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How Does Communication Heal? Pathways Linking Clinician-Patient Communication to Health Outcomes
Abstract
Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions.
Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway.
Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.
... The knowledge disparities between healthcare providers and communities can lead to misunderstandings and reduced effectiveness of health communication efforts . Street Jr et al. (2009) emphasised the importance of translating medical knowledge into formats that are understandable to the general public. Addressing this challenge requires ongoing feedback and adjustments to health communication strategies. ...
... Healthcare providers face significant challenges in translating medical knowledge into understandable formats for the general public. This issue, examined by Street Jr et al. (2009), underscores the need for ongoing feedback and adjustment cycles to improve health communication effectiveness. ...
... Barriers to effective health communication include knowledge gaps, resistance to behaviour change, and disparities in technological access. Translating complex medical information into comprehensible formats is essential for bridging these gaps (Street Jr et al., 2009). Furthermore, continuous feedback loops and adaptive strategies are critical in overcoming resistance and ensuring sustained engagement (Nutbeam, 2000). ...
... This study draws upon Street et al. (2009) pathway mediation model as the conceptual framework linking PCC to sexual minority peoples' mental health. In the model, Street et al. (2009) suggests that psychological well-being can be enhanced through affective, comprehensive, and effective patientprovider communication by which patients feel respected, known, and comforted. ...
... This study draws upon Street et al. (2009) pathway mediation model as the conceptual framework linking PCC to sexual minority peoples' mental health. In the model, Street et al. (2009) suggests that psychological well-being can be enhanced through affective, comprehensive, and effective patientprovider communication by which patients feel respected, known, and comforted. This is because adopting a patientcentered approach in counseling and talking with patients can be therapeutic. ...
... PCC can also contribute to positive psychological outcomes through an indirect association mediated by factors such as self-care skills and health self-efficacy (Street, 2013;Street et al., 2009). For example, a physician's clear explanations and expression of empathy and concerns can increase patients' confidence and equip them with the necessary skills for selfcare given that PPC allows patients to ask all health-related questions, acquire health information, and reveal their feelings and emotions. ...
... The theoretical framework for this study is based on two theories: the pathway model (Street et al., 2009) and the social role theory (Eagly & Wood, 2016). ...
... Thus, this study expands the understanding of trust formation in healthcare by emphasizing that patients' revisit behavior is driven by emotional trust rather than just cognitive evaluations of physician competence. The findings support the pathway model of patient-provider communication (Street et al., 2009), which suggests that communication impacts health outcomes indirectly through intermediate factors like trust. The full mediation of emotional trust in the physician communication-revisit intention link confirms that effective communication alone is not sufficient; it must build emotional trust for behavioral outcomes like patient loyalty. ...
This study aims to evaluate the impact of perceived physician communication skills on patients’ revisit intention, focusing on the mediating role of two dimensions of trust and the moderating role of gender. While several studies on revisit intention examine the effect of service quality as a whole, this is one of the few that not only focuses solely on physician-patient communication but also examines both dimensions of trust and revisit intention with the same physician. A cross-sectional survey was employed via questionnaire distribution. A total of 265 valid responses were used for data analysis. The findings revealed that perceived physician communication skills impact trust and revisit intention. Emotional trust was seen to have a full mediating effect on the relationship. Gender had no moderating effect on the proposed relationship, which suggests that irrespective of gender, patients’ expectations and preferences for effective communication are similar. By cultivating a supportive and empathetic attitude, physicians can create a positive emotional environment that enhances patient trust and positive behavioral intentions.
... Theoretical foundation. The conceptual framework of this study integrates two theoretical models: the health information model (Longo, 2005), and the pathway model of health communication (Street et al., 2009). Longo's (2005) health information model provides a streamlined approach for examining how different forms of information acquisition are associated with cancer survivors' health outcomes, highlighting the impact of both seeking and scanning. ...
... For instance, a patient's desire to share health information with healthcare providers does not guarantee the information will be understood or reacted to as intended (Lai et al., 2024). Therefore, in addition to the health information model, this study expands on it by incorporating insights from the pathway model of health communication (Street et al., 2009). This model explains how PCC influences health outcomes by emphasizing processes such as eliciting, understanding, and validating the patient's perspective, considering their psychological and social context, achieving a shared understanding of their issues and treatment, and empowering the patient in health decisions. ...
Guided by the health information model and pathway model of health communication, this study investigates the relationship between different health information acquisition (seeking/scanning) and healthy lifestyle behaviors in a nationally representative, cross-sectional sample of cancer survivors (N = 567) in China. A moderated mediation model was employed to explore the mediating roles of patient-centered communication (PCC) and patient trust in physicians in the relationship between health information acquisition and healthy lifestyle behaviors. The study also examined the moderating role of system trust. Results indicate that health information seeking and scanning positively correlate with healthy lifestyle behaviors (i.e. fruit and vegetable consumption) via PCC and patient trust. Moreover, system trust positively moderates the relationship between health information seeking and PCC. These findings contribute to health communication and psychology literature and highlight the importance of patient-centered care in managing self-health, especially within the Chinese healthcare context.
... Our findings also underscore the importance of a process-oriented mindset in managing PJI, as proposed by existing coping theories [21] that emphasize the importance of assessing one's own resources adequately and adapting actively when coping with chronic illnesses [22,23]. Thus, a process-oriented approach shifts the focus from the often unpredictable long-term goal of complete recovery to more immediate, manageable objectives that patients can influence directly. ...
... Additionally, fostering transparent communication and trust between patients and physicians is crucial, particularly in managing expectations and addressing the fluctuating nature of PJI recovery. Transparent communication plays a pivotal role in building this trust and ensuring that care is truly patient-centered [20,21]. Implementing these strategies could significantly enhance patient care by aligning treatment with patients' physical and psychological needs, ultimately leading to better health outcomes [18]. ...
Periprosthetic joint infections (PJI), along with the extensive medical and surgical interventions required for treatment, impose a substantial psychological burden on patients. Given the need for patients to adapt to long-term physical limitations and ongoing medical challenges, this qualitative study aims to explore the nature of psychological coping amongst patients with chronic cases of PJI. A total of 18 patients (8 men and 10 women, aged 55 to 92) who underwent a total knee or hip arthroplasty revision due to chronic PJI were recruited at a single academic institution between August 2022 and July 2023. Semi-structured interviews were conducted at two timepoints and analyzed using thematic analysis. We identified the nature of coping with PJI as patients’ process-orientation towards healing. This encapsulates constant adaptation to challenges and losses in day-to-day life, managing expectations and proactively developing a sense of self-efficacy during treatment and healing. Patients expressed uncertainty and unpredictability to treatment trajectories and getting a feeling of being stuck, where health and well-being oscillates between progression and regression. These experiences contributed to unstable relationships with healthcare practitioners which were influenced by loss of trust and perceived treatment failures. A holistic view on patients, taking them seriously in their concerns and providing clear information were identified as crucial factors in shaping a positive patient-physician relationship. Acknowledging the fluctuating nature of chronic PJI treatment, physicians should adopt a process-oriented approach that promotes step-by-step healing while maintaining a positive patient-physician relationship. Recognizing the profound psychological impact, we propose the establishment of a new subdiscipline, namely ‘Psycho-Endoprosthetics’, to facilitate interdisciplinary collaborations for research and practice in septic surgery.
... To address this issue, Epstein and Street (2007) proposed a framework that included: (1) responding to emotions; (2) exchanging information; (3) making decisions; (4) managing uncertainty; (5) enabling patient-self management; (6) and fostering healing relationships. These functions are hypothesized to associate with health outcomes, directly and indirectly through mechanisms such as patient satisfaction, patient-clinician agreement, access to care, trust in the system, and commitment to treatment (Street et al. 2009). ...
... Both forms of communication fit the inclusion criteria of measuring patient-clinician communication and were included in the review. In contrast, studies that defined communication as patient trust in their clinician and were excluded because patient trust is more accurately considered a proximal outcome of communication (or relationship quality), rather than the process of communication itself (Street et al. 2009). or "Are the findings adequately derived from the data?" for qualitative studies). ...
Purpose
Black perinatal people in the United States are disproportionately affected by morbidity and mortality. An emerging hypothesis is that these disparities may be in part due to poor communication in obstetric care which may lead to poor perinatal care quality and adverse health outcomes. The purpose of this review is to provide a systematic review of the literature on patient-clinician communication amongst Black patients in perinatal healthcare settings.
Methods
A literature search was conducted for studies published between January 2006 to December 2024 using PubMed, PsycINFO, and Web of Science. PRISMA guidelines were followed to extract relevant articles and study methodologies and results were synthesized.
Results
A total of 11 qualitative and 18 quantitative studies met inclusion criteria. Overall, findings indicate reliable evidence of Black patients’ reports of discrimination, being left out of decision-making, and being ignored by their clinicians. We discuss methodological limitations of the work and suggest improvements.
Conclusion
The results of this review may inform interventions to target the quality of communication between perinatal clinicians and their Black patients to improve morbidity and mortality outcomes.
... PCC emphasizes a cooperative approach between healthcare providers and patients, which has become crucial in healthcare delivery. Clear communication from healthcare providers improves patients' understanding of their health conditions and treatments [13]. In addition, studies show a strong association between effective communication and improved patient satisfaction [14]. ...
Background
Increased internet use for health information in the United States enhances interactions with healthcare professionals, but its effects on healthcare utilization and care quality are still being investigated. We explored the association between internet use for health information, patient-centered communication (PCC), and sociodemographic factors on the likelihood of visiting a health care provider and quality of care. We also examined if PCC mediates this association.
Methods
We conducted a secondary data analysis using the National Cancer Center Institutes (NCI) Health Information National Trends Survey (HINTS) 2018–2020. Multinomial logistic regression and path analyses assessed variable interrelationships and mediating effects.
Results
Individuals using the internet for health information for themselves were 2.40 times more likely (P <.001) to have frequent provider visits and 1.18 times more likely (P <.022) to rate their care as very good/good compared to excellent, compared to those who did not use the internet for health information for themselves. In contrast, individuals using the internet for discussion with their providers were 2.05 times more likely (P <.001) to have increased visits, and they were 40% less likely (P <.001) to rate their care as fair/poor compared to excellent, relative to those who did not use the internet for discussions. Path analysis indicated that individuals using the internet for health information for themselves may negatively impact PCC, resulting in lower quality ratings, while those who use the internet for discussions with healthcare providers had a positive effect on PCC, leading to higher care ratings.
Conclusion
This study enhances our understanding of how PCC and internet use for health information impact US healthcare. Using the internet for provider discussions positively impacts perceived care quality, highlighting PCC’s vital role.
... Additionally, it is crucial to promote effective communication, education, opportunities for acquiring new skills, interpersonal development, involvement in decision-making, acknowledgment of contributions and advancements, occupational safety regulations, and teamwork among staff. These elements are vital for fostering collaboration within the organization and strengthening the relationship between healthcare providers and patients [2,21,[51][52][53][54]. ...
