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Purpose: Mindfulness (ie, purposeful and nonjudgmental attentiveness to one's own experience, thoughts, and feelings) is associated with physician well-being. We sought to assess whether clinician self-rated mindfulness is associated with the quality of patient care. Methods: We conducted an observational study of 45 clinicians (34 physicians, 8 nurse practitioners, and 3 physician assistants) caring for patients infected with the human immunodeficiency virus (HIV) who completed the Mindful Attention Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites across the United States. We measured patient-clinician communication quality with audio-recorded encounters coded using the Roter Interaction Analysis System (RIAS) and patient ratings of care. Results: In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58-10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted β = 1.17; 95% CI, 0.46-1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17-1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15-1.84) with high-mindfulness clinicians. There was no association between clinician mindfulness and the amount of conversation about biomedical issues. Conclusions: Clinicians rating themselves as more mindful engage in more patient-centered communication and have more satisfied patients. Interventions should determine whether improving clinician mindfulness can also improve patient health outcomes.
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VOL. 11, NO. 5
VOL. 11, NO. 5
A Multicenter Study of Physician Mindfulness
and Health Care Quality
PURPOSE Mindfulness (ie, purposeful and nonjudgmental attentiveness to one’s
own experience, thoughts, and feelings) is associated with physician well-being.
We sought to assess whether clinician self-rated mindfulness is associated with
the quality of patient care.
METHODS We conducted an observational study of 45 clinicians (34 physicians,
8 nurse practitioners, and 3 physician assistants) caring for patients infected with
the human immunodeciency virus (HIV) who completed the Mindful Atten-
tion Awareness Scale and 437 HIV-infected patients at 4 HIV specialty clinic sites
across the United States. We measured patient-clinician communication quality
with audio-recorded encounters coded using the Roter Interaction Analysis Sys-
tem (RIAS) and patient ratings of care.
RESULTS In adjusted analyses comparing clinicians with highest and lowest
tertile mindfulness scores, patient visits with high-mindfulness clinicians were
more likely to be characterized by a patient-centered pattern of communication
(adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58-10.86), in
which both patients and clinicians engaged in more rapport building and discus-
sion of psychosocial issues. Clinicians with high-mindfulness scores also displayed
more positive emotional tone with patients (adjusted β = 1.17; 95% CI, 0.46-
1.9). Patients were more likely to give high ratings on clinician communication
(adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17-1.86) and to report high
overall satisfaction (APR = 1.45; 95 CI, 1.15-1.84) with high-mindfulness clini-
cians. There was no association between clinician mindfulness and the amount of
conversation about biomedical issues.
CONCLUSIONS Clinicians rating themselves as more mindful engage in more
patient-centered communication and have more satised patients. Interventions
should determine whether improving clinician mindfulness can also improve
patient health outcomes.
Ann Fam Med 2013;421-428. doi:10.1370/afm.1507.
indfulness refers to a person’s tendency to remain “purpose-
fully and nonjudgmentally attentive to their own experience,
thoughts and feelings.”
Mindfulness has gained popularity as
a medical treatment for patients, primarily through mindfulness-based
stress reduction (MBSR), with beneficial effects shown for pain, psoriasis,
and depression, and with biochemical evidence of changes in immune
Less attention has focused on the potential benefits of mind-
fulness among physicians and other health professionals. During the past
decade, it has been recommended that physicians enhance their own
capacities for mindfulness when practicing medicine and interacting with
Mindfulness is likely to have numerous personal benefits to
practicing clinicians. Several studies have shown that MBSR reduces psy-
chological distress or improves the well-being of nurses and physicians
in training,
and a recent study found that a program teaching mindful
communication reduces burnout, as well as improves self-reported well-
Mary Catherine Beach, MD, MPH
Debra Roter, DrPH
P. Todd Korthuis, MD, MPH
Ronald M. Epstein, MD
Victoria Sharp, MD
Neda Ratanawongsa, MD, MPH
Jonathon Cohn, MD
Susan Eggly, PhD
Andrea Sankar, PhD
Richard D. Moore, MD, MHS
Somnath Saha, MD, MPH
Johns Hopkins University, Baltimore,
Oregon Health Science University, Port-
land, Oregon
University of Rochester, Rochester, New
St Luke’s-Roosevelt Medical Center, New
York, New York
University of California, San Francisco,
Wayne State University, Detroit, Michigan
Portland VA Medical Center, Portland,
Conflicts of interest: The authors report none.
Mary Catherine Beach, MD, MPH
Room 2-511
Division of General Internal Medicine
Johns Hopkins University
2024 East Monument St
Baltimore, MD 21287
VOL. 11, NO. 5
being, psychosocial orientation, and empathy among
practicing physicians.
In addition to improving the personal well-being of
health professionals, a theoretical potential of mind-
fulness to improve the quality of care delivered to
patients has been described. Epstein writes of mindful
practice: “This critical self-reflection enables physicians
to listen attentively to patients’ distress, recognize their
own errors, refine their technical skills, make evidence-
based decisions, and clarify their values so they can
act with compassion, technical competence, presence,
and insight.
In particular, by enabling physicians to be
more attentive to patients and their needs, a mindful
orientation holds promise for making clinical encoun-
ters more patient centered and for enhancing patient-
clinician communication.
Despite the theoretical benefits of mindfulness
to the patient-clinician relationship and to patients’
experiences and outcomes, these associations have not
been empirically studied. The purpose of this study
was to assess the associations of clinicians’ self-reported
mindfulness with the patient-centeredness of clini-
cal encounters, patient and clinician communication
behaviors, and patients’ evaluations of their care. We
hypothesized that clinician mindfulness would be asso-
ciated with higher quality interpersonal care.
We conducted a cross-sectional analysis of data from
the Enhancing Communication and HIV Outcomes
(ECHO) Study.
Study participants were patients
infected with the human immunodeficiency virus
(HIV) and their clinicians at 4 HIV care sites in the
United States (Baltimore, Detroit, New York, and
Portland). The study received institutional review
board approval from each of the 4 sites; both patients
and clinicians gave written informed consent. Clini-
cians who agreed to participate completed a baseline
questionnaire. Research assistants then enrolled a
convenience sample of 10 patients per clinician, plac-
ing a digital audio-recording device in the examination
room to record the patient-clinician encounter. After
the encounter, patients completed an interview with
trained research assistants that assessed demographic,
social, and behavioral characteristics, as well as patient
evaluations of care.
Main Measures
Clinician Mindfulness
Our independent variable was clinician self-rated mind-
fulness, as measured on the baseline questionnaire by
the previously validated Mindful Attention Awareness
Scale (MAAS).
