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Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions. Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway. Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.
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How does communication heal? Pathways linking clinician–patient
communication to health outcomes
Richard L. Street Jr.
*, Gregory Makoul
, Neeraj K. Arora
, Ronald M. Epstein
Texas A&M University, College Station, TX, United States
The Houston Center for Quality of Care and Utilization Studies and Baylor College of Medicine, Houston, TX, United States
Saint Francis Hospital and Medical Center, Hartford, CT, United States
Outcomes Research Branch, ARP, DCCPS, National Cancer Institute, Bethesda, MD, United States
Department of Family Medicine, Psychiatry and Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
1. Introduction
Oneof themost interesting,but leastunderstoodfindingsin health
communication is provided by studies that have established an
association between clinician–patient communication and patient
healthoutcomes [1–6]. Yet, researchers seldomtry to test hypotheses
explaining how communication might impact patient health.
The purpose of this article is three-fold. First, we offer a brief
critique of current approaches to the study of communication and
health outcomes. Second, we identify specific pathways through
which communication can lead to better health. Finally, we
propose a research agenda to discover mechanisms that can
explain and influence ways in which communication affects
health. Relevant health outcomes include disease markers (e.g.,
blood pressure, tumor markers), survival, and quality of life (e.g.,
functioning and well-being in physical, psychological and social
2. Clinician–patient communication and outcomes: the state of
the science
Research linking communication to improved health outcomes
typically falls into two categories. First, a number of RCTs have
examined the effects of interventions designed to alter clinician
and patient communication and decision-making in medical
encounters [7,8]. In a review of these studies, Griffin et al. [8]
demonstrated that communication interventions generally pro-
moted physician and/or patient communication behaviors thought
to be desirable and effective (e.g., patients asking more questions;
physicians using more patient-centered communication), but less
than half (44%) of the studies were associated with improved
outcomes. Moreover, similar interventions had different effects
across studies, likely because the outcomes were measured
differently and were associated with small sample sizes.
Patient Education and Counseling 74 (2009) 295–301
Article history:
Received 31 July 2008
Received in revised form 19 November 2008
Accepted 24 November 2008
Physician–patient communication
Health outcomes
Disease management
Although prior research indicates that features of clinician–patient communication can
predict health outcomes weeks and months after the consul tation, the mechanisms accounting for these
findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient’s anxiety,
providing comfort), more often clinician–patient communication influences health outcomes via a more
indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician–
patient agreement. These affect intermediate out comes (e.g., increased adherence, better self-care skills)
which, in turn, affect health and well-being. Seven pathways through which communication can lead to
better health include increased access to care, greater patient knowledge and shared understanding,
higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient
agency and empowerment, and better management of emotions.
Conclusion: Future research should hypothesize pathways connecting communication to health
outcomes and select measures specific to that pathway.
Practice implications: Clinicians and patients should maximize the therapeutic effects of communication
by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual under-
standing, adherence, social support, self-efficacy) associated with improved health.
ß2008 Elsevier Ireland Ltd All rights reserved.
* Corresponding author at: Department of Communication, Texas A&M
University, College Station, TX 77843-4234, United States.
Tel.: +1 979 845 0209; fax: +1 979 845 6594.
E-mail address: (R.L. Street Jr.).
Contents lists available at ScienceDirect
Patient Education and Counseling
journal homepage:
0738-3991/$ – see front matter ß2008 Elsevier Ireland Ltd All rights reserved.
The second group consists of cross-sectional, descriptive
studies that have reported correlations between physician and
patient communication behaviors and different health outcomes.
For example, various features of patient-centered communication
– physicians’ clear explanations, physician compassion, active
patient participation, and patient involvement in decision-making
– have correlated with lower blood pressure [9], less patient
anxiety [10], less organ damage among patients with systemic
lupus erythematosus [11], and higher quality of life among breast
cancer patients [12]. However, other studies have found null to
mixed results regarding relationships between communication
and health outcomes [12–14].
The inconsistency of these findings from both RCT and cross-
sectional studies is likely due to a number of factors. First, research
to date has failed to explicate processes and fundamental
pathways linking communication to outcomes. As most of the
research is correlational, causal explanation can only be inferred.
For example, in one of our own early studies [15], patients with
diabetes had poorer metabolic control after consultations with
nurses who used more controlling communication (e.g., interrup-
tions, directives, disagreement). One might infer that the nurses’
dominance prevented patient involvement in decision-making
which in turn led to less adherence and understanding of the
treatment regimen. However, an alternative explanation may be
that nurses were more controlling with less cooperative and
adherent patients (i.e., patients at higher risk of poor control). Thus,
it is not clear which came first, patient lack of follow-through or
nurse’s controlling behavior, or whether this represented a cycle of
escalating dysfunctional communication.
Second, it remains unclear what elements of communication
are associated with specific outcomes. Several researchers have
identified key functions of patient-centered communication
including information exchange, managing uncertainty, enabling
patient self-management, responding to emotions, fostering the
clinician–patient relationship, and making decisions [3,16,17].
However, the manner in which a particular communication
function might or might not lead to improved health remains
untested. For example, in a RCT of a clinician communication
intervention to promote physician active listening and negotiation
skills with their patients with diabetes, patients in the intervention
group reported greater satisfaction with communication and
greater well-being. However there was no effect on metabolic
control, and these patients tended to gain more weight than the
control group [18]. In short, the intervention led to patients having
better feelings about their health, but no improvement in clinical
markers of disease and poorer management of risk factors. Thus, a
general statement that better outcomes are associated with better
communication would be uninformative because it fails to specify
which elements of communication are associated with which
health outcomes.
Third, researchers rarely address, if even acknowledge, the need
to situate clinician–patient communication within the broader
context of physiological, personal, and social determinants of
health. Once the patient leaves the consultation any number of
factors may affect subsequent health. The communication that led
to a decision to undergo chemotherapy would be associated with a
positive health outcome if the patient had transportation to receive
the treatment, could afford the treatment, was able to tolerate the
treatment, and the treatment was effective in curing the cancer.
Yet, that same communication might not lead to a good outcome if
the patient terminated treatment because of side effects, had
unreliable transportation, substituted questionable herbal reme-
dies for chemotherapy, or the cancer did not respond to treatment.
Research to date has not adequately examined how the relation-
ship between communication and health may be mediated
through the effects of communication on behavior change,
adherence, and self-efficacy or how communication might
moderate the relationship of well known social determinants of
health, the nature of which will depend on the clinical context.
