Concordance between physician communication style and patient attitudes predicts patient satisfaction

Objective

This study tested whether the impact of the physician's communication style on patient satisfaction differs depending on patients’ attitudes toward caring and sharing. We predicted that the impact of physician caring on patient satisfaction depends on patient attitudes toward caring, and that the impact of physician sharing on patient satisfaction depends on patient attitudes toward sharing.

Methods

Participants (N = 167) were asked to imagine that they were consulting for recurrent headaches. They interacted on a computer with a virtual physician that communicated either in a low or high caring way and either in a low or high sharing way (2 × 2 design). Then, participants answered questions about their attitudes toward caring and sharing and about their satisfaction with the physician.

Results

Hypotheses were confirmed. Furthermore, a high caring physician communication style led to higher satisfaction than a low caring one, regardless of participants’ attitudes toward caring, while satisfaction with physicians’ level of sharing was dependent on the participants’ attitude toward sharing.

Conclusion and practice implications

Physicians may adopt a high caring style with confidence that all patients will benefit. Adoption of a sharing style should be more carefully adjusted to patient attitudes.     

Patient use of weight-management activities: A comparison of patient and physician assessments

Objective

Examine concordance between patient and physician assessments of patient self-reported use of weight-management activities.

Methods

Analysis of baseline data from a randomized controlled trial of patient and physician interventions to improve patient–physician communication (41 physicians and 274 of their patients).

Results

A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%) while physicians only perceived one-third of patients as engaging in those activities (exercise, 36.6%; weight loss, 33.3%). Kappa scores indicated small agreement between patient and physician assessments of patient self-reported use of exercise, mean kappa 0.28 (range 0.15 to 0.40) and no agreement between patient and physician assessments of patient self-reported efforts to lose weight, mean kappa −0.14 (range −0.26 to −0.01). Obese patients were more likely than non-obese patients to report trying to lose weight or exercising regularly (p < 0.05), but physicians were less likely to perceive obese patients as engaging in those activities (p < 0.05).

Conclusions

Primary care physicians differed considerably from their patients, especially obese patients, in their assessments of patient use of weight-management activities.

Practice implications

These results highlight the importance of improving patient–provider communication about weight-management activities, particularly among obese patients.     

Factors associated with patient reports of positive physician relational communication

Objective

To evaluate the patient, physician, and visit-related factors associated with patient ratings of positive physician relational communication.

Methods

Pre- and post-visit surveys were conducted with 485 patients attending a routine periodic health exam with one of 64 participating physicians. The audio-recorded visits were coded for elements of patient–physician communication including assertive responses, partnership building, question asking, supportive talk, and expressions of concern.

Results

Patient reports of positive physician relational communication were associated with patient perceptions of how well the physician understood the patient's health care preferences and values, a patient–physician interaction outside of the exam room, and physician-prompted patient expressions of concern.

Conclusion

In addition to a patient's perception of their relationship with their physician going into the visit, relatively simple acts like extending the interaction beyond the exam room and ensuring that patients feel invited to express concerns they may have during the visit may influence patient perceptions of physician relational communication.

Practice implications

This study offers preliminary support for the idea that relational communication and its associated benefits may be fostered through simple physician-driven acts such as interacting with patients outside of the exam room and encouraging patients to express concerns within the visit.     

Physician gender,physician patient-centered behavior,and patient satisfaction: A study in three practice settings within a hospital

Objective

To compare male and female physicians on patient-centeredness and patients’ satisfaction in three practice settings within a hospital; to test whether satisfaction is more strongly predicted by patient-centeredness in male than female physicians.

Methods

Encounters between physicians (N = 71) and patients (N = 497) in a hospital were videotaped and patients’ satisfaction was measured. Patient-centeredness was measured by trained coders.