The MAAS contains 14 items, such
as, “I tend to walk quickly to where I am going without
paying attention to what I experience along the way,”
I find myself listening to someone with one ear, doing
something else at the same time, “ and “I forget a per-
son’s name almost as soon as I’ve been told it for the
rst time.”
Possible responses are on a 6-point Likert
scale anchored between almost always and almost
never. The total score is an average of the 14 items;
higher scores indicate more mindfulness.
Audio-Recorded Measures of Patient and Clinician
Audiotapes were analyzed using the Roter Interaction
Analysis System (RIAS), a widely used coding sys-
tem with well-documented reliability and predictive
validity in assessing patient and clinician communica-
tion behaviors during medical encounters.
analysts assign 1 of 37 categories to each complete
thought expressed by the patient or clinician. These
categories can be combined to reflect broad types
of exchange, such as rapport building (talk oriented
toward enhancing the patient-clinician relationship),
biomedical talk (oriented toward the patients’ illness
and therapy), and psychosocial/lifestyle talk (oriented
toward the patients’ experience and life situation).
RIAS codes are used to construct a summary
measure of patient-centeredness as a ratio of patient-
centered categories of talk (all talk about psychosocial
or lifestyle-related issues, physicians’ information giv-
ing about biomedical topics, all patients’ questions, all
physicians’ emotionally focused talk, and partnership
talk) divided by physician-centered categories of talk
(physicians’ biomedical question asking, physicians’
directive statements, and patients’ biomedical informa-
tion giving).
A value greater than 1 denotes a
more patient-centered and a value less than 1 a more
doctor-centered encounter.
In addition to providing information on what was
said in an encounter, the RIAS also provides global
ratings of how the words were said. Emotional tone
scores are calculated by summing coders’ subjective
ratings for patients and physicians (separately). RIAS
analysts additionally recorded for each encounter the
total duration of the recorded visit (visit length) and
the ratio of clinician-to-patient talk during the visit
(verbal dominance). All RIAS coding for this study was
done by 2 women.
Patient Evaluations of Care
Patient-reported dependent variables in our analysis
included (1) patients’ perceptions of clinician commu-
nication, and (2) patients’ overall satisfaction, derived
from postencounter patient interviews. Patients rated
clinician communication behaviors using the Interper-
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VOL. 11, NO. 5
sonal Processes of Care Instrument’s general commu-
nication subscale, which consists of 21 items.
responses were on a 5-point scale between never and
always. We measured overall satisfaction with the
question, “Overall, how would you rate the quality of
medical care you have received in the past 6 months?
Possible responses were on a 5-point scale ranging
between poor and excellent.
Patient interviews also elicited the patients’ sociodemo-
graphic information (age, sex, employment, education,
drug use, and the single racial/ethnic group with which
patients identified themselves). Medical records pro-
vided data on patients’ most recent CD 4 lymphocyte
counts. Clinician baseline questionnaires provided self-
reported basic demographic information including age,
sex, and primary racial/ethnic group.
We used descriptive statistics to explore and describe
the characteristics of our study sample. We examined
the distribution, means, and internal consistencies of
the mindfulness scale. Based on the nonnormal distri-
bution of scores, we divided our mindfulness variable
into low, medium, and high tertiles to account for the
skewed distribution while still allowing the examina-
tion of graded associations. We then performed t tests
for continuous variables and χ
tests for categorical
variables to test for differences in patient and clinician
characteristics (covariates) by clinician mindfulness.
Audiotapes from 1 of our 4 study sites included
the patients’ interactions with more than 1 clinician (a
nurse or nurse practitioner in addition to the primary
HIV clinician). For that site, it was impossible to distin-
guish which RIAS communication behaviors emanated
from interaction with the primary HIV clinician whose
mindfulness we had assessed. We therefore restricted
analyses of audio-recorded communication behaviors
to data obtained from the other 3 sites.
We categorized patient-centered visits vs physician-
centered visits based on whether the RIAS patient-
centeredness ratio for the visit was greater than or
equal to 1 or less than 1, respectively. We used logistic
regression to examine the association of clinician mind-
fulness with patient-centered visits. We used linear
regression to compare patient and clinician communi-
cation behaviors by tertiles of clinician mindfulness.
We examined several communication behaviors: rap-
port building, psychosocial talk, biomedical talk, and
emotional tone.
Based on the positive skew in the distribution of the
2 patient evaluation variables, we dichotomized patient
evaluations of communication quality (at the median
score) and overall satisfaction (excellent vs all other
responses). We used logistic regression to compare
patient evaluations of clinician communication and
patient satisfaction by clinician mindfulness tertiles.
Data for these analyses came from all 4 sites.
In both bivariate and multivariate analyses, we
adjusted for site and accounted for nesting of patients
within clinicians using generalized estimating equa-
tions. We conducted multivariate analyses in 2 steps.
In the first, we adjusted for patient and clinician age,
sex, and race/ethnicity, as well as any other character-
istics found to be associated with clinician mindfulness
in bivariate analyses at P <.20. In the second step, we
added visit length to each model. Adding visit length
was particularly important for analyses in which our
dependent variable represented counts of specific com-
munication behaviors, because longer visits afford the
opportunity for more talk by both patients and clini-
cians. All analyses were conducted using Stata/SE 9.0
(StataCorp LP).
Study Sample
There were 55 clinicians eligible for the study, and 45
(82%) agreed to participate. We identified 617 eligible
patients. Clinicians refused to allow 18 patients to be
approached for the study (12 because the clinician
felt too rushed, 5 because the patient was too sick,
and 1 because the patient was coming for laboratory
results only and not a complete visit). Of the remain-
ing 599 patients, 437 (73%) agreed to participate and
completed all study procedures. Of the 162 patients
who declined to enroll in the study, the most common
reasons were that they did not have time to complete
the interview (n = 106), were not feeling well (n = 22),
or were no interested in studies (n = 13).
Mindfulness scores among clinicians ranged from
2.57 to 5.93 (possible range = 1-6) with a mean of
4.33. The scale had good internal consistency (Cron-
bach’s α = .90). The mean score in the low tertile
was 3.53, in the middle tertile 4.31, and in the high
tertile 5.17. Patient and clinician characteristics are
displayed in Table 1. Clinician mindfulness was asso-
ciated with such characteristics of his or her patient
panel as patient race/ethnicity, but not with patient
age, sex, education, active drug use, or CD4 lympho-
cyte count. Clinician mindfulness was not associated
with clinician age or training background, but was
associated with clinician sex and race, in that female
clinicians were more likely to be in the highest mind-
fulness tertile and nonwhite, non-Asian clinicians
were also more likely to rate themselves as high on
the mindfulness scale.