Patients represent the primary stakeholders in health systems, making it crucial to enhance their level of satisfaction. The relationship between physician and patient is crucial during treatment, especially for patients dealing with long-term issues. Generally, every illness has the potential to cause high levels of stress, leading to varying reactions from individuals, influenced by factors such as age, personality, relationships with caregivers, treatment environment, and specific disease characteristics. As the healthcare provider acquires a more profound insight into how the disease affects the patient's quality of life, the relationship between the patient and the physician evolves. In this study, we analyzed information from hospital clinics that took part in the survey for the same timeframe, from July 2019 to December 2020. Correlated data were derived from two separate surveys. The initial survey, created by Spector, focused on gathering feedback from health professionals in hospitals, with 3278 responses collected. A second survey was designed to gather feedback from patients in hospitals, with 2851 responses collected. The survey revealed a total of 97 common observations among physicians and patients in the hospital clinics. According to the findings from the two-stage least squares (2SLS) regression analysis, an essential method for researchers addressing endogeneity challenges in structural equation modeling, an increase of 1 point in the job satisfaction of physicians is associated with a corresponding positive increase of 1.12 points in patient satisfaction. At the heart of effective healthcare is the relationship between physicians and patients. Positive attitudes from patients during medical appointments help improve health outcomes, especially for those with long-term illnesses. In order to encourage patients to take an active role, physicians need to focus on enhancing the physician-patient bond, humaneness, creating trust and stable communication, encouraging the sharing of information, and empowering patients to participate in decision-making.
... Healthcare-seeking behaviour, on the other hand, encapsulates the actions and decisions individuals undertake when confronted with health concerns, ranging from consulting a healthcare provider to adhering to prescribed treatments. This behaviour is influenced by a complex interplay of factors, including personal beliefs, socioeconomic status, and the quality of communication received from healthcare systems (Street, Makoul, Arora & Epstein, 2009). In Akwanga and Wamba LGAs, where rurality and gender norms shape access, this behaviour varies significantly between men and women; women may delay seeking care due to domestic responsibilities, while men might avoid it due to perceptions of invulnerability (Olakunde, Adeyinka, & Adeyinka, 2019). ...
This study explored gender-responsive communication strategies in healthcare delivery within Akwanga and Wamba Local Government Areas (LGAs) of Nasarawa State, Nigeria, focusing on their role in addressing gender-specific health needs and improving healthcare-seeking behaviour. The primary objective was to evaluate the effectiveness of these strategies and identify barriers to their implementation. Grounded in Narrative Medicine Theory and Feminist Communication Theory, the research adopted a mixed-methods approach combining survey and semi structured
interviews. A total of 400 questionnaires were administered to healthcare professionals and individuals seeking healthcare services, with 394 retrieved (98.5% response rate), alongside 20 key informant interviews (KIIs) with purposively selected healthcare providers. Key findings revealed that 63.5% of respondents were moderately to very aware of gender-specific health issues, with verbal communication (55.8%) and visual aids (50%) as dominant strategies used to
disseminate related information. Gender-responsive communication positively impacted healthcare-seeking behaviour, with 58.4% reporting moderate to significant personal influence and 62.9% noting community-level effects. However, challenges included inadequate training (38.1%), resource scarcity (25.4%), and sociocultural barriers (20.3%). The study concluded that while awareness existed, systemic and cultural obstacles hindered effectiveness of gender responsive communication efforts. Recommendations included training for healthcare professionals, integration of gender-responsive policies, and culturally tailored communication materials to enhance healthcare equity and outcomes in these LGAs.
... We know that the words physicians use can have a large impact on what patients understand. 2 Patient comprehension can greatly influence overall outcomes including medical adherence and patient involvement in their care. 3 Furthermore, it is difficult to gauge the medical literacy of patients, with studies demonstrating that medical students inaccurately estimate what medical terms patients understand. 4 Overall, effectively communicating with patients about medical topics while using medical jargon is challenging and can greatly impact the quality of care we can give. ...
... In increasing patient satisfaction in the inpatient room, one solution is to use therapeutic communication (Williams & Irurita, 2004). Therapeutic communication is very important because it affects the level of patient satisfaction with the health services provided (Street Jr et al., 2009). Therapeutic communication is a professional communication that is planned and implemented to help the healing or recovery of the patient. ...
Patient satisfaction is a feeling that arises from the patient as a result of the performance of health services after the patient compares with what he expects. Therapeutic communication is the ability of a nurse to help deal with stress and overcome psychological disorders of patients by providing understanding to reduce the burden on the patient's mind. The purpose of this study was to determine the relationship between nurse therapeutic communication and patient satisfaction in the inpatient room at Saint Elisabeth Hospital Medan. The method used in this research is descriptive correlation with a cross sectional approach. The sampling technique uses is accidental sampling, with a sample of 52 people. The research instrument used is a nurse therapeutic communication questionnaire and a patient satisfaction questionnaire. The results show that the majority of nurses' therapeutic communication with inpatients was good (92.3%), while the satisfaction of inpatients is mostly satisfied (65.4%). statistical test Spearman rank obtained p value = 0.010 where p <0.05, r = 0.354 indicates that there is a moderate relationship between nurse therapeutic communication and inpatient satisfaction at Saint Elisabeth Hospital Medan. Nurses are advised to maintain therapeutic communication in hospitalized patients.
... They expose students to a broad spectrum of scenarios, including rare conditions and challenging patient interactions, while allowing repeated practice to build skills without real-life risks. Effective communication is essential for gathering information, fostering patient relationships, and supporting clinical decision-making, whereas poor communication can compromise diagnostic accuracy and jeopardize patient safety (De Haes and Bensing, 2009;Street Jr et al., 2009;Stewart, 1995;Goold and Lipkin Jr, 1999;Hausberg et al., 2012). These underscore the importance of VP tools in honing these critical skills, also granting flexibility and cost-effectiveness for modern medical training. ...
Effective patient communication is pivotal in healthcare, yet traditional medical training often lacks exposure to diverse, challenging interpersonal dynamics. To bridge this gap, this study proposes the use of Large Language Models (LLMs) to simulate authentic patient communication styles, specifically the "accuser" and "rationalizer" personas derived from the Satir model, while also ensuring multilingual applicability to accommodate diverse cultural contexts and enhance accessibility for medical professionals. Leveraging advanced prompt engineering, including behavioral prompts, author's notes, and stubbornness mechanisms, we developed virtual patients (VPs) that embody nuanced emotional and conversational traits. Medical professionals evaluated these VPs, rating their authenticity (accuser: ; rationalizer: on a 5-point Likert scale (from one to five)) and correctly identifying their styles. Emotion analysis revealed distinct profiles: the accuser exhibited pain, anger, and distress, while the rationalizer displayed contemplation and calmness, aligning with predefined, detailed patient description including medical history. Sentiment scores (on a scale from zero to nine) further validated these differences in the communication styles, with the accuser adopting negative () and the rationalizer more neutral () tone. These results underscore LLMs' capability to replicate complex communication styles, offering transformative potential for medical education. This approach equips trainees to navigate challenging clinical scenarios by providing realistic, adaptable patient interactions, enhancing empathy and diagnostic acumen. Our findings advocate for AI-driven tools as scalable, cost-effective solutions to cultivate nuanced communication skills, setting a foundation for future innovations in healthcare training.
... This means that health orientation remains relatively stable and does not change merely due to a disease diagnosis. Given the cumulative nature of healthcare communication (Street et al., 2009), PCC could significantly influence health orientation development. When patients feel valued in their healthcare interactions, they are more likely to feel empowered and develop an internal locus of control over their health outcomes. ...
... Health communication problems refer to barriers that hinder effective information exchange between healthcare providers and patients. These barriers may include unclear or inconsistent medical explanations, lack of patient involvement in decision-making, and emotional insensitivity from healthcare professionals (Kreps, 2015;Street et al., 2009). When patients feel excluded from discussions about their care or struggle to obtain clear medical information, they may become more skeptical of healthcare providers' intentions, ultimately diminishing their trust in the system (Souvatzi et al., 2021). ...
Objective: This study investigates the impact of communication problems between patients and healthcare professionals on distrust in the healthcare system, as inpatients perceive. Methods: The research was conducted as a cross-sectional study, and criterion sampling was used to select participants. The study sample comprised individuals aged 18-65 who had received treatment and care services in the inpatient units of a Training and Research Hospital in Türkiye at least once in the past year. Data were collected using the “Individual Identification Information Form,” the “Health Communication Problems Scale,” and the “Healthcare System Distrust Scale.” Results: Patients' perceptions of health communication problems were measured at an average level of X̅=2.59±0.71, while their perceptions of distrust towards the healthcare system averaged X̅=2.75±0.74. Additionally, health communication problems accounted for 19% of the variance in explaining distrust in the healthcare system (R=0.43; R2=0.19). Conclusion: The findings indicate that inpatients experienced relatively low communication problems with healthcare professionals and held moderate levels of distrust towards the healthcare system. The research concluded that health communication problems positively impact distrust in the healthcare system.
... [26][27][28] It can be influenced by previous positive or negative experience, physiological arousal, emotional state, and persuasion. [28][29][30][31] For instance, e-health provides a convenient way of health information communication with its interactive media forms; 32 PCC characterized by mutual persuasion, 33 also has potential to improve CS. From this perspective, CS could potentially be the second mediator. ...
Background
The journey of any new treatment begins in the lab and through a clinical trial. Clinical trials have become an important means to promote public health causes. In digital age, e-health usage (EHU) might be a key factor to promote clinical trials. However, how consideration for clinical trial participation is impacted by EHU remains unclear.
Method
Secondary analyses were conducted on data from the Health Information National Trends Survey 2020 (HINTS 5, Cycle 4). This study proposed and tested a serial mediation model linking EHU to consideration for clinical trial participation, mediated by patient-centered communication (PCC) and cancer-related self-efficacy (CS). Analysis was performed using a sample survey targeted at individuals with chronic disease and/or family cancer history, conducted in 2020 in the United States (N = 3292).
Result
This study found that EHU exerted positive effects on clinical trial participation directly. Furthermore, their relationship can be mediated by PCC and CS. Only when PCC serves as the first mediator did CS exert the serial meditation effect. Annual household income significantly moderates the path from CS to consideration for clinical trial participation. For low-income groups, an increase in CS significantly expends their consideration for clinical trial participation.
Conclusion
EHU can improve PCC and CS. This can be considered as motivators for increasing participation to clinical trials. Based on the finding, information related clinical trials should be promoted through e-health channels and the information should gain better patients’ understanding. Those findings throw out suggestions on building trust, addressing concerns and alleviating fears to clinical trial participation.
... 6 Good communication skills not only enhance adherence to treatment protocols and patient safety but also improve patient satisfaction. 11,21 Moreover, clear and empathetic communication with patients can alleviate anxiety, improve cooperation, and enhance the overall patient experience. Such communication is essential for explaining procedures to patients, while empathy and compassion help build trust and rapport, making patients feel valued and understood during their healthcare journey. ...