Fourth, measurement matters. At the most basic level, different
operational and conceptual definitions of the variables to be
measured are problematic. For instance, two recent reviews
revealed that there is no shared definition of shared decision-
making [19,20]. Further, different methods of measuring commu-
nication (e.g., self-report vs. observer coding) may generate very
different assessment of the behavior [21]. For example, even
though an observer coding system indicated that the clinician
provided treatment information, it may not have been understood
by the patient, or perceived as having been informative [22].
Similarly, patient reports of involvement in decision-making may
not correspond with observers’ judgments about whether parti-
cipation had occurred [23].
Explaining how and why communication contributes to health
outcomes requires a deeper understanding of how specific, well-
defined aspects of communication are linked to specific outcomes,
as well as an understanding of how contextual factors – within the
clinical setting as well as family and social factors extrinsic to the
clinical setting – moderate or mediate the effects of communica-
tion on health. This requires that investigators move beyond
descriptive conceptual frameworks to formulate theoretical
explanations linking communication to health. Moreover,
researchers must also recognize and try to account for the fact
that outcomes, especially those related to cancer and chronic
disease, are likely less influenced by a single clinician–patient
encounter, and more by the cumulative effect of the patient’s
communication over time with their physicians, others on the
health care team, families, and friends.
3. Linking communication to improved health
3.1. What improves physical health?
Physical health status includes pain and other symptoms,
disease markers (e.g., hemoglobin A1C, blood pressure, weight,
prostate-specific antigen), functional capacity (e.g., ability to
walk) and subjective self-ratings of health. There are essentially
four types of therapeutic regimens that lead to improved physical
health—chemical (e.g., medication), mechanical (e.g., surgery),
behavioral (e.g., smoking cessation, diet) and psychological (e.g.,
placebo effects, cognitive therapy). For example, a patient could
experience improved physical health because he or she received
medication that controlled the disease, received necessary
surgical intervention (e.g., a stent), adopted healthier exercise
routines, or believed that the treatment was effective [24,25].
Thus, communication could lead to better physical health if
conversation between clinician and patient helped to identify the
correct diagnosis and appropriate treatment plan, led to following
through with treatment or self-care, and/or affected patients’
health beliefs.
3.2. What improves psychosocial aspects of health?
Psychosocial health is a function of the degree to which an
individual has more positive beliefs and feelings, harbors fewer
negative beliefs and feelings (e.g., worry, anger, anxiety, fear,
despair), and has a well-functioning social network. Psychological
well-being, vitality, self-efficacy, and social functioning [26] are
typically measured by patient (sometimes family) self-report.
Positive psychosocial outcomes can be the direct result of
communicative encounters (including those with clinicians) from
which patients feel known, validated, hope, worthy, reassured, and
comforted [27,28] and indirectly through diagnosis and treatment
R.L. Street Jr. et al. / Patient Education and Counseling 74 (2009) 295–301
of mental disorders (e.g., depression) and reinforcing social
4. Communication pathways to improved health outcomes
To understand why communication may lead to better or worse
health outcomes, researchers must identify the pathway through
which communication influences health and well-being. As shown
in Fig. 1, the pathways through which clinician–patient/family
communication can influence health outcomes may be direct. For
example, talk can be therapeutic in that a physician who validates
the patient’s perspective or expresses empathy may help a patient
experience improved psychological well-being—fewer negative
emotions (e.g., fear, anxiety) and more positive ones (e.g., hope,
optimism, and self-worth) [10,29,30]. Talk may affect physical
symptoms as well. In one study, for example, empathic commu-
nication lowered physiological arousal and pain in patients with
irritable bowel symptoms [31]. Finally, nonverbal behaviors, such
as touch or tone of voice, may directly enhance well-being by
lessening anxiety or providing comfort [32–34].
However, in most cases, communication affects health through a
more indirect or mediated route through proximal outcomes of the
interaction(e.g., satisfaction with care,motivation to adhere, trust in
the clinician and system, self-efficacy in self-care, clinician–patient
agreement, and shared understanding) that could then affect health
or that could contribute to the intermediate outcomes (e.g.,
adherence, self-management skills, social support) that lead to
better health (see Fig. 1)[1,3]. For example, a clinician’s clear
explanations and expressions of support could lead to greater
patient trust and understanding of treatment options (proximal
outcomes). This in turn may facilitate patient follow-through with
recommended therapy (an intermediate outcome), which in turn
improves a particular health outcome (e.g., disease control,
emotional well-being). Or, patient participation in the consultation
could help the physician better understand the patient’s needs and
preferences as wellas discover possible misconceptions the patient
might have about treatment options. The physician can then
communicate risk information in a way the patient understands
which in turn could lead to a mutually agreed upon, higher quality
decision that best matches the patient’s circumstances.
In a recent NationalCancer Institute monograph [3],we proposed
that clinician–patient communication can contribute to improved
health through at least seven ‘pathways’—access to needed care,
increased patient knowledge and shared understanding, enhancing
therapeutic alliances (among clinicians, patient, and family),
enhancing emotional self-management, activating social support
and advocacy resources, increasing the quality of medical decisions
(e.g., informed, clinically sound, concordant with patientvalues, and
mutually endorsed), and enabling patient agency (self-efficacy and
empowerment). Although these pathways were explored with
respect to cancer care, they are certainly applicable to other health
conditions as well.
4.1. Access to care
In the USA, access to care is poor for many patients, particularly
for poorer, less health literate, and uninsured patients [35]. While
barriers to care often are economic, they also involve other factors.
For example, many patients may not be aware that a problem
requires medical attention. Many more may need assistance
navigating a complex health system. Clinicians can contribute to
improved access to care by not only communicating the need for a
test or treatment, but also providing information about where to
get specific health services, facilitating collaboration among health
professionals, and advocating on behalf of the patient for needed
clinical and community services [35–37]. Patients, in turn, may
need coaching to disclose barriers to access (e.g., lack of
transportation, family resistance) and engage with clinicians in
suggesting potential solutions.
4.2. Patient knowledge and shared understanding
Patients must have an understanding of illness, risks, and
benefits of various treatment options in order to make informed
decisions about medical care [38]. Clinicians also need to under-
stand a patient’s values, preferences, and beliefs about health.
However, achieving a shared understanding can be difficult
because clinicians and patients often understand health and
illness through different lenses [39,40]. Clinical evidence is
typically in the form of probabilities applicable to populations,
not individual patients [41]. Patients’ understandings are idiosyn-
cratic and based on the combination of personal experiences,
interpretation of scientific evidence (e.g., acquired through the
mass media or internet), and ‘common sense’ understandings of
Fig. 1. Direct and indirect pathways from communication to health outcomes.