VOL. 11, NO. 5
Association of Clinician Mindfulness With
Observed Communication Behaviors
The overall intercoder reliability, calculated on a
random sample of 41 audiotapes, across categories
for patient and clinician behaviors was 0.71-0.95. In
both unadjusted and adjusted analyses, higher clini-
cian mindfulness was associated with higher odds of
having a patient-centered visit (Table 2). There was
some evidence of a graded association, with the odds
of a patient-centered visit increasing as mindfulness
increased, but only clinicians in the high tertile com-
pared with the low tertile of mindfulness were signifi-
cantly more likely to engage in patient-centered visits.
Associations of clinician mindfulness with specific
clinician and patient communication behaviors are
shown in Table 3. In encounters with clinicians in the
high compared with the low tertile of mindfulness, both
patients and clinicians engaged in substantially more
rapport building and psychosocial
talk. On average, clinicians with
high compared with low self-rated
mindfulness made 30 more state-
ments per visit categorized as rap-
port building (95% CI, 5-55), and
16 more statements related to psy-
chosocial issues (95% CI, 3-29).
In visits with high-mindfulness
compared with low-mindfulness
clinicians, patients made 40 more
rapport-building statements (95%
CI, 18-63) and 46 more state-
ments about psychosocial issues
(95% CI, 20-73) per visit. Clini-
cians’ affect, or emotional tone,
during the encounter was more
positive as mindfulness increased.
Patients’ emotional tone was not
significantly associated with clini-
cian mindfulness, and we found
no association between clinician
mindfulness and the amount of
biomedical talk during the visit.
When comparing communica-
tion in the high-mindfulness with
communication in the medium-
mindfulness categories, we also
found differences only in patient
rapport-building and psycho-
social talk, with no statistically
significant differences comparing
high- with medium-mindfulness
categories in the overall commu-
nication measures or in any of the
clinician behaviors.
Effect of Visit Length
The average visit among HIV-
infected patients and their
clinicians lasted about 22 min-
utes (Table 3). After adjusting
for study site and patient and
clinician characteristics, high-
mindfulness clinicians spent on
Table 1. Characteristics of Study Sample
Characteristics All
Clinician Mindfulness Tertile
ValueLow Middle High
Patient, No. 437 150 146 141
Age, mean (SD), y 45.4
Female, No. (%) 147 (34) 48 (32) 46 (31) 53 (36) 0.45
High school degree, No. (%) 317 (73) 44 (37) 37 (31) 39 (33) 0.74
Race/ethnicity, No. (%) <0.01
Black 254 (58) 97 (65) 61 (42) 96 (68)
Hispanic 62 (14) 13 (9) 33 (23) 16 (11)
White 106 (24) 37 (25) 44 (30) 25 (18)
Other 15 (3) 3 (2) 8 (5) 4 (3)
Active drug use, No. (%) 128 (29) 50 (33) 47 (32) 41 (22) 0.07
Depression score, mean (SD) 2.11
CD4 cell count, mean (SD) 470 (329) 458 (318) 440 (278) 513 (383) 0.37
Length of patient-physician
relationship >5 year, No. (%)
144 (33) 51 (34) 53 (37) 40 (29) 0.39
Clinician, No. 45 15 15 15
Age, mean (SD), y 44.5
Female, No. (%) 25 (56) 4 (27) 8 (53) 13 (87) <0.01
Physicians, No. (%) 34 (76) 13 (38) 10 (29) 11 (32) 0.43
Race/ethnicity, No. (%) 0.05
White 30 (67) 11 ( 73) 12 (80) 7 (47)
Asian 11 (24) 4 (27) 3 (20) 4 (27)
Other 4 (9) 0 (0) 0 (0) 4 (27)
Mean mindfulness scores: low tertile = 3.53, middle tertile = 4.31, high tertile = 5.17.
Table 2. Patient-Centeredness of Clinical Encounter, by Clinicians
Self-Rated Mindfulness
Clinician Evaluation
Clinician Mindfulness Tertile
(n = 116)
(n = 127)
(n = 119)
Patient-centered visit, No. (%) 23 (19.8) 38 (29.9) 51 (42.9)
Unadjusted, OR (95% CI) 1.64 (0.79-3.38) 3.76 (1.69-8.37)
Adjusted for covariates, OR (95% CI) 1.64 (0.73-3.67) 4.14 (1.58 -10.86)
Adjusted for covariates + visit
length, OR (95% CI)
1.30 (0.54-3.11) 3.36 (1.17-9.60)
OR = odds ratio.
Note: Data from 3 sites. Unadjusted and adjusted logistic regression models account for clustering of patients
within clinicians using generalized estimating equations and adjust for study site; adjusted model also includes
patient age, sex, race/ethnicity, and current drug use, and clinician age, sex, and race/ethnicity. Referent group
for odds ratios is the low clinician mindfulness tertile.
VOL. 11, NO. 5
VOL. 11, NO. 5
average 5.8 (95% CI, 0.9-10.8) minutes longer with
their patients than did those in the lowest tier. After
adjusting for visit length, the association between mind-
fulness and the odds of a patient-centered visit (Table
2) remained significant, as did differences in patient
expression of rapport-building and psychosocial state-
ments (Table 3). Adjusting for visit length, however, did
substantially reduce differences in the amount of physi-
cian rapport-building and psychosocial talk (Table 3).
Patient Evaluations of Care
The Cronbach’s α for the interpersonal processes of
care measure of communication quality in our sample
was .88. In unadjusted and adjusted analyses, patients
of clinicians in the high tertile compared with the low
tertile of mindfulness had greater odds of reporting
high-quality communication and high overall satisfac-
tion with care (Table 4). Neither of these associations
changed after accounting for visit length.
Mindfulness among health care clinicians was associ-
ated with more patient-centered communication, pro-
viding the first evidence of which we are aware that
clinician mindfulness is associated with the quality
of care patients receive as measured by patient-cen-
teredness and patient satisfaction. Mindfulness among
clinicians was associated with more rapport building
and communication about psychosocial issues between
patient and clinician, and a more positive emotional
atmosphere within the clinical encounter. These find-
ings give empirical weight to Epstein’s speculation that
the benefits of mindful practice extend beyond the
practitioner to his or her patients; it is not only that
mindful practitioners can listen attentively, but that
their patients are empowered to make their voice heard
in areas that matter to them. It is perhaps this recipro-
cal communication dynamic that drives the differences
observed across levels of mindfulness and the patient-
centeredness score and related categories.
