients and doctors in the university environment so that students will not travel a long distance to seek minor medical attention.

Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

Article

Full-text available

Apr 2017
J Res Med Sci

Background It is assumed that doctor-patient relationship plays an effective role in patients’ satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients’ satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. Materials and Methods This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1) patients’ satisfaction derived from the relationship with doctors and (2) medication adherence named “Morisky Medication Adherence Scale” with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR) of patients’ satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. Results A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06–0.71 and OR = 0.20) and empathy subscales (CI = 0.95, 13–0.80 and OR = 0.33) was associated with nonadherence to treatment after controlling the physicians’ gender and patients’ age, gender, education, and duration of disease. Conclusion Patients’ satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

Patient satisfaction with doctor-patient interactions: a mixed methods study among diabetes mellitus patients in Pakistan

Article

Full-text available

Feb 2017
BMC HEALTH SERV RES

Background: Patient satisfaction with doctor-patient interactions is an indicator of physicians’ competence. The satisfaction of diabetes patients is rarely studied in public diabetes clinics of Pakistan. Thus, this study aims to analyse the association between patient satisfaction and five dimensions of medical interaction: technical expertise, interpersonal aspects, communication, consultation time, and access/availability. Methods: A cross-sectional mixed methods study was conducted during July and August 2015 in the largest public diabetes outpatient clinic in Punjab province. We used the criterion sampling method to identify 1164 patients who: (i) were adult (18 years and above), (ii) had diabetes mellitus, (iii) had made at least three previous visits to the same clinic. The data was collected through face-to-face interviews. The structured part of the questionnaire was based on demographic characteristics and the Patient Satisfaction Questionnaire (PSQ-III). We translated the questionnaire into Urdu and pretested it with 25 patients in a similar context. Data storage and analysis were carried out using SPSS (version 22.0). Bivariate analyses and multinomial logistic regression model were used to generate the quantitative findings. Out of the 1164 eligible patients approached for interviews, 1095 patients completed the structured questionnaire and 186 respondents provided qualitative information in comments section. We conducted a thematic content analysis of qualitative responses in order to explain the quantitative findings. Results: Demographic characteristics such as gender, education and occupation were significantly associated with the levels of patient satisfaction. The dimensions of doctor-patient interaction were significantly associated with patient satisfaction: technical expertise (OR = .87; 95% CI = .84–.91), interpersonal aspects (OR = .82; 95% CI = .77–.87), communication (OR = .83; 95% CI = .78–.89), time dimension (OR = .90; 95% CI = .81–.99) and access/availability (OR = .78; 95% CI = .72–.84). Several factors involving doctors’ incompetence, such as inappropriate handling of critical cases, inaccurate diagnose, excessive reliance on medical tests, absence of physical examination, nonavailability of specialist doctors, and experimentation by trainee doctors were related to patient dissatisfaction. Conclusion: The findings of this study highlight a need to develop the interpersonal and clinical skills of doctors in order to improve the quality of doctor-patient interactions in public clinics for diabetes in Pakistan. Prospective researches should explore context-specific factors that form patient satisfaction.

Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

Article

Full-text available

Sep 2014
PALLIATIVE MED

Background Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients’ quality of life. Little is known about the effect of training general practitioners in palliative care–specific communication. We hypothesized that palliative care patients of general practitioners exposed to the ‘Availability, Current issues and Anticipation’ communication training programme would report better outcomes than patients of control general practitioners. Aim To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. Design In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire–III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368. Setting/participants General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. Results Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire–III and Availability, Current issues and Anticipation Scale. Conclusion General practitioner participation in the Availability, Current issues and Anticipation training programme did not have a measurable effect on any of the outcomes investigated. Patients reported high levels of satisfaction with general practitioner care, regardless of group assignment. Future research might focus on general practitioners without special interest in palliative care.

Strategies and interventions used to provide communication education for midwifery students. A scoping review

Article

Full-text available

May 2024
Nurse Educ Pract

Aim: To examine the current literature on educational strategies and interventions developed with the objective of teaching or enhancing communication skills of student midwives during their pre registration education programmes. Design: A scoping review based on the Joanna Briggs Institute framework was conducted using predefined criteria and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Methods: A comprehensive search was conducted using various databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PsycINFO, Maternity and Infant Care Database (MIDIRS), Web of Science and Education Resources Information Centre (ERIC)) in October 2023. Results: A total of 120 titles and abstracts were screened. A final number of eight articles were subjected to quality appraisal and included in the scoping review. Five themes were identified which describe educational strategies and interventions including: simulation-based training, the use of role-play, pedagogical approaches, theory-based information workshops and debrief and reflection. Conclusions: This review highlights a gap in research focusing on the importance of communication skills training for student midwives throughout midwifery education. Despite the limited numbers of studies, different interventions and educational strategies have been recognized for enhancing these skills. To equip midwives with strong communication skills, a combination of interventions is recommended, including communication-focused workshops tailored for midwifery education and debriefing and student reflection sessions specifically designed to enhanced communication skills.

Effects of blended learning training for oncology physicians to advise their patients about complementary and integrative therapies: results from the multicenter cluster-randomized KOKON-KTO trial

Article

Full-text available

Sep 2023
BMC CANCER

Background Many oncology physicians are confronted with the topic of complementary and integrative medicine (CIM) by cancer patients. This study examined whether a blended learning (e-learning and a workshop) to train oncology physicians in providing advice on CIM therapies to their cancer patients, in addition to distributing an information leaflet about reputable CIM websites, had different effects on physician-reported outcomes in regard to consultations compared with only distributing the leaflet. Methods In a multicenter, cluster-randomized trial, 48 oncology physicians were randomly allocated to an intervention group (CIM consultation and an information leaflet) or a control group (information leaflet only). After the training, the oncology physicians conducted 297 consultations with their cancer patients. Measurements were assessed at oncology physician, physician–patient-interaction (measured by external reviewers), and patient levels. This analysis focused on the physician outcomes of stress reaction and perceived consultation skill competency. In addition, qualitative interviews were conducted with a subsample of oncology physicians who experienced both, the intervention and control condition. Results The oncology physicians in the intervention group showed a lower stress reaction in all measured dimensions after CIM consultations than those in the control group. There was no significant difference between oncology physicians in the intervention and control groups regarding the perceived consultation skill competency (overburden: intervention 1.4 [95% CI: 0.7;2.1]; control 2.1 [95% CI: 1.4;2.7], tension: 1.3 [95% CI: 0.7;2.0] vs. 1.9 [95% CI: 1.3;2.5], and discomfort with consultation situations: 1.0 [95% CI: 0.4;1.7]; vs. 1.7 [95% CI: 1.2;2.3]). The qualitative data showed that only providing the leaflet seemed impersonal to oncology physicians, while the training made them feel well prepared to conduct a full conversation about CIM and provide the information leaflet. Conclusions In our exploratory study providing structured CIM consultations showed positive effects on the perceived stress of oncology physicians, and the training was subjectively experienced as an approach that improved physician preparation for advising cancer patients about CIM, however no effects regarding perceived consultation skill competency were found. Trial registration The trial registration number of the KOKON-KTO study is DRKS00012704 in the German Clinical Trials Register (Date of registration: 28.08.2017).

Impact of a communication skills training course for students of therapist training schools

Article

Jan 2013

Kanetaka K, Suzukamo Y, Kakui T, Michimata A, Izumi S. Impact of a communication skills training course for students of therapist training schools. Jpn J Compr Rehabil Sci 2013; 4:47-54. Purpose: Communication skills are necessary when students of therapist training schools undergo clinical practice. We verified the effects of introducing a course on communication skills training based on coaching theory. Methods: Second-year students of a vocational college participated in the study. Fourteen students in the occupational therapy department attended a course on communication skills training (CS group) and 21 students in the physiotherapy department did not attend the course (control group). The CS group received 6 classes on communication skills. Assessments by self and others (CS group only) on communication skills, anxiety assessment, and self-efficacy assessment were conducted before the course (T1), two months after T1 (T2), and 3 months after T1 before clinical practice (T3). In the CS group, course evaluation was also conducted at T2. Results: For course evaluation, all participants selected the top two grades on a five-grade scale for necessity, satisfaction, contents, interest and understanding. For communication skills self-assessment, the scores at T2 and T3 were higher than that at T1 in both groups. For communication skills assessment by others, the score at T3 was higher compared to those at T1 and T2. For anxiety assessment, state anxiety did not change in the CS group, but increased at T3 in the control group. Conclusion: The findings of this study indicate that the communication skills training course improves the communication skills of students and eases their state anxiety before clinical practice.

Addressing palliative care and end-of-life issues in patients with advanced cancer: a systematic review of communication interventions for physicians not specialised in palliative care

Article

Full-text available

Jun 2022

Objective To identify and summarise evaluated interventions aiming to improve the communication of palliative care (PC) and end-of-life (EoL) issues in physicians caring for cancer patients. Such interventions are needed with regard to the aim of an earlier communication of those issues in oncology daily practice, which is associated with a range of benefits for patients and caregivers but is often impeded by physicians’ communication insecurities. Design Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources Relevant publications were systematically searched in MEDLINE, PsycINFO, CINAHL and Web of Science databases in September 2020 with an update in July 2021. Eligibility criteria We included publications reporting a quantitative evaluation of a communication intervention on one or more PC/EoL issues with a communication-related main outcome. Target group had to be physicians caring for cancer patients non-specialist in PC. Data extraction and synthesis Two independent raters extracted intervention characteristics, publication characteristics and publication quality. Results were narratively synthesised. Results 24 publications reporting 22 interventions were included. 13 publications reported randomised controlled trials. A majority of the interventions addressed one specific PC/EoL issue, most often breaking bad news. Teaching strategies mostly involved role-plays. Target group were mainly oncologists. In addition to self-reported outcome measurements for evaluation, most publications also reported the use of external rating data. All but one publication reported significant intervention effects on at least one outcome parameter. Publication quality was overall moderate. Conclusions The empirically tested communication interventions on PC/EoL issues seem to effectively improve physicians’ communication. Future interventions should focus on other issues than breaking bad news, such as preparing for the future. Target group should also be organ-specific oncologists, as all primary caring physicians are responsible for timely communication. Our risk-of-bias assessment revealed some weaknesses, indicating that more high-quality studies for evaluation are needed. PROSPERO registration number CRD42020191054.

Patient Expectation in China: Exploring Patient Satisfaction in Online and Offline Patient–Provider Communication

Article

Full-text available

Jun 2022

Introduction Online patient–provider communication (OPPC) has become an alternative approach to seek medical advice and contact health professionals. However, its penetration rate remains low, and the underlying mechanisms of patient satisfaction with OPPC are underexamined. This study investigates the role of patient expectancy and the expectancy violation of patient-centered communication (PCC) in patient satisfaction in emerging OPPC scenarios by integrating the concepts of PCC and expectancy violation theory (EVT). Method An online survey was conducted in October 2019 among Chinese respondents who experienced OPPC and offline medical services. Results The 471 qualified participants reported high satisfaction with OPPC (mean [M] = 3.63, standard deviation [SD] = 0.81). However, patient satisfaction with OPPC was lower than that in offline medical encounters (M = 3.75, SD = 0.80), and patients suffered a higher expectancy violation of PCC in OPPC scenarios (M = 0.45, SD = 0.76) than in offline medical encounters (M = 0.27, SD = 0.69). Nevertheless, patients’ satisfaction with OPPC significantly increased as the frequency of OPPC usage increased (β = 0.209, p < 0.001). This positive relationship was partially mediated by the decrease in the expectancy violation of PCC in OPPC scenarios. Discussion The study can contribute to increasing the adoption of OPPC and reducing the burden of offline medical resources.