R.L. Street Jr. et al. / Patient Education and Counseling 74 (2009) 295–301
health and illness [42] (e.g., hypertension medicines are taken
when feeling tense [43]; surgery can spread cancer [44]). Similarly,
clinicians’ ‘truths’ are a mixture of personal experience, unex-
amined heuristics, and clinical evidence.
Both clinicians and patients need the skill to present their own
frame-of-reference, and see the others’ point of view, as well as the
ability to explore their own health beliefs, understand relevant
clinical evidence, and articulate their values and preferences [45].
When successful, effective management of information can
increase satisfaction [46], facilitate participation in the consulta-
tion [47], increase the patient’s ability to cope with illness [48],
promote greater trust in their clinicians [49], all of which could
increase the patient’s commitment to treatment [50].
4.3. Enhancing the therapeutic alliance
The therapeutic alliance includes the interrelationships among
the patient and multiple health care professionals, friends, family
members, and caregivers [51,52]. Indicators of a strong therapeutic
alliance include mutual trust among all parties, coordinated and
continuous health care, and the patient’s perception of feeling
respected and cared for [3]. These alliances are ‘therapeutic’
because the quality of these relationships can affect health
outcomes in two respects. First, a patient’s perception that he or
she has good care, will not be abandoned, and is understood can
promote emotional well-being [53–55], especially when facing
serious and life-threatening illness [56]. Second, a patient’s trust in
his or her clinicians and the health care system can have an indirect
effect through better continuity of care, patient satisfaction with
decisions, and patient commitment to treatment plans [57–60].
The clinician–patient alliance is enhanced when clinicians are
optimally informative and show empathy with the patient’s
circumstances, when patients have an opportunity to express their
concerns, and when the patient receives consistent messages and
coordinated care from the clinical team [3].
4.4. Enhancing patients’ ability to manage emotions
A patient’s concernsabout health may elicit a number of negative
emotions (anger, sadness, fear, worry) that can threaten emotional
well-being and even physical health [61,62]. Clinicians can help
patients manage these emotions in ways that directly or indirectly
attenuate or alleviate suffering. First, providing clear and thorough
explanations about health and treatment options can help patients
gain a greater sense of control, be more hopeful, and manage
uncertainty [30]. Second, eliciting, exploring, and validating
patients’ emotions can reduce patient anxiety and depression
[10,63–65]. Third,communication that enhances the patient’s sense
of worth, confidence, and hope may confermeaning, motivation,and
energy needed to pursue work or leisure activities, and allow the
patient to enjoy greater quality of life despite the disease [66].
Success in helping patients manage negative emotions is often
difficult because clinicians are not particularly good judges of the
emotions patients are experiencing [61,62,67,68], patients often try
to hide or mask theirdistress, and some patientsthink the discussion
of negative feelings fall outside the boundaries of clinician–patient
relationships[69–71]. Clinicians can facilitate the patient’s ability to
manage emotions by presenting diagnostic and treatment informa-
tion clearly and honestly [72], by showing interest in the patient’s
life [73], by attentive listening, and by validating patient’s
expressions of feelings [65,74].
4.5. Improving family and social support
Social support consists of patient’s access to emotional, fiscal,
and tangible resources within their social network [75]. Social
support can affect physical health and quality of life in several
ways. First, the perception of having social support may directly
affect physiological processes such as lowering arousal and
reversing the effects of overactivation of hypothalamic-pituitary
axis and psychologically induced immunomodulation [76,77].
Social support can enhance a patient’s emotional well-being by
providing a sense of connectedness with others and opportunities
to discuss difficult situations [78]. Social support networks can also
provide instrumental help (e.g., transportation), financial
resources, encouragement, and advocacy in gaining access to
needed health services [79,80].
Although social support typically is treated as a resource
external to clinical settings, clinician–patient communication can
contribute to social support in several ways. First, the clinician’s
communication itself is a form of support that can offer
encouragement, praise, reassurance, advice, and advocacy [3].
Second, clinicians can talk with patients about ways to strengthen
existing social networks to provide tangible help, emotional
support; they can also suggest new sources of support such as
online support networks [81]. Finally, clinicians could potentially
counter, or at least help address the effects of ‘negative’ social
support (e.g., peer pressure to engage in unhealthy behaviors;
well-intentioned nagging) [82].
4.6. Enhancing patient empowerment and agency
Clinician–patient communication also can improve health by
empowering patients to be active, capable agents in managing
their health. Patient ‘agency’ requires skills across the spectrum of
participation in care, ranging from active participation in medical
encounters and decision-making to self-care skills for managing
everyday health-related activities [83]. Patient involvement can
lead to higher quality decisions that are better suited to the
patient’s unique needs and circumstances. Clinicians can facilitate
patient involvement in the decision-making process by helping
patients actively seek information, clarify treatment goals [84,85],
and express concerns and feelings [86]. Topics discussed during the
clinician–patient conversation could focus on autonomy, self-
efficacy, specific skills in managing one’s health, and where to get
access to self-care resources (e.g., websites, community groups)
that in turn lead to greater ability and motivation to solve health-
related problems, cope with complications, and follow-through
with treatment [87–90]. The importance of enhanced patient
agency has been demonstrated in several studies. For example,
cancer patients’ sense of control over disease has been linked to
emotional well-being and coping during survivorship [12,91].In
diabetes, more effective self-management has led to better
metabolic control and improved functioning [92].
4.7. Higher quality decisions
Patients will more likely experience better health when they
and clinicians reach decisions that are based on the best clinical
evidence, are consistent with patient values, are mutually agreed
upon, and are feasible to implement [3,93,94]. Charles et al. [47]
propose that medical decision-making proceeds through three
stages—information exchange, deliberation, and making the
decision. Information exchange consists of sharing clinician and
patient perspectives, such as the clinical evidence pertinent to the
patient’s condition and the patient’s expression of beliefs, values,
preferences and expectations. Deliberation involves discussion
focused on finding common ground, reconciling differences of
opinion and beliefs, addressing uncertainty, and achieving a shared
understanding of the patient’s health status and the risks and
benefits of different treatment options. The final stage is making
the decision. Although Charles et al. contend that these three
R.L. Street Jr. et al. / Patient Education and Counseling 74 (2009) 295–301
stages are distinctively different with respect to paternalistic,
informed, and shared decision-making styles, we [3] argue that
there can be considerable flexibility as one proceeds through these
stages. For example, some patients may be actively involved in
information exchange and deliberating, but choose to defer the
decision to the clinician; other patients may be relatively passive
by listening to the clinician’s information and opinions, but choose
to make the decision themselves.