How might clinicians’ mindfulness affect their
communication with patients? Although our study did
not address this question directly, we can speculate
on possible explanations. Mindfulness is defined as
attentiveness, curiosity, presence, and the ability to
adopt multiple perspectives simultaneously—all quali-
ties that promote greater awareness of self and oth-
Table 3. Observed Patient-Clinician Communication, by Clinicians’ Self-Rated Mindfulness
Clinician Mindfulness Tertile
Mean No. (SD)
β Coefcient (95% CI)
Adjusted for Covariates
Adjusted for Covariates
+ Visit Length
(n = 116)
(n = 127)
(n = 119)
vs Low
High vs Low
vs Low
High vs Low
Overall measures
Visit length,
22.7 (9.0) 22.2 (8.9) 22.5 (10.5) 2.2
(–1.9 to 6.3)
(0.9 to 10.8)
Verbal dominance 1.36 (0.6) 1.49 (0.5) 1.24 (0.4) 0.12
(–0.10 to 0.34)
(–0.34 to 0.15)
(–0.12 to 0.37)
(–0.45 to 0.15)
Clinician behaviors
80 (37) 87 (38) 89 (44)
17 (–3 to 38) 30 (5 to 55) 12 (–5 to 29) 15 (–5 to 36)
Psychosocial talk 18 (18) 23 (27) 27 (29)
5 (–6 to 16) 16 (3 to 29) 3 (–8 to 12) 9 (–3 to 21)
Biomedical talk 120 (63) 135 (71) 111 (66) 27 (–1 to 56) 17 (–17 to 51) 16 (–8 to 40) 12 (–42 to 17)
Emotional tone 11.6 (1.7) 11.8 (1.7) 11.8 (1.8) 0.69
(0.11 to 1.3)
(0.46 to 1.9)
(0.04 to 1.6)
(0.22 to 1.6)
Patient behaviors
95 (48) 97 (47) 107 (59)
14 (–4 to 33) 40 (18 to 63) 6 (–7 to 19) 19 (3 to 35)
Psychosocial talk 52 (47) 62 (63) 78 (55)
13 (–9 to 34) 46 (20 to 73) 6 (–14 to 25) 28 (4 to 52)
Biomedical talk 94 (56) 91 (52) 96 (65) 8 (–14 to 29) 23 (–4 to 50) 0 (–16 to 16) 2 (–18 to 22)
Emotional tone 21.1 (1.8) 21.0 (2.0) 21.3 (1.6) 0.07
(–0.53 to 0.66)
(–0.12 to 1.36)
(–0.56 to 0.64)
(–0.22 to 1.29)
Note: Data are from 3 sites.
Visit-level data for each variable. Verbal dominance is the ratio of clinician to patient talk. Talk variables are numbers of statements. Emotional tone is sum of scaled
ratings by coders listening to audiotaped dialogue.
Results from linear regression models using generalized estimating equations to account for clustering of patients within clinicians and adjusting for study site; patient
age, sex, race/ethnicity, and current drug use; and clinician age, sex, and race/ethnicity. Referent group for β coefcients is the low clinician mindfulness tertile.
P <.05.
P <.01, for comparisons of middle or high- vs low-mindfulness tertile, accounting for clustering of patients within clinicians and adjusting for study site.
VOL. 11, NO. 5
ers. Mindfulness training also includes skills to lower
reactivity and to enhance responsiveness to stressful
situations. Mindfulness may free clinicians’ attention
so that they are better able to attend to others’ experi-
ence, less likely to distance themselves from distress-
ing situations, and more likely to consider a variety of
explanations in complex situations. As mindful clini-
cians maintain greater attention to their own, as well
as their patients’, experiences, they may be more able
to appreciate the impact of an illness on the patient’s
life or the nuances of the patient’s emotions. This
deeper appreciation of the patient’s experience per-
haps enables the clinician to respond to such opportu-
nities with understanding, empathy, and compassion,
attending to the “lifeworld” in which in which the
patients reside,
and these exchanges are conveyed
through emotional tones of warmth, acceptance, and
positive regard. Although patient-centered commu-
nication skills must still be learned, the practice of
mindfulness may make it more likely that the clinician
is able to employ this technique.
Notably, the association between clinician mind-
fulness and both clinician and patient communication
behaviors was partly attributable to the increased aver-
age time spent with patients by clinicians with high
self-rated mindfulness. In addition, many associations,
particularly those with patient evaluations of their care,
were not solely attributable to longer visits; therefore,
mindfulness may enhance patient-centeredness in clini-
cal encounters by improving both the quantity and
quality of attention clinicians give to their patients.
Greater patient-centeredness
and improved patient experiences
with mindful clinicians as found
in this study could ultimately also
enhance retention in care and
clinical outcomes, especially in
the setting of HIV care, where
positive patient-clinician relation-
ships have been linked to higher
quality, greater medication adher-
ence, and better outcomes.
It may furthermore be true
that these benefits extend to all
patients, especially to those from
underserved or marginalized pop-
ulations who may be particularly
attentive to a clinician’s affective
demeanor and for whom issues of
trust and respect are central.
Our study had several limi-
tations. One limitation relates
to the difculty in measuring
both mindfulness and patient-
centeredness. Mindfulness is a highly complex practice
and may be imperfectly measured by the MAAS. The
MAAS measures only 1 of several constructs inherent
in mindfulness, and more recently developed opera-
tional definitions and instruments
may allow a more
nuanced understanding of which aspects of mindfulness
are important. A somewhat similar methodological issue
may be raised in regard to patient-centerednessa
concept with many dimensions.
Nevertheless, the
RIAS measure used is well validated and has been found
to be predictive of patient outcomes in other stud-
Also, patients and clinicians in our study knew
that they were being recorded and may have attempted
to communicate differently, which could bias our study
toward more favorable communication behaviors. Prior
studies, however, have directly addressed this issue and
have not found that recorded visits were substantively
different from nonrecorded ones
37,3 8
; moreover, any
Hawthorne effect would have to have differentially
influenced clinicians with varying levels of mindfulness
to have affected our findings. The clinical context of
these study visits was HIV care. HIV-infected patients
have a serious, chronic illness. Perhaps as a result, they
may have particularly close relationships with their cli-
nicians within which the effect of a clinician’s mindful-
ness may be more (or less) pronounced than in routine
ambulatory care. Although we found an association
between mindfulness and physician race/ethnicity, we
had a limited number of nonwhite, non-Asian clinicians.
