The Current State of Doctors’ Communication Skills in Mainland China from the Perspective of Doctors’ Self-evaluation and Patients’ Evaluation: A Cross-Sectional Study

ObjectiveTo assess doctors’ communication skills in mainland China using the SEGUE Framework.MethodsA survey on doctors’ communication skills with doctors (n = 1361) and patients (n = 1757) from 14 provinces in eastern, central and western China was conducted.ResultsThe doctors’ self-evaluation scores were higher than patients’ evaluations (p < .001). The scores of female doctors were higher than males (p = .022). Both doctors’ self-evaluations and patients’ evaluations indicated that the scores of doctors in tertiary hospitals were higher than those in primary hospitals.ConclusionDoctors’ communication skills don’t match patients’ needs. Female doctors are more empathetic and patient than male doctors and consequently have better communication skills. Doctors in tertiary hospitals have better communication skills because tertiary hospitals provide more training opportunities in communication skills and have better medical services and management.Practice implicationsThis study confirms the applicability of the SEGUE Framework to doctors and patients in mainland China. The effectiveness of cultivating doctors’ communication skills should be evaluated through feedback from the perspective of both doctors and patients. Medical institutes need to prioritize patients’ needs and provide training in doctors’ communication skills to address the discrepancy in the perceptions of doctors and patients.     

Doctors’ experience of becoming patients and its influence on their medical practice: A literature review

PurposeDoctors’ illness experiences can deeply influence not only their perceptions of illness and roles but also their medical practice. Researchers and doctors have sought to understand what happens when doctors become patients. However, currently, literature reviews focused exclusively on their illness experiences are lacking.This review examines academic literature and combines it with illness narratives (i.e., pathographies) written by doctors to elucidate the unknown about doctors’ experiences and its subsequent influence on medical practice.MethodsAn electronic search of the databases Academic Search Complete, Google Scholar, PubMed, ProQuest, and Ichushi-Web was conducted using relevant keywords. The literature reviewed included studies that described doctors’ illness experiences or doctors’ perspectives on their experiences of being patients.ResultsPrevious studies showed that doctors’ disease prognoses are generally better than or similar to those of patients belonging to the general population. However, doctors’ documented illness experiences are multi-dimensional and have several common themes. These include the concept of the ‘medical self’ (behaving as a doctor despite being a patient) and ‘role reversal’ (the doctor adjusting to the patient role). The other elements of their experiences include barriers to health care, self-treatment and self-doctoring, presenteeism, and ‘wounded healers’ (those who can heal others using the wisdom from their illness experiences). Most previous literature has omitted the sociocultural and historical dispositions of doctors and their biomedical perspectives of their own afflictions, even though these strongly impact their illness experiences.ConclusionFurther research that re-contextualises the meaning of illness for doctors is necessary.     

Factors influencing autonomy supportive consultation: A realist review

ObjectiveGaining insight into contextual factors and mechanisms supporting or hindering autonomy supportive consultation and into outcomes of such consultations.MethodsWe conducted a systematic review using the realist synthesis procedure according to RAMESES guideline. A search was performed in PubMed, Embase, PsycINFO and Cinahl from inception to March 2019 using the search terms: ‘autonomy’ AND ‘support’ AND ‘consultation’ OR ‘communication’ AND ‘intervention’. The review process including paper selection, quality assessment, full text reading for data-extraction was conducted by two researchers independently.ResultsOf 2792 articles, 18 met our inclusion criteria. Contextual factors influencing an autonomy supportive consultation were: work organization and the attitude of professionals. An overarching supporting mechanism for AS was relationship building. In addition, each phase of the decision-making process seems to need supporting mechanisms fulfilling patients ‘specific psychological needs in that phase. The outcome of AS is higher levels of patient well-being.ConclusionAutonomy supportive consultation works under various contexts coupled with mechanisms that give rise to favourable-outcomes, of which relationship building, taking time and exploring patients’ needs seem the most important.Practice implicationsThe results of our review facilitate professionals to reflect on their autonomy supportive consultation skills, which could improve their autonomy supportive behaviour.     

Seeking medical services through guanxi in China

ObjectiveSeeking access to medical services through social networks and personal relationships, referred to as ‘guanxi’, is a common phenomenon in China. This study aims to use a qualitative methodology to examine the experiences and perceptions of patients using guanxi in seeking medical services in China.MethodsA semi-structured, face-to-face interview was conducted with eleven participants who had the experiences of using guanxi in seeking medical services. An inductive content analysis was employed to explore the themes and subthemes of these interviews.ResultsFive themes were generated: (1) underlying systemic context, (2) reasons for utilizing guanxi, (3) personal practices, (4) personal attitudes towards guanxi in healthcare seeking, (5) suggested solutions.ConclusionsSeeking medical services through guanxi exerts a negative influence on the doctor-patient relationship in China. This study uncovered a range of factors unidentified in the previous studies, which may have been important in helping to understand the social phenomenon of seeking medical services through guanxi in China. Further research needs to be conducted to explore measures that could reduce the disharmonious doctor-patient relationship caused by the social phenomenon of seeking medical services through guanxi.Practice implicationsWe recommend that doctors need to improve their communication skills, and pay more attention to the patient’s biopsychosocial care; (2) hospitals should supervise doctors to treat patients in strict accordance with medical procedures; (3)government should implement healthcare reforms to provide affordable and reliable medical care services.     