Clinician and patient efforts to achieve high quality decisions
often face challenges. First, many decisions are complicated by the
lack of clinical evidence or evidence that is ambiguous or
inconsistent [45]. For example, different experts may give
conflicting recommendations (e.g., surgeons favor surgery for
prostate cancer, while radiation oncologists favor radiation
therapy), and patients may be forced to choose among different
sources of authority. Second, many patients have difficulty in
understanding clinical information, and clinicians may struggle to
place that information in the context of the patient’s unique health
situation. Finally, clinicians and patients often understand risk
differently. Clinicians typically approach risk analytically by
focusing on epidemiological evidence, while patients may perceive
risk based on personal experience and associational meanings [95].
Lack of shared understanding of risks and benefits associated with
different treatments and how the treatment options fit within the
patient’s values and life circumstances may lead to medical errors,
treatment plans that are not feasible, and lower patient commit-
ment to treatment [96].
Thus, the decision quality pathway to better health requires
clinical encounters where patients (and families) and clinicians
present and understand one another’s perspectives, find common
ground, reconcile differences, achieve consensus on treatment and,
when differences cannot be reconciled, negotiate a mutually
acceptable plan.
5. Directions for future research
Future research on the relationship between communication
and outcomes should strive to identify the particular pathways
through which the events of the consultation can affect subsequent
health and well-being. In fact, researchers might be advised to
identify the outcome of interest first, then work backwards to
ascertain the relevant proximal and intermediate outcomes which
should be measured, and finally determine what aspects of
clinician–patient communication should be analyzed to predict
the success of that pathway. Consider examples of how this might
be done.
5.1. Hypertension control
In a study of hypertensive patients, researchers might assume
that hypertension medications taken appropriately effectively
lower blood pressure to normal levels thereby reducing the
patient’s risk of cardiovascular mortality and morbidity. One
pathway through which clinician–patient communication could
lead to this health outcome is patient adherence to the appropriate
medication regimen. To test this pathway, researchers would
determine the key proximal outcomes that influence adherence
such as clinician–patient agreement on the patient’s risk and the
medication as well as patient understanding of the treatment plan.
Clinician–patient communication that enhances the likelihood of
achieving these proximal outcomes might be physician-specific
communication behaviors such as nonverbal attentiveness to
signal interest in the patient’s perspective and clear, jargon free
explanations about clinical risk, the need for treatment, treatment
goals, and side effects. Important patient communication beha-
viors might be sharing beliefs about hypertension, expressing
concerns about side effects, and being actively involved in the
decision-making. Other communication responses of importance
for both interactants might be periodic checks for understanding,
negotiating a specific treatment plan, and explicit statements of
agreement on the plan.
5.2. Pain management in cancer care
Patients with cancer often experience pain that has a negative
effect on quality of life. Thus, the primary health outcomes a
researcher might be interested in would be the patient’s self-report
on pain control and the degree to which pain interferes with
functioning. An intermediate outcome would be the patient’s skills
for managing pain. Proximal outcomes of the consultation that
could lead to pain management skills might be the patient’s
confidence in his/her ability to use pain medication effectively
(e.g., without worry of dependency), understanding the dosage and
how to titrate dosage to avoid over medicating, and learning
strategies to minimize or cope with constipation (e.g., use of
laxatives). With respect to the clinician, proximal outcomes might
include understanding of the patient’s beliefs about pain, the
patient’s concerns about pain medication (fear of addiction,
unwanted side effects), and confidence in the patient’s ability to
use pain medication appropriately. Clinician–patient communica-
tion behaviors that could accomplish these proximal outcomes
include discussing the severity of the patient’s pain, eliciting the
patient’s beliefs (and possible misconceptions) about cancer pain
(e.g., ‘just have to live with it as part of having cancer’) and
medications (‘I do not want to get addicted’), clear explanation of
what to expect from pain medication and possible side effects,
clinician support and encouragement, active patient participation
in formulating the treatment plan, and communication that
confirms mutual agreement on treatment plan.
5.3. End-of-life care
The decision to change focus from disease-modifying treatment
to comfort care places considerable stress on patients and their
families. Health outcomes pertinent to end-of-life care include the
emotional well-being of the family as well as the comfort of the
patient. Two pathways that can contribute to these outcomes are
(a) an enhanced therapeutic alliance of physicians, skilled nurses,
hospice workers, pastoral care, and family and (b) activating the
social support system of the patient and family. Proximal outcomes
of the consultation that can contribute to these outcomes include
trust in the clinicians and health care facilities, patient and family
‘feeling heard and known’ regarding fears and concerns, and
patients feeling reassured about not being abandoned. The
communication that contributes to these proximal outcomes
would include responding and validating patient/family emotions,
describing the coordination of care the patient will receive,
attentive listening, addressing the uncertainty of prognostic
information in terms of time left, and discussing social support
resources with the patient/families social network.
6. Conclusion
In this article, we focus on the relationship between commu-
nication and health outcomes. We have tried to illustrate ways in
which theory can inform communication practice and assist with
the design of studies that examine the relationship between
specific communication behaviors and proximal and intermediate
outcomes that contribute to health outcomes that are meaningful
to patients. We have proposed a simple, pragmatic model that can
inform hypotheses to guide future research; specifically, commu-
nication can influence health outcomes by direct and indirect
R.L. Street Jr. et al. / Patient Education and Counseling 74 (2009) 295–301
pathways, and there are relevant intrinsic and extrinsic contextual
modifiers of these relationships. Although we have proposed a
number of pathways through which communication can lead to
improved health, we also recognize that the relative importance of
a particular pathway will depend on the outcome of interest, the
health condition, where the patient is in the illness trajectory, and
the patient’s life circumstances. Yet, these factors must be taken
into account when hypothesizing the means through which
communication can contribute to improved health and well-
being. More rigorous approaches to integrating theory, context,
and measurement are needed if we are to make significant gains in
our understanding of how clinician–patient communication
contributes to healing and well-being.
This work was in part supported by a contract to the senior and
lead authors from the Outcomes Research Branch of the Applied
Research Program in the Division of Cancer Control and Population
Sciences, National Cancer Institute, NIH and in part by the Houston
VA HSR&D Center of Excellence (HFP90-020).