One clinician had been trained in mindfulness, and we
do not know how amenable to training clinicians would
Table 4. Patient Evaluations of Care, by Clinicians’ Self-Rated
Patient Evaluation
Clinician Mindfulness Tertile
(n = 150)
(n = 146)
(n = 141)
High clinician communication score,
No. (%)
62 (41.3) 67 (46.5) 79 (56.8)
Prevalence ratio (95% CI)
Unadjusted 1.23 (0.92-1.64) 1.47 (1.15-1.87)
Adjusted for covariates 1.27 (0.98-1.65) 1.51 (1.21-1.87)
Adjusted for covariates + visit length 1.26 (0.96-1.66) 1.48 (1.17-1.86)
Highest patient satisfaction,
No. (%)
82 (54.7) 91 (63.2) 95 (68.4)
Prevalence ratio (95% CI)
Unadjusted 1.23 (0.97-1.55) 1.36 (1.05-1.76)
Adjusted for covariates 1.25 (1.00-1.55) 1.46 (1.16-1.83)
Adjusted for covariates + visit length 1.26 (1.01-1.58) 1.45 (1.15-1.84)
Note: Unadjusted and adjusted regression models account for clustering of patients within clinicians using
generalized estimating equations and adjust for study site; adjusted models also include patient age, sex, race/
ethnicity, and current drug use, and clinician age, sex, and race/ethnicity. Referent group is the low clinician
mindfulness tertile.
High clinician communication score dened as higher than median patient ratings of clinician communication.
High patient satisfaction dened as overall quality of care rated as excellent vs all other responses.
VOL. 11, NO. 5
VOL. 11, NO. 5
be. Finally, we cannot determine from this cross-sec-
tional analysis whether mindfulness training for health
care clinicians will result in better clinical interactions,
or whether some other characteristics of mindful physi-
cians were responsible for the positive patient outcomes
we observed.
Future research should attempt to replicate these
findings by measuring mindfulness among clinicians
and exploring its effects on the quality of patient care
in terms of patient-centeredness, as well as consider-
ing other aspects of quality, such as safety, effective-
ness, efficiency, and equity. Such research might also
consider exploring potential explanatory mechanisms
for such findings in terms of the quality of information
gathered by the clinician, clinical decision making,
patient engagement, and trust. Further, studies should
test whether interventions to improve the mindfulness
of practicing clinicians affect patient satisfaction and
other aspects of quality.
Mindfulness may be an important pathway to a
more humanistic, effective, and satisfying practice of
medicine. The highly reciprocal influence of patients
and clinicians on one another is in itself a powerful
and positive medical toolperhaps in some situations
more powerful than other interventions that can be
offered to patients. In an era in which many physicians
suffer professional burnout, mindful practice may be
the way in which physicians not only heal themselves,
but heal their patients as well.
To read or post commentaries in response to this article, see it
online at
Key words: patient-physician relations; patient-physician communica-
tion; mindfulness; HIV; acquired immunodeciency syndrome
Submitted September 9, 2011; submitted, revised, November 29, 2012;
accepted December 27, 2012.
Funding support: This research was supported by a contract from the
Health Resources Service Administration and the Agency for Healthcare
Research and Quality (AHRQ 290-01-0012). In addition, Dr Korthuis was
supported by the National Institute of Drug Abuse (K23 DA019809), Dr
Saha was supported by the Department of Veterans Affairs, Dr Beach
was supported by the Agency for Healthcare Research and Quality (K08
HS013903-05), and both Drs Beach and Saha were supported by Robert
Wood Johnson Generalist Physician Faculty Scholars Awards.
Disclaimer: None of the funders had a role in the design and conduct
of this analysis, nor was it subject to their nal approval.
Previous presentations: The results relating to mindfulness were pre-
sented in part at the International Conference on Communication in
Healthcare (Oslo, Norway, September 2008) and the Society of General
Internal Medicine’s Annual National Meeting (Miami, Florida, May 2009).
1. Epstein RM. Mindful practice. JAMA. 1999;282(9):833-839.
2. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008;
3. Segal Z, Williams J, Teasdale J. Mindfulness-based Cognitive Therapy
for Depression: A New Approach to Preventing Relapse. New York, NY:
The Guilford Press; 2002.
4. Connelly JE. Narrative possibilities: using mindfulness in clinical
practice. Perspect Biol Med. 2005;48(1):84-94.
5. Epstein RM, Siegel DJ, Silberman J. Self-monitoring in clinical prac-
tice: a challenge for medical educators. J Contin Educ Health Prof.
6. Lovas JG, Lovas DA, Lovas PM. Mindfulness and professionalism in
dentistry. J Dent Educ. 2008;72(9):998-1009.
7. Shapiro SL, Schwartz GE. Intentional systemic mindfulness: an inte-
grative model for self-regulation and health. Adv Mind Body Med.
8. Beddoe AE, Murphy SO. Does mindfulness decrease stress and
foster empathy among nursing students? J Nurs Educ. 2004;43(7):
9. Hassed C, de Lisle S, Sullivan G, Pier C. Enhancing the health of
medical students: outcomes of an integrated mindfulness and life-
style program. Adv Health Sci Educ Theory Pract. 2009;14(3):387-398.
10. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M.
Mindfulness-based stress reduction lowers psychological distress in
medical students. Teach Learn Med. 20 03;15(2):88 -92.
11. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based
stress reduction on medical and premedical students. J Behav Med.
12. Ospina-Kammerer V, Figley CR. An evaluation of the Respiratory
One Method (ROM) in reducing emotional exhaustion among fam-
ily physician residents. Int J Emerg Ment Health. 2003;5(1):29-32.
13. Krasner MS, Epstein RM, Beckman H, et al. Association of an edu-
cational program in mindful communication with burnout, empa-
thy, and attitudes among primary care physicians. JAMA. 2009;302
14. Beach MC, Saha S, Korthuis PT, et al. Patient-provider communica-
tion differs for black compared to white HIV-infected patients. AIDS
Behav. 2011;15(4):8 05 - 811.
15. Beach MC, Saha S, Korthuis PT, et al. Differences in patient-pro-
vider communication for Hispanic compared to non-Hispanic white
patients in HIV care. J Gen Intern Med. 2010;25(7):682-687.
16. Brown KW, Ryan RM. The benets of being present: mindfulness
and its role in psychological well-being. J Pers Soc Psychol. 2003;
17. Carlson LE, Brown KW. Validation of the Mindful Attention Aware-
ness Scale in a cancer population. J Psychosom Res. 2005;58(1):29-33.