Patient Satisfaction and Its Predictors in the General Hospitals of Southwest Saudi Arabia: A Cross-sectional Survey

Article

Full-text available

Mar 2022

Background: Patient satisfaction occupies a central position in measuring the quality of care as it provides information on the provider's success, meeting the patient’s values and expectations. Hence, it is an essential tool for assessing health services outcomes. This study aimed to assess patients' satisfaction level and factors influencing healthcare quality of general hospitals in the Jazan region, Saudi Arabia (SA). Methods: This observational cross-sectional study was conducted on a sample of 423 patients selected through stratified random sampling from general hospitals of the Jazan region. Results: The overall satisfaction rate among the study participants was 80.9%. Satisfaction with food services was the highest (91.15%) followed by doctor services (81.0%), reception and entry procedures (80%), and nursing services (78.15%). The various aspects of satisfaction with doctors and nurses included the treatment prescribed by physicians, clarity in communication with patients, compassion and providing clear explanation of what they were doing. However, about 27.3% of the patients were dissatisfied with the length of waiting period before seeing a doctor. Binary logistic regression analysis suggested that uneducated patients and patients with secondary school education were more likely to have higher satisfaction level than university-educated patients (OR = 3.40, 95% C.I. [1.56–7.45], p = 0.002), (OR = 2.66, 95% C.I. [1.28–5.55], p = 0.009), and (OR = 2.29, 95% C.I. [1.40–3.73], p = 0.001), respectively. Conclusion: The health services satisfaction level was high in the Jazan population. However, some aspects of dissatisfaction were reported, such as the long waiting period before seeing a doctor. These aspects are recommended to be improved to ensure that the services provided by general hospitals are of high quality. Keywords: satisfaction, health services, general hospitals, Jazan

Analisis Pengaruh Mutu Layanan Terhadap Minat Pemanfaatan Ulang Layanan Rawat Jalan RS Helsa Jatirahayu Tahun 2021

Article

Full-text available

Apr 2022

ABSTRAK Latar Belakang: Mutu layanan tidak hanya menjadi elemen penting bagi pasien dalam membuat keputusan pemilihan rumah sakit tetapi juga menjadi alat untuk menentukan minat pemanfaatan ulang dan niat untuk merekomendasikannya kepada orang lain. Turunnya angka kunjungan pasien lama di instalasi rawat jalan RS Helsa Jatirahayu mengindikasikan kemungkinan adanya ketidakpuasan pasien terhadap kualitas layanan yang diberikan sehingga mempengaruhi minat pemanfaatan ulang layanan. Penurunan jumlah kunjungan ini juga tidak lepas dari kondisi Pandemi Covid-19, yang menimbulkan kekhawatiran masyarakat terhadap keamanan rumah sakit di masa Pandemi Covid-19. Tujuan penelitian ini adalah untuk mengetahui pengaruh mutu layanan rawat jalan meliputi efektivitas, efisiensi, informasi, hubungan antar manusia, keamanan, dan tepat waktu terhadap minat pemanfaatan ulang layanan rawat jalan. Metode: Penelitian ini merupakan penelitian kuantitatif dengan pendekatan cross sectional dengan jumlah sampel sebanyak 100 responden. Data diolah dan dianalisis dengan metode univariat, bivariat, dan multivariat menggunakan uji analisis regresi logistik. Hasil: Terdapat hubungan efisiensi (p=0,000), hubungan antar manusia (p=0,000), informasi (p=0,041) dan keamanan (0,002), namun tidak ada hubungan efektivitas (p=0,077), dan tepat waktu (p=0,314) terhadap minat pemanfaatan ulang layanan rawat jalan RS Helsa. Hasil analisis pengaruh secara bersama-sama didapatkan bahwa hubungan antar manusia dengan OR = 3,87 (95%CI: 1,244-12,057) dan keamanan dengan OR = 2,89 (95%CI:1,244-12,057) berpengaruh terhadap minat pemanfaatan ulang layanan rawat jalan, dengan efektivitas dan efisiensi sebagai faktor perancu. Simpulan: Terdapat pengaruh efisiensi, informasi, hubungan antar manusia serta keamanan terhadap minat pemanfaatan ulang layanan rawat jalan, dan variabel yang paling dominan berpengaruh adalah hubungan antar manusia.Kata kunci : Mutu Layanan, Minat Pemanfaatan Ulang

Patient Satisfaction and Its Predictors in the General Hospitals of Southwest Saudi Arabia: A Cross-sectional Survey

Article

Full-text available

Mar 2022

Perception of university students about doctors and quality of health care provision at clinics: a multi-national study in India, Pakistan, Spain and United States of America

Article

Full-text available

Jan 2020

Background: Patient satisfaction is considered as an indicator of the healthcare quality. Information on patient satisfaction based on medical expertise of the physician, interpersonal skills, physician-patient interaction time, perception and needs of the patient allow policymakers to identify areas for improvement. Primary care services and healthcare structure differ between the countries. The present study was done to determine and analyze the determinants associated with patient satisfaction in India, Pakistan, Spain and USA. Methods: This descriptive study was performed in January to August 2019 among students from Mumbai University, India, Dow University of Health Sciences, Karachi, Pakistan, University CEU Cardenal Herrera, Valencia, Spain, Texas State University, Texas, USA. On the basis of the eligibility criterion (those who gave a written informed consent and were registered students of respective university) 890 (India: 369, Pakistan: 128, Spain: 195, USA: 99) students were selected for the present study. Results: India had almost similar male (49%) to female (51%) ratio of participants. For other 3 countries (PK, ES, US), female participant percentage was nearly 20% or even more as compared to male participants. Overall participant’s satisfaction score about medial expertise of the doctor were highest in India (71%) and were lowest in Spain (43%). Overall satisfaction score about time spent with doctor were highest for India (64%) and were lowest for Spain (41%). Overall satisfaction score about communication with doctor were highest for US (60%) and were lowest for PK (53%). Overall satisfaction score for medical care given by the doctor was lowest in PK (43%) and was highest in US (64%). Overall satisfaction about doctor, highest number of US (83%) and lowest number of PK (32%) participants were satisfied about medical interaction with doctors. Conclusions: These multi-country findings can provide information for health policy making in India, Pakistan, Spain and USA. Although the average satisfaction per country, except Pakistan is more than 60%, the results suggest that there is ample room for improvement.

Undergraduate Training in Breaking Bad News: A Continuation Study Exploring the Patient Perspective

Article

Nov 2019

Objective: This paper reports on the continuation of an initial study that demonstrated the effectiveness, as rated by experts, of an undergraduate training in breaking bad news (BBN) using simulated patient (SP) and individual feedback. The current study aimed to further explore whether such an individualized training approach also has positive effects from the perspective of the patient, using the analogue patient (AP) methodology. Methods: A subsample of 180 videotaped interviews with SPs were selected from the existing dataset (N = 332), consisting of 60 pre- and post-training interviews of students benefiting from the individualized approach (intervention group) and 60 post-training interviews of students having small-group SP training and collective supervision (comparison group). Sixty-eight APs - healthy untrained observers - were asked to view the videotaped interviews while "putting themselves in the patient's shoes" and evaluate satisfaction, trust, liking, and the competence of medical students. Results: The intervention group students improved significantly from pre- to post-training on several dimensions evaluated by the APs: patient satisfaction, trust in the student, liking of the student, and perceived medical competence. Increased AP satisfaction was related to different changes in students' communication behavior between pre- and post-training: increase in positive talk, emotional responsiveness, biomedical and psychosocial information, and biomedical counseling. There was no significant between-group difference at post-training. Conclusions: AP evaluation showed significant improvement between pre- and post-training. This result provides additional and complementary evidence of the positive effects of individualized training in BBN from the AP perspective, a proxy of (real) patients.

The Effects of Doctors’ Interpersonal Communication on Low-Income Inpatients’ Satisfaction Level

Article

Full-text available

Mar 2019

Doctors' interpersonal communication skill is an integral part of health services and become one of the main indicators of patients’ satisfaction towards healthcare provider. This study aims at examining the influence of doctors' interpersonal communication on the satisfaction levels of class III (low income) inpatients at Hasan Sadikin Hospital, Bandung, Indonesia. The method applied in this study is quantitative method utilizing survey as study instrument and tool of analysis. There were 261 patients as the study population, and 72 randomly selected respondents were taken as the study sample. The authors used simple random sampling method in carrying out selection of patients in this study. The data were analyzed using the continuum line and multiple linear regression analysis, either simultaneously or partially. In the hypothesis test, F-test was conducted, and H1 was accepted. The results of the study indicated that there was an influence between the two variables. The respondents’ responses indicated that the doctors' interpersonal communication was in the category of a very high interpersonal skill. Moreover, the respondents also had a very high level of satisfaction with the health service. Thus, based on the findings, the doctors' interpersonal communication skills had a significant effect on low-income patients’ satisfaction levels simultaneously. © 2019, Universiti Kebangsaan Malaysia Press. All rights reserved.

Factors affecting the relationship between physician and patient in Ahvaz Community Health Centers

Article

Full-text available

Dec 2018

Background and purpose: The patient-physician relationship is a cornerstone of a good primary healthcare. This study was aimed to study the factors affecting the relationship between physician and patient in Ahvaz community health centers.Materials and Methods: In this cross-sectional study, two-hundred participants were randomly selected from 14 community health centers in Ahwaz, 2016. Data were collected using a valid Patient-Doctor relationship questionnaire (PDRQ-9). A total score of 9-45 was considered to assess communication skill of doctors. Data were analyzed using SPSS.20 Software.Results: The results showed that the total mean and median score of physician-patient relationship was slightly higher than moderate (mean=28.58 and median=26 out of 45). The highest score (3.36 out of 5) was related to the item "I can talk to my doctor". The lowest score (2.95 out of 5) was related to the item "My doctor is dedicated to help me." Linear regression analysis shows that the waiting time for receiving services had a negative impact on the patient-doctor relationship. By increasing the waiting time for receiving services, patients' satisfaction from communication with their physicians is decreased (B = -0.112; P = 0.041).Conclusion: The researchers concluded that the relationship between physician and patient in the studied health centers was moderate. It is necessary to develop managerial techniques to reduce waiting time of patients in order to improve the relationship between physicians and patients.

Effects of Gender on Patient’s Satisfaction with Physician Care and Communication Skills in a Tertiary Hospital in Nigeria

Article

Sep 2018

Patient satisfaction is an important indicator of quality of care. Satisfied patients tend to be more adherent to medical recommendations and are less likely to disenroll from healthcare plans. The study set out to empirically investigate the influence of patient and physician gender on patient’s satisfaction with the clinical care and physician’s communication skills. The study is a cross sectional survey of 300 patient-physician pairs at 5 adult outpatient clinics of a tertiary hospital in Nigeria. Satisfaction to the clinical care received and communication skills of the physician were assessed by the patients using the adapted Patients Satisfaction Questionnaire Form 18 (PSF-18). Three hundred patient-physician pairs were examined, and they made up of 300 patients and 150 physicians. Two hundred and eleven (70.3%) and 249 (83%) respondents were satisfied with the clinical care and physician’s communication skills respectively. Respondents attended to by female physicians were more likely to be satisfied with the clinical care [female 72.8% vs male 62.8%, p < 0.01] and communication skills [female 88.8% vs male 77%, p < 0.01] than those attended to by male physicians. Respondent’s gender had no influence on both the clinical care [male 49.7% vs female 50.3%, p - 0.90] and physician’s communication skills [male 49.0% vs female 51.0%, p - 0.44]. Physician’s gender [Odd Ratio (OR), 2.4] and cadre (OR, 3.8) independently predict patient’s satisfaction to the clinical care received, while only physician’s gender (OR, 1.7) predicts patient’s satisfaction to communication skills. This study showed that physician’s gender influenced patient’s satisfaction to both the clinical care and physician’s communication skills during medical consultation.