Conflict of interest
The authors have no conflict of interest in the authoring of this
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... RN's communication with the patient is the basis for the exploration and understanding of patient health concerns [12]. It also has therapeutic value, as it can lead to better health outcomes for patients, more effective processing of information, improved adherence to treatment and advice, and higher patient satisfaction [13][14][15]. Communication is fundamental for sharing expertise, building a trustful relationship and decision-making [16]. In contrast, instances of miscommunication can be linked to problems such as impaired patient safety and poor patient experiences [14,17]. ...
... Communication is fundamental for sharing expertise, building a trustful relationship and decision-making [16]. In contrast, instances of miscommunication can be linked to problems such as impaired patient safety and poor patient experiences [14,17]. Moreover, communication with patients can improve the level of health literacy among the public, a rarely noticed part of RNs' communication practices. ...
... Moreover, communication enhancing patients' involvement in decision-making can empower them to become active and capable in managing their own health [14,20,21]. Ideally, communication should be tailored to patients' needs and expectations [22,23]. ...
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Background A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses’ initial assessment of patients’ health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. Methods Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. Discussion This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients’ level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses’ communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. Trial registration Identifier: NCT06067672.
... Furthermore, we aim to investigate practical measures that can enhance caregivers' well-being. Communication and connectedness have been identified as beneficial for caregivers' mental health [11,12], potentially acting as moderators to mitigate the adverse effects of caregiving burden on caregivers' mental and psychical well-being [13,14]. In the digital era, both online and offline forms of communication and connectedness are available to caregivers [13,14]. ...
... They can slow down the release of chemicals that affect the immune system, such as cortisol and cytokines [12]. Connecting and communicating help to prevent the overactivation of the hypothalamic-pituitary-adrenal axis [11,12,41], and can provide caregivers with emotional support and opportunities to express negative feelings [11,12]. The diversity of social communication and connectedness is more beneficial than relying on single ties [42,43]. ...
... They can slow down the release of chemicals that affect the immune system, such as cortisol and cytokines [12]. Connecting and communicating help to prevent the overactivation of the hypothalamic-pituitary-adrenal axis [11,12,41], and can provide caregivers with emotional support and opportunities to express negative feelings [11,12]. The diversity of social communication and connectedness is more beneficial than relying on single ties [42,43]. ...
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Background The prevalence of caregiving in the United States has increased from 16.6% to 19.2% during the period between 2015 and 2020. Caregivers play a critical public health role post-pandemic and as the population ages. However, caregiving can be detrimental to the health of caregivers. Many studies have shown that communication and connectedness are effective forms of health intervention for caregivers, but how this can be achieved requires further investigation. Objective This study aimed to investigate the indirect effect of caregiving on problems of alcohol drinking through psychological distress. Moreover, this study aimed to provide initial evidence of the distinct effects of online and offline communication and connectedness on caregivers' well-being. Methods The predictions were evaluated by examining responses to the Health Information National Trends Survey 2020 (n = 3,865). A mediation analysis was conducted to test the mediating effect of psychological distress on the association between caregiving and alcohol drinking. A second-level moderation analysis was performed. The online communication and connectedness, social media use for health, and the offline type, marital or romantic partnership, were tested as moderators to lessen the psychological distress of caregiving. Results A competitive mediation was identified. We found a positive indirect effect from caregiving to alcohol drinking mediated by psychological distress (bp = .0017, p < .05) but a negative direct effect from caregiving to alcohol drinking (bp = -.0340, p < .05). Furthermore, the study reported a strongly positive effect of moderated moderation on the linkage from caregiving to psychological distress. The negative impact of caregiving on mental distress was greater among those who used social media less, particularly those without a romantic or marital partner. Conclusions The findings indicate that caregivers experience more mental distress, which leads to risky behavior. This study highlights the crucial role of both online and offline connectedness in mitigating the adverse consequences of caregiving.
... Trust among patients and physicians is the foundation for achieving positive treatment outcomes [1][2][3] . Increasing trust can help achieve treatment consistency [4][5][6] , upgrade patient satisfaction 7,8) , and improve treatment adequacy 9,10) . ...
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Purpose] Trust among patients and clinical suppliers is the foundation for achieving appropriate treatment. This double-blind randomized control trial aimed to determine whether providing patients a pre-treatment physical therapists’ introductions and positive appraisal can enhance the trust of patients in therapists. [Participants and Methods] This study included patients diagnosed with lumbar spine spondylosis or non-acute lower back muscle strain who were divided into intervention and control groups. The previously recorded video informed the intervention group patients that they were assigned to our best therapist because of their participation. The primary outcome was evaluated twice, once before and once after the treatment, and the secondary outcome was measured using the second time pain inventory evaluation. [Results] A total of 32 patients participated in this study. No significant difference was found in patients’ trust in therapists between the two groups, and a lower successful treatment rate with a higher pain influence level to daily life was noted in the intervention group. [Conclusion] Doctors who offer introductions with a positive assessment of physical therapists cannot change the trust of patients on therapists. Furthermore, this action may risk worse treatment outcomes.
... Similarly, the overlap between MBCTs and Eliciting patient feelings and views coding highlighted HCs' efforts to demonstrate interest in the patient (MBCT 11, 'What is your favourite family meal to cook?'). This empathic expression fosters commitment and the sense of being heard by their HC, which aligns with research suggesting that eliciting and validating patients' perspectives plays a vital role in enhancing patient engagement and catalyzing BC [41]. Overall, these ndings reinforce empathy's role in boosting patients' self-esteem and motivation, aligning with the principles of SDT that emphasize autonomy, competence, and relatedness [9], particularly within the realm of MBCTs. ...
Full-text available
Background: The global rise in noncommunicable diseases (NCDs) demands innovative public health strategies. Key NCD risk factors are lifestyle-related, emphasizing the importance of behavior change (BC) interventions. Here, empathy plays a pivotal role by fostering rapport, enhancing patient-provider communication, and promoting an individual's motivation to change. However, the role of empathy in BC interventions and its potential intersection with BC techniques (BCTs) remains understudied, especially in telehealth. This study seeks to investigate this intersection in the context of asynchronous health coaching. Methods: We conducted a two-round survey with 11 health coaches (HCs) who responded to 10 participant messages from the Bump2Baby and Me trial. In total, we examined 88 HC messages for empathic responses and the presence of techniques from the taxonomies of BC techniques (BCTs), Motivational BCTs (MBCTs), and Self-Determination Theory techniques (SDTTs). Results: We identified 121 empathic responses that strongly overlapped with MBCTs (79%, n=213) in the form of Praise (47%, n=100) via unconditional positive regard and acknowledging patient perspectives and feelings, and Normalizing (23%, n=49) via neutral support and unconditional regard. While BCTs and SDTTs showed no substantial overlaps with empathic responses, 67% of BCTs elicited participants’ feelings and views about their coaching program. Conclusions: The role of MBCTs in empathy expressions boosts patient engagement and self-perception, fostering relatedness. BCTs supported a patient-centered approach by empowering patients to articulate and plan their goals, which promotes autonomy. The lack of alignment in other categories suggests that considering empathy and BC techniques in isolation provides an incomplete picture of BC interventions.