... As in any chronic disease, angina patients must be educated and play a major role in their care, in the context of recommendations and periodic supervision by the physician. Effective, two-way communication between physicians and patients is essential for exchanging information and establishing a relationship [74]. Rehabilitation programs should include a strong focus on patient education in addition to physical exercise during the relatively short rehabilitation period. ...
Plain Language Summary
Advances in the diagnosis and treatment of coronary heart diseases have greatly increased survival after a heart attack and increased life expectancy. As a result, an increasing number of people are living with chronic heart diseases that impair blood flow to the heart muscle, causing chest pain (angina). This can limit one’s quality of life and capacity to perform daily functions without pain. There are several underlying causes of angina, and it also occurs in people who have not had a heart attack. Management should address three important areas: (i) Lifestyle changes should include regular exercise, a heart-healthy diet, and avoidance of smoking, while keeping blood pressure, serum cholesterol levels, and other so-called risk factors under control to prevent future cardiovascular events. (ii) Anti-angina medications (antianginal drugs) should be personalized based on the underlying cause of a patient’s angina, their cardiovascular characteristics, the presence of other medical conditions and the medications that they are currently taking. The physician may need to adjust this tailored treatment to achieve optimal results for the individual patient. (iii) If this optimal medical therapy does not provide sustained relief, the physician may refer the patient to a cardiology center for further testing and to evaluate whether a revascularization procedure would be appropriate. Administering the optimal antianginal treatment for each patient, and careful adherence to lifestyle recommendations provide the best chance for restoring quality of life, reducing medical visits and improving long-term outcomes.
... Veatch argued that shared decision-making would greatly impact the quality of physician-patient communication and medical care. Physician-patient shared decision-making is considered crucial for strengthening trust, improving communication, and enhancing the effectiveness of medical diagnosis [13]. Consequently, shared decision-making could be a significant factor affecting the relationship between discourse strategies and patients' online consultation behavior. ...
Background
Online health platforms are currently experiencing significant growth. Patients can conveniently seek medical consulting services on such platforms. Against the backdrop of the thriving development of digital health care, the patterns of physician-patient communication are undergoing profound changes. It is imperative to focus on physician discourse strategies during online physician-patient interactions, which will improve the efficiency of physician-patient communication and achieve better management of the physician-patient relationship.
Objective
This study aims to explore the influencing mechanism between physician discourse strategies and patient consultation behavior on online health platforms. Additionally, we explore the crucial mediating role of online physician-patient trust and the moderating role of shared decision-making in the online physician-patient communication process.
Methods
We used a mixed research approach to explore the influencing mechanism. Data on physician basic attributes and physician-patient communication text records were collected from the Chunyu Doctor website using a web spider. The study obtained a total of 8628 interaction texts from January 2022 to July 2023. Physician discourse strategies (capacity-oriented strategy, quality-oriented strategy, and goodwill-oriented strategy), online physician-patient trust, and shared decision-making were captured through text mining and a random forest model. First, we employed text mining to extract the speech acts, modal resources, and special linguistic resources of each record. Then, using a well-trained random forest model, we captured the specific discourse strategy of each interaction text based on the learned features and patterns. The study generated 863 groups of physician samples with 17 data fields. The hypotheses were tested using an “ordinary least squares” model, and a stability test was conducted by replacing the dependent variable.
Results
The capacity-oriented strategy, goodwill-oriented strategy, and quality-oriented strategy had significant effects on patient consultation behavior (β=.151, P=.007; β=.154, P<.001; and β=.17, P<.001, respectively). It should be noted that the anticipated strong effect of the capacity-oriented strategy on patient consultation behavior was not observed. Instead, the effects of the quality-oriented strategy and goodwill-oriented strategy were more prominent. Physician notification adequacy from shared decision-making moderated the effect between the goodwill-oriented strategy and patient consultation behavior (β=.172; P<.001). Additionally, patient expression adequacy from shared decision-making moderated the effect between the capacity-oriented strategy and patient consultation behavior (β=.124; P<.001), and between the goodwill-oriented strategy and patient consultation behavior (β=.104; P=.003). Online physician-patient trust played a significant mediating role between physician discourse strategies and patient consultation behavior.
Conclusions
The study findings suggest significant implications for stimulating patient consultation behavior on online health platforms by providing guidance on effective discourse strategies for physicians, thus constructing a trustworthy physician image, improving the physician-patient relationship, and increasing platform traffic.
... • Empathy and Active Listening: Patients who perceived their providers as empathetic and attentive were more likely to trust their recommendations and adhere to treatment plans (Street et al., 2009). ...
1. Abstract Patient trust in medical staff is a critical component of effective healthcare delivery, influencing patient satisfaction, adherence to treatment, and overall health outcomes. This study investigates the multifaceted factors that contribute to building and maintaining patient trust, with a focus on the roles of medical staff uniforms, personal style, the healthcare environment, and communication styles. Uniforms and professional attire serve as visual indicators of professionalism and competence, potentially enhancing patient confidence in the care provider. Similarly, the personal style of medical staff, including grooming and demeanor, can impact perceptions of approachability and reliability. The healthcare environment, including the cleanliness, organization, and comfort of clinical settings, plays a significant role in shaping patient perceptions of the quality of care. A well-designed and patient-centered environment can foster a sense of safety and trust. Furthermore, the communication style of medical staff-encompassing empathy, clarity, and active listening-is a cornerstone of patient-provider interactions. Effective communication not only addresses patient concerns but also builds rapport and reassures patients of their caregivers' competence and dedication. This research employs a mixed-methods approach, combining quantitative surveys and qualitative interviews with patients across diverse healthcare settings. The study aims to identify the relative importance of each factor (uniforms, style, environment, and communication) in influencing patient trust and to provide actionable insights for healthcare administrators and practitioners. By understanding how these elements interact, healthcare providers can implement targeted strategies to enhance patient trust, ultimately improving the quality of care and patient outcomes. The findings of this study are expected to contribute to the growing body of literature on patient-centered care and offer practical recommendations for optimizing the patient experience in clinical settings.
... 4,5 Effective communication of bad news is crucial for patients' satisfaction and long-term health. 6 While adhering to BBN principles can facilitate teaching of a foundational skillset, medical consultations profit from being viewed as dynamic, interactive processes in which physicians and patients collaboratively construct meaning. As both parties interpret and integrate verbal and nonverbal cues, a shared understanding is fostered that guides the conversation forward. ...
Introduction
Breaking bad news (BBN) is a distressing yet essential task in medicine, imposing emotional strain on both physicians and patients. Crucially, effective BBN relies on both verbal and nonverbal communication, which can be impaired by elevated stress associated with the task. Efficient teaching of communication skills continues to present a challenge, and the role of stress management in BBN encounters remains largely overlooked. In this study, we investigated the effects of stress arousal reappraisal (SAR; positive reframing of stress arousal) and worked example (WE; step‐by‐step demonstration of BBN) interventions on medical students' communication performance.
Methods
This pre‐registered randomised controlled trial employed a 2 × 2 between‐subjects design to evaluate the individual and combined effects of SAR and WE interventions on the verbal and nonverbal communication performance of 221 third‐year medical students. To do so, students completed a 40‐min web‐based learning module before disclosing bad news to a simulated patient within a 12‐min consultation. Performances were videorecorded and assessed by three independent raters.
Results
The WE intervention significantly improved both verbal and nonverbal communication performance, whereas the SAR intervention enhanced nonverbal communication only. Combining SAR with WE did not yield additional improvements in nonverbal communication beyond those achieved by either intervention alone.
Discussion
These findings highlight the potential of both SAR and WE interventions to optimise resource‐intensive simulated BBN training. By demonstrating the efficacy of WE in improving both verbal and nonverbal communication, this study advances the literature on the application of WEs in the BBN context. Furthermore, this study is among the first to demonstrate the importance of stress coping in delivering bad news effectively. Given their low threshold, both SAR and WE interventions represent promising tools for equipping medical students with essential BBN communication skills and are well‐suited for integration into already time‐constrained medical curricula.
... According to the US Agency for Health Care Research and Quality, marginalized and low-income communities continue to experience poorer health outcomes compared to their counterparts [1]. The persistent inequalities are partly due to the substandard healthcare these communities receive of which the quality of communication between doctors and patients is a crucial component [2][3][4]. Indeed, Penner et al. argued that the health disparities seen between Black and White patients especially in cancer are influenced by the nature of communication in medical interactions [5]. ...
Healthcare disparities persist in the USA, with Black patients often receiving lower-quality care. Effective doctor-patient communication is crucial for influencing satisfaction, adherence to treatment, and overall health outcomes. This study examined racial disparities in doctor-patient communication, focusing on encounters with Black and White patients recently diagnosed with myelodysplastic neoplasm (MDS). Thirty-seven oncologists participated in simulated encounters with trained actors portraying either Black or White patients. Using an innovative approach combining the comparison of communication characteristics, thematic content, and linguistic analyses, we observed significant disparities in time allocation, linguistic complexity, and relation-building efforts. Encounters with Black patients were notably shorter, with doctors using fewer words per sentence, asking fewer questions, and employing less inclusive and optimistic language. Doctors also had less thorough discussions about transplant options and used fewer words communicating authenticity when talking with Black patients. The post-encounter surveys revealed that doctors were not aware of their shortcomings when interacting with Black patients. The findings provide important insights for the development of training programs aimed at improving healthcare outcomes for marginalized communities and reducing racial healthcare disparities.
... Ahí aparece la comunicación empática y compasiva, para la cual se tienen que desarrollar habilidades comunicativas para el ejercicio profesional. No hay que olvidar que, además, la comunicación (efectiva y afectiva) tiene valor terapéutico en sí misma (Healing communication) 32 , porque el establecimiento de un vínculo de confianza con el paciente contribuye a: ...
... However, there remains a gap in understanding the processes and mechanisms linking communication to outcomes in serious illness care [19][20][21]. Addressing this gap requires isolating what actually happens during palliative care conversations -"what is expressed, how, where, when, and by who" -and evaluating the impact of these discrete communication elements on patient experiences and health outcomes [20,22]. For example, these conversations often involve discussion related to important existential questions of identity, meaning, and purpose [23], and can thus be emotionally demanding. ...
Background
While telehealth may offer promise for accessible, efficient palliative care delivery, leveraging telehealth technologies as an opportunity to better understand and advance the science of palliative care communication has been less well explored. Without identifying solutions to overcome challenges to conducting research in the virtual environment, we are unable to conduct the foundational work to offer evidence-based recommendations for high-quality telehealth, particularly in the context of palliative care. Our objective is to highlight methodological challenges in the use of telehealth for the study of palliative care communication and share lessons learned from using these methods.
Methods
This paper is the result of a reflective process and experience across three ongoing observational communication research studies focused on the use of telehealth during serious illness. These research datasets have been collected from multiple sites and represent rural and urban telehealth palliative care consultations for patients receiving dialysis (n = 34), patients with cancer (n = 13), and seriously ill, home-bound patients (n = 9). We illustrate challenges, insights, and recommendations with case studies from these studies.
Results
We identify key challenges, and offer recommendations to address them, in telehealth palliative care communication research. Key insights fall within three themes: 1) addressing accessibility barriers to enrollment in telehealth research; 2) technical considerations regarding how software and hardware choices have implications for data collection and analysis; and 3) ethical considerations regarding the nuances of consent and privacy in telehealth encounters.