Results

In the outpatient setting, female physicians were somewhat more patient-centered than male physicians; patient satisfaction did not differ. In the inpatient and emergency room settings, female physicians were notably more patient-centered than male physicians; satisfaction paralleled these differences. Nevertheless, there was some, though mixed, evidence that patient-centeredness predicted satisfaction more strongly in male than female physicians, suggesting that patients valued patient-centered behavior more in male than female physicians.

Conclusion

Even though satisfaction mirrored the different behavior styles of male and female physicians in the inpatient and emergency room settings, in all settings male physicians got somewhat more credit for being patient-centered than female physicians did.

Practice implications

If female physicians do not consistently receive credit for high patient-centeredness in the eyes of patients, this could lead female physicians to reduce their patient-centered behavior.     

Impact of communication training on physician expression of empathy in patient encounters

Objective

To examine whether an educational intervention that focused on physician communication training influenced physician empathic expression during patient interactions.

Methods

This study used a quantitative research method to investigate the influence of communication training on physician-expressed empathy using two measures (global and hierarchical) of physician empathic behavior.

Results

The differences in global empathy scores in the physician training group from baseline to follow-up improved by 37%, and hierarchical scores of physician empathic expression improved by up to 51% from baseline scores for the same group.

Conclusions

The results strongly supported the hypotheses that training made a significant difference in physician empathic expression during patient interactions demonstrated by both outside observer measures of global ratings and hierarchical ratings of physician empathic behavior.

Practice implications

These findings have significant implications for program design and development in medical education and professional training with the potential to improve patient outcomes.     

Talking about depression: An analogue study of physician gender and communication style on patient disclosures

Objectives

To disentangle the effects of physician gender and patient-centered communication style on patients’ oral engagement in depression care.

Methods

Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS).

Results

Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p < .05). APs were more willing to continue treatment with gender-discordant HPC physicians (p < .05). No effects were evident in the LPC condition.

Conclusions

Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender.

Practice implications

High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.     

Impact of physicians’ personal discomfort and patient prognosis on discussion of fertility preservation with young cancer patients

Objective

This study sought to determine if physician's personal discomfort with the topic of FP and a patient's prognosis would have an impact on the likelihood of discussing FP with cancer patients.

Methods

Data from larger studies of qualitative semi-structured interviews with pediatric and adult oncologists were analyzed using grounded theory and crystallizing immersion method to examine the themes of “personal comfort” and “patient prognosis” in relation to discussion.

Results

Results showed that, across both physician types, the majority of respondents’ personal comfort with the topic of FP was related to the likelihood of discussion. Personal discomfort manifested as: (a) lack of knowledge; (b) language/cultural barriers; (c) perception that subject of FP adds more stress to situation; (d) general uncertainty about success of FP methods. Data also indicate physicians do not feel discussions are appropriate for patients with poor prognosis.

Conclusion

Despite the ASCO guidelines suggesting physicians should discuss FP with all patients, the majority of physicians are not following these guidelines.

Practice implications

Improved training on recognition of such biases and communication strategies may improve the quality and frequency of such discussions. Involving the entire healthcare team in discussions may alleviate the need for physicians to have sole responsibility.     

Development and psychometric properties of the Shared Decision Making Questionnaire--physician version (SDM-Q-Doc)

Objective

To develop and psychometrically test a brief instrument for assessing the physician's perspective of the shared decision-making process in clinical encounters.

Methods

We adapted the 9-item Shared Decision Making Questionnaire (SDM-Q-9) for patients to generate a new version for physicians (SDM-Q-Doc). The physician version was tested in clinical encounters between 29 physicians and 324 patients in German outpatient care contexts. Analyses of the extent to which the instrument was accepted, the reliability of the instrument, and the factorial structure of the scale were performed.

Results

Physicians showed a high level of acceptance toward the SDM-Q-Doc. Item discrimination parameters were above .4 for all but one item. An analysis of internal consistency yielded a Cronbach's α of .88. Factor analysis confirmed a one-dimensional structure.