Evaluating Dog and Cat Owner Preferences for Calgary-Cambridge Communication Skills: Results of a Questionnaire

Article

Full-text available

Oct 2018

Veterinary client retention by companion animal practices is influenced by whether the client feels connected to the healthcare provider. Effective communication between the veterinarian and the client facilitates that connection. To prepare new graduates for success in clinical practice, many colleges of veterinary medicine are now incorporating communication into the curriculum to emphasize its importance in establishing and maintaining the veterinarian-client relationship. A 2016 focus group study by Englar et al. evaluated dog and cat owner communication preferences for Calgary-Cambridge Guide (CCG) communication skills and concluded that dog and cat owners may have different communication needs. This study was conducted to confirm whether species-based communication preferences exist among veterinary clients. A questionnaire was distributed online and on-site, within veterinary teaching hospitals and private practices. Based upon 215 submissions from dog owners and 166 from cat owners, the communication preferences of dog and cat owners overlap. Both dog and cat owners prioritize reflective listening as the most important foundational CCG communication skill, and both prioritize asking permission as the most important core CCG skill. However, dog owners valued open-ended questions more than cat owners, and cat owners valued empathy more than dog owners. Survey limitations were largely demographic: participants were predominantly female and between the ages of 18-40 years. Survey data may therefore not be representative of the perspective of males and/or those >40 years of age.

Improving compliance with medical fitness to drive reviews: The role of behaviourally-optimised letters

Article

May 2018
TRANSPORT RES F-TRAF

To manage the increased crash risk posed by drivers with medical conditions and impairments, many licensing authorities ask high-risk drivers to undergo medical fitness to drive assessments. Maximising drivers’ compliance and satisfaction with these assessments is an ongoing challenge for these authorities. This study tested whether drivers’ compliance and satisfaction with a licensing authority’s request to provide a medical report could be improved by incorporating two applied behaviour change principles – simplified messaging and procedural fairness – into the authority’s request letter. Drivers undergoing medical review (N = 876) were assigned to receive either a standard request letter currently used by the authority, or a revised letter that incorporated simplified messaging and procedural fairness amendments. Drivers who received the revised letter were significantly more likely to submit a medical report by the due date. Additionally, of the drivers who submitted the report, those who received the revised letter submitted the report an average of four days faster than those who received the standard letter. These findings demonstrate that optimising letters using behavioural principles can improve compliance with licensing authorities’ requests, resulting in substantial time and cost savings for licensing authorities, possible road safety benefits, and potential reductions in the number of licences suspended for failure to provide a report.

Health Literacy Competencies for European Health Care Personnel

Article

Full-text available

Dec 2017

Background: Health literacy as a concept is gaining importance in European countries, although still not adequately addressed among health personnel. Health literacy supports the self-management of patients in maintaining and improving health, which could decrease the burden on health systems in Europe. However, health professionals lack adequate knowledge about health literacy and skills to promote health literacy among patients. Aim: Recently in the U.S., Coleman et al. developed the Health Literacy Practices and Educational Competencies for Health Professionals and this study aimed to refine that assessment for health personnel in European settings. Method: The modified Delphi method was used and data collected online to achieve consensus among a group of 20 health literacy and health care experts from 10 professional fields representing 13 European countries. Participants rated health literacy competencies on a four-point Likert scale and provided written feedback and recommendations. If a predetermined threshold of 70% or more of the participants agreed on the competency, the consensus was defined, similarly to Coleman et al.’s criteria. After three rounds of ratings and modifications, consensus agreement was reached on 56 health literacy competencies (20 knowledge items, 25 skills items, 11 attitude items) and 38 practices. Eight items were removed from the original list and eight new items were included to the final list. Conclusion: This study is the first known attempt to develop a measurable list of health literacy competencies for health personnel in Europe. Further work is needed to develop educational curricula, standard national and regional guidelines and questionnaires for the process of implementation to maximize the health literacy responsiveness in health care organizations.

Doctor, Ease My Mind! Associations between Cancer Patients’ Emotional Distress and Their Perception of Patient-Centeredness during Oncology Consultations

Article

Full-text available

Jan 2017

Objective: To investigate whether perceived patient-centered communication during oncology consultations relates to patient satisfaction and degree of emotional distress following the medical encounter. Methods: 226 cancer patients attending an oncology outpatient clinic completed questionnaires before and after a consultation including the Physician-Patient Relationship Inventory, the brief Profile of Mood States, and the Information satisfaction questionnaire. Results: Patients who perceived the communication during the consultations to be highly patient-centered were more likely to be maximally satisfied with information provided by the oncologist. Additionally, adjusting for pre-consultation distress, as well as sociodemographic, clinical, and consultation-related variables, patients who perceived the oncologist to communicate in a highly patient-centered manner, experienced lower levels of emotional distress after the consultation. Conclusion: Patient-centered communication may be an important quality in oncology as an approach to positively influence patient outcomes, including emotional distress. However, the findings in the present study of an effect of PCC on patient satisfaction and emotional distress are modest, and no firm conclusions can thus be drawn. Practice Implications: Oncology settings may benefit from the positive effects of patient-centered care and physicians should acknowledge the potential of their own relational competence in order to facilitate patient-centered communication.

Patient satisfaction with TB care clinical consultations in Kampala: A cross sectional study.

Article

Full-text available

Mar 2017
Afr Health Sci

Background: Patient satisfaction towards care during encounter with clinicians is key for better treatment outcomes. We assessed patient satisfaction with TB clinical care consultations in Kampala, Uganda. Methods: This was a facility-based cross sectional study done between September 2012 and February 2013 using qualitative method of data collection. Participants consecutively completed a pre-tested structured satisfaction questionnaire. A criteria of the rating as good; >75% was considered acceptable, (50-75%) as more effort is needed and <50 as unacceptable and require immediate action was used to categorize data for analysis using Epi-info 7.1.4.0. Results: Of the 260 registered TB patients, 178(68.5%) completed the questionnaire. Overall, 162 (91.0%) were satisfied with the clinical consultation. Factors that contributed to high patient satisfaction, were: time spent with clinician (85.4%), explanation of what was done (87.6%), technical skills (91.6%), personal manner of the clinician seen (91.6%). Factors for low satisfaction were; waiting time before getting an appointment (61.8%), convenience of location of consultation office (53.4%), getting through to the office by phone (21.3%) and length of time waiting at the office (61.2%). Conclusion: Tuberculosis patients in Kampala are satisfied with TB clinical care consultations. Addressing factors with low patient satisfaction may significantly impact on treatment outcome.

Comparative Effectiveness of Closed System Drug Transfer Devices versus Traditional Compounding Devices for Injectable Antineoplastic Agents

Article

Feb 2025

Hospital Pharmacists’ Patient-Centered Communication, Trust, and Satisfaction: Patients’ Perceptions and Opinions

Article

Nov 2023

Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis

Article

Full-text available

Feb 2023

Patient satisfaction with healthcare provision services and the factors influencing it are becoming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients' expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000-2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient's age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.

The satisfaction of healthcare consumers: analysis and comparison of different methodologies

Article

Jan 2022

Patient satisfaction and the factors influencing it are becoming a significant concern for health organizations and patients around the world. This study evaluates patients' satisfaction regarding the inpatient service while tackling the existent literature gap on which method best suits the patient satisfaction analysis. We perform a methodological comparison (using factor analysis, structural equation modeling, ordinal logistic regression (OLR), and multicriteria satisfaction analysis (MUSA)) to contrast the different results from different methodologies. After implementing the methods, we concluded that, out of the eleven analyzed factors, seven influence satisfaction: accommodations, auxiliary staff, exams and treatments, medical staff, food quality, volunteering staff, and obtained information. Three were consistent for structural equation modeling and OLR: accommodations, exams and treatments, and health services. The outputs of MUSA were not compatible with the other methods. However, we concluded that the MUSA method is a good option when dealing with patient satisfaction studies since it provides insightful outputs that facilitate managers' decision making and improve the provider's performance efficiency.

Efficacy of communication-based interventions on physicians and patients’ outcome: A meta-analysis of randomised controlled trials

Article

Full-text available

Sep 2021

Communication-based intervention on physicians are strongly linked to patient health improvement. We proceeded examine the efficiency of these programs interventions for relevant outcomes in patients life, along with study quality, publication bias and potential moderators. For this meta-analysis, we searched 2 databases, including: Web of Science and PubMed, using a comprehensive search strategy to identify the efficacy of the physician interventions on patient’s outcome studies in the literature, published from inception of 1965. Studies reporting means of health-related outcome in patients were included in the analyses. Studies quality was assessed with risk of bias tool. Meta-regression was used to explore heterogeneity of the year of published studies moderator and subgroup analysis was used to explore the medical specialty moderator. Of the 3,470 studies initially identified, 14 were eligible for inclusion. These studies had a large diversity of program interventions. The mean effect size representing the impact of communication intervention on patients physical and psychological health was not significant. The only significant mean effect was represented by psychological outcome. Significant associations were found between year of studies and general medicine specialization. In conclusion the impact of physicians’ intervention in not efficient on patients’ communication and medical outcome but it improves psychological health.

Developing communication curricula in healthcare education: An evidence-based guide

Article

Nov 2021
PATIENT EDUC COUNS

Objective To present a guide for communication curriculum development in healthcare professions for educators and curriculum planners. Methods:\ We collated a selection of theories, frameworks and approaches to communication curriculum development to provide a roadmap of the main factors to consider when developing or enhancing communication skills curricula. Results We present an evidence-based guide for developing and enhancing communication curriculum that can be applied to undergraduate and postgraduate healthcare education. Recommended steps to consider during the communication curricula development process include thoughtful examination of current communication education, needs assessment, focused learning goals and objectives, incorporation of experiential educational strategies allowing for skills practice and feedback and use of formative and summative assessment methods. A longitudinal, developmental and helical implementation approach contributes to reinforcement and sustainment of learners’ knowledge and skills. Conclusion and Practice implications Drawing on best practices in developing communication curricula can be helpful in ensuring successful approaches to communication skills training for any level of learner or healthcare profession. This position paper provides a guide and identifies resources for new and established communication curriculum developers to reflect on strengths and opportunities in their own approaches to addressing the communication education needs of their learners.

The Effectiveness of a Simulation Program to Enhance Readiness to Engage in Difficult Conversations in Clinical Practice

Article

Sep 2021
Dimens Crit Care Nurs

Jennifer Coates

Health care providers are often tasked with communicating difficult, emotionally charged news, including delivering an unwelcome diagnosis and planning end-of-life care. Patients and family members often cannot recall specifics of these conversations, although their perceptions of how information was communicated by health care providers impact not only their evaluation of the quality of care received, but also their abilities to cope with the communicated bad news. What can be done to better prepare novice clinicians to have these types of conversations? This quality improvement project used a simulation-based difficult conversation workshop given to adult-gerontology acute care nurse practitioner students in their final year of study. The workshop comprised both standardized patient actors and a structured communication curriculum. A pretest/posttest was conducted to show that this intervention was effective in increasing student confidence to facilitate difficult conversations in clinical practice.