18. Garland SN, Tamagawa R, Todd SC, Speca M, Carlson LE. Increased
mindfulness Is related to improved stress and mood following
participation in a mindfulness-based stress reduction program in
individuals with cancer. Integr Cancer Ther. 2013;12(1):31-4 0.
19. Schütze R, Rees C, Preece M, Schütze M. Low mindfulness predicts
pain catastrophizing in a fear-avoidance model of chronic pain.
Pain. 2010;148(1):120 -127.
20. Bertakis KD, Roter D, Putnam SM. The relationship of physician
medical interview style to patient satisfaction. J Fam Pract. 1991;
32( 2):175-181.
21. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-
patient communication. The relationship with malpractice claims
among primary care physicians and surgeons. JAMA. 1997;277(7):
22. Roter DL. Patient participation in the patient-provider interaction:
the effects of patient question asking on the quality of interaction,
satisfaction and compliance. Health Educ Monogr. 1977;5(4):281-315.
23. Wissow LS, Roter D, Bauman LJ, et al. Patient-provider com-
munication during the emergency department care of children
with asthma. The National Cooperative Inner-City Asthma Study,
National Institute of Allergy and Infectious Diseases, NIH, Bethesda,
MD. Med Care. 1998;36(10):1439-1450.
VOL. 11, NO. 5
24. Roter DL, Hall JA, Katz NR. Relations between physicians’ behaviors
and analogue patients’ satisfaction, recall, and impressions. Med
Care. 1987;25(5):437-451.
25. Roter DL, Larson SM, Beach MC, Cooper LA. Interactive and evalua-
tive correlates of dialogue sequence: a simulation study applying the
RIAS to turn taking structures. Patient Educ Couns. 2008;71(1):26 -33.
26. Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal
processes of care in diverse populations. Milbank Q. 1999;77(3):
305-339, 274.
27. Mead N, Bower P. Measuring patient-centredness: a compari-
son of three observation-based instruments. Patient Educ Couns.
28. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe
NR. Patient-centered communication, ratings of care, and concor-
dance of patient and physician race. Ann Intern Med. 2003;139(11):
29. Mishler E. The Discourse of Medicine: Dialectics of Medical Interviews.
Norwood, NJ: Ablex; 1983.
30. Schneider J, Kaplan SH, Greeneld S, Li W, Wilson IB. Better
physician-patient relationships are associated with higher reported
adherence to antiretroviral therapy in patients with HIV infection.
J Gen Intern Med. 2004;19(11):1096-1103.
31. Beach MC, Keruly J, Moore RD. Is the quality of the patient-pro-
vider relationship associated with better adherence and health out-
comes for patients with HIV? J Gen Intern Med. 2006;21(6):661-665.
32. Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the
health care system and the use of preventive health services by older
black and white adults. Am J Public Health. 2009;99(7):1293-1299.
33. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-
report assessment methods to explore facets of mindfulness. Assess-
ment. 2006;13(1):27-45.
34. Baer RA, Smith GT, Lykins E, et al. Construct validity of the ve
facet mindfulness questionnaire in meditating and nonmeditating
samples. Assessment. 2008;15(3):329-342.
35. Bishop SR, Lau M, Shapiro S, et al. Mindfulness: a proposed opera-
tional denition. Clin Psychol Sci Pract. 2006;11(3):230-241.
36. Saha S, Beach MC, Cooper LA. Patient centeredness, cultural com-
petence and healthcare quality. J Natl Med Assoc. 2008;100(11):
37. Pringle M, Stewart-Evans C. Does awareness of being video
recorded affect doctors’ consultation behaviour? Br J Gen Pract.
38. Wolraich ML, Albanese M, Stone G, et al. Medical Communication
Behavior System. An interactional analysis system for medical inter-
actions. Med Care. 1986;24(10):891-903.
... After mindfulness training, doctors reported enhanced connection with patients as a better ability to listen deeply, be attentive to patients' concerns and effectively respond to their request (Krasner et al., 2009;Beckman et al., 2012;Lases et al., 2016;Bentley et al., 2018;Verweij et al., 2018). Patients positively recognized this attitude reporting that mindful clinicians (both doctors and nurses) communicated in a more patient-centered way, and engaged to a greater degree in psychosocial relationship (Beach et al., 2013). ...
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Health awareness and self-care are key variables that influence the health-oriented behavioral repertoire of people who face extraordinary situations, such as epidemics or pandemics caused by new viral diseases. At the end of 2019, a picture of atypical pneumonia became increasingly apparent, and later it was officially called SARS-CoV-2, the virus causing COVID-19 disease. Until October 2021, this viral condition has caused 4,922,065 deaths and 242,033,650 contagions worldwide via human-human transmission. To prevent its spread, countries have instituted different individual, social, and community measures. An example of this was isolation, which has caused the closure of cities, borders, and the confinement of people at their homes during the acute situation of the pandemic, and in some places, along different waves. Although quarantine measures have been essential to diminish the number of contagions while avoiding the collapse of countries' health systems, these measures may, in turn, impact the incorporation and modification of peoples' health habits, and therefore, influence their wellbeing and stress perception. This implies that the effects of the COVID-19 are not limited to medical issues since the virus has caused important sociological, psychological, and economic consequences worldwide, which may or may not last beyond the pandemic. Therefore, organizing a body of scientific evidence that allows understanding the usefulness of the psychological resources implemented in the current pandemic will be essential to be adapted in future situations that compromise population's public health. The simultaneous occurrence of behavioral changes related to the COVID-19 pandemic and their consequent positive or negative outcomes may stimulate or discourage individuals and, therefore, lead to adherence or abandonment of their self-care behaviors. In this Research Topic, we welcome contributions inquiring on the implementation of self-care repertoires oriented at mitigating the effects of COVID-19 that have affected the mental health of the citizens. In addition, we will encourage the studies exploring strategies, both at individual and community level aimed to allow to individuals (children, adolescents adults or any other specific population) to manage social isolation, stress, and their detrimental effects on health and well-being. Likewise, we are eager to include works that emphasize pieces of evidence about how the pandemic context may facilitate the implementation of self-care behaviors in people that, once adhered to, make it possible to face other situations that threaten their physical health and mental status. The current research topic aims to collect original multidisciplinary contributions (research articles, reviews, methods, or protocols) from fields such as health, clinical, and social-community psychology, nursing, medicine, neuroscience, or sociology. Such contributions must provide relevant evidence about the factors learned by people during the pandemic that compromised their health and their ways of coping with it, which is essential to face in future situations that affect their physical and mental health.