Conclusion

The results of this study suggest that the SDM-Q-Doc is a well-accepted and reliable instrument for assessing the physician's perspective during SDM processes in clinical encounters. To our knowledge, the SDM-Q-Doc is the first psychometrically tested scale available for assessing the physician's perspective.

Practice implications

The SDM-Q-Doc can be used in studies that analyze the effectiveness of the implementation of SDM and as a quality indicator in quality assurance programs and health service assessments.     

The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction

Objective

The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants’ report of skill use and patient satisfaction.

Methods

Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction.

Results

Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all p < .05); post intervention, physicians reported using more skills in the same 5 areas (all p < .01). Intervention group patients reported higher levels of satisfaction than controls in five of six domains (all p < .05).

Conclusion

Communication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction.

Practice Implications

Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training.     

Extending Physician ReACH: Influencing patient activation and behavior through multichannel physician communication

Objective

Despite evidence-based recommendations, physical activity as a self-management technique is underutilized. Many physical activity interventions require significant resources, ranging from repeated phone follow-up with nursing staff to intensive sessions with cooperating physical therapists. This intervention, Extending Physician ReACH (Relationship And Communication in Healthcare), examined physician to patient communication tactics for promoting walking exercise to patients with type 2 diabetes, using limited clinic time and financial resources.

Methods

This was a single-site, six-month prospective intervention, which implemented theoretically driven, evidenced-based information factor strategies. Of the 128 volunteers who participated in the initial clinic visit, 67 patients with type 2 diabetes completed the six-month intervention.

Results

Significant intervention effects were detected risk perception, social norms, and patient activation.

Conclusions

This study was designed to identify information factors that could affect physician success in motivating patients with type 2 diabetes to enact the ADA physical activity recommendations.

Practice implications

The success of this intervention models a strategy through which clinicians can reach beyond “one-shot” persuasion without placing onerous time and resource demands on physicians.     

Cancer screening adherence: Does physician–patient communication matter?

Objective

The objective of this study was to examine the separate contributions of patients and physicians to their communication regarding cancer screening.

Methods

Research design and subjects: The authors conducted a cross-sectional analysis of survey data collected from 63 community-based primary care physicians and 904 of their female patients in Los Angeles.

Results

Patients who perceived their physicians to be enthusiastic (at any level) in their discussions of mammography or fecal occult blood tests (FOBT) were significantly more likely to report a recent test than patients who reported no discussions.

Conclusion

Physician discussions of cancer screening are important and effective even when, as in the case of mammography, screening rates are already high, or, as in the case of FOBT, rates have tended to remain low. The value of communication about screening should be taught and promoted to primary care physicians who serve as gatekeepers to screening.

Practice implications

Those who train physicians in communication skills should take into account our finding that the communication style of physicians (e.g., enthusiasm for screening) was the only patient or physician variable that both influenced screening adherence and that could be taught.     

Disclosing medical errors to patients: Effects of nonverbal involvement

Objective

The purpose of this study was to test causal effects of physicians’ nonverbal involvement on medical error disclosure outcomes.

Methods

216 hospital outpatients were randomly assigned to two experimental treatment groups. The first group watched a video vignette of a verbally effective and nonverbally involved error disclosure. The second group was exposed to a verbally effective but nonverbally uninvolved error disclosure. All patients responded to seven outcome measures.

Results

Patients in the nonverbally uninvolved error disclosure treatment group perceived the physician's apology as less sincere and remorseful compared to patients in the involved disclosure group. They also rated the implications of the error as more severe, were more likely to ascribe fault to the physician, and indicated a higher intent to change doctors after the disclosure.

Conclusion

The results of this study imply that nonverbal involvement during medical error disclosures facilitates more accurate patient understanding and assessment of the medical error and its consequences on their health and quality of life.

Practice implications

In the context of disclosing medical errors, nonverbal involvement increases the likelihood that physicians will be able to continue caring for their patient. Thus, providers are advised to consider adopting this communication skill into their medical practice.     