Assessment of Patient Satisfaction Among Pregnant Patients in The Out-Patient Department of Obstetrics and Gynecology Section at Metropolitan Medical Center Manila

Article

Full-text available

Dec 2020

Herry Prabowo Krestiyanto Widjaja

ABSTRACT Patient satisfaction reflects the quality of an institution’s delivery of health care services. Patient satisfaction is a critical factor in improvement or complete recuperation to wellness because satisfied patients will mean better compliance to treatment or follow up. As reported in the 2017 Annual OPD census of the Department of Obstetrics and Gynecology, there were 2617 total patient consultations. Majority of these (2138 or 81.7 %) were obstetrical cases. The average number of consultations per day (for Obstetrics and Gynecology patients combined) is 9 1 . Therefore, the Out-Patient Clinic plays an important role in prenatal care specifically the prevention of adverse maternal and neonatal morbidity and mortality. This study aimed to assess the level of patient satisfaction among obstetrical patients in the Out Patient Department of the Obstetrics and Gynecology Section at Metropolitan Medical Center from July 1, 2018 to July 31, 2018 and to see the relationship between socio-demographic characteristic and the level of patient satisfaction. This is a descriptive, cross sectional study. The level of patient satisfaction assessed as to physical facilities, interaction between doctor and patient, interaction between nurses and patient, and registration service. There were sixty three subjects in this study. Sixty three were satisfied with inclusion criteria. The validated questionnaire was the pretested questionnaire which was 96 % valid and reliable by Cronbach’s analysis. Statistical analysis was done which showed respondents were generally satisfied. There were significant relationship association between socio-demographic characteristics and level of patient satisfaction with P value < 0.05. Key Word : Patient Satisfaction, Socio Demographic Characteristic

Development and national consensus finding on patient-centred high stakes communication skills assessments for the Swiss Federal Licensing Examination in Medicine

Article

Dec 2020
PATIENT EDUC COUNS

Objective To describe and evaluate a consensus finding and expert validation process for the development of patient-centred communication assessments for a national Licensing Exam in Medicine. Methods A multi-professional team of clinicians and experts in communication, assessment and role-play developed communication assessments for the Swiss Federal Licensing Examination. The six-month process, informed by a preceding national needs-assessment, an expert symposium and a critical literature review covered the application of patient-centred communication frameworks, the development of assessment guides, concrete assessments and pilot-tests. The participants evaluated the process. Results The multiple-step consensus process, based on expert validation of the medical and communication content, led to six high-stakes patient-centred communication OSCE-assessments. The process evaluation revealed areas of challenge such as calibrating rating-scales and case difficulty to the graduates’ competencies and integrating differing opinions. Main success factors were attributed to the outcome-oriented process and the multi-professional exchange of expertise. A model for developing high stakes patient-centred communication OSCE-assessments was derived. Conclusions Consensus finding was facilitated by using well-established communication frameworks, by ensuring outcome-orientated knowledge exchange among multi-professional experts, and collaborative validation of content through experts. Practice implications We propose developing high-stakes communication assessments in a multi-professional expert consensus and provide a conceptual model.

Evaluation of the “Shared Community Follow‐up” after a germ cell tumour—A novel initiative for remote cancer follow‐up enhanced by online patient‐reported outcome measures

Article

Full-text available

Jun 2020

Objective Replying to germ cell tumour patients' needs, we implemented “Shared Community Follow‐up”—a collaborative initiative, enabling remote delivery of specialist cancer care across large geographical areas. Blood, radiological investigations and patient‐reported outcome measures (PROMs) are completed remotely and integrated within the electronic patient records for specialist review without patients requiring appointments. We describe the service evaluation estimating the feasibility, safety and acceptability of this initiative versus traditional Standard Follow‐up. Methods This cross‐sectional evaluation estimated feasibility (uptake, adherence) and safety (via missed appointments, timeliness, cancellations) using routinely collected service process data. An acceptability questionnaire, evaluating patient satisfaction, was administered to 91 patients. Results The new service is feasible. Across 2 years (2014–2016), uptake increased 54% (N = 123 to N = 270) and only 4.8% (N = 13) of patients were non‐adherent. Fewer missed/cancelled investigations (N = 39, 5.9% vs. N = 566, 85.5%), timelier investigations (seven vs. 14 timely investigations) and equal relapse detection suggest its safety. PROMs replaced 3 appointments/patient. Patients were as satisfied with both services (3.4/4 vs. 3.6/4). Conclusion New follow‐up services, with investigations completed remotely and shared between community providers and cancer centres, offer an alternative to traditional appointments with advantages for patients and the National Health Service.

FACTORS INFLUENCING THE SATISFACTION OF PATIENTS WITH MEDICAL CARE DURING MEDICAL REHABILITATION

Article

Full-text available

Jan 2020

Communication soignant-soigné : problématiques

Chapter

Jan 2019

Diferencias individuales y burnout en médicos oncólogos venezolanos

Article

Full-text available

Jun 2012

El presente estudio explora la influencia de ciertas diferencias individuales como la sensibilidad emocional, los estilos de afrontamiento y los estilos de comunicación sobre el burnout de médicos oncólogos venezolanos. Participaron en el estudio 93 médicos oncólogos de diversos hospitales oncológicos públicos de Caracas (Venezuela), quienes completaron los cuestionarios que evaluaban las variables mencionadas. Los resultados indicaron niveles medios de burnout en los médicos estudiados, una mayor sensibilidad emocional positiva, adopción de funcionales estilos de afrontamiento y estilos de comunicación más centrados en sí mismos. Por su parte, el análisis de regresión reveló que una mayor sensibilidad egocéntrica negativa y una menor sensibilidad interpersonal positiva determinan mayores niveles de burnout en los oncólogos.

Maximizing Communication

Chapter

Oct 2018

Laura D Garrett

Good communication skills are a cornerstone of successful veterinary practice. While strong communication skills are of benefit in all aspects of veterinary medicine, they become even more critical in highly charged situations such as emergency room visits. Some clinicians express concern in regard to use of these skills due to the belief that they will increase the time spent with owners. However, while some aspects of core communication may be more time consuming, many aspects can save time during the visit and in the long run. The core skills of open‐ended questions, reflective listening, empathy, and non‐verbals can be applied in the ER setting for the benefit of the client, patient, and clinician.

Communication skills training for healthcare professionals working with people who have cancer

Article

Full-text available

Jul 2018

Background: This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. Objectives: To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. Search methods: For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. Selection criteria: The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. Data collection and analysis: Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). Main results: We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. Authors' conclusions: Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.

The Role of Depression, Anxiety, and Stress in Medication Adherence in Patients with Hypertension

Article

Sep 2017

Background: Despite the importance of psychological factors in adherence to the treatment in patients with hypertension, a few studies have been done to identify the factors affecting adherence to treatment and particularly to investigate the role of psychology factors in Iranian population. This study aimed to investigate the role of mental health in adherence to medication in patients with hypertension in rural areas of Isfahan Province, Iran. Methods: In this cross-sectional study, 300 patients with hypertension were studied. Multistage sampling was performed in health centers. Data collection tools included depression, anxiety and stress scale (DASS) short form and the Morisky 8-items medication adherence questionnaire. The odds ratio (OR) for different levels of depression, anxiety, and stress in both groups with appropriate adherence and non-appropriate adherence to treatment were determined. We used multivariate logistic regression model for statistical analysis. Findings: Patients with very severe levels of anxiety were more non-adherent to drug therapy than those with normal levels of anxiety (OR = 2.8; CI95%: 1.07-7.38). While other levels of anxiety and severity of depression and stress were not significant predictors for predicting patients' adherence to treatment. Conclusion: Understanding the severity of depression, stress, and anxiety to ensure adherence and treatment outcomes in patients with hypertension are essential. According to this study, very severe anxiety can be considered as an important predicting factor in the lack of adherence to medication.

A Systematic Review of End-of-Life Care Communication Skills Training for Generalist Palliative Care Providers: Research Quality and Reporting Guidance

Article

Full-text available

Aug 2017
J PAIN SYMPTOM MANAG

Context: End of life care (EoLC) communication skills training for generalist palliative care providers is recommended in policy guidance globally. Whilst many training programmes now exist, there has been no comprehensive evidence synthesis to inform future training delivery and evaluation. Objectives: To identify and appraise how EoLC communication skills training interventions for generalist palliative care providers are developed, delivered, evaluated, and reported. Methods: Systematic review. Ten electronic databases (inception to December 2015) and five relevant journals (January 2004 to December 2015) were searched. Studies testing the effectiveness of EoLC communication skills training for generalists were included. Two independent authors assessed study quality. Descriptive statistics and narrative synthesis are used to summarise the findings. Results: From 11,441 unique records, 170 reports were identified (157 published, 13 unpublished), representing 160 evaluation studies of 153 training interventions. Of published papers, eight were low quality, 108 medium, and 41 high. Few interventions were developed with service user involvement (n=7), and most were taught using a mixture of didactics (n=123), reflection and discussion (n=105), and roleplay (n=86). Evaluation designs were weak: <30% were controlled, <15% randomised participants. Over half (n=85) relied on staff self-reported outcomes to assess effectiveness, and 49% did not cite psychometrically validated measures. Key information (e.g. training duration, participant flow) was poorly reported. Conclusions: Despite a proliferation of EoLC communication skills training interventions in the literature, evidence is limited by poor reporting and weak methodology. Based on our findings we present a CONSORT statement supplement to improve future reporting and encourage more rigorous testing. Registration number: CRD42014014777.

The Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis

Article

Full-text available

Aug 2017
J PAIN SYMPTOM MANAG

Context: As most end of life care is provided by healthcare providers who are generalists rather than specialists in palliative care, effective communication skills training for generalists is essential. Objectives: To determine the effect of communication training interventions for generalist palliative care providers on patient-reported outcomes and trainee behaviours. Methods: Systematic review from searches of 10 databases to December 2015 (MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, CENTRAL, Web of Science, ICTRP, CORDIS and OpenGrey), plus hand-searching. Randomised controlled trials of training interventions intended to enhance generalists' communication skills in end of life care were included. Two authors independently assessed eligibility after screening, extracted data, and graded quality. Data were pooled for meta-analysis using a random effects model. PRISMA guidelines were followed. Results: 19/11,441 papers were eligible, representing 14 trials. Eleven were included in meta-analyses (patients n=3144, trainees n=791). Meta-analysis showed little effect on patient outcomes (SMD=0.10, 95%CI -0.05 to 0.24) and high levels of heterogeneity (Chi(2)=21.32, df=7, p=0.003; I(2)=67%). The effect on trainee behaviours in simulated interactions (SMD=0.50, 95%CI 0.19-0.81) was greater than in real patient interactions (SMD=0.21, 95%CI -0.01-0.43); moderate heterogeneity (Chi(2)=8.90, df=5, p=0.11; I(2)=44%; Chi(2)=5.96, df=3, p=0.11; I(2)=50%, respectively). Two interventions with medium effects on showing empathy in real patient interactions included personalised feedback on recorded interactions. Conclusions: The effect of communication skills training for generalists on patient-reported outcomes remains unclear. Training can improve clinicians' ability to show empathy and discuss emotions, at least in simulated consultations. Personalised feedback on recorded patient interactions may be beneficial. Registration number: CRD42014014777.

Medical students’ communication skills in clinical education: Results from a cohort study

Article

May 2017

Objective To assess students’ communication skills during clinical medical education and at graduation. Methods We conducted an observational cohort study from 2007 to 2011 with 26 voluntary undergraduate medical students at Hamburg University based on video-taped consultations in year four and at graduation. 176 consultations were analyzed quantitatively with validated and non-validated context-independent communication observation instruments (interrater reliability ≥ 0.8). Based on observational protocols each consultation was also documented in free-text comments, salient topics were extracted afterwards. Results 26 students, seven males, were enrolled in the survey. On average, graduates scored higher in differential-diagnostic questioning and time management but showed deficiencies in taking systematic and complete symptom-oriented histories, in communication techniques, in structuring consultations and in gathering the patients’ perspectives. Patient-centeredness and empathy were rather low at graduation. Individual deficiencies could barely be eliminated. Conclusion Medical students were able to enhance their clinical reasoning skills and their time management. Still, various communication deficiencies in final year students became evident regarding appropriate history taking, communication skills, empathy and patient-centeredness. Practice implications The necessity of developing a longitudinal communication curriculum with enhanced communication trainings and assessments became evident. A curriculum should ensure that students’ communication competencies are firmly achieved at graduation.