Conclusions
Overall, our approach demonstrates possibilities for the use of telehealth to study palliative care communication and provides a “how-to” example for unique telehealth considerations from data collection through analysis. These strategies can facilitate success with large-scale health communication research studies in the telehealth context.
Cette étude examine comment le Centre d'Addictologie IBN ALHASSAN à Fès, Maroc, gère la prise en charge des toxicomanes, un enjeu majeur de santé publique touchant diverses populations. À travers une approche qualitative, cette recherche explore les pratiques actuelles, les ressources, les défis du centre et les opportunités d'amélioration du traitement des toxicomanes. Elle met en avant l'importance de l'évaluation psychiatrique initiale, du soutien psychosocial et de l'engagement familial. La recherche révèle également des défis comme le manque de ressources, le besoin de formations spécialiséespour le personnel soignant et la stigmatisation. Elle appelle à l'innovation dans les méthodes de traitement et à une meilleure intégration des services de santé mentale, tout en soulignant l'importance de sensibiliser et de soutenir la communauté pour améliorer l'accès aux soins et la qualité de la prise en charge.
PURPOSE
Patients with cirrhosis undergo frequent abdominal imaging including semiannual hepatocellular carcinoma (HCC) screening, with results released immediately via the patient portal. We characterized time from patient review to patient-provider communication (PPC) for patients with abnormal liver imaging results.
METHODS
We identified patients with cirrhosis enrolled in the patient portal with a new abnormal liver lesion (LI-RADS, LR) on ambulatory liver ultrasound (US) or multiphasic computed tomography/magnetic resonance imaging. Imaging findings were grouped into low-risk (US-2, LR-2), intermediate-risk (US-3, LR-3), and high-risk (LR-4, LR-5, LR-M, LR-TIV) results. We extracted three date-time events from the electronic health record, including result release to the patient, patient review of the result, and result-related PPC. We compared communication methods and the median time with PPC after patient review of results between groups.
RESULTS
The cohort included 133 patients (median age, 62 years, 56% male) with 34 (25.6%) low-risk, 61 (45.9%) intermediate-risk, and 38 (28.6%) high-risk results. PPC for high-risk results was predominantly via telephone calls (60.5%), whereas portal messages were most commonly used for low- and intermediate-risk results (61.8% and 45.9%, respectively; P < .001). For patients who reviewed their result on the portal, most (79.3%) reviewed the result before PPC, among whom the median time between review and PPC was 55.8 (IQR, 22.0-219.0), 167 (IQR, 42.7-324.0), and 47.3 (IQR, 25.8-78.8) hours for low-, intermediate-, and high-risk results, respectively ( P = .02).
CONCLUSION
Portal-based review of abnormal imaging results by patients before provider communication is common, including results concerning a new HCC diagnosis. Further studies are needed to evaluate patient-reported outcomes, such as psychological distress, associated with this method of disclosing cancer-related results.
This study applies Relational Dialectics Theory (RDT 2.0) to examine the dominant and marginal discourses surrounding the speculum on Weibo in China and how these discourses compete to make meaning of the speculum object. Through contrapuntal analysis, we explore how two discourses—the centripetal discourse, “Speculum is Scientific and Beneficial” (SSB), and the centrifugal discourse, “Speculum is Regressive and Detrimental” (SRD)—interact and compete across three contractive practices, two types of synchronic interplay, and two forms of dialogic transformation. Our research broadens the application of RDT to non-Western stigmatized health contexts. Additionally, the current research deepens our understanding of the unique characteristics of digital platforms and their role in facilitating discourse competition, while illuminating broader social tensions around health, gender, and power in the context of women’s health in China, highlighting the complexities and constraints of public discourse on these issues.
Introduction
Lung cancer is especially prevalent among US veterans, and lung cancer mortality can be reduced through lung cancer screening (LCS). LCS guidelines recommend shared decision making (SDM) to help patients weigh the benefits and harms of LCS and make informed, values-based decisions about screening. Yet some question whether SDM affects patient outcomes. This study evaluated US veterans’ perceptions of LCS SDM quality and its relationship with satisfaction in LCS decisions.
Methods
We administered surveys via mail and phone to veterans in the VA New England Healthcare Network after recent LCS conversations. SDM quality was measured using CollaboRATE, with top scores indicating high quality. Decision satisfaction was assessed using the Satisfaction with Decision scale. Generalized linear models analyzed associations between perceived SDM quality and decision satisfaction, adjusting for demographics, health, and overall care satisfaction.
Results
Among 1,033 patients who received surveys, 320 responded (31.0%), with 220 recalling the LCS conversation. Among those who answered the CollaboRATE questions, 34.0% (73/215) perceived SDM to be high quality (“top scorers”). Perceived high-quality SDM was significantly associated with greater decision satisfaction compared with lower perceived SDM quality (adjusted mean satisfaction on a 30-point scale = 26.75 v. 24.23; P < 0.001). A greater proportion of patients who received, versus did not receive, patient education materials rated SDM as high quality (44.4% v. 27.7%, P = 0.018).
Limitations
The sample was primarily White, male, and all US veterans, limiting generalizability to other LCS-eligible cohorts. The cross-sectional design prevents causal inferences and long-term follow-up.
Conclusions
Higher perceived SDM quality was associated with greater patient satisfaction with the LCS decision. Improving SDM processes can enhance patient engagement and may improve LCS adherence and health outcomes.
Highlights
Higher perceived shared decision making (SDM) quality in lung cancer screening (LCS) discussions leads to greater patient satisfaction with screening decisions.
While the use of patient education materials was linked to higher perceived SDM quality, less than half of patients who received materials rated SDM as high quality. There remains room for improved design and delivery to ensure materials effectively support the SDM process and guidance to providers on how to effectively incorporate patient educational materials to support, rather than replace, high-quality SDM conversations.
Enhancing SDM processes and aligning them with patient preferences can support patient satisfaction with their decision, which may have downstream benefits to patient engagement, adherence, and improved outcomes.
The outcomes of this mixed method research show the intersection of biological and societal factors which affects the doctor-patient relationship, specifically for poor hygienic patient who were seeking the medical help by health care providers. To explore the doctor-patient relationships and treatment procedures for in-hygienic patients by noticing the intersection of biological and social factors. World Health Organization (2019) stated that the biological and societal factors that contribute to in-hygienic patients' health issues are intricately linked. Islam et al., (2025) study reveal that the negative experience of a situation hurts the mental health of a person. It affects the mood and introduces anger and distress which is responsible for the change of emotions leads to impolite behaviour of a person. For analyzes the factors affecting doctor-patient relationship approach of grounded theory was used in this research. A semi-structured interview was conducted by the health care provider to collect the data. Thematic analysis was used to filter the data. The result reveals that a strong doctor-patient relationship enhances the treatment outcomes fostering trust, empathy and compliance. The intersection of biological and social factors also showed that socioeconomic backgrounds and cultural stigmas pose unique treatment challenges. Provider biases critically affect care quality with negative perception leading inadequate treatment. However, some participant argued that alone doctor-patient relationships may not determine outcomes suggesting a multifaceted approach care are essential. This study emphasizes the importance of addressing both social determinants and provider attitudes to improve
The use of respectful communication is essential to establishing a good therapeutic relationship between the healthcare professional (HCP) and the patient. Negative language can adversely affect interactions between the public and HCPs. Person-centred care is advocated in cardiovascular care, but there is lack of information regarding on how communication and respectful language can be applied. The aim of this statement is to explore the concept of respectful language in the delivery of person-centred cardiovascular care and present a working definition of respectful language in the context of healthcare and HCPs. This paper outlines of the role of communication in the delivery of cardiovascular care with critical analysis of the relevant literature. Factors influencing respectful language including ethnicity and culture and the move from the term ‘patient’ to ‘person’ are explored. Digital technologies (such as remote monitoring) now play a key role in delivering healthcare and HCPs need to be mindful on how it affects communication. Another important consideration is artificial intelligence and its potential impact on respectful language. Many healthcare providers and organizations have developed plain language documents, and non-technical lay summaries are available for evidence-based guidelines and research. This paper offers suggestions for ensuring best practice in the use of respectful language. Undoubtedly, respectful language is central to delivering person centred care. Every individual HCP involved in providing cardiovascular care can make some changes to their communication. Further education and training in the use of respectful language is needed along with evidence highlighting patient-reported outcomes and experience.
While patient-centered communication (PCC) has been recognized for its potential to enhance health and well-being, existing research presents mixed findings, partly due to limited attention to intermediary processes. Additionally, disparities in communication quality leave minority populations at a disadvantage, experiencing less effective communication and lower levels of patient-centeredness. This study addresses these gaps by examining how different PCC functions influence both general and mental health outcomes within minority populations. Furthermore, it investigates the role of health competence as a potential mediator, given its importance in navigating the healthcare system. This study used secondary data from four iterations spanning from 2011 to 2022 (HINTS 4 Cycle 1 - 2011, HINTS 5 Cycle 1 - 2017, HINTS 5 Cycle 4 - 2020, HINTS 6 Cycle 1 - 2022) with a sample size of n = 5501, focusing exclusively on individuals from minority racial backgrounds. The study used ANOVA, chi-square tests, and multiple linear regressions to investigate how different PCC functions and sociodemographic factors affect general health, health competence, and mental health within these populations. The present study revealed that PCC has varying impacts on the reporting of general and mental health within minority populations. Although we observed positive associations, they were not consistent across all the patients. In certain years, specific PCC dimensions demonstrated significant relationships with mental health, emphasizing their influence on mental well-being. Health competence emerged as a crucial mediator between PCC and health outcomes, particularly in terms of general health. This study provides valuable insights into the relationships between PCC and health competence and health outcomes among minority populations. These findings emphasize the importance of tailored healthcare approaches for minority populations, recognizing the multifaceted nature of healthcare interactions.
Predictive modeling has advanced healthcare management by informing operational and strategic decisions; however, such models often exclude the fundamental care elements that shape patients' experiences, thereby limiting person-centered, quality-driven decisions. This gap is addressed by piloting a predictive model grounded in the Fundamentals of Care (FoC) Framework, which captures how system-level and policy-level conditions ( Context of Care ) influence care outcomes ( Integration of Care ) through the clinician–patient Relationship . A cross-sectional, exploratory design was implemented across Spain (hospital-based care, n = 55) and Australia (community-based care, n = 32). A culturally adapted, 41-item patient-reported experience measure was developed to operationalize the FoC Framework’s three core dimensions. Structural relationships were tested using Consistent Partial Least Squares Structural Equation Modeling to assess model feasibility. Results indicate that the Context of Care significantly predicted Relationship in both countries (Spain: β = 0.33; Australia: β = 0.68), which strongly predicted Integration of Care (Spain: β = 0.84; Australia: β = 0.92), fully mediating the effect of Context , which had no direct influence on Integration . Findings highlight a consistent structural pathway: Context of Care → Relationship → Integration of Care . This pilot demonstrates the feasibility of integrating patient-reported experience data into predictive modeling grounded in fundamental care delivery theory, offering transferable insights into how system- and policy-level conditions shape care quality through the Relationship dimension. The model supports early-stage decision-making tools for quality improvement, workforce planning, and system design, emphasizing the importance of a Context of Care that enables clinician-patient Relationships to achieve effective Integration of Care .