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

ObjectivePatients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians’ responsiveness to patients’ uncertainty and difficult emotions were associated with better health and well-being.MethodsPatients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress.Results317 respondents participated in the study. Patients’ perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health.ConclusionEven when controlling for patients’ personal and health-related characteristics, clinicians’ communication addressing patients’ uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status.Practice implicationsClinicians’ communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.     

Does the structure of the medical consultation align with an educational model of clinical communication? A study of physicians’ consultations from a postgraduate examination

ObjectiveThis study examined whether the structure of consultations in which physicians were tasked with sharing information corresponded to the chronological stages proposed by an established educational model of clinical communication.MethodSeventy six simulated consultations from a postgraduate examination for general medical hospital physicians were transcribed verbatim and converted into diagrams showing consultation structure. All doctor-patient/relative talk was allocated into six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing, using the ‘communication process skills’ from the Calgary-Cambridge Guide to the Medical Interview.ResultsThe majority of consultations included four or five of the expected phases, with most talk (41–92%) in Explanation and Planning. There was no discernible consistency of structure across the consultations or in consultations from the same scenario. Consultations varied in the presence, sequential order, size, location and reappearance of phases.ConclusionsThe structure of consultations in this standardised setting bore little resemblance to the chronological order of phases predicted by an educational model.Practice implicationsEducational guidance and interventions to support patients in preparing for consultations need to take account of doctors’ behaviour in practice. Assumptions about the organisation of medical consultations should be queried in the absence of an evidence base.     

A scoping review of communication tools applicable to patients and their primary care providers after discharge from hospital

ObjectiveTransitions from hospital to home are high-risk episodes. Communication problems between patients/carers and their primary healthcare providers are a central part of the risk. This literature review aimed to identify any existing tools or information (including secondary care instruments) that would facilitate designing new communication instruments for primary care to manage and mitigate risk at discharge.MethodFive databases (Pubmed, Embase, Cinahl, Web of Science and Cochrane) were searched using a three stem approach (primary/transitional care, discharge period, communication). A dual reviewer system was used, following PRISMA guidelines.ResultsFrom 61 full text articles a total of ten tools were found, 25 articles contained other useful content, 19 further tools were found in grey literature. Most material originated from the USA and described hospital-based transitional care interventions.ConclusionNo ready-made patient/provider communication tool for the post-discharge period in primary care was found. Future communication tools should enhance education and engagement of patients so they feel able to initiate communication.Practice implicationsCollating post-discharge communication material is of importance to improving the safety of care transitions and will enable creation of new tools specifically designed for primary care. These tools will improve patient activation (‘the knowledge, skills and confidence a person has in managing their own health and care’) with the ultimate aim of reducing error and harm in primary care through improved communication of healthcare decisions.     

Integration of online and offline health services: The role of doctor-patient online interaction

ObjectiveThis study aims to investigate how doctor-patient online interaction affects the integration of online and offline health services. Drawing on justice theory and the stimulus-organism-response (S-O-R) framework, justice perceptions are conceptualized as online health communication in influencing patient experiences and subsequent responses.MethodsData were collected from 241 online consultation patients. Partial least squares structural equation modeling (PLS-SEM) approach was used to test the research model and 12 hypothesized relationships.ResultsDistributive justice, procedural justice, and interpersonal justice significantly affect trust, which in turn affects satisfaction and the continued intention to consult. Distributive justice and informational justice significantly affect satisfaction, which in turn affects the continued intention to consult. Finally, the continued intention to consult significantly affects the behavioral intention to visit.ConclusionDoctors can attract patients to visit them in physical hospitals by providing good online health services. Before physically visiting doctors, patients can also search for a suitable doctor that meets their needs through online consultations. To the best of our knowledge, this study is the first to integrate online and offline health services.Practice implicationsFrom the perspective of health communication, the understanding of doctor-patient online interaction offers doctors and hospitals guidance to improve doctor-patient relationships.     