All patients are not the same: An audit comparing the public and private sectors

Article

Apr 2017

Background It is acknowledged that a variety of patient factors are known to influence consultation length as well as outcomes and complication rates following surgery. As little research has been published in this area, our aim was to compare the prevalence of such factors amongst foot and ankle surgical patients treated in the private and public sectors. Methods Information was prospectively collected on 100 consecutive new patients presenting to foot and ankle clinics in private practice, a trauma center and a metropolitan hospital. Data was collected for age, primary pathology, availability of home support, employment status, necessity for interpreter, smoking status, presence of diabetes and ASA (American Society of Anesthesiologists) status. Results Statistically significant differences were found between the private and public patients for availability of home support, employment status and necessity for an interpreter. When compared with the other two sets of patients, the trauma center had a greater proportion of smokers and diabetics. In addition, a higher ASA grade was observed. Conclusion A statistically significant difference in patient factors was noted between patients treated in the public and private sector and between a trauma center and a metropolitan hospital. We believe that careful consideration of these issues is needed when interpreting clinical outcomes and assessing potential service provision. Study design Cohort study.

Effects of patient-centered communication on anxiety, negative affect, and trust in the physician in delivering a cancer diagnosis: A randomized, experimental study

Article

Full-text available

Apr 2017
CANCER-AM CANCER SOC

Background: When bad news about a cancer diagnosis is being delivered, patient-centered communication (PCC) has been considered important for patients' adjustment and well-being. However, few studies have explored how interpersonal skills might help cancer patients cope with anxiety and distress during bad-news encounters. Methods: A prospective, experimental design was used to investigate the impact of the physician communication style during a bad-news encounter. Ninety-eight cancer patients and 92 unaffected subjects of both sexes were randomly assigned to view a video of a clinician delivering a first cancer diagnosis with either an enhanced patient-centered communication (E-PCC) style or a low patient-centered communication (L-PCC) style. Participants rated state anxiety and negative affect before and immediately after the video exposure, whereas trust in the physician was rated after the video exposure only. Main and interaction effects were analyzed with generalized linear models. Results: Viewing the disclosure of a cancer diagnosis resulted in a substantial increase in state anxiety and negative affect among all participants. This emotional response was moderated by the physician's communication style: Participants viewing an oncologist displaying an E-PCC style were significantly less anxious than those watching an oncologist displaying an L-PCC style. They also reported significantly higher trust in the physician. Conclusions: Under a threatening, anxiety-provoking disclosure of bad news, a short sequence of empathic PCC influences subjects' psychological state, insofar that they report feeling less anxious and more trustful of the oncologist. Video exposure appears to be a valuable method for investigating the impact of a physician's communication style during critical encounters. Cancer 2017. © 2017 American Cancer Society.

Patient Adherence to Health Care Regimens

Article

Dec 2015

A significant barrier to effective medical treatment involves patients' failure to follow treatment recommendations given by their health care provider, a term known as nonadherence (or noncompliance). More than 40% of patients take medications incorrectly, and almost 80% fail to follow dietary or exercise recommendations; some continue to engage in compromising health behaviors (e.g., smoking and alcohol abuse). Improving adherence depends upon effective communication between patients and providers, trust in the therapeutic relationship, and a realistic assessment of patients' knowledge and understanding of treatment. Such collaboration fosters improvements in health outcomes and reduces nonadherence.

Implication du patient dans le choix de son traitement: état actuel des recherches et de la pratique

Chapter

Jan 2006

Le concept de «prise de décision partagée» a surtout émergé au début des années 90. Ce concept met en avant l’idée d’un partenariat entre le médecin et le patient lors d’une prise de décision liée à un choix de traitement. Bien que dans sa description initiale cette approche semble trop idéaliste, l’implication du patient dans le choix de son traitement apparaît possible, conseillée et favorable. Pour détailler ce processus, il faut alors considérer les deux composantes que sont la compétence d’implication et la préférence d’implication. En effet, la réalisation d’une prise de décision n’est commune et efficiente que si le patient et le médecin peuvent et désirent la réaliser. Ces conditions rendent le processus complexe et sa pratique difficile. Des outils existent néanmoins, qui sont ici présentés, ainsi que quelques résultats de recherches récentes sur ce thème. Ces recherches doivent être encouragées pour permettre d’établir des recommandations utiles aux médecins et aux patients.

Efficacy of a Cancer Research UK communication skills training model for oncologists: A randomised controlled trial

Article

Full-text available

Jan 2002

Doctors' communication with patients is commonly hampered by lack of training in this core skill. This study aimed to assess the efficacy of an intensive 3-day training course on communication skills in a randomised controlled trial with a two-by-two factorial design and several outcomes. METHODS: 160 oncologists from 34 UK cancer centres were randomly allocated to four groups: written feedback followed by course; course alone; written feedback alone; and control. At each of two assessment periods, consultations with six to ten consecutive, consenting patients per doctor were videotaped. 2407 patients participated. Outcome measures included objective and subjective ratings made by researchers, doctors, and patients. The primary outcomes were objective improvements after the intervention in key communication skills. Course content included structured feedback, videotape review of consultations, role-play with simulated patients, interactive group demonstrations, and discussion led by a trained facilitator. FINDINGS: In Poisson regression analysis of counts of communication behaviours, course attendance significantly improved key outcomes. The estimated effect sizes corresponded to higher rates of use of focused questions (difference between course attenders [n=80] and non-attenders [n=80] 34%, p=0.003), focused and open questions (27%, p=0.005), expressions of empathy (69%, p=0.003), and appropriate responses to patients' cues (38%, p=0.026), and a 24% lower rate of use of leading questions (p=0.11). There was little evidence for the effectiveness of written feedback. INTERPRETATION: The communication problems of senior doctors working in cancer medicine are not resolved by time and clinical experience. This trial shows that training courses significantly improve key communication skills. More resources should be allocated to address doctors' training needs in this vital area.

Communication Patterns of Primary Care Physicians

Article

Full-text available

Jan 1997

Objectives. —To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction.Design. —Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires.Setting. —A total of 11 ambulatory clinics and private practices.Participants. —The participants were 127 physicians and 537 patients coping with ongoing problems related to disease.Main Outcomes Measures. —Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires.Results. —Cluster analysis revealed 5 distinct Communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical." like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.Conclusions. —Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.

Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial

Article

Full-text available

Oct 1990

To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon's opinion or the patient's choice. To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery was associated with their participation in a randomised clinical trial. Prospective, multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer. 12 District general hospitals, three London teaching hospitals, and four private hospitals. 269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons. Surgery and radiotherapy or adjuvant chemotherapy, or both, depending on the individual surgeon's stated preferences for managing early breast cancer. Anxiety and depression as assessed by standard methods two weeks, three months, and 12 months after surgery. Of the 269 women, 31 were treated by surgeons who favoured mastectomy, 120 by surgeons who favoured breast conservation, and 118 by surgeons who offered a choice of treatment. Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery, and 43 of these chose breast conserving surgery. The incidences of anxiety, depression, and sexual dysfunction were high in all treatment groups. There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy. A significant effect of surgeon type on the incidence of depression was observed, with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons (p = 0.06). There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose. Most of the women (159/244) gave fear of cancer as their primary fear rather than fear of losing a breast. The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study. At 12 months 28% of women who underwent mastectomy in the present study were anxious compared with 26% in the earlier study, and 27% of women in the present study who underwent lumpectomy were anxious compared with 31% in the earlier study. In both the present and earlier study 21% of women who underwent mastectomy were depressed, and 19% of women who underwent lumpectomy in the present study were depressed compared with 27% in the earlier study.) There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy. Women who surrender autonomy for decision making by agreeing to participate in randomised clinical trials do not experience any different psychological, sexual, or social problems from those women who are treated for breast cancer outside a clinical trial.

Factor-Analytic Methods of Scale Development in Personality and Clinical Psychology

Article

Full-text available

Oct 1988

Andrew L. Comrey

Many clinical and social psychologists need to develop scales to carry out their research. Without adequate training in psychometric methods, they can easily run into difficulty. This article is designed to address some of the more common pitfalls in homogeneous scale construction. Empirical scale development by the criterion-group method is not considered. Suggestions are offered about item writing, answer scale formats, data analysis procedures, and overall scale development strategy. Particular emphasis is placed on the effective use of factor-analytic methods to select items for the scale and to determine its proper location in the hierarchy of factor constructs.

Burnout and psychiatric disorder among cancer clinicians

Article

Full-text available

Jul 1995

The prevalence and causes of 'burnout' and psychiatric disorder among senior oncologists and palliative care specialists have been measured in a national questionnaire-based survey. All consultant non-surgical oncologists in the UK were asked to participate. Sources of work-related stress and satisfaction were measured using study-specific questions which were aggregated into factors. Psychiatric disorder was estimated using the 12-item General Health Questionnaire. The three components of 'burnout'--emotional exhaustion, depersonalisation and low personal accomplishment--were assessed using the Maslach Burnout Inventory. Three hundred and ninety-three out of 476 (83%) consultants returned their questionnaires. The estimated prevalence of psychiatric disorder in cancer clinicians was 28%, and this is similar to the rate among British junior house officers. The study group had equivalent levels of emotional exhaustion and low personal accomplishment to those found in American doctors and nurses, but lower levels of depersonalisation. Among cancer clinicians, 'burnout' was more prevalent among clinical oncologists than among medical oncologists and palliative care specialists. Psychiatric disorder was independently associated with the stress of feeling overloaded (P < 0.0001), dealing with treatment toxicity/errors (P < 0.004) and deriving little satisfaction from professional status/esteem (P = 0.002). 'Burnout' was also related to these factors, and in addition was associated with high stress and low satisfaction from dealing with patients, and with low satisfaction from having adequate resources (each at a level of P < or = 0.002). Clinicians who felt insufficiently trained in communication and management skills had significantly higher levels of distress than those who felt sufficiently trained. If 'burnout' and psychiatric disorder among cancer clinicians are to be reduced, increased resources will be required to lessen overload and to improve training in communication and management skills.

Communication Patterns of Primary Care Physicians

Article

Full-text available

Jan 1997

To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction. Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires. A total of 11 ambulatory clinics and private practices. The participants were 127 physicians and 537 patients coping with ongoing problems related to disease. Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires. Cluster analysis revealed 5 distinct communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical," like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern. Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.

Defining and Measuring Patient Satisfaction With Medical Care

Article

Full-text available

Feb 1983
EVAL PROGRAM PLANN

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.

Patient surveys identify needs

Article

Full-text available

Feb 2000

Editor—Cleary is right to exhort us to undertake patient surveys to improve the quality of care provided.1 Surveys are particularly important with regard to ethnic minority populations since, because of different languages, they may find it difficult to communicate their experiences or may be generally less forthcoming than others. We undertook surveys of the provision of hospital services in Middlesbrough to ascertain the needs of Asian people. As a result, appropriate services were made available and satisfaction levels were improved.2 A further survey highlighted the need for continuous monitoring, since some aspects—for example, provision of interpreting services—had not been fully implemented.3 The second survey was extended to ascertain views on and use of a range of clinical services, including family planning, cervical smear and breast examination tests, and other settings including primary care.3,4 An interesting finding was the high level of satisfaction with many aspects of healthcare provision—for example, over 90% of Pakistani people were very satisfied or satisfied with the care received in inpatient and outpatient departments and from their general practitioners. In conclusion, therefore, patient surveys can, and should, be undertaken. They can not only identify needs and help in the planning of better services but also dispel some myths: the feedback is not always negative. The surveys are most beneficial if they are part of the continuous quality improvement programme.