PURPOSE
Endocrine treatments for patients with hormone-sensitive breast cancer are associated with significant side effects that can negatively affect health-related quality of life and result in treatment discontinuation. The objective of this qualitative study was to obtain feedback from stakeholder clinicians and patients about an online interactive tool that was designed to provide information and visualizations of breast cancer symptoms.
METHODS
The online Breast Cancer Symptom Explorer tool was developed to allow patients to visualize trajectories for common symptoms associated with tamoxifen and anastrozole using symptom data from the NSABP B35 breast cancer clinical trial. To refine the tool, virtual focus groups were conducted among oncology clinicians and women with a history of breast cancer who had received treatment with an aromatase inhibitor or tamoxifen, seeking feedback on the tool and its potential usefulness. Discussions took place using a secure web-conferencing platform following a semi-structured interview guide. Focus groups were audio-recorded, transcribed, and analyzed using reflexive thematic analysis.
RESULTS
Nine focus groups were conducted (n = 21 participants: eight clinicians and 13 patients). Key benefits and barriers to tool use emerged from the discussions. Both patients and oncologists valued the ability to engage with the tool and visualize symptoms over time. They indicated that ideal settings for its use would be at home before treatment initiation. Combinations of graphical representations with text were perceived to be most effective in communicating symptoms. Key barriers identified included concerns about accessibility to the tool and digital literacy, with recommendations to simplify the text and provide health literacy support to enhance its clinical utility in the future.
CONCLUSION
Clinician and patient involvement was critical for refinement of the breast cancer symptom explorer and provided insights into its future use and evaluation of the tool in clinical decision making.
Previous studies have predominantly focused on the relationship between death anxiety and quality of life in breast cancer patients, with limited exploration on how to alleviate their death anxiety. To address this gap, we recruited 533 breast cancer patients and utilized structural equation modeling and Process Model 4 to analyze the internal mechanisms and boundary conditions between family support and death anxiety. The study results indicated that family support significantly negatively impacts death anxiety in breast cancer patients; similarly, meaning in life also significantly negatively impacts death anxiety. More importantly, we found that meaning in life plays a full mediating role between family support and death anxiety. This study suggests that by enhancing family support levels and strengthening patients’ perception of meaning in life, we can significantly improve the psychological health status of breast cancer patients, thereby potentially improving their quality of life.
Accurately interpreting medical images and generating insightful narrative reports is indispensable for patient care but places heavy burdens on clinical experts. Advances in artificial intelligence (AI), especially in an area that we refer to as multimodal generative medical image interpretation (GenMI), create opportunities to automate parts of this complex process. In this Perspective, we synthesize progress and challenges in developing AI systems for generation of medical reports from images. We focus extensively on radiology as a domain with enormous reporting needs and research efforts. In addition to analysing the strengths and applications of new models for medical report generation, we advocate for a novel paradigm to deploy GenMI in a manner that empowers clinicians and their patients. Initial research suggests that GenMI could one day match human expert performance in generating reports across disciplines, such as radiology, pathology and dermatology. However, formidable obstacles remain in validating model accuracy, ensuring transparency and eliciting nuanced impressions. If carefully implemented, GenMI could meaningfully assist clinicians in improving quality of care, enhancing medical education, reducing workloads, expanding specialty access and providing real-time expertise. Overall, we highlight opportunities alongside key challenges for developing multimodal generative AI that complements human experts for reliable medical report writing.
In online medical consultations, patients convey their medical condition through self-disclosure, and the linguistic features of this disclosure, as signals, may significantly impact doctors’ diagnostic behavior and service quality. Based on signaling theory, this paper collects consultation data from a large online medical platform in China, employs text mining and classification techniques to extract relevant variables, and applies econometric models to empirically examine the effect of patients’ self-disclosure linguistic features on the quality of online medical services. The results indicate that the completeness and readability of patients’ self-disclosure have a significant positive impact on the quality of doctors’ services, while the expertise and positive sentiment of the disclosure have a significant negative effect. From the perspective of signaling theory, this study reveals the mechanism through which patients’ self-disclosure linguistic features influence doctors’ online consultation behavior, providing an important theoretical foundation for promoting online doctor–patient interaction and enhancing patient well-being.
Many journalists believe they must become more engaged with the public to improve trust in news. What remains unknown is how the public weighs the trustworthiness of engagement relative to the trustworthiness of a more traditional journalistic value: expertise. This study aims to address this gap by assessing public perceptions of engagement and expertise within journalism and comparing them with perceptions of expertise and engagement within another institution dealing with similarly high levels of distrust: healthcare. Professionals within both journalism and healthcare are attempting to mitigate their trust crises by increasing their engagement with the people they seek to serve, which means each profession is currently navigating an uncertain balancing act between engagement and people’s perceived expertise that this study seeks to explore. Using a US-based survey (N = 981) and employing structural equation modeling (SEM), we find that, when it comes to journalism, engagement does not significantly influence trust, while perceived expertise has a positive impact. In contrast, perceptions of healthcare specialists show both perceived expertise and engagement positively influencing trust, with engagement having a stronger effect. We conclude by exploring the implications of these findings for the relationship between journalists and the public.
Background
Previous studies have identified considerable health outcome disparities for adults with intellectual and developmental disabilities (IDD) as well as poor or ineffective communication between adults with IDD and their medical providers.
Methods
Using National Health Interview Survey (NHIS) data, this paper uses logistic regression to estimate disparities in healthcare communication and satisfaction between adults with IDD, adults with non‐IDD disabilities, and adults with no reported disabilities, controlling for sociodemographic characteristics. Communication quality is measured with survey questions about whether medical providers are respectful, ask for patients' opinions, and offer understandable medical information.
Results
We identified sizeable disparities in communication quality and satisfaction between adults with non‐IDD disabilities and no reported disabilities. Adults with IDD experienced significantly lower odds of receiving understandable information compared to adults with no reported disabilities. There are suggestive evidence that adults with IDD have lower odds of being satisfied with healthcare, having their opinion asked, and feeling respected.
Conclusions
There are healthcare communication and satisfaction disparities between adults with and without IDD or other disabilities. Future research should characterise the size and exact nature of these disparities in communication quality and satisfaction for those with IDD. These findings can inform interventions and trainings to improve communication quality and satisfaction for those with all forms of disability.
Objectives:
The Question Prompt List (QPL) enhances patients' consultation preparation by improving health literacy and communication with healthcare professionals. A validated tool for this context is not yet available. We adapted and translated an Australian QPL to ensure its validity. This study seeks to improve patient-centred communication and health literacy through the QPL. This study aims to conduct a translation and cross-cultural adaptation of the QPL.
Study design:
Cross-cultural adaptation.
Methods:
Beaton's five-step guide inspired the cross-cultural adaptation, which involved forward and back translations from the Australian to Danish versions. Patients at the orthopaedic department tested the final version, evaluating the QPL for clarity, usefulness, and context. Four semi-structured interviews supplemented this process. Feedback from patients led to the refinement and finalisation of the QPL.
Results:
The translations revealed some contradictions, indicating a need for QPL adjustments to fit the Danish context. Most patients were satisfied with the QPL, finding it beneficial and comprehensive. They noted that the QPL would have been helpful in previous consultations. Minor criticisms of specific questions were also raised, leading to further discussion and refinement.
Conclusions:
This cross-cultural adaptation has ensured the validity and quality of a Danish QPL, and implementation strategies are now ready for investigation.
Purpose - The utilization of virtual agents, particularly chatbots, within healthcare and medical contexts is witnessing exponential growth owing to their capacity to provide comprehensive support to patients throughout their healthcare journey, by reshaping the healthcare business processes. Such transformation in healthcare service delivery processes is enabled by those digital entities able to offer a preliminary screening and consultation platform, facilitating patients' interactions with real medical professionals. However, when redesigning processes through the integration of new technologies, particular attention to the reactions of end users cannot be neglected. Thus, the purpose of this paper is investigating how both chatbots' features and patients' individual differences may shape a redesigned/renewed service in the healthcare sector.
Design/methodology/approach - Through two experimental studies (Study 1 and Study 2), we examined the impact of chatbot tone of voice (formal vs unformal) on patients' behavioral responses, particularly their intention to use.
Findings - Our investigation shed light on chatbots' characteristics in terms of perceived warmth, denoting the friendliness and empathy conveyed by the chatbot, and competence, reflecting its effectiveness in addressing user queries or tasks, when used to reshape the service delivery process; Moreover, we also shed light on the moderating role of emotional receptivity seeking, indicating that the emotionality and non-verbal communication between doctor and patient, cannot be overlooked even in innovative digital environments.
Practical implications - Managers and marketers could leverage insights from this study to tailor chatbot interactions, optimizing tone of voice to enhance patient engagement and satisfaction. By focusing on perceived warmth and competence, they can design more effective digital health solutions. Additionally, recognizing the role of emotional receptivity can guide strategies for integrating chatbots in a way that maintains a human touch in patient communications.
Social implications - Findings importantly underscore the relevance of chatbot in improving patient care, making digital interactions more empathetic and responsive. This relevance extends to business process management by demonstrating how integrating emotionally intelligent chatbots may contribute to better service delivery on the basis of personalized and effective healthcare experiences.
Originality/value - The originality of this paper is about the relevance of considering chatbots' and final users' characteristics to strategically plan healthcare services process redesign. Indeed, it examines chatbots' perceived warmth and competence in reshaping service delivery processes. Additionally, it highlights the moderating role of emotional receptivity seeking, emphasizing the importance of emotional communication in digital healthcare environments.
Objectives
This research aimed to improve understanding of persisting impacts of patient-reported psychosomatic and psychiatric misdiagnoses on patients with systemic autoimmune rheumatic diseases (SARDs).
Methods
Mixed methods data from two SARDs cohorts were analysed (N = 1,543 and N = 1,853). Validated instruments and patient-designed questions were used to measure self-reported depression, anxiety and mental wellbeing, in addition to medical relationships and healthcare behaviours. Comparative tests were used to evaluate differences between patients reporting a psychosomatic and/or psychiatric misdiagnoses and other patients.
Results
Persisting adverse outcomes of perceived psychosomatic and psychiatric misdiagnoses were identified in multiple domains. This included >80% of patients reporting that it had damaged their self-worth, and 72% reporting that it still upset them. Patients reporting psychosomatic and/or psychiatric misdiagnoses had significantly lower mental wellbeing, and higher depression and anxiety levels (all p< 0.001), and lower levels of satisfaction with every aspect of medical care, compared with patients reporting no psychosomatic or psychiatric misdiagnoses. Psychosomatic and psychiatric misdiagnoses had varying associations with healthcare behaviours, including a significantly higher likelihood of under-reporting symptoms (p< 0.001) and healthcare avoidance (p= 0.012), but not with medication adherence (p= 0.2). Thematic analysis of qualitative data revealed that symptom under-reporting and healthcare avoidance often resulted from distrust and fear that symptoms would be disbelieved and misattributed again.