... Existing research identifies positive effects on patients and clients of care professionals who complete mindfulness-based training programs. Such research indicates that completing these programs can increase work effectiveness for health care providers, such as an increasing patient satisfaction ratings and inpatients experiencing a reduction in safety incidents (Beach et al., 2013;Brady et al., 2012). Furthermore, the clients of mental health professionals who complete mindfulness programs are also more likely to experience a reduction in psychological distress (Dunn et al., 2013;Grepmair et al., 2007). ...
This quantitative study explores the relationships among trait mindfulness, self-compassion, and compassion fatigue (CF) in mental health professionals working with clients with a terminal illness. The Five-Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale, and Quality of Life Version 5 were used to explore these facets through linear multiple regression analysis. The Reactions to Research Participation Questionnaire–Revised was used to explore the cost–benefit ratio based on participant perceptions of the research experience. Participants (N = 43) self-selected from emailed invitations sent to members of professional organizations. Data was analyzed using multiple linear regression. Significant correlations included individual relationships between elevated trait mindfulness levels, self-compassion levels, percentage of session content focused on a client’s terminal illness, and FFMQ nonjudge subscale scores with lower CF levels. Additional outcomes also identified significant support for a correlation between higher FFMQ observe subscale scores with higher CF levels, and a moderating effect from gender in the correlation between trait mindfulness and CF levels. Generally, participants reported perceived benefits outweighed perceived costs of contributing to this project. Results warrant additional research to explore significant findings and potential intervention strategies for bolstering trait mindfulness and self-compassion levels among mental health professionals working with clients with a terminal illness.
... In recent years, there has been an emergence of intervention techniques focused on overcoming such barriers and reducing their negative impact on the physical and mental health symptoms of law enforcement. One intervention showing promise with law enforcement officers, as well as other populations such as teachers (Flook et al., 2013) and physicians (Beach et al., 2013), is mindfulness training. This type of intervention aims to intentionally bring "one's attention to the internal and external experiences occurring in the present moment" (Baer, 2003: 125) by cultivating the skills of observation, acting with awareness, nonjudgement, and non-reactivity (Krick and Felfe, 2020). ...
Law enforcement officers are frequently subjected to highly stressful and traumatic situations with increased negative physical and mental health outcomes. Mindfulness is proposed as a means of improving self-reported physical or mental health outcomes, including depression, anxiety, burnout, and sleep disturbances. This meta-analysis aims to pool the results from studies evaluating mindfulness for police officers, providing an overall effect size for each outcome of interest. Through systematic review, four studies were identified for meta-analysis. Fixed and random inverse variance effects were used. Results indicate that mindfulness-based intervention programs likely decrease depression and may result in reductions of anxiety and burnout.
... He also highlighted the necessity of creating the proper conditions for group affiliation and cooperation. Beach et al. (2013) found that higher clinician trait mindfulness was associated with more favorable patient ratings of communication quality and overall satisfaction. Similarly, a mindfulness intervention improved the family-friendliness of admissions treatment teams (Singh et al., 2002). ...
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This research paper was an attempt to assess the relationship between workplace spirituality and work performance while mindfulness was acting as a moderator. The research was done on 200 Employees of various manufacturing industries of Gwalior and Standardized Questionnaires based on a likert scale were used for the study. In this study Structural equation modeling was applied in order to measure the relationship between workplace spirituality and Work performance and also to find the mediating effects of mindfulness. Finally the study revealed that there is a significant mediation effect of mindfulness on the relationship between workplace spirituality and work performance
Patients highly value being listened to, taken seriously, heard, and understood; indeed, listening to patients is essential to alleviate suffering. Yet listening as a clinical skill has been virtually ignored in the training of physicians. In this paper, we synthesize literature related to listening in medicine and explore the internal and external challenges and complexity of listening - including the need to listen with a diagnostic as well as a relational ear to take in physical symptoms, emotions, and contexts - often in chaotic and time-pressured environments. We suggest physicians focus on the development of "deep listening" skills, involving cultivating curiosity, openness, reflective self-questioning, and epistemic reciprocity; we also suggest how to ensure patients know they are being listened to.
Students in health professions often face high levels of stress due to demanding academic schedules, heavy workloads, disrupted work-life balance, and sleep deprivation. Addressing stress during their education can prevent negative consequences for their mental health and the well-being of their future patients. Previous reviews on the effectiveness of mindfulness-based interventions (MBIs) focused on working health professionals or included a wide range of intervention types and durations. This study aims to investigate the effect of 6- to 12-week MBIs with 1- to 2-h weekly sessions on stress in future health professionals. We conducted a systematic review and meta-analysis of randomized controlled trials published in English by searching Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and PsycINFO. We used post-intervention stress levels and standard deviations to assess the ability of MBIs to reduce stress, summarized by the standardized mean difference (SMD). This review is reported according to the PRISMA checklist (2020). We identified 2932 studies, of which 11 were included in the systematic review and 10 had sufficient data for inclusion in the meta-analysis. The overall effect of MBIs on reducing stress was a SMD of 0.60 (95% CI [0.27, 0.94]). Our study provides evidence that MBIs have a moderate reducing effect on stress in students in health professions; however, given the high risk of bias, these findings should be interpreted with caution, and further high-quality studies are needed.
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The aim of this multi-center study was to look into how personality traits such as nomophobia, which is on the rise among young people due to the increased use of technology, relate to fear levels in nursing students. The study included 424 prospective nurses in total, with an average age of 25 and a female participation rate of 84.7%. According to the findings, most nursing students showed mild panic when confronted with injections. Data on the individuals' levels of fear and personality qualities were gathered using the Nomophobia Questionnaire and the Ten-Item Personality Inventory (TIPI), respectively. The research revealed a substantial relationship between nomophobia and particular personality characteristics, shedding light on the causes of this fear. These results may be helpful in creating focused interventions to assist nursing students in overcoming their anxieties and enhancing their well-being.
Objective: To explore whether a mentalization-based communication training for pharmacy staff impacts their ability to elicit and recognize patients' implicit and explicit medication related needs and concerns. Methods: A single-arm intervention pilot study was conducted, in which pre-post video-recordings of pharmacy counter-conversations on dispensed-medication (N = 50 and N = 34, respectively; pharmacy staff: N = 22) were coded. Outcome measures included: detecting needs and concerns, and implicitly and explicitly eliciting and recognizing them. Descriptive statistics and a multi-level logistic regression were conducted. Excerpts of videos with needs or concerns were analyzed thematically on mentalizing attitude aspects. Results: Indications show that patients more often express their concerns in an explicit way post-measurement, just as pharmacy staffs' explicit recognition and elicitation of needs and concerns. This was not seen for patients' needs. No statistically significant differences were found for determinants for detecting needs or concerns (i.e., measurement-, professional-type, or interaction). Differences in mentalizing attitude were observed between pre-post-measurements, e.g., more attention for patients. Conclusion: This mentalizing training shows the potential of mentalizing to improve pharmacy staff members' explicit elicitation and recognition of patients' medication-related needs and concerns. Practice implications: The training seems promising for improving patient-oriented communication skills in pharmacy staff. Future studies should confirm this result.