Discussing Adjuvant Cancer Therapy

Article

Full-text available

Apr 2001

To document the adequacy of patient information in oncology consultations concerning adjuvant therapy and explore predictors of physician communication patterns, treatment decisions, patient information recall, and satisfaction. Retrospective analysis of audiotapes and verbatim transcripts of 101 initial adjuvant therapy consultations with medical and radiation oncologists was undertaken. Content analysis, data on communication patterns, treatment decisions, patient anxiety, satisfaction, and information recall were collected. Predictors of physician communication, treatment decisions, recall, and satisfaction with the consultation were identified. The majority of patients were well informed of their prognosis, benefits and risks of therapy, and alternative management options. Only half were asked about preferences for information or decision-making involvement. Predictors of information detail given include patient sex, age, occupation, and education. Radiation and medical oncologists express prognosis and treatment benefit using similar phrases. When offered the chance to delay decision-making, most patients do so (P <.01). Final treatment decisions appear to be influenced by the presentation of choice in treatment options by the oncologist and whether the treatment decision was made during the initial consultation (P <.01). Information recall was not influenced by communication factors. Patients receiving less detailed information had slightly higher satisfaction with the consultation (P =.03). More anxious patients tended to be less satisfied (P =.07). The optimal way to discuss adjuvant therapy is undefined. More emphasis can be placed on soliciting patient preferences for information and decision-making involvement and tailoring both to the needs of the individual patient. Providing choice in treatment and delaying decision-making may affect the patient's treatment decision.

Communication Between Physicians and Older Women With Localized Breast Cancer: Implications for Treatment and Patient Satisfaction

Article

Full-text available

Mar 2002

To identify factors associated with patient-physician communication and to examine the impact of communication on patients' perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients. Data were collected from 613 pairs of surgeons and their older (greater-than-or-equal 67 years) patients diagnosed with localized breast cancer. Measures of patients' self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes. Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients (greater-than-or-equal 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients' perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery. Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.

Truth may hurt but deceit hurts more: communication in palliative care

Article

Full-text available

Jun 2002
PALLIATIVE MED

Healthcare professionals often censor their information giving to patients in an attempt to protect them from potentially hurtful, sad or bad news. There is a commonly expressed belief that what people do not know does not harm them. Analysis of doctor and nurse/patient interactions reveals that this well-intentioned but misguided assumption about human behaviour is present at all stages of cancer care. Less than honest disclosure is seen from the moment that a patient reports symptoms, to the confirmation of diagnosis, during discussions about the therapeutic benefits of treatment, at relapse and terminal illness. This desire to shield patients from the reality of their situation usually creates even greater difficulties for patients, their relatives and friends and other members of the healthcare team. Although the motivation behind economy with the truth is often well meant, a conspiracy of silence usually results in a heightened state of fear, anxiety and confusion not one of calm and equanimity. Ambiguous or deliberately misleading information may afford short-term benefits while things continue to go well, but denies individuals and their families opportunities to reorganize and adapt their lives towards the attainment of more achievable goals, realistic hopes and aspirations. In this paper, some examples and consequences of accidental, deliberate, if well-meaning, attempts to disguise the truth from patients, taken verbatim from interviews, are given, together with cases of unintentional deception or misunderstandings created by the use of ambiguous language. We also provide evidence from research studies showing that although truth hurts, deceit may well hurt more. ‘I think the best physician is the one who has the providence to tell to the patients according to his knowledge the present situation, what has happened before, and what is going to happen in the future’ (Hippocrates).

Communication Between Physicians and Older Women With Localized Breast Cancer: Implications for Treatment and Patient Satisfaction

Article

Feb 2002

PURPOSE: To identify factors associated with patient-physician communication and to examine the impact of communication on patients’ perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients. MATERIALS AND METHODS: Data were collected from 613 pairs of surgeons and their older (≥ 67 years) patients diagnosed with localized breast cancer. Measures of patients’ self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes. RESULTS: Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients (≥ 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients’ perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery. CONCLUSION: Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.

Brown JB, Boles M, Mullooly JP, Levinson W. Effects of clinician communication skills training on patient satisfaction

Article

Dec 1999

Jonathan B Brown

Background: Although substantial resources have been invested in communication skills training for clinicians, little research has been done to test the actual effect of such training on patient satisfaction. Objective: To determine whether clinicians' exposure to a widely used communication skills training program increased patient satisfaction with ambulatory medical care visits. Design: Randomized, controlled trial. Setting: A not-for-profit group-model health maintenance organization in Portland, Oregon. Participants: 69 primary care physicians, surgeons, medical subspecialists, physician assistants, and nurse practitioners from the Permanente Medical Group of the North-west. Intervention: Thriving in a Busy Practice: Physician-Patient Communication, a communication skills training program consisting of two 4-hour interactive workshops. Between workshops, participants audiotaped office visits and studied the audiotapes. Measurements: Change in mean overall score on the Art of Medicine survey (HealthCare Research, Inc., Denver, Colorado), which measures patients' satisfaction with clinicians' communication behaviors, and global visit satisfaction. Results: Although participating clinicians' self-reported ratings of their communication skills moderately improved, communication skills training did not improve patient satisfaction scores. The mean score on the Art of Medicine survey improved more in the control group (0.072 [95% CI, -0.010 to 0.154]) than in the intervention group (0.030 [Cl, -0.060 to 0.120]). Conclusions: Thriving in a Busy Practice: Physician-Patient Communication, a typical continuing medical education program geared toward developing clinicians' communication skills, is not effective in improving general patient satisfaction. To improve global visit satisfaction, communication skills training programs may need to be longer and more intensive, teach a broader range of skills, and provide ongoing performance feedback.

Breast cancer care in older women

Article

Aug 1998
CANCER-AM CANCER SOC

BACKGROUND The authors studied older women with breast cancer and asked: 1) where do older women get information regarding breast cancer care and how helpful do they perceive each of these sources to be? and 2) what aspects of social support are associated with older women's general and breast cancer specific emotional health outcomes?METHODS To be eligible, women had to be at least 55 years of age and newly diagnosed with TNM Stage I or II breast cancer. Data were collected from women's surgical records and a 35-minute, computer-assisted telephone interview.RESULTSNearly all women rated information that was provided by their breast cancer physicians as very or somewhat helpful. Written materials provided by breast cancer physicians also were frequently rated as very or somewhat helpful. Women's marital status, religious service attendance, ratings of their physicians' technical and interpersonal care, and perceptions of their own abilities to communicate with their physicians were significantly associated with both general and breast cancer specific emotional health outcomes (all P < 0.05).CONCLUSIONS Although older women obtained information regarding breast cancer from a variety of sources, they relied heavily on their physicians for information. To care most effectively for this group of patients, an increased understanding of the relation between the processes and outcomes of breast cancer care is needed Identifying older women with breast cancer at risk for poor emotional health outcomes and developing methods to enhance physician-patient communication in this setting may improve these outcomes. Cancer 1998;83:706-711. © 1998 American Cancer Society.

When the diagnosis is cancer: Patient communication experiences and preferences

Article

Jun 1996
CANCER-AM CANCER SOC

Background: Discrepancies exist between reported experiences of patients when they have been given a diagnosis of cancer, published guidelines for telling a diagnosis, and patterns of communication patients rate as favorable. Several studies have identified what happened and what is important to cancer patients when told their diagnosis, but no studies have addressed subsequent communications concerning the implications of the diagnosis and treatment choices. This study extended previous research by investigating the experiences and preferences for communication about diagnosis, prognosis, and treatment of patients diagnosed with breast cancer or melanoma. Methods: A self-report questionnaire was designed for this study based on previous research and qualitative data generated from focus groups. Patients with breast cancer or melanoma answered questions about their experiences with communication at the time of diagnosis and concerning prognosis, treatment and related issues. Comparisons were made between patient experiences, preferences and published guidelines. Differences between the experiences of breast cancer and melanoma patients were tested and the relationship between communication and subsequent psychological adjustment to cancer was assessed. Results: Patient preferences for communication during diagnostic consultation were not always consistent with published guidelines. Type of cancer did not significantly affect patient preferences. Psychological adjustment was related to patient ratings of the quality of doctor discussion about treatment options, but not about the diagnosis of cancer and its implications. Patients who wanted more emotional support at the time of diagnosis subsequently experienced poorer psychological adjustment. Conclusions: The differences in patient preferences show that a list of prescriptions for how to disclose a cancer diagnosis is too simplistic. Guidelines for clinicians should be derived from patient-based data rather than be limited only to clinical opinion. Guidelines concerning communication at the time of diagnosis also need to address discussions concerning the implications of the diagnosis and making treatment decisions.

Influence of Physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making

Article

Aug 1994
CANCER-AM CANCER SOC

Physician-patient communication is of critical importance when a breast cancer diagnosis is made, because the emotionally overwhelmed patient must be educated about her disease and available treatments so she can participate in decisions about her care. A research study addressed the hypothesis that patients whose surgeons used psychotherapeutic techniques during the cancer diagnostic interview would have better psychologic adjustment to their cancer. One hundred women surveyed 6 months after surgery completed the Cancer Diagnostic Interview Scale (CDIS) and the SCL-90-R, a measure of psychologic well being. Factor analysis of the CDIS revealed that the physician's caring attitude was perceived by the women as most important, with information-giving as a much weaker component. Multiple regression analysis supported the hypothesis that psychologic adjustment was predicted by physician behavior during the cancer diagnostic interview. Other significant predictors of adjustment were a history of psychiatric problems and premorbid life stressors. Provision of information needed for decision-making appears to be valued largely within the context of a caring physician-patient relationship. Specific surgeons' behaviors believed to facilitate patient adjustment include expressing empathy, allowing sufficient time for patients to absorb the cancer diagnosis, providing information, and engaging the patient in treatment decision-making.

Effect of Clinical Communication Skills Training on Patient Satisfaction

Article

Dec 1999

Although substantial resources have been invested in communication skills training for clinicians, little research has been done to test the actual effect of such training on patient satisfaction. To determine whether clinicians' exposure to a widely used communication skills training program increased patient satisfaction with ambulatory medical care visits. Randomized, controlled trial. A not-for-profit group-model health maintenance organization in Portland, Oregon. 69 primary care physicians, surgeons, medical subspecialists, physician assistants, and nurse practitioners from the Permanente Medical Group of the Northwest. "Thriving in a Busy Practice: Physician-Patient Communication," a communication skills training program consisting of two 4-hour interactive workshops. Between workshops, participants audiotaped office visits and studied the audiotapes. Change in mean overall score on the Art of Medicine survey (HealthCare Research, Inc., Denver, Colorado), which measures patients' satisfaction with clinicians' communication behaviors, and global visit satisfaction. Although participating clinicians' self-reported ratings of their communication skills moderately improved, communication skills training did not improve patient satisfaction scores. The mean score on the Art of Medicine survey improved more in the control group (0.072 [95% CI, -0.010 to 0.154]) than in the intervention group (0.030 [CI, -0.060 to 0.1201). "Thriving in a Busy Practice: Physician-Patient Communication," a typical continuing medical education program geared toward developing clinicians' communication skills, is not effective in improving general patient satisfaction. To improve global visit satisfaction, communication skills training programs may need to be longer and more intensive, teach a broader range of skills, and provide ongoing performance feedback.