Conclusion
Patient-reported psychosomatic and psychiatric (mis)diagnoses are associated with persisting adverse impacts in multiple domains including mental health, medical relationships, self-worth, and some healthcare behaviours. Health services and clinicians should consider these potential adverse impacts on patients and offer support to reduce any persisting negative impacts.
Importance
Some US populations experience perceived discrimination in health care settings (PDHS) that may lead to delaying health care and worse health outcomes. It is crucial to understand potential mechanisms, such as patient-clinician communication (PCC), that may reduce these disparities.
Objective
To examine PCC as a mediating pathway between PDHS and health care delays due to nervousness about seeing a health care professional while considering the moderating roles of age and race and ethnicity.
Design, Setting, and Participants
This cross-sectional study examined data from the All of Us Research Program between May 31, 2017, and April 30, 2022. Included participants were adults aged 18 years or older with type 2 diabetes and/or hypertension. The data analysis was performed between February 20 and April 29, 2024.
Exposure
Perceived discrimination in the health care setting.
Main Outcome and Measures
The study outcome was health care delays due to being nervous about seeing a health care professional. The association between PDHS and health care delays was examined through PCC using a structural equation model with moderated mediation analysis.
Results
The analytic sample comprised 25 581 participants (mean [SD] age, 62.4 [12.8] years; 58.1% women; and 9.5% of Black, 6.3% of Hispanic, 81.3% of White, and 2.9% of other race and ethnicity). Delaying health care due to feeling nervous about seeing a health care professional was reported by 2300 participants (8.9%). Patient-clinician communication mediated the association between PDHS and delayed care. Mediation proportions decreased with age across all racial and ethnic groups, with the highest proportions observed among participants aged 18 to 44 years (Black participants, 19.5% [95% CI, 14.9%-24.1%]; Hispanic participants, 20.3% [95% CI, 15.6%-25.1%]; White participants, 19.0% [95% CI, 14.7%-23.2%]; participants of other race and ethnicity, 18.3% [95% CI, 13.2%-23.5%]). Within each age group, the highest mediation proportions were observed among Hispanic participants, followed by Black and White participants, and participants of other race and ethnicity.
Conclusions and Relevance
These findings suggest that higher PDHS is positively associated with delaying health care due to nervousness about seeing a health care professional. The largest mediation proportion observed was among younger adults and racial and ethnic minority groups. By prioritizing better PCC, health care delays associated with patient apprehension related to perceived discrimination may be reduced.
Objective:
To examine patient-reported experiences of healthcare services by disability status.
Study setting and design:
We conducted a cross-sectional analysis of Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures of overall healthcare satisfaction, timeliness of care, and patient-provider interactions to assess differences by disability status and, among those with a disability, between those with sensory, physical, cognitive, or multiple disabilities.
Data sources and analytic sample:
CAHPS measures included in the 2021 Medical Expenditure Panel Survey for U.S. adults.
Principal findings:
People with disabilities reported significantly lower ratings of healthcare services compared to the general population (7.98, 95% CI: 7.89-8.08 vs. 8.38, 95% CI: 8.34-8.43 on a scale of 0 [worst] to 10 [best]), with the lowest satisfaction among people with multiple disabilities (7.87, 95% CI: 7.72-8.02). Disabled people reported worse experiences on all measures compared to people without disabilities. People with physical, cognitive, and multiple disabilities reported significantly worse experiences of healthcare services than those with sensory disabilities.
Conclusions:
In a nationally representative sample of U.S. adults, disabled people reported lower satisfaction with healthcare services, less timely care, and worse provider interactions than people without disabilities. Changes to policy and practice are needed to improve healthcare experiences for disabled people.
Background This study investigates the communication strategies adopted by Key Opinion Leaders (KOLs) in the fields of obstetrics and gynecology to share knowledge about women’s reproductive health and examines their impacts on user engagement. Method Based on the SACCIA model of doctor-patient communication, attribution theory, and a stigma reduction framework, this study conducts a content analysis of 2,892 video posts published by the top ten obstetrics and gynecology KOLs (ranked by the numbers of followers) on Xiaohongshu (小红书) from July 2023 to June 2024. Results The findings suggest that these KOLs, using strategies such as Q&A and guidance and advice, have challenged the traditional values of women’s health and promoted open public discussions about female physiology. Moreover, their video content highlights healthy lifestyles, disease prevention, and the integration of Western medicine with traditional Chinese medicine, which indicates a trending medical treatment. The study also discusses the limitations in their communication strategies and offers new perspectives for future research and practice. Conclusion The health education videos by KOLs on Xiaohongshu have significantly increased user engagement with topics such as menstrual issues and pregnancy complications and enhanced public awareness of women’s health.
This chapter explores interprofessional communication in the neonatal intensive care unit (NICU), where the difficult, complex, intensive patient care required makes teamwork more challenging and at the same time more necessary. These challenges stem, in part, from the need for high-reliability communication among professionals who bring differing frames and scripts for problem solving and who must navigate power and status differences in their actions. Furthermore, the requirements of family-centered care, such as collaborative decision making with diverse families, makes interprofessional teamwork even more demanding. The chapter reviews existing communication interventions for high-reliability interprofessional communication in this context, where institutional, organizational, and family dynamics intersect, and it discusses how interprofessional teams address these challenges.
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.
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.
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. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes.
Design Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle.
Setting 41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England.
Subjects 250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group).
Intervention 1.5 days' group training for the doctors and nurses—introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions.
Main outcome measures Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2).
Results Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6;1.1 to 2.5) and wellbeing (difference in means (d) 2.8;
0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower −2.74;−0.23 to −5.25. Differences in lifestyle and glycaemic control were not significant.
Conclusions The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.
The assessment of health-related quality of life (HR-QOL) is an essential element of healthcare evaluation. Hundreds of generic and specific HR-QOL instruments have been developed. Generic HR-QOL instruments are designed to be applicable across a wide range of populations and interventions. Specific HR-QOL measures are designed to be relevant to particular interventions or in certain subpopulations (e.g. individuals with rheumatoid arthritis). This review examines 7 generic HR-QOL instruments: (i) the Medical Outcomes Study 36-Item Short Form (SF-36) health survey; (ii) the Nottingham Health Profile (NHP); (iii) the Sickness Impact Profile (SIP); (iv) the Dartmouth Primary care Cooperative Information Project (COOP) Charts; (v) the Quality of Well-Being (QWB) Scale; (vi) the Health Utilities Index (HUI); and (vii) the EuroQol Instrument (EQ-5D). These instruments were selected because they are commonly used and/or cited in the English language literature. The 6 characteristics of an instrument addressed by this review are: (i) conceptual and measurement model; (ii) reliability; (iii) validity; (iv) respondent and administrative burden; (v) alternative forms; and (vi) cultural and language adaptations. Of the instruments reviewed, the SF-36 health survey is the most commonly used HR-QOL measure. It was developed as a short-form measure of functioning and well-being in the Medical Outcomes Study. The Dartmouth COOP Charts were designed to be used in everyday clinical practice to provide immediate feedback to clinicians about the health status of their patients. The NHP was developed to reflect lay rather than professional perceptions of health. The SIP was constructed as a measure of sickness in relation to impact on behaviour. The QWB, HUI and EQ-5D are preference-based measures designed to summarise HR-QOL in a single number ranging from 0 to 1. We found that there are no uniformly `worst' or `best' performing instruments. The decision to use one over another, to use a combination of 2 or more, to use a profile and/or a preference-based measure or to use a generic measure along with a targeted measure will be driven by the purpose of the measurment. In addition, the choice will depend on a variety of factors including the characteristics of the population (e.g. age, health status, language/culture) and the environment in which the measurement is undertaken (e.g. clinical trial, routine physician visit). We provide our summary of the level of evidence in the literature regarding each instrument's characteristics based on the review criteria. The potential user of these instruments should base their instrument selection decision on the characteristics that are most relevant to their particular HR-QOL measurment needs.
Hypertensive patients' expressing themselves in their own words (Exposition) and providers' giving information (Explanation) during medical interviews were hypothesized to be associated with subsequent blood pressure control. Transcripts of routine return visits to clinics in low-income areas of Houston, TX, were coded using the Verbal Response Modes (VRM) system. VRM indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home interviews 2 weeks after the clinic visits. Patient Exposition was significantly correlated with reductions in systolic and diastolic blood pressure from clinic visit to home interview, and Provider Explanation was significantly correlated with lower diastolic blood pressure at home interview. The results suggest that patients' and providers' verbal behavior in medical interviews should be included in predictive models of blood pressure control.
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 71% 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: they had reported symptoms to the practitioner at the first treatment session, or 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.
Attributions for cancer and beliefs about control over cancer were examined for their association with adjustment to breast cancer. Although 95% of the respondents made attributions for their cancer, no particular attribution (e.g., stress, diet) was associated with better adjustment. Analyses of attributions of responsibility for the cancer to the self, environment, another person, or chance yielded only a negative relation between adjustment and blaming another person. In contrast, both the belief that one could now control one's cancer and the belief that others (e.g. the physician) could now control the cancer were significantly associated with good adjustment. Of the different types of control, cognitive control was most strongly associated with adjustment, behavior control was less strongly associated with adjustment, and information control and retrospective control were unassociated with adjustment. The theoretical and practical implications of these results are discussed.
The influence of physicians' attributes and practice style on patients' adherence to treatment was examined in a 2-year longitudinal study of 186 physicians and their diabetes, hypertension, and heart disease patients. A physician-level analysis was conducted, controlling for baseline patient adherence rates and for patient characteristics predictive of adherence in previous analyses. General adherence and adherence to medication, exercise, and diet recommendations were examined. Baseline adherence rates were associated with adherence rates 2 years later. Other predictors were physician job satisfaction (general adherence), number of patients seen per week (medication), scheduling a follow-up appointment (medication), tendency to answer patients' questions (exercise), number of tests ordered (diet), seriousness of illness (diet), physician specialty (medication, diet), and patient health distress (medication, exercise).
Social support and immune status were assessed in women treated with adjuvant chemotherapy for breast cancer. Perception of enhanced attachment was associated with an increased number of white blood cell levels three months after, but not during, chemotherapy. After treatment, patients with high attachment ratings had higher numbers and proportions of granulocytes, and lower proportions of lymphocytes and monocytes. It is concluded that the support experienced by a cancer patient can be associated with counts and proportions of leukocytes, but that this effect, if present during chemotherapy, is overridden by the biological factor that affects the haematopoetic process.
To examine positive and negative social support and other selected social context variables (age, education, marital status, gender, and exposure to other smokers inside and outside the home) as predictors of smoking cessation in non-hospitalised adults with diagnosed cardiovascular disease at follow up after one, six, and 12 months.
Discriminant function analyses (DFA) and longitudinal "lag" analyses.