... These aspects limit the clinical application of the recommendations made to date on PNE in CMP patients, and therefore its clinical efficacy is uncertain and dependent on several factors that need to be further explored. PNE is a clinical intervention that has the communication process as a key point of its application and where the patient feels listened to, cared for and, in addition, allows patients to better understand their clinical condition process (Street et al., 2009). This increased knowledge from a patient perspective, together with an adequate context promoted by empathy, shared understanding between health professional and patient and increasing social support, seems to help improve the influence of psychological variables that are widely present in chronic musculoskeletal pain processes (Lee et al., 2016;Traeger et al., 2019). ...
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Introduction In recent years, pain neuroscience education (PNE) has been the focus of extensive research in the scientific literature in the field of physical therapy, but the results obtained are controversial and its clinical application remains unclear. The main aim of this umbrella review was to assess the effectiveness of PNE in patients with chronic musculoskeletal pain (CMP). Methods We searched systematically in PubMed (Medline), PEDro, EMBASE, CINAHL and PsycINFO. Methodological quality was analyzed using AMSTAR-2 scale and overlapping analysis using GROOVE tool. Results 16 systematic reviews were included. A qualitative synthesis was performed for the following sets of patients with CMP: overall CMP, chronic spinal pain, patients with fibromyalgia and patients with osteoarthritis. In general terms, it seems that the addition of the PNE-based intervention to other treatments, mostly exercise-based interventions although we might refer to it in terms of a multimodal approach, leads to greater clinical improvements than the multimodal approach alone. We have found this especially in the reduction of the influence of psychosocial variables. However, it seems that studies testing the effectiveness of PNE in isolation, systematic reviews with or without meta-analysis did not show statistically significant improvements overall in terms of pain intensity, disability levels or psychosocial variables. Discussion There is a great heterogeneity in the results obtained and the PNE protocols used, a critically low quality in the reviews included and a very high overlap, so there is a need to improve the studies in this field before clinical application. Systematic review registration PROSPERO (CRD42022355634).
... Furthermore, nurses in oncology departments do not have the opportunity to develop a real empathic care relationship likely to optimize emotional management (Hjeij et al., 2022) and lack time, making them less likely to meet patients' needs for support despite their efforts to do so (Coppée, 2022). However, numerous studies have shown that the relational dimension is an essential variable in guaranteeing patient satisfaction during treatment (Street et al., 2009) 20, Prip et al., 2018), as the richness of this relationship plays a primordial role in compliance with treatment, particularly during chemotherapy (Prip et al., 2018). Given this reality in the field, new technological tools such as VR, especially when offered by the nursing staff, could make up for their lack of availability. ...
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Objectives: Our study is a follow-up of a previous research study that was carried out in physiotherapy. The present study aims to evaluate the effectiveness of virtual reality (VR) as a tool to support emotional management during the acute phase of breast cancer treatment (chemotherapy session). Materials and methods: A quasi-experimental protocol was implemented in an oncology department with 120 patients randomly assigned to one of four conditions that were being compared. During the first 10 minutes of a chemotherapy session, patients could either be exposed to a participatory immersion in a natural environment; or be placed in a contemplative immersion condition in the same environment; or listen to classical music; or receive no distraction. The involvement of the patients in the virtual environment and the relevance of the immersive modalities were measured through the evaluation of sense of presence. Particular interest was given to the evaluation of anxiety level and the emotional state of the patients. Results: VR during chemotherapy reduces anxiety and calms emotional tension. The multi-sensory nature of this emotional regulation support tool was more effective than music in inducing positive emotion, and this benefit was the most salient when immersion was offered in an interactive format. Conclusion: The relevance of providing support through VR in oncology is confirmed in this study. This tool can compensate for the fluctuating availability of caregivers by offering patients the possibility of shaping their own relaxing worlds and could help preserve the patient-caregiver relationship.
... Patient-provider communication is key in any healthcare interaction. While a positive relationship between a patient and a healthcare professional (HCP) results in better outcomes [1], a good clinical interaction improves information recall after the consultation, the individual's trust in the HCP and, consequently their adherence to the recommendations and counselling received [2]. These effects are extremely important in the management of chronic conditions, such as diabetes or cardiovascular diseases, which can be improved or even reversed through health-related behaviour change interventions [3]. ...
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Background Although healthcare professionals (HCP) undergo communicative skills training, these are sometimes unsatisfactory for patients (empathy, discussion managing). Existing coding tools overlook the interaction and patients' responses. Meanwhile, remote consultations are redefining communication channels. While some researchers adapt those tools to telehealth, few investigate written interactions. Objective To identify and evaluate coding tools for healthcare interactions and examine their suitability for written interactions. Methods We conducted a meta-narrative review in PubMed, PsycINFO, Embase, Web of Science, CINAHL, and Scopus databases up to December 2022 with Communicati* AND Human* AND Linguistic* AND Professional-Patient Relation* as search terms. We extracted data regarding methodology, unit of analysis (UoA), coding categories, reliability, strengths, weaknesses, and inter-rater reliability (IRR). Results We identified 11 mixed-methods tools. Qualitatively, coding dimension was focused (n = 6) or comprehensive (n = 5). Main quantitative methods were descriptive statistics (n = 4) and cross-tabulations (n = 4). Main UoA was utterance (n = 7). Relevant categories were processes (n = 4), content (n = 3), emotional expressions and responses (n = 3), and grammatical format (n = 2). IRR ranged from 0.68 to 0.85 for coding categories. Conclusion Despite similarities, category terminologies were inconsistent, one-sided, and mostly covered conversation topics and behaviours. A tool with emotional and grammar categories could bridge the gap between a speaker's intended meaning and the receiver's interpretation to enhance patient-HCP communication. Furthermore, we need empirical research to determine whether these tools are suitable for written interactions. Innovation This review presents a comprehensive and state-of-the-art overview of healthcare interactions' coding tools and identifies their barriers. Our findings will support communication researchers in selecting appropriate coding tools for evaluating health interactions and enhancing HCP training.