Dimensions of Patient Attitudes Regarding Doctors and Medical Care Services

Article

Sep 1975
MED CARE

The factor analytic development and validation of numerous index scores to measure patient attitudes regarding characteristics of doctors and medical care services is described. Index scores meeting factor analytic criteria and found to be reliable were used to study the nature and number of attitudinal dimensions underlying patient satisfaction. The use of index scores which have met logical and empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis. Four major dimensions of patient attitudes were identified and described, including attitudes toward doctor conduct (humanness and quality) and such enabling components as availability of services, continuity/convenience of care and access mechanisms (cost, payment mechanisms, and ease of emergency care). Measures of attitudes toward caring (humanness) and curing (quality/competence) aspects of doctor conduct appear to reflect the same underlying attitudinal dimension. Findings are discussed in relation to concepts and measures mentioned in the published literature and suggestions are offered for future research.

Surveys of Patient Satisfaction: 1 - Important General Considerations

Article

May 1991

R Fitzpatrick

Cancer patient satisfaction with care

Article

Aug 1990

A diagnosis of cancer places considerable stress on patients and requires them to make major adjustments in many areas of their lives. As a consequence, considerable demands are placed on health care providers to satisfy the complex care needs of cancer patients. Currently, there is little available information to indicate the extent to which cancer patients are satisfied with the quality of care they receive. The present study assessed the perceptions of 232 ambulatory cancer patients about the importance of and satisfaction with the following aspects of care: doctors technical competence and interpersonal and communication skills, accessibility and continuity of care, hospital and clinic care, nonmedical care, family care, and finances. The results indicate that all 60 questionnaire items used were considered to reflect important aspects of care, but that greater importance was given to the technical quality of medical care, the interpersonal and communication skills of doctors, and the accessibility of care. Most patients were satisfied with the opportunities provided to discuss their needs with doctors, the interpersonal support of doctors, and the technical competence of doctors. However, few patients were satisfied with the provision of information concerning their disease, treatment, and symptom control and the provision of care in the home and to family and friends.

Exploring patient satisfaction with out-patient services

Article

Apr 1995

Despite the widespread use of satisfaction surveys to obtain patients' views about health services, the validity and relevance of self-completion questionnaire surveys has been questioned. This paper reports on an exploratory, qualitative investigation into patients' perspectives on satisfaction and dissatisfaction with out-patient care. Eighty-one new referrals to two out-patient clinics were interviewed before and after their first consultation. Of this initial sample, 23 were interviewed again at their follow-up appointment and a further 10 were interviewed in depth at a location of their choice. The features of the service that drew appreciative comments when they were thought to be present, and criticism when they were felt to be lacking, were: humanity, efficiency, informativeness and continuity of communication. Examples of these features are discussed using patients' own words to illustrate their perspectives. The study demonstrates that unstructured approaches to service evaluation can be employed to develop services which are genuinely listening to their users' views.

Patient satisfaction with communication in general surgery: Problems of measurement and improvement

Article

Oct 1993

Philip Meredith

The research reported here is taken from a pilot inquiry into patient experiences of general surgery provided in National Health Service hospitals. This study sought to identify how the cross section of patients facing general surgery experienced communication and information problems particular to their surgical 'settings', how such discontent is understood or rationalised by them, and consequently how it would be reported to relatives or researchers. Drawing on interviews with patients and surgical staff, the paper explores the range of communication difficulties facing certain types of patient which arise from the hospital setting and the routines and rituals of service providers. While it is concluded that communication should be explored with some reference to disease classification, this should not divert attention from the general context of care to the unique circumstances of patient or surgeon. It is questioned whether patients are always disposed to rationalise their difficulties in terms of 'dissatisfaction' in the way required by survey research. Drawing on interview-generated comments by patients and staff, the paper illustrates less obvious validity problems for patient satisfaction studies, and addresses briefly questionnaire design which may account for them.

Helping Health Professionals Involved in Cancer Care Acquire Key Interviewing Skills--The Impact of Workshops

Article

Sep 1996
EUR J CANCER

To assess the impact of workshops on key interviewing skills, 169 health professionals involved in cancer care interviewed a simulated patient immediately before and after the workshops and 6 months later. Each interview was audiotaped, transcribed and rated by trained raters using a newly developed rating system which permits an utterance by utterance analysis. The workshops led to significant increases in the use of three behaviours which promote patient disclosure of key concerns. Namely, open directive questions, questions with a psychological focus and clarification of psychological aspects. However, there was no increase in the use of educated guesses and empathic statements which promote disclosure of key problems and feelings. There were significant reductions in behaviours which inhibit disclosure including the use of questions with a physical focus, utterances clarifying physical aspects and the giving of advice prematurely. These significant gains were still evident 6 months later, but there had been some decline over time. There were also significant improvements in the ability of health professionals to elicit patients key problems. Before the workshop, 75 (44%) participants were able to identify at least 60% of their patients' main problems (a criterion of clinical competence) compared with 119 (70%) at 6-month follow-up, an increase in numbers of 59%. Before training, health professionals used as many behaviours which inhibit disclosure as those that promote it. This was unaffected by their professional discipline, prior training or age. It highlights the need for health professionals involved in cancer care to have training in these communication skills. We believe that more intensive group work in smaller groups which focuses on the feelings and attitudes of participants as well as their interviewing behaviour would lead to an increase in the use of educated guesses and empathy and better exploration of patients' feelings.

Is it worth the wait? A survey of patients’ satisfaction with an oncology outpatient clinic

Article

Apr 1997

Increasing numbers of cancer survivors and the tradition of long-term follow-up in the outpatient clinic has resulted in overcrowded oncology clinics and long waiting times. Little is known about patients' perceptions of their clinic attendance. This survey of 252 oncology patients investigated patients' satisfaction with the clinic, anxiety associated with clinic attendance and the strengths and weaknesses of the oncology service. Results demonstrated high levels of satisfaction. Far from being perceived as anxiety-provoking, the clinic was looked upon as a valuable source of reassurance, 92% of patients reporting they were 'always' or 'usually' reassured as a consequence of their visit. Qualitative data showed that clinic staff were the most important source of satisfaction. Waiting was overwhelmingly the worst aspect of the clinic, described by 27% of patients as 'excessively long'. One-fifth of the total sample had attended the clinic for 10 years or more and over a third of this group reported they would be worried at the prospect of being discharged to the care of their general practitioners. Despite disadvantages associated with long waits, the clinic was perceived as providing a valuable source of reassurance which a proportion of patients were clearly reluctant to be without.

Breast cancer care in older women: Sources of information, social support, and emotional health outcomes

Article

Aug 1998

The authors studied older women with breast cancer and asked: 1) where do older women get information regarding breast cancer care and how helpful do they perceive each of these sources to be? and 2) what aspects of social support are associated with older women's general and breast cancer specific emotional health outcomes? To be eligible, women had to be at least 55 years of age and newly diagnosed with TNM Stage I or II breast cancer. Data were collected from women's surgical records and a 35-minute, computer-assisted telephone interview. Nearly all women rated information that was provided by their breast cancer physicians as very or somewhat helpful. Written materials provided by breast cancer physicians also were frequently rated as very or somewhat helpful. Women's marital status, religious service attendance, ratings of their physicians' technical and interpersonal care, and perceptions of their own abilities to communicate with their physicians were significantly associated with both general and breast cancer specific emotional health outcomes (all P < 0.05). Although older women obtained information regarding breast cancer from a variety of sources, they relied heavily on their physicians for information. To care most effectively for this group of patients, an increased understanding of the relation between the processes and outcomes of breast cancer care is needed Identifying older women with breast cancer at risk for poor emotional health outcomes and developing methods to enhance physician-patient communication in this setting may improve these outcomes.

How valid and reliable are patient satisfaction data? An analysis of 195 studies

Article

Sep 1999

John Sitzia

To assess the properties of validity and reliability of instruments used to assess satisfaction in a broad sample of health service user satisfaction studies, and to assess the level of awareness of these issues among study authors. Examination and analysis of 195 papers published in 1994 in 139 journals. The following databases were searched: British Nursing Index, CINAHL, EMBASE, MedLine, Popline, and PsycLIT. Number and types of strategies used for content, criterion, and construct validity, and for stability and internal consistency. Associations between validity/reliability and other study characteristics. Eighty-nine (46%) of the 195 studies reported some validity or reliability data; 76 reported some element of content validity; 14 reported criterion validity, with patient's intent to return the most commonly used criterion; four reported construct validity. Thirty-four studies reported internal consistency reliability, 31 of which used Cronbach's coefficient alpha; eight studies reported test-retest reliability. Only 11 studies (6% of the 181 quantitative studies) reported content validity and criterion or construct validity and reliability. 'New' instruments designed specifically for the reported study demonstrated significantly less evidence for reliability/validity than did 'old' instruments. With few exceptions, the study instruments in this sample demonstrated little evidence of reliability or validity. Moreover, study authors exhibited a poor understanding of the importance of these properties in the assessment of satisfaction. Researchers must be aware that this is poor research practice, and that lack of a reliable and valid assessment instrument casts doubt on the credibility of satisfaction findings.

Patients need more than written prompts for communication to be successful

Article

Feb 2000

EDITOR—We were interested in Slowie's suggestions on helping patients to communicate better with them1 as we recently carried out a randomised controlled trial to test a written prompt to aid doctor—patient communication in an outpatient setting.2 We sent a letter and help card to a random sample of patients at home before their appointment to encourage them …

Unsaid but Not Forgotten: Patients' Unvoiced Desires in Office Visits

Article

Oct 2001
ARCH INTERN MED

To examine patient, physician, and health care system characteristics associated with unvoiced desires for action, as well as the consequences of these unspoken requests. Patient surveys were administered before, immediately after, and 2 weeks after outpatient visits in the practices of 45 family practice, internal medicine, and cardiology physicians working in a multispecialty group practice or group model health maintenance organization. Data were collected at the index visit from 909 patients, of whom 97.6% were surveyed 2 weeks after the outpatient visit. Before the visit, patients rated their trust in the physician, health concerns, and health status. After the visit, patients reported on various types of unexpressed desires and rated their visit satisfaction. At follow-up, patients rated their satisfaction, health concerns, and health status, and also described their postvisit health care use. Evaluations of the visit were also obtained from physicians. Approximately 9% of the patients had 1 or more unvoiced desire(s). Desires for referrals (16.5% of desiring patients) and physical therapy (8.2%) were least likely to be communicated. Patients with unexpressed desires tended to be young, undereducated, and unmarried and were less likely to trust their physician. Patients with unvoiced desires evaluated the physician and visit less positively; these encounters were evaluated by physicians as requiring more effort. Holding an unvoiced desire was associated with less symptom improvement, but did not affect postvisit health care use. Patients' unvoiced needs affect patients' and physicians' visit evaluations and patients' subjective perceptions of improvement. Implications of these findings for clinical practice are examined.

Patients’ Perceptions of Receiving Bad News About Cancer

Article

Dec 2001

The purpose of this investigation was to document patients' recollections about what transpired during bad news interactions between physicians and themselves. One hundred twenty cancer patients provided information about the most recent time they received bad cancer-specific news. Using a series of descriptive statements, patients reported on what the physician did while communicating the bad news. Patients also indicated the extent to which they were satisfied with the transaction and whether they believed that the interaction had any long-lasting impact on their adjustment or on their subsequent interactions with the physician who delivered the news. Overall, patients reported having similar experiences, with most physicians behaving in ways that were consistent with advice published in the medical literature. Satisfaction with the bad news transaction was high. Younger patients and women found the transaction to be more stressful, and older patients believed that the transaction was less important for subsequent interactions with the physician. Logistic regression analyses indicated that satisfaction with the transaction was uniquely predicted by factors related to the environment, to what the physician said, and to how the physician said it. Despite high levels of self-reported satisfaction by patients, some factors differentiated the most satisfied patients from patients who were less satisfied. The findings suggest that special attention should be given to making the environment comfortable, taking plenty of time with the patient, and attempting to empathize with the patient's experiences.