137 Non-hospitalised adults with diagnosed cardiovascular health problems.
Examination of the concurrent DFAs revealed significant univariate F ratios for the predictor variables of gender and marital status at one year and low negative support at all three follow ups. Quitters reported significantly lower levels of negative support than non-quitters over the course of the year and tended to be male and married. Longitudinal "lag" analyses, however, revealed that higher positive social support at one month and higher negative support at six months were both predictive of smoking cessation at one year. At one year more men than women and more married than not married smokers were successful in quitting. No effects for age, education, or exposure to others smoking inside or outside the home were found on any of the concurrent DFAs or longitudinal analyses.
A series of concurrent DFAs revealed that positive support was a significant predictor of quitting at one year and negative support was predictive of not quitting at all three follow ups. Longitudinal "lag" analyses showed that positive support at one month and negative support at six months both predicted quitting at one year. Being male and married were found to contribute to quitting on both sets of analyses. The effects for positive and negative support on the smoking behaviour of adults with cardiovascular disease tended to change over the course of a year. These findings suggest that positive and negative social support may have differential effects over time. As the smoker moves along the "quitting trajectory" it may be that more "nagging" or negative interactions are needed at some point to get smokers to quit, if positive support has not worked or is not working. Progression of disease also may have served as a stimulus for family members and friends to become more insistent and negative about the person's continued smoking. More research is needed to examine the quitting process to determine which and how social context variables contribute.
To assess the effect of additional training of practice nurses and general practitioners in patient centred care on the lifestyle and psychological and physiological status of patients with newly diagnosed type 2 diabetes.
Pragmatic parallel group design, with randomisation between practice teams to routine care (comparison group) or routine care plus additional training (intervention group); analysis at one year, allowing for practice effects and stratifiers; self reporting by patients on communication with practitioners, satisfaction with treatment, style of care, and lifestyle.
41 practices (21 in intervention group, 20 in comparison group) in a health region in southern England.
250/360 patients (aged 30-70 years) diagnosed with type 2 diabetes and completing follow up at one year (142 in intervention group, 108 in comparison group).
1.5 days' group training for the doctors and nurses-introducing evidence for and skills of patient centred care and a patient held booklet encouraging questions.
Quality of life, wellbeing, haemoglobin A1c and lipid concentrations, blood pressure, body mass index (kg/m2).
Compared with patients in the C group, those in the intervention group reported better communication with the doctors (odds ratio 2.8; 95% confidence interval 1.8 to 4.3) and greater treatment satisfaction (1.6; 1.1 to 2.5) and wellbeing (difference in means (d) 2.8; 0.4 to 5.2). However, their body mass index was significantly higher (d=2.0; 0.3 to 3.8), as were triglyceride concentrations (d=0.4 mmol/l; 0.07 to 0.73 mmol/l), whereas knowledge scores were lower (d=-2.74; -0.23 to -5.25). Differences in lifestyle and glycaemic control were not significant.
The findings suggest greater attention to the consultation process than to preventive care among trained practitioners; those committed to achieving the benefits of patient centred consulting should not lose the focus on disease management.
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.
To assess how patients present clues and how physicians respond to these clues in routine primary care and surgical settings.
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.
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.
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.
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. JAMA. 2000;284:1021-1027
The six research teams highlighted in this special issue of Health Communication were concerned with developing a methodologically sound and theoretically heuristic coding scheme to document the provider-patient interaction, and all articles coded the same set of provider-patient interactions. In this article, I first summarize the similarities and differences among the six articles and then raise two fundamental questions that are designed to stimulate further research in the field.
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.
Effective patient–professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient–professional communication should be tailored to meet individual need.
In this paper we revisit and add elements to our earlier conceptual framework on shared treatment decision-making within the context of different decision-making approaches in the medical encounter (Charles, C., Gafni, A., Whelan, T., 1997. Shared decision-making in the medical encounter: what does it mean? (or, it takes at least two to tango). Social Science & Medicine 44, 681-692.). This revised framework (1) explicitly identifies different analytic steps in the treatment decision-making process; (2) provides a dynamic view of treatment decision-making by recognizing that the approach adopted at the outset of a medical encounter may change as the interaction evolves; (3) identifies decision-making approaches which lie between the three predominant models (paternalistic, shared and informed) and (4) has practical applications for clinical practice, research and medical education. Rather than advocating a particular approach, we emphasize the importance of flexibility in the way that physicians structure the decision-making process so that individual differences in patient preferences can be respected.
Many clinicians have called for an increased emphasis on the patient's role in clinical decision making. However, little is known about the extent to which physicians foster patient involvement in decision making, particularly in routine office practice.
To characterize the nature and completeness of informed decision making in routine office visits of both primary care physicians and surgeons.
Cross-sectional descriptive evaluation of audiotaped office visits during 1993.
A total of 1057 encounters among 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons; 2 to 12 patients were recruited from each physician's community-based private office.
Analysis of audiotaped patient-physician discussions for elements of informed decision making, using criteria that varied with the level of decision complexity: basic (eg, laboratory test), intermediate (eg, new medication), or complex (eg, procedure). Criteria for basic decisions included discussion of the nature of the decision and asking the patient to voice a preference; other categories had criteria that were progressively more stringent.
The 1057 audiotaped encounters contained 3552 clinical decisions. Overall, 9.0% of decisions met our definition of completeness for informed decision making. Basic decisions were most often completely informed (17.2%), while no intermediate decisions were completely informed, and only 1 (0.5%) complex decision was completely informed. Among the elements of informed decision making, discussion of the nature of the intervention occurred most frequently (71 %) and assessment of patient understanding least frequently (1.5%).
Informed decision making among this group of primary care physicians and surgeons was often incomplete. This deficit was present even when criteria for informed decision making were tailored to expect less extensive discussion for decisions of lower complexity. These findings signal the need for efforts to encourage informed decision making in clinical practice.
Our objective was to determine how large, random samples of Americans define health. Two questions were used to ascertain concepts of health: Are you healthy? and How do you know? (What does health mean to you?) These questions were added to omnibus telephone surveys conducted with two random samples of adults from the 48 contiguous United States: one in 1995 (N = 1,000); the other in 2002 (N = 1,011). The surveys also collected demographic data. This study focuses on cases with complete data (N = 950 in 1995, N = 967 in 2002). In both survey samples, more than 92% of respondents reported that they were healthy. Four distinct conceptions of health emerged from responses to the "how do you know" question: physical, psychosocial, capacity, and control. While prevalence varied with survey year as well as respondent age and education, these four concepts were evident in both 1995 and 2002. There are four robust concepts of health in America. Ongoing attention to these concepts may enhance efforts to communicate about and improve health.
The study aimed to investigate the effects of a five-day tactile touch intervention in order to find new and unconventional measures to moderate the detrimental influence of patients' stressors during intensive care. The hypothesis was that tactile touch would decrease stress indicators such as anxiety, glucose metabolism, blood pressure, heart rate and requirements of sedative drugs and noradrenalin. A randomized controlled trial was undertaken with 44 patients, which were assigned either to tactile touch or standard treatment (a rest hour). Observations of the stress indicators were made before, during and after the intervention or standard treatment. The study showed that tactile touch led to significantly lower levels of anxiety. The circulatory parameters suggested increased circulatory stability indicated by a reduction in noradrenalin requirement. The results need to be further validated through studies with larger sample sizes.
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.
This report is concerned with the prediction of natural killer (NK) cell activity in 61 Stage I and II breast cancer patients, between the ages of 25 and 70, who were accrued to this project. All baseline interview and testing data were obtained either just before patients were discharged from the hospital, or at their first outpatient visit, within two weeks of discharge. A major interest of this project is the predictive value of perceived social support, as a potential "stress" buffer, related to NK activity. In the main model reported here, we found that a significant amount of NK activity variance could be explained by five variables. Higher NK activity could be predicted by the perception of high quality emotional support from a spouse or intimate other, perceived social support from the patient's physician, estrogen receptor-negative tumor status, having an excisional biopsy as surgical treatment, and actively seeking social support as a major coping strategy (R2 = 0.33, F(5,55) = 5.5, p less than 0.0004). Findings are discussed in terms of host interaction with tumor endocrine status, and the role that social support might play in modulating such activity.
Growing interest in the doctor-patient relationship focuses attention on the specific elements of that relationship that affect patients' health outcomes. Data are presented for four clinical trials conducted in varied practice settings among chronically ill patients differing markedly in sociodemographic characteristics. These trials demonstrated that "better health" measured physiologically (blood pressure or blood sugar), behaviorally (functional status), or more subjectively (evaluations of overall health status) was consistently related to specific aspects of physician-patient communication. We conclude that the physician-patient relationship may be an important influence on patients' health outcomes and must be taken into account in light of current changes in the health care delivery system that may place this relationship at risk.
To replicate an earlier study and explore associations between verbal behaviors in patient-physician interactions and outcomes of care, 102 visits to a medicine walk-in clinic were tape-recorded, transcribed, and coded according to the Verbal Response Mode (VRM) system. Questionnaires given before and after the clinic visit and telephone interviews 1 week and 4 weeks after the visit were used to measure patient satisfaction, compliance, and change in symptoms. Data were collected on patients' sociodemographic characteristics, illness characteristics, and health beliefs. Two verbal exchanges were examined: in the medical history, the Patient Exposition exchange, which was measured as the frequency with which patients make statements about their illnesses in their own words; and in the conclusion, the Physician Explanation exchange, which was measured as the percentage of physician statements that are factual. These verbal indexes showed correlations with patient satisfaction, thus replicating the earlier study, but no significant correlations with compliance. Analysis of variance showed that the association between verbal exchanges and patient satisfaction remained after controlling for physician differences and for patient age, education, and belief in the controllability of the illness.
To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes.
The MEDLINE database was searched for articles published from 1983 to 1993 using "physician-patient relations" as the primary medical subject heading. Several bibliographies and conference proceedings were also reviewed.
Randomized controlled trials (RCTs) and analytic studies of physician-patient communication in which patient health was an outcome variable.
The following information was recorded about each study: sample size, patient characteristics, clinical setting, elements of communication assessed, patient outcomes measured, and direction and significance of any association found between aspects of communication and patient outcomes.
Of the 21 studies that met the final criteria for review, 16 reported positive results, 4 reported negative (i.e., nonsignificant) results, and 1 was inconclusive. The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. The outcomes affected were, in descending order of frequency, emotional health, symptom resolution, function, physiologic measures (i.e., blood pressure and blood sugar level) and pain control.
Most of the studies reviewed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes. The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs. Future research should focus on evaluating such educational programs.
To determine whether nurses' and NIDDM patients' communication styles during consultations are related to subsequent metabolic control and to examine factors influencing patterns of communication in these consultations.
A total of 47 NIDDM patients participated in the study and completed the following procedures: 1) assessment of baseline HbA1, 2) attended 3.5 days of diabetes education, 3) returned in 1 mo for a follow-up consultation with a nurse, and (4) returned in 9-12 wk for a follow-up HbA1 assessment. The communication variables coded from the consultations were the frequency with which nurses produced controlling, informative, and patient-centered utterances and the frequency with which patients sought information, engaged in decision making, and expressed negative affect.