This chapter examines the importance of family involvement in infant and adolescent psychological practices and interventions. It emphasizes the significance of involving families in the therapeutic process, which leads to enhanced treatment outcomes, increased parent and carer satisfaction, and a higher probability of long-term success. It discusses evidence-based interventions that effectively engage and empower parents and carers, such as parent education, family therapy, and parent-child interaction therapy. Despite the numerous advantages, family involvement may face cultural differences, language barriers, stigma, and lack of awareness. Mental health professionals must adopt culturally sensitive approaches, combat stigma, and provide ongoing support and education to surmount these obstacles. When families are actively involved and empowered, they establish a strong support network beyond therapy sessions, promoting resilience and positive change for the child's development and well-being.
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Objective: The COVID-19 pandemic in Indonesia has transformed various aspects of life, particularly in healthcare, where communication between doctors and patients has shifted toward increased utilization of telemedicine. This research aims to achieve several objectives. Firstly, it investigates the deployment process of telemedicine as a remote medical service solution during pandemic circumstances, involving physical distancing and constraints. Secondly, it explores how telemedicine is adapted within clinic settings, considering the unique challenges and necessary adjustments for effective integration. Method: This research utilizes a case study approach, specifically a multiple case study. Result: Telemedicine heavily relies on patients' knowledge, information, and their role in substituting a physician's sensory input in making comprehensive medical decisions. Effective communication skills emerge as a critical solution, often overlooked as a soft skill for medical practitioners. Telemedicine encounters difficulties in discerning nonverbal cues compared to in-person consultations. To address this challenge, information gathering should encompass various media, such as photos and videos, in addition to text or verbal exchanges. Furthermore, telemedicine faces barriers related to connectivity and network issues. Conclusion: Recognizing the equal standing of doctors and patients is imperative, with physicians fostering openness and trust as the foundation for mediated communication. Although specific criteria for information collection exist, doctors should proactively explore relevant patient aspects. To mitigate network issues, healthcare facilities should establish robust network infrastructure, provide healthcare professionals with suitable devices, and consider dedicated telemedicine applications for comprehensive technology mastery.
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This volume addresses the issue of pragmatic meaning and interpretation in communication contexts regarding health and does so by combining a series of diverse and complementary approaches, which together highlight the relevance of successfully shared understanding to achieve more accessible, inclusive, and sustainable healthcare systems. The volume is divided into five thematic sections: 1) Analytical approaches to health communication, 2) Intercultural and mediated communication, 3) Negotiation and meaning construction, 4) Expertise and common ground, 5) Uncertainty and evasive answers, bringing together a group of top scholars on the much-debated issue of shared understanding both at the micro-level of dialogues between professionals and patients, and the macro-level of institutional communication. In the variety of its contributions, it represents an ambitious attempt at setting pragmatics at the core of healthcare communication research and practice, by combining conceptual reflections on core topics in the field of pragmatics (among which are speech acts, common ground, ambiguity, implicitness), with discourse and linguistic analysis of real-world examples exploring various problems in health communication.
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Our premise was that actions taken to reduce health risks are guided by the actor’s subjective or common-sense constructions of the health threat. We hypothesized that illness threats are represented by their labels and symptoms (their identity), their causes, consequences, and duration. These attributes are represented at two levels: as concrete, immediately perceptible events and as abstract ideas. Both levels guide coping behavior. We interviewed 230 patients about hypertension, presumably an asymptomatic condition. When asked if they could monitor blood pressure changes, 46% of 50 nonhypertensive, clinic control cases said yes, as did 11% of 65 patients new to treatment, 92% of 50 patients in continuing treatment, and 94% of 65 re-entry patients, who had previously quit and returned to treatment. Patients in the continuing treatment group, who believed the treatment had beneficial effects upon their symptoms, reported complying with medication and were more likely to have their blood pressure controlled. Patients new to treatment were likely to drop out of treatment if: (1) they had reported symptoms to the practitioner at the first treatment session, or (2) they construed the disease and treatment to be acute. The data suggest that patients develop implicit models or beliefs about disease threats, which guide their treatment behavior, and that the initially most common model of high blood pressure is based on prior acute, symptomatic conditions.
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Despite the growing attention to the how, when and where of disclosing a cancer diagnosis, not all patients are satisfied with how the news is broken to them. As in German-speaking countries there is a lack of empirical studies on this subject, this analysis was conducted to determine how the cancer diagnosis was given in a German sample, and how satisfied the patients are with the disclosure experience. 162 outpatients received a self-report questionnaire focusing on their experiences with physician-patient communication when the diagnosis was disclosed. Guidelines had been respected in most cases. 17% of patients were dissatisfied with the diagnosis disclosure. They reported a significantly shorter duration of the interaction, lack of privacy, deficits in understanding the information, and less emotional support by the physician. Adherence to guidelines of diagnosis disclosure in the German sample was fairly high. Respecting both informational and emotional needs is essential for patient satisfaction and can be taught in communication training.
PURPOSE: Informed decision making now is considered the underpinning of ethical medical practice. We aimed to determine the extent to which patients with incurable cancer are adequately informed of their prognosis and treatment options and encouraged to participate in treatment decisions. PATIENTS AND METHODS: One hundred eighteen cancer patients with incurable disease presenting for an initial consultation with one of nine oncologists at two Sydney tertiary referral hospitals participated in the study. Consultations were recorded on audiotape to permit a content analysis of doctor-patient interactions. We devised a coding system to assess disclosure of information and to evaluate doctor encouragement of patient participation in treatment decision making. Patient recall, satisfaction, anxiety, and perceptions of the decision-making process were assessed to determine the effects of informed decision making on patient outcomes. RESULTS: Most patients were informed about the aim of anticancer treatment (84.7%), that their disease was incurable (74.6%), and about life expectancy (57.6%). An alternative to anticancer treatments was presented to 44.1%, 36.4% were informed about how anticancer treatment would affect quality of life, and 29.7% were offered a management choice. Oncologists checked patient understanding in only 10.2% of consultations. Although greater information disclosure did not seem to elevate anxiety levels, greater patient participation in the decision-making process was associated with increased anxiety levels (P = .0005), which persisted over a 2-week time span. CONCLUSION: Most patients were well informed, but important gaps remain, especially concerning information about prognosis and alternatives to anticancer treatment. These gaps invite the question concerning whether patients are led toward anticancer treatment.
For some people it is so enmeshed in their daily lives that they take it for granted, others experience it when people rally around them in a crisis, and still others may never experience it at all. This tangible and intangible aspect of human behavior is called social support. The term “social support” is generally not used in everyday conversation, rather it is referred to as “she is always there when I need her,” or “she is the only person I can trust and confide in,” or “I get lots of help from my neighbors,” or “he is someone I can always count on.” Socially supportive behavior indicates that people have a reciprocal helping relationship, that they genuinely care about one another, and that the needs of others equal or surpass one’s own needs.