How Doctors View and Use Social Media: A National Survey

BackgroundDoctors are uncertain of their ethical and legal obligations when communicating with patients online. Professional guidelines for patient-doctor interaction online have been written with limited quantitative data about doctors’ current usage and attitudes toward the medium. Further research into these trends will help to inform more focused policy and guidelines for doctors communicating with patients online.ObjectiveThe intent of the study was to provide the first national profile of Australian doctors’ attitudes toward and use of online social media.MethodsThe study involved a quantitative, cross-sectional online survey of Australian doctors using a random sample from a large representative database.ResultsOf the 1500 doctors approached, 187 participated (12.47%). Most participants used social media privately, with only one-quarter not using any social media websites at all (48/187, 25.7%). One in five participants (30/155, 19.4%) had received a “friend request” from a patient. There was limited use of online communication in clinical practice: only 30.5% (57/187) had communicated with a patient through email and fewer than half (89/185, 48.1%) could offer their patients electronic forms of information if that were the patients’ preference. Three in five participants (110/181, 60.8%) reported not being uncomfortable about interacting with patients who had accessed personal information about them online, prior to the consultation. Most of the participants (119/181, 65.8%) were hesitant to immerse themselves more fully in social media and online communication due to worries about public access and legal concerns.ConclusionsDoctors have different practices and views regarding whether or how to communicate appropriately with patients on the Internet, despite online and social media becoming an increasingly common feature of clinical practice. Additional training would assist doctors in protecting their personal information online, integrating online communication in patient care, and guidance on the best approach in ethically difficult online situations.     

The inseparability of emotional and instrumental care in cancer: Towards a more powerful science of clinical communication

ObjectiveClinical communication literature currently distinguishes clinicians’ emotional care of patients from instrumental aspects of clinical care, and regards clinicians’ explicit emotional engagement with patients as the key to emotional care. Here we critically appraise this view.MethodsWe draw on empirical evidence and recent reviews and critiques focusing on cancer care.ResultsPatients and families do not generally seek explicit emotional engagement from their practitioners; nor does such engagement consistently improve patient outcomes. Instead some evidence indicates that anxious patients and families can be comforted by clinicians’ focus on instrumental care.ConclusionsSuch findings can be interpreted according to the view that clinical relationships evoke attachment processes. In the context of mortal illness, patients are comforted by being able to trust clinicians whom they regard as having the expertize to look after them. From this perspective, instrumental and emotional care are inseparable. Clinicians’ clinical authority and expertize are the basis for the emotional comfort they can provide.Practice implicationsFor researchers and educators, a consequence of appreciating the inseparability of emotional and instrumental care will be greater emphasis on learning from, and collaborating with, clinicians. Clinicians, in turn, can benefit by communication scientists developing new approaches to supporting their communication. These approaches will need to recognize that clinicians’ emphasis on their authority and clinical expertize in communicating with patients can be central to providing emotional comfort, and not necessarily a way to avoid doing so.     

The good,the bad,and the contingency: How patients’ treatment verification behaviors are linked to doctors’ reactions

ObjectiveThis article introducesTreatment Verification Behavior (TVB) to conceptualize patient proactivity. The article also aims to examine doctors’ responses to patients’ TVBs.MethodsA doctor-patient paired, two-wave data set was collected from eight hospitals in North China. We collected data from 304 doctor-patient dyads with each doctor rating, on average, three inpatients.ResultsThe results show that when patients consulted their doctors about information regarding a diagnosis or treatment (i.e.,consulting TVB), it improved doctors’ perception of the patients’ ability, which further increased doctors’ work engagement. Alternatively, when patients challenged doctors about information regarding a diagnosis or treatment (i.e., challenging TVB), it induced doctors’ perception of threat but without significantly decreasing doctors’ work engagement. In addition, when doctors felt respected by patients, this feeling moderated the effects of patients’ TVBs on doctors’ reactions.ConclusionBoth the content (the “what”) and the manner (the “how”) of patients’ proactive communications with their doctors will influence doctors’ responses.Practice implicationsThese insights suggest that patient and doctor communication training should include components that address both the content and performance of communication.     

Promoting patient participation in healthcare interactions through communication skills training: A systematic review

ObjectiveTo present literature on training patients in the use of effective communication skills.MethodsSystematic searches were conducted in six databases. References were screened for inclusion through several phases. Extracted data included intervention study design, sample characteristics, content and structure of training programs, outcomes assessed, and findings reported.ResultsA total of 32 unique intervention studies were included. Most targeted primary care or cancer patients and used a randomized controlled study design. Interventions used a variety of training formats and modes of delivering educational material. Reported findings suggest that communication training is an effective approach to increase patients’ total level of active participation in healthcare interactions and that some communication behaviors may be more amenable to training (e.g., expressing concerns). Trained patients do not have longer visits and tend to receive more information from their providers. Most studies have found no relationship between communication training and improved health, psychosocial wellbeing, or treatment-related outcomes.ConclusionsFindings reinforce the importance and potential benefits of patient communication training.Practice implicationsAdditional research is warranted to determine the most efficacious training programs with the strongest potential for dissemination.     