The results were as follows: 1) patients experienced poorer metabolic control after interacting with nurses who were more controlling and directive in their communication with patients (r = 0.39, P < 0.01); 2) the nurses' use of patient-centered responses was directly related to the degree to which patients expressed feelings (r = 0.34, P < 0.01) and exhibited decision-making behavior (r = 0.62, P < 0.01); and 3) several of the nurses' and patients' communicative behaviors were related to patient characteristics such as age, sex, education, and baseline HbA1 levels.
The results suggest that providers' attempts to exert considerable control during consultations with NIDDM patients may be counterproductive and contribute to poorer outcomes. The findings also indicate that patient-centered behaviors (e.g., encouraging the patient's involvement, respecting the patient's opinion, and offering support) facilitate the patient's ability to be an active participant in the consultation.
Many patients are reluctant to talk to family physicians about certain health issues that affect quality of life. This research examines factors that influence a patient's willingness to discuss three aspects of health-related quality of life: overall well-being, physical health, and psychosocial health.
Prior to their consultations, 254 patients completed questionnaires that assessed their perceptions of health limitations, beliefs about the family physician's job responsibilities, willingness to discuss various topics with the physician, and relational history with the physician (ie, number of previous visits). On the post-visit instrument, patients reported whether certain topics were discussed during the consultation and their satisfaction with the physician.
Patients were more willing to discuss all aspects of health-related quality of life when they believed it was the doctor's job to ask about these issues and when they had a longer relational history with the doctor. Patients' health limitations did not predispose patients to talk about certain issues. Patients were more satisfied with care when there was more discussion of the patient's overall well-being and physical health. However, discussions about psychosocial issues were not related to patient satisfaction.
A theoretical model is proposed that may be useful in explaining why patients often vary in their willingness to discuss certain topics, particularly psychosocial issues. Future research should analyze how doctors and patients introduce, manage, and terminate discussions of health-related quality of life.
This investigation of patients with early breast cancer examined relationships among patient involvement in deciding treatment (i.e., whether to undergo breast removal or breast conservation), perceptions of control over treatment decisions, and subsequent health-related quality of life. It was predicted 1) that patients who more actively participated in consultations to decide treatment would perceive more decision control than would more passive patients and 2) that patients who perceived greater decision control would report better health-related quality of life following treatment than would patients perceiving less decision control. Sixty patients with stage I or II breast cancer allowed their consultations with surgeons to be audiorecorded. Following these visits, patients reported on their involvement in the consultation, optimism for the future, knowledge about treatment, and two aspects of perceived decision control, the perception of having a choice for treatment and the extent to which the doctor or patient was responsible for the decision. Six and 12 months postoperatively, 51 patients (85%) returned a follow-up survey assessing perceived decision control and health-related quality of life. The first prediction received some support. The patients who had more actively participated in their consultations, particularly in terms of offering opinions, assumed more responsibility for treatment decisions during the year following surgery than did less expressive patients. Also, the patients who reported more involvement in their consultations later believed they had had more of a choice for treatment. The second hypothesis was partially supported. Six and 12 months following treatment, the patients who believed they were more responsible for treatment decisions and believed they had more choice of treatment reported higher levels of quality of life than did the patients who perceived themselves to have less decision control. However, perceived control at the time of treatment did not predict later quality of life. Theoretical and clinical implications are discussed.
To explore current knowledge of placebo effects, including proposed explanatory mechanisms, influencing factors, characteristics, and implications for practice and research.
Published and unpublished articles, books, and monographs.
Placebo effects occur in up to 90% of nursing interventions. They may be explained by several mechanisms and are influenced by nurse/physician demeanor, patient factors, the patient-provider relationship, treatment factors, and context of the healthcare encounter.
Nurses need to control for placebo effects when testing whether an intervention has desired effects, but once such effects have been demonstrated, nurses can make use of placebo effects to enhance the impact of their interventions.
Nurses can take measures to improve the patient's response to treatment, including providing a comfortable environment, using therapeutic communication techniques, helping patients to understand specific mechanisms of their treatment, and encouraging positive expectations and motivation for effectiveness.
To use a standardized videotape stimulus to assess the effect of physician compassion on viewers' anxiety, information recall, treatment decisions, and assessment of physician characteristics.
One hundred twenty-three healthy female breast cancer survivors and 87 women without cancer were recruited for this study. A randomized pretest/posttest control group design with a standardized videotape intervention was used. Participants completed the State-Trait Anxiety Inventory (STAI), an information recall test, a compassion rating, and physician attribute rating scales.
Women who saw an "enhanced compassion" videotape rated the physician as warmer and more caring, sensitive, and compassionate than did women who watched the "standard" videotape. Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group. Nevertheless, information recall was relatively low for both groups, and enhanced compassion did not influence patient decisions. Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes, such as wanting what was best for the patient and encouraging the patient's questions and involvement in decisions.
The enhanced compassion segment was short, simple, and effective in decreasing viewers' anxiety. Further research is needed to translate these findings to the clinical setting, where reducing patient anxiety is a therapeutic goal.
This study investigated (1) the attitudes of cancer patients toward discussing health-related quality-of-life (HRQL) issues; (2) the association between such attitudes and patients' characteristics; and (3) oncologists' attitudes and self-reported behavior regarding these same issues.
Two hundred seventy-three patients receiving palliative chemotherapy and ten physicians were asked to complete a series of questionnaires.
Almost all patients wanted to discuss their physical symptoms and physical functioning and were also willing to address their emotional functioning and daily activities. However, 25% of the patients were only willing to discuss these latter two issues at the initiative of their physician. Patients varied most in their willingness to discuss their family and social life, with 20% reporting no interest in discussing these issues at all. Female patients were more reluctant to discuss various HRQL issues than male patients. Older and less well-educated patients were more likely to prefer that their physician initiate discussion of HRQL issues. All physicians considered it to be primarily their task to discuss the physical aspects of their patients' health, whereas four physicians indicated that discussion of psychosocial issues was a task to be shared with other health care providers. All physicians indicated that they generally defer to their patients in initiating discussion of psychosocial issues.
Although both patients and oncologists seem willing to discuss a wide range of HRQL issues, communication regarding psychosocial issues may be hampered by competing expectations as to who should take the lead in initiating such discussions.
We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization.
We selected 39 family physicians at random, and 315 of their patients participated. Office visits were audiotaped and scored for patient-centered communication. In addition, patients were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1) patients' health, assessed by a visual analogue scale on symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by chart review. The 2 measures of patient-centeredness were correlated with the outcomes of visits, adjusting for the clustering of patients by physician and controlling for confounding variables.
Patient-centered communication was correlated with the patients' perceptions of finding common ground. In addition, positive perceptions (both the total score and the subscore on finding common ground) were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.
Patient-centered communication influences patients' health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.
For life-threatening illnesses such as cancer that require a long-term treatment regimen, communication is particularly important between doctors and patients. While it is assumed that the more serious the illness, the greater the need to relieve patients' anxiety, physicians' communication styles can directly influence patients' anxiety levels. The purpose of this study was to examine the relationship between outpatients' perceptions of physicians' communication styles and the patients' anxiety levels in oncology settings. Patient anxiety level was measured using the State Trait Anxiety Inventory before and after the consultation. The Perceived Physician's Communication Style Scale was developed in this study. Analysis of responses to the scale resulted in four factors--"acceptive", "patient-centered", "attentive", and "facilitative"--of the physician's communication style and explained 63.7% of the variance. The inter-correlation for overall scale items was 0.95. Patient satisfaction with the medical encounter was also measured to validate the physician's communication style scale. Moderate correlation between the physician's communication style and satisfaction was observed and confirms the relationship between a favorable communication style and a patient's satisfaction. After the consultation, the patients' anxiety levels dropped 5.0 +/- 1.5 points (p<0.001), and the physician's communication style was shown in many cases to be linked to patient anxiety levels after the consultation. The effect of the physician's communication style on patients' post-consultation anxiety levels was small among the patients with an advanced disease status. Also, the findings showed that patients' post-consultation anxiety levels remained low even among those patients with unfavorable examination results if the patients evaluated their physician's communication style as high. This study suggested that the physician's communication style is important not only for moderating patients' anxiety, but could also be helpful for moderating physicians' own stress levels when communicating bad news to patients.
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.
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.
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.
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.
The diagnosis and treatment of cancer cause considerable psychological distress and morbidity. Consequently, cancer patients have high needs for informational and emotional support and doctors vary in their ability to recognise and address these needs. This study investigated patients' attempts to gain informational and emotional support through the use of verbal cues. The sample consisted of 298 patients with heterogeneous cancers, seeing one of five medical and four radiation oncologists for the first time. Sociodemographic variables and patient anxiety and satisfaction ratings were obtained. Transcripts of the audiotaped consultations were analysed and question-asking, use of indirect cues, cue type (informational or emotional), content categories in which questions and cues occurred and doctor response (responded to or not responded to), were recorded. Patients asked a median of 11 questions and gave two cues per consultation, usually during treatment discussions. Patients gave, and doctors responded to, more informational than emotional cues. Patients gave significantly more informational cues during longer consultations. Younger and female patients gave more cues for emotional support and asked questions. No demographic variables were associated with the doctors' response to emotional and informational cues; however, consultations in which more informational cues were responded to were shorter, even when controlling for the number of cues given. Satisfaction with the consultation and patient anxiety were unaffected by doctors' responses to cues. Overall, results showed that doctors effectively identify and respond to the majority of informational cues; however, they are less observant of and able to address cues for emotional support. Cues can be addressed without lengthening the consultation or increasing patient anxiety.
Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles on patients' diabetes self-management. This study assessed the influence of patients' evaluation of their physicians' participatory decision-making style, rating of physician communication, and reported understanding of diabetes self-care on their self-reported diabetes management.
We surveyed 2,000 patients receiving diabetes care across 25 Veterans' Affairs facilities. We measured patients' evaluation of provider participatory decision making with a 4-item scale (Provider Participatory Decision-making Style [PDMstyle]; alpha = 0.96), rating of providers' communication with a 5-item scale (Provider Communication [PCOM]; alpha = 0.93), understanding of diabetes self-care with an 8-item scale (alpha = 0.90), and patients' completion of diabetes self-care activities (self-management) in 5 domains (alpha = 0.68). Using multivariable linear regression, we examined self-management with the independent associations of PDMstyle, PCOM, and Understanding.
Sixty-six percent of the sample completed the surveys (N = 1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self-management assessments (P < .01 in all models). When modeled together, PCOM remained a significant independent predictor of self-management (standardized beta: 0.18; P < .001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized beta: 0.10; P =.004). Understanding was strongly and independently associated with self-management (standardized beta: 0.25; P < .001).
For these patients, ratings of providers' communication effectiveness were more important than a participatory decision-making style in predicting diabetes self-management. Reported understanding of self-care behaviors was highly predictive of and attenuated the effect of both PDMstyle and PCOM on self-management, raising the possibility that both provider styles enhance self-management through increased patient understanding or self-confidence.
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.