Mindfulness and self-compassion practices and programs are evidence-based practices that have positive effects for HCPs as they can be used to build resilience and minimize burnout. Detailed examples and vignettes of the practices are provided. Implementing these practices in the individual, academic, and healthcare system have yielded positive results, but must be balanced with other factors. Knowing when and how to implement or use these programs and practices requires discernment.KeywordsMindfulnessHealthcare professionalsEmpathyMeditation
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Background: Coronavirus disease 2019 (COVID-19) placed healthcare professionals (HCPs) at a higher risk for stress-related conditions. Implementing a brief online mindfulness-based intervention (MBI) was hypothesised to transform the HCPs' ability to cope with stress by enhancing their self-care. Aim: This study aimed to explore the impact of an online MBI on HCPs' self-care practices and determine if personality traits were a moderating variable. Setting: An online MBI was implemented for HCPs working in South Africa during the COVID-19 pandemic lockdowns. Methods: A quantitative study design included a pre-assessment and post-assessment component, which allowed paired comparison and regression analysis to confer correlations. Data were collected via two validated instruments: the Mindful Self-Care scale-2018 and the Big Five Personality test. Results: Forty-nine HCPs participated in the study. Significant improvements were found in all the major self-care subscales post-intervention (p < 0.05). No significant associations were found between the personality traits and self-care except for neuroticism, which appeared to be an essential moderating variable. Conclusion: An online MBI significantly impacted health professionals' ability to care for themselves, despite their personality styles. Contribution: The impact of an online MBI on HCPs' self-care during the most intense time of stress and with a cohort of people known to be the most vulnerable to stress, namely those with neuroticism to date, has not been commented on.
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Background: Mindfulness-based stress reduction (MBSR) has demonstrated efficacy for alleviating cancer-related distress. Although theorized to be the means by which people improve, it is yet to be determined whether outcomes are related to the development or enhancement of mindfulness among participants. This study examined the effect of participation in an MBSR program on levels of mindfulness in a heterogeneous sample of individuals with cancer, and if these changes were related to improvements in stress and mood outcomes. Methods: In all, 268 individuals with cancer completed self-report assessments of stress and mood disturbances before and after participation in an 8-week MBSR program. Of these, 177 participants completed the Mindful Attention Awareness Scale and 91 participants completed the Five Facet Mindfulness Questionnaire, at both time points. Results: Levels of mindfulness on both measures increased significantly over the course of the program. These were accompanied by significant reductions in mood disturbance (55%) and symptoms of stress (29%). Increases in mindfulness accounted for a significant percentage of the reductions in mood disturbance (21%) and symptoms of stress (14%). Being aware of the present moment and refraining from judging inner experience were the 2 most important mindfulness skills for improvements of psychological functioning among cancer patients. Conclusions: These results add to a growing literature measuring the impact of mindfulness and its relationship to improved psychological health. Moreover, specific mindfulness skills may be important in supporting these improvements.
Objectives: This study examined the construct and criterion validity of the Mindful Attention Awareness Scale (MAAS) in cancer outpatients, using matched community members as controls. Methods: Cancer outpatients (n = 122) applying for enrollment in a mindfulness-based stress reduction (MBSR) program completed the MAAS and measures of mood disturbance and stress. Local community members (n = 122) matched to the patients on gender, age, and education level completed the same measures. Results: The single-factor structure of the MAAS was invariant across the groups. Higher MAAS scores were associated with lower mood disturbance and stress symptoms in cancer patients, and the structure of these relations was invariant across groups. Conclusions: The MAAS appears to have appropriate application in research examining the role of mindfulness in the psychological well-being of cancer patients, with or without comparisons to nonclinical controls. (c) 2005 Elsevier Inc. All rights reserved.
OBJECTIVES. Poor children's reliance on emergency facilities is one factor implicated in the rise of morbidity attributed to asthma. Although studies have examined doctor-patient communication during routine pediatric visits, little data are available about communication during emergency care. This study sought to describe communication during emergency treatment of childhood asthma to learn if a "patient-centered" provider style was associated with increased parent satisfaction and increased parent and child participation. METHODS. This cross-sectional, observational study examined 104 children aged 4 to 9 years and their guardian(s) attending emergency departments in seven cities. Quantitative analysis of provider-family dialogue was performed. Questionnaires measured satisfaction with care, provider informativeness, and partnership. RESULTS. Providers' talk to children was largely supportive and directive; parents received most counseling and information. Children spoke little to providers (mean: 20 statements per visit versus 156 by parents). Providers made few statements about psychosocial aspects of asthma care (mean: three per visit). Providers' patient-centered style with parents was associated with more talk from parents and higher ratings for informativeness and partnership. Patient-centered style with children was associated with five times the amount of talk from children and with higher parent ratings for "good care," but not for informativeness or partnership. CONCLUSIONS. Communication during emergency asthma care was overwhelmingly biomedical. Children took little part in discussions. A patient-centered style correlated with increased parent and child participation, but required directing conversation toward both parents and children.
Objective. —To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons.Design. —Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician.Settings. —One hundred twenty-four physician offices in Oregon and Colorado.Participants. —Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (≥2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty.Main Outcome Measures. —Audiotape analysis using the Roter Interaction Analysis System.Results. —Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons.Conclusions. —Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.
Persons of lower socioeconomic status and members of racial and ethnic minority groups experience poorer health and increased health risk factors. A framework of interpersonal processes of care specifies distinct components and incorporates the perspective of diverse racial and ethnic or socioeconomic groups. Its dimensions, each with several domains, are communication (general clarity, elicitation of and responsiveness to patient concerns, explanations, empowerment), decision making (responsiveness to patient preferences, consideration of ability and desire to comply), and interpersonal style (friendliness, respectfulness, discrimination, cultural sensitivity, support). All the domains, except cultural sensitivity, were validated through a survey of 603 ethnically diverse, low-income adults. Confirmation of the framework's usefulness should enable researchers to explore how interpersonal processes might account for observed ethnic and social class differences in health care and health.