Patients’ perspectives about doctor-patient communication regarding transvaginal mesh implant surgery

ObjectivesMany women experience pelvic floor disorders which may require medical intervention such as transvaginal mesh implant surgeries (TVM; the abdominal or vaginal insertion of woven netting to support pelvic tissue). We examined women’s perceptions of communication with their health professionals concerning TVM.DesignWe analysed 153 women’s written submissions to an Australian Government Inquiry regarding their experiences of transvaginal mesh surgery to explore their perceptions of TVM-related doctor-patient communication. Data were analysed using deductive and inductive reflexive thematic analysis.ResultsWomen expressed several challenges in their communication with their health professionals. Three themes regarding communication were generated: Insufficient information was abundant; Normalisation and minimisation of the procedure and risks; and, Desired communication interactions.ConclusionsAccording to women’s accounts, doctor-patient communication was poor. Health professionals must be knowledgeable about medical procedures and their potential complications and provide their patients with adequate, accurate information to make informed choices about their health. Health professionals should also document informed consent.Practice implicationsHealth professionals should be well-informed about TVM, including best-practice treatments for pelvic floor disorders, indications for TVM, the risks, outcomes and potential complications from various forms of TVM, and ways to adequately communicate sufficient information to women.     

Definitions and use of the teach-back method in healthcare consultations with patients: A systematic review and thematic synthesis

ObjectiveTo review and synthesise definitions of the teach-back method in the literature. The second aim is to synthesise the barriers, facilitators and perceptions of teach-back use in healthcare consultations with patients.MethodsA systematic review and thematic synthesis following Braun and Clarke’s method.ResultsThe primary search found 1429 citations and the secondary search added 221 citations. Screening identified 66 citations eligible for data extraction. We contrasted and synthesised operational definitions of the teach-back method. The synthesis generated seven themes related to healthcare provider (HCP) and patient perceptions of teach-back (effectiveness, stigma and time-related perceptions), the universal application of teach-back, patient health outcomes and healthcare provider training.DiscussionOperational definitions of the teach-back method varied in the literature and contained implied steps. HCPs and patient perceptions of teach-back operated as both enablers and barriers to its use. HCPs training programs for the teach-back method were identified as beneficial for altering HCPs perceptions about the method and increased its use with patients.Practice implicationsStandardising operational definitions of the teach-back method can support replicability of research and enhance HCPs communication skills training programs. HCPs training on teach-back use can support the increased use of the technique with broader patient populations.     

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial

ObjectivesTo assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group’s experiences and learning preferences.MethodsA single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N = 210) to computer-based learning (N = 211). Primary outcomes: communication scores during repeat interactions with MPathic-VR’s intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. Secondary outcomes: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning.ResultsMPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters.ConclusionsMPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation.Practice implicationsMPathic-VR’s virtual human simulation offers an effective and engaging means of advanced communication training.     

Nurses’ experiences of using an interactive tailored patient assessment tool one year past implementation

BackgroundDespite evidence of benefits, integration of patient-centered communication in clinical practice is challenging. Interactive tailored patient assessment (ITPA) tools can contribute to a more patient-centered care approach. However, little research has examined the impact of such tools on nursing care once they have been implemented.ObjectiveTo explore nurses’ experiences of the benefits of and barriers to using an ITPA called Choice, in cancer care one year after its implementation.MethodsThis investigation is a part of a larger study examining the use of Choice in cancer care. Four focus group interviews were conducted with 20 nurses experienced in using the Choice application. The data were analyzed using qualitative content analysis.ResultsThree themes and nine sub-themes emerged: (1) “Choice as facilitator for shared understanding and engagement in patients’ own care,” with three sub-themes: preparing both patient and nurse for communication, shared engagement in care planning, and giving the patients a voice; (2) “enhancing the patients’ strengths,” with two sub-themes: releasing patient's internal strengths and confirming “normalcy” for the patient; and (3) “new challenges for the nurse,” with four sub-themes: organizational challenges, interactions with technology, a need for training in communication skills, and new ethical challenges.ConclusionsFindings suggest that, from nurses’ perspectives, integration of ITPAs such as Choice in clinical practice offers many benefits that can contribute to patient-centered care. However, to reap these benefits, use of such tools must receive equal priority as other routines, and require sufficient time, space and competence. Choice also challenged nurses’ professional roles and created dilemmas such as nurses’ ambivalence regarding patients’ levels of disclosure of sensitive issues and the nurses’ ability to respond to them. Although patient-centered care is advocated as model for good clinical practice, this is not always internalized. Tools such as Choice may help to make such a shift happen.