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Patient-centered communication: Do patients really prefer it?

Article (PDF Available)inJournal of General Internal Medicine 19(11):1069-79 · November 2004with76 Reads
DOI: 10.1111/j.1525-1497.2004.30384.x · Source: PubMed
Abstract
To investigate patient preferences for a patient-centered or a biomedical communication style. Randomized study. Urgent care and ambulatory medicine clinics in an academic medical center. We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82% [51/62] for age < 30; 68% [100/148] for ages 30-59; 55% [21/38] for age > 59; P < .03), more educated (76% [54/71] for postcollege education; 73% [94/128] for some college; 49% [23/47] for high school only; P= .003), use CAM (75% [140/188] vs. 55% [33/60] for nonusers; P= .006), and have a patient-centered physician (88% [74/84] vs. 30% [16/54] for those with a biomedical physician; P < .0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a "doctor's interest in you as a person" as "very important." Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication.
    • "These characteristics were the mainstays of the HWLB programs. Women with more education may be more receptive to both self-management of health, principles of patient-centered care, and public health messaging (de Boer, Delnoij, & Rademakers, 2013; Key, Allen, Spencer, & Travis, 2002; Kontos, Emmons, Puleo, & Viswanath, 2011; Swenson et al., 2004). Our study found that college educated LB participants were more likely to achieve increased total PA minutes compared with less than college educated participants. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks. Methods: Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report. Analytical plan: Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models. Results: Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n = 43) and mindfulness (n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18-2.36; p = .004; RR, 1.38; 95% CI, 1.01-1.89; p = .042, respectively) and those in the gym program (n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97-3.68, p = .06) compared with the comparison group (n = 67). Conclusion: This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.
    Full-text · Article · Jul 2016
    • "Oncology is indeed among the medical fields in which the ideal of SDM has grown and developed most over several decades [8,9]. Despite the interest in patients' communicative needs and preferences in oncology [10,11], only a few studies have observed how oncologists deal with the complex tasks of delivering information and draw treatment recommendation in their routine visits with their patients. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: the article analyzes how a doctor delivers diagnoses and recommends treatment in a set of post-surgical oncological visits. The pattern of activities are explored in two different cases: when all diagnostic information is available, and when information is still missing. Methods: The data consist of 12 video-recorded visits of breast cancer patients to a senior oncologist. Conversation analysis is employed to analyze sequences in which the delivery of diagnosis and treatment recommendation unfold. Results: The oncologist formulates the treatment recommendation as a logical consequence deriving from the available diagnostic information. In cases when definitive diagnostic information on the cancer type is missing, the oncologist opts to anticipate hypothetical diagnostic scenarios, and to draw the therapeutic alternatives as logical outcomes envisionable from each of the different scenarios. Conclusion: The communicative practice appears functional to encourage the patients' acceptance of a single treatment option rather than present the patients to and involve them in deliberating over multiple available treatment alternatives. Practice implications: Rather than a normative adoption of existing protocols of communication in cancer care, a better understanding of communication practices in use can help practitioners to reflect upon and make intentional choices about different arrangements for the patient's participation.
    Full-text · Article · Feb 2016
    • "Chi square, independent sample t-tests, and Mann Whitney U tests were used to compare demographic, clinical, and behavioral variables by depressive symptoms status. Covariates for adjusted analyses were based on a priori hypotheses [5,[19][20][21]. Ordinal logistic regression was used to test the association between depressive symptoms (elevated vs. non-elevated) and preference for clinician-directed decisionmaking (strong clinician-direction to little clinician-input) (Model 1). "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness. Methods: We enrolled 195 patients ≥18years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians. Results: The mean age was 64.2years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p=0.02; AOR 2.51, 95% CI 1.30-4.85, p=0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference. Conclusions: Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed.
    Article · Dec 2015
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