Can Communication Skills Training Alter Physicians' Beliefs and Behavior in Clinics?

Article

Mar 2002

To measure the psychosocial attitudes and beliefs of physicians working within oncology in the United Kingdom and to examine whether beliefs alter after communication skills training. Additionally, to investigate whether physicians' attitudes are reflected in communication behaviors with patients during interviews. Ninety-three physicians completed a 32-item Physician Psychosocial Belief (PPSB) questionnaire at baseline (T1) before randomization to attendance at a 3-day residential communication skills course (n = 48) or a control group (n = 45). Three months later (T2), both groups completed another PPSB and a self-assessment questionnaire recording perceived changes in communication with patients. At both time points, physicians' consultations with two consenting patients were videotaped. Communication behaviors were measured using the Medical Interaction Processing System. Physicians who attended the course showed significantly improved attitudes and beliefs toward psychosocial issues compared with controls (P =.002). This improvement was reflected in the analysis of the videotaped recordings of their communication behaviors with patients. Expressions of empathy were more likely for the course group at T2 than the controls (P =.02), as were open questions (P =.001), appropriate responses to patient cues (P =.005), and psychosocial probing (P =.041). These objective findings were supported by physicians' self report of changes in communication style during interviews with patients. Our results show that a communication skills training intervention using behavioral, cognitive, and affective components not only increases potentially beneficial and more effective interviewing styles but can also alter attitudes and beliefs, thus increasing the likelihood that such skills will be used in the clinical setting.

Communication in the cancer 'bad news' consultation: Patient perceptions and psychological adjustment

Article

Jan 2002

The purpose of this study was to explore relationships between breast cancer survivors' experiences during the diagnostic consultation and their subsequent long-term psychological adjustment. Sixty women (M age=53 years) who had been diagnosed with local or regional breast cancer (Stage 0-IIIA) an average of 28 months prior were interviewed by telephone. Measures included: Cancer Diagnostic Interview Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist - Civilian Version, Center for Epidemiologic Studies Depression Scale, and ad hoc items regarding memory for, and satisfaction with, the diagnostic consultation. After controlling for demographic and clinical variables, the three CDIS subscales accounted for 12% of the variance in women's PCL-C scores (F change=3.46, p<0.05). The CDIS-Caring subscale was a significant predictor in the 'best-fit' regression model for each of the three indices of long-term distress (all B's>-0.23, p<0.05). In contrast, the CDIS-Competence subscale was not a significant predictor in any of the 'best-fit' models. Additionally, women's satisfaction with physician behavior during the diagnostic consultation was unrelated to all adjustment measures (r's<0.10, p's>0.50). Findings suggest that women's perceptions of physicians' interpersonal skills during the diagnostic consultation are associated with later psychological adjustment.

The effectiveness of a computer-assisted instruction programme on communication skills of medical specialists in oncology

Article

Mar 2002

Although doctor--patient communication is important in health care, medical specialists are generally not well trained in communication skills. Conventional training programmes are generally time consuming and hard to fit into busy working schedules of medical specialists. A computer-assisted instruction (CAI) programme was developed -- 'Interact-Cancer' -- which is a time-efficient learning method and easily accessible at the workplace. To investigate the effect of the CAI training, 'Interact-Cancer', on the communication behaviour of medical specialists, and on satisfaction of patients about their physician interaction. Consultations of medical specialists with cancer outpatients were videotaped at 4 specific stages, 2 before and 2 after Interact-Cancer, with intervals of 4 weeks. Participants were 21 medical specialists, mainly internists, working in 7 hospitals, and 385 cancer outpatients. Communication behaviour was assessed on 23 observation categories derived from the course content. Frequencies were rated as well as judgements about the quality of the performance of each target skill. Satisfaction was measured by the Medical Interview Satisfaction Scale. Data were analyzed by means of multilevel statistical methods. The behavioural assessment showed course effects on ratings of the physicians' quality of performance. No course effects were found on the frequencies of physicians' behaviours and on the patient satisfaction ratings. CAI is a promising method to supply medical specialists with postgraduate training of communication skills. The application of judgement ratings of communication behaviour proved to be valuable to evaluate course effects in real-life patient encounters.

Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves BEfficacy of a Cancer Research UK communication skills model: a randomised controlled trial. Lancet 359: 650-656

Article

Mar 2002

Doctors' communication with patients is commonly hampered by lack of training in this core skill. This study aimed to assess the efficacy of an intensive 3-day training course on communication skills in a randomised controlled trial with a two-by-two factorial design and several outcomes. 160 oncologists from 34 UK cancer centres were randomly allocated to four groups: written feedback followed by course; course alone; written feedback alone; and control. At each of two assessment periods, consultations with six to ten consecutive, consenting patients per doctor were videotaped. 2407 patients participated. Outcome measures included objective and subjective ratings made by researchers, doctors, and patients. The primary outcomes were objective improvements after the intervention in key communication skills. Course content included structured feedback, videotape review of consultations, role-play with simulated patients, interactive group demonstrations, and discussion led by a trained facilitator. In Poisson regression analysis of counts of communication behaviours, course attendance significantly improved key outcomes. The estimated effect sizes corresponded to higher rates of use of focused questions (difference between course attenders [n=80] and non-attenders [n=80] 34%, p=0.003), focused and open questions (27%, p=0.005), expressions of empathy (69%, p=0.003), and appropriate responses to patients' cues (38%, p=0.026), and a 24% lower rate of use of leading questions (p=0.11). There was little evidence for the effectiveness of written feedback. The communication problems of senior doctors working in cancer medicine are not resolved by time and clinical experience. This trial shows that training courses significantly improve key communication skills. More resources should be allocated to address doctors' training needs in this vital area.

Doctor-Patient communication and cancer patients' quality of life and satisfaction

Article

Oct 2000
PATIENT EDUC COUNS

In this study, the relationship between (a) doctor's and patients' communication and (b) doctors' patient-centredness during the oncological consultation and patients' quality of life and satisfaction was examined. Consultations of 96 consecutive cancer patients were recorded and content analysed by means of the Roter Interaction Analysis System. Data collection (mailed questionnaires) took place after 1 week and after 3 months. Oncologists' behaviours were unrelated to patients' quality of life. Their socio-emotional behaviours related to both patients' visit-specific and global satisfaction. Patients' behaviour related to both patient outcomes although mostly to satisfaction. Multiple regression analyses showed that patients' quality of life and satisfaction were most clearly predicted by the affective quality of the consultation. Surprisingly, oncologists' patient-centredness was negatively related to patients' global satisfaction after 3 months. In summary, doctor-patient communication during the oncological consultation is related to patients' quality of life and satisfaction. The affective quality of the consultation seems to be the most important factor in determining these outcomes.

Communication Planning to Help Breast Cancer Patients Prepare for Medical Consultations

Article

Jul 2002

To measure the prevalence of communication barriers between breast cancer patients and their physicians and to present the results of a study evaluating the impact of two visit preparation techniques on communication and satisfaction for breast cancer patients and their physicians. We recruited 132 breast cancer patients from two outpatient cancer centers in a sequential, controlled trial. Ninety-four consented and completed the trial. Patients were assigned to one of two visit preparation interventions before their appointment with either a surgeon or a medical oncologist. In the control intervention, called Productive Listening, a researcher listened to and prompted patients to reflect on their experiences communicating with physicians. In the experimental intervention, called Consultation Planning, a researcher elicited questions and concerns, generated a printed agenda for the upcoming consultation, and engaged patients in techniques to improve communication with their physicians. Valid and reliable surveys measured communication barriers, satisfaction with the intervention, and patients' and physicians' satisfaction with the consultation. Sixty-four percent of the patients reported three or more communication barriers. Patients reported a significant reduction in communication barriers after both the intervention and the control session. Patients reported significantly higher satisfaction after the Consultation Planning sessions. Physicians reported significantly higher satisfaction with those patients who had participated in a Consultation Planning session. Visit preparation sessions help patients prepare for medical consultations and reduce barriers to communication. Consultation Planning sessions, in which a researcher solicited the patient's agenda, were more satisfying to patients and physicians than the Productive Listening sessions.

‘Satisfaction with care’: Associations with health-related quality of life and psychosocial function among Swedish patients with endocrine gastrointestinal tumours

Article

Jul 2002

The aims of this study were to investigate 'satisfaction with care' and its possible relationships to hope, health-related quality of life, anxiety and depression. Eighty-five patients with endocrine gastrointestinal (GI) tumours responded to questionnaires a few days after a hospital visit. 'Satisfaction with care' was assessed by the Comprehensive Assessment of Satisfaction with Care (CASC), health-related quality of life by the EORTC QLQ C-30 and anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Patients' highest satisfaction scores were obtained for 'general satisfaction' and 'nurses' and doctors' technical skills'. The lowest satisfaction was expressed for 'doctors' interpersonal skills', 'nurses' communication skills' and 'care organization'. Patients reporting a clinically relevant level of anxiety were less satisfied with several care aspects than those reporting less anxiety. Satisfaction with 'nurses' communication skills' and 'doctors' interpersonal skills' was associated with several aspects of health-related quality of life, whereas satisfaction with 'doctors' information', 'nurses' technical skills' and 'general satisfaction' was not. Satisfaction with psychosocial aspects of care is related to the psychosocial function of patients with endocrine GI tumours.

Roter DL, Hall JA, Aoki YPhysician gender effects in medical communication: a meta-analytic review. JAMA 288: 756-764

Article

Sep 2002

Physician gender has been viewed as a possible source of variation in the interpersonal aspects of medical practice, with speculation that female physicians facilitate more open and equal exchange and a different therapeutic milieu from that of male physicians. However, studies in this area are generally based on small samples, with conflicting results. To systematically review and quantify the effect of physician gender on communication during medical visits. Online database searches of English-language abstracts for the years 1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was conducted of reprint files and the reference sections of review articles and other publications. Studies using a communication data source, such as audiotape, videotape, or direct observation, and large national or regional studies in which physician report was used to establish length of visit, were identified through bibliographic and computerized searches. Twenty-three observational studies and 3 large physician-report studies reported in 29 publications met inclusion criteria and were rated. The Cohen d was computed based on 2 reviewers' (J.A.H. and Y.A.) independent extraction of quantitative information from the publications. Study heterogeneity was tested using Q statistics and pooled effect sizes were computed using the appropriate effects model. The characteristics of the study populations were also extracted. Female physicians engage in significantly more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk. There were no gender differences evident in the amount, quality, or manner of biomedical information giving or social conversation. Medical visits with female physicians are, on average, 2 minutes (10%) longer than those with male physicians. Obstetrics and gynecology may present a different pattern than that of primary care, with male physicians demonstrating higher levels of emotionally focused talk than their female colleagues. Female primary care physicians engage in more communication that can be considered patient centered and have longer visits than their male colleagues. Limited studies exist outside of primary care, and gender-related practice patterns in some subspecialties may differ from those evident in primary care.

Cancer National Overview

D O Health

Health DO. 2002. Cancer National Overview 1999/2000: National Survey of NHS Patients. Department of Health, London.

Cancer National Overview 1999/2000: National Survey of NHS Patients. Department of Health

Jan 2002

D O Health
Health DO

Factors affecting patient and clinician satisfaction with the clinical consultation: Can communication skills training for clinicians improve satisfaction?

Abstract

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