Self-determination theory was applied to explore the motivational basis of adherence to long-term medication prescriptions. Adult outpatients with various diagnoses who had been on a medication for at least 1 month and expected to continue (a) completed questionnaires that assessed their autonomous regulation, other motivation variables, and perceptions of their physicians' support of their autonomy by hearing their concerns and offering choice; (b) provided subjective ratings of their adherence and a 2-day retrospective pill count during an interview with a clinical psychologist; and (c) provided a 14-day prospective pill count during a subsequent, brief telephone survey. LISREL analyses supported the self-determination model for adherence by confirming that patients' autonomous motivation for adherence did mediate the relation between patients' perceptions of their physicians' autonomy support and their own medication adherence.
Background: Patients vary in their willingness and ability to actively participate in medical consultations. Because more active patient participation contributes to improved health outcomes and quality of care, it is important to understand factors affecting the way patients communicate with healthcare providers. Objectives: The objectives of this study were to examine the extent to which patient participation in medical interactions is influenced by 1) the patient's personal characteristics (age, gender, education, ethnicity); 2) the physician's communication style (eg, use of partnership-building and supportive talk); and 3) the clinical setting (eg, the health condition, medical specialty). Research Design and Subjects: The authors conducted a post hoc cross-sectional analysis of 279 physician–patient interactions from 3 clinical sites: 1) primary care patients in Sacramento, California, 2) patients with systemic lupus erythematosus (SLE) from the San Francisco Bay area, and 3) patients with lung cancer from a VA hospital in Texas. Main Outcome Measures: The outcome measures included the degree to which patients asked questions, were assertive, and expressed concerns and the degree to which physicians used partnership-building and supportive talk (praise, reassurance, empathy) in their consultations. Results: The majority of active participation behaviors were patient-initiated (84%) rather than prompted by physician partnership-building or supportive talk. Patients who were more active participants received more facilitative communication from physicians, were more educated, and were more likely to be white than of another ethnicity. Women more willingly expressed negative feelings and concerns. There was considerable variability in patient participation across the 3 clinical settings. Female physicians were more likely to use supportive talk than males, and physicians generally used less supportive talk with nonwhite compared with white patients. Conclusions: Patient participation in medical encounters depends on a complex interplay of personal, physician, and contextual factors. Although more educated and white patients tended to be more active participants than their counterparts, the strongest predictors of patient participation were situation-specific, namely the clinical setting and the physician's communicative style. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Future research should investigate how the nuances of individual clinical settings (eg, the health condition, time allotted for the visit) impose constraints or opportunities for more effective patient involvement in care.
Social support is an important aspect of psychological functioning during diagnosis and treatment of cancer. Gender has been found to influence support preferences, and previous research suggests that women are more likely to seek and utilize support by comparison to men. This qualitative study explores how patients perceive the support they receive. It also examines patient preferences and satisfaction with information and emotional support provided by staff. Eleven melanoma patients (6 men and 5 women) and 5 breast cancer patients participated in a semistructured interview. Thematic analysis suggests that gender is central to patients' satisfaction and preference for support. Whereas women expected staff to provide information and emotional support, men felt that emotional support from staff was inappropriate and perceived information as supportive in helping them deal with their emotions. Men were also more satisfied with support generally, and women perceived staff to have less time to provide support. Breast cancer patients were more satisfied with access to and the nature of support available to them. Findings suggest that female melanoma patients would benefit from similar services. Meeting the support needs of men appears less clear. If support were available as part of a structured care plan, it is possible that men would also utilize support. Future research is required to gain greater understanding of men's support needs.
Context Patients often present clues (direct or indirect comments about personal aspects of their lives or their emotions) during conversations with their physicians. These clues represent opportunities for physicians to demonstrate understanding and empathy and thus, to deepen the therapeutic alliance that is at the heart of clinical care. A paucity of information exists regarding how physicians address the psychological and social concerns of patients.Objectives To assess how patients present clues and how physicians respond to these clues in routine primary care and surgical settings.Design, Setting, and Participants Descriptive, qualitative study of 116 randomly selected routine office visits to 54 primary care physicians and 62 surgeons in community-based practices in Oregon and Colorado, audiotaped and transcribed in 1994.Main Outcome Measures Frequency of presentation of clues by patients during office visits, nature (emotional vs social) and content of clues, and nature of physician responses to clues, coded as positive or missed opportunity.Results Fifty-two percent and 53% of the visits in primary care and surgery, respectively, included 1 or more clues. During visits with clues, the mean number of clues per visit was 2.6 in primary care and 1.9 in surgery. Patients initiated approximately 70% of clues, and physicians initiated 30%. Seventy-six percent of patient-initiated clues in primary care settings and 60% in surgical settings were emotional in nature. In surgery, 70% of emotional clues related to patients' feelings about their biomedical condition, while in primary care, emotional clues more often related to psychological or social concerns (80%) in patients' lives. Physicians responded positively to patient emotions in 38% of cases in surgery and 21% in primary care, but more frequently they missed opportunities to adequately acknowledge patients' feelings. Visits with missed opportunities tended to be longer than visits with a positive response.Conclusion This study suggests that physicians in both primary care and surgery can improve their ability to respond to patient clues even in the context of their busy clinical practices.
When analyzing relationships between physician-patient communication and medical outcomes, researchers typically rely on quantitative measures of behavior (e.g., frequencies or ratios) derived from observer-coding of transcripts, audiotapes, or videotapes. Interestingly, rarely have researchers assessed whether quantitative measures of communication (e.g., the physician's information giving) correspond to patients' perceptions of physicians' communication (e.g., informative). This investigation of 115 pediatric consultations examined this issue and yielded several notable findings. First, less satisfied parents received more directives and proportionally less patient-centered utterances from physicians than did more satisfied parents. Second, findings were mixed regarding the degree to which behavioral measures related to analogue measures of parents' perceptions. For example, the doctors' use of patient-centered statements was predictive of parents' perceptions of physicians' interpersonal sensitivity and partnership building, but the amount of information physicians provided parents was unrelated to judgments of the doctors' informativeness. Third, with some important exceptions, relationships between behavioral measures and parents' evaluations did not vary for parents differing in education and anxiety about the child's health. Finally, behavioral measures in the form of frequencies tended to be better predictors of parents' perceptions than were measures in the form of proportions. Implications are discussed. (C) Lippincott-Raven Publishers.