Revisiting patient communication training: An updated needs assessment and the AGENDA model

Objective

To assess physician needs for patient-centered communication training for medical consultations and to develop an updated patient training curriculum.

Methods

An online needs assessment was distributed through physician email listserves at the University of Florida College of Medicine. Frequency tabulation and content analyses were conducted to assess patient communication themes.

Results

Responses were received from 336 physicians. Physicians reported that patients are reluctant to ask questions when they do not understand information related to their medical condition, treatment plan, or medical advice. Furthermore, physicians reported that a lack of patient negotiation inhibits patient-centered communication and may negatively influence patient adherence and compliance. Based on these results the AGENDA model was created for patient training and consists of (1) agenda setting; (2) goals for health; (3) expressing concerns, questions, and negotiations; (4) navigating health literacy issues; (5) disclosing detailed information; and (6) active types of listening.

Conclusion

This study supports revisiting patient communication training and tailoring future training interventions to specific communities.

Practice implications

The AGENDA model can be used to train patients to enhance patient-centered communication with physicians. Additionally, patient communication training could help to address the barriers to care identified by the physicians in our study.     

Agreement in patient-physician communication in primary care: a study from Central and Eastern Europe

Objective

Efficient patient–physician collaboration is proven to have a direct benefit on health care outcomes through improved compliance, appointment keeping and use of preventive services. The aim of this study was to evaluate the patient–physician agreement on communication during primary care consultations and consider possible discrepancies.

Methods

A cross-sectional survey using self-administered questionnaires was performed in primary care in four European countries (Lithuania, Slovenia, Serbia and Russia). Post-consultation evaluations of doctor–patient communication were made by patients and physicians and were compared with pre-consultation expectations of the patient. Discrepancies in these evaluations were determined for the entire database, and within groups of expectations, using factor analysis.

Results

One thousand three hundred and thirty-two sets of questionnaires were collected by the study team. In this sample, in more than 90% of consultations physicians and patients agreed about meeting patient expectations. Discrepancies were more likely to be identified when the patients were consulting the physician for the first time or had not seen that physician for more than 12 months (up to 26.1%). There is a significantly lower correlation between the physician recognising patient's unmet expectations for all factors if the physician had been working in Primary Care for between 6 and 10 years (8.6%). The results demonstrate that physicians working more than 16 years in practice are less likely to recognise that they have failed to meet the expectations of patients who are seeking reassurance (9%).

Conclusion

Personal continuity of care is associated with a lower discrepancy between the opinions of patients and physicians regarding meeting patient expectations during consultations in primary care. The highest agreement is within first 6 years in practice, which may reflect long-term effects of training.

Practice implications

Primary care physicians should put more emphasis on identifying and addressing patient expectations in primary care consultation, including agreement with patient. Existing discrepancies may be considered to be indicators of potential opportunities to improve physician's performance and overall quality of care.     

The effect of physician–patient collaboration on patient adherence in non-psychiatric medicine

Objective

Factors contributing to treatment adherence are poorly understood but the physician–patient interaction is one factor that is known to affect patient adherence.

Methods

This meta-analysis systematically reviewed the published literature to determine the magnitude of the relationships between physician–patient collaboration and patient adherence.

Results

A statistically significant weighted mean effect size of M_d = 0.145 from 48 published studies indicated better physician–patient collaboration is associated with better patient adherence. The relationship between collaboration and adherence was sustained for pediatric and adult populations, chronic and acute conditions, and primary physician and specialists.

Conclusion

These results emphasize the need for physician–patient collaboration within the medical consultation.

Practice implications

The inclusion of the patient's perspective during the consultation is essential to obtaining cooperation once the patient has left the physician's office.     

Teen CHAT: Development and utilization of a web-based intervention to improve physician communication with adolescents about healthy weight

Objective

To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician–adolescent communication about healthy weight.

Methods

Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys.

Results

Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54 min to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients.

Conclusion

The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner.

Practice implications

If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated.     

The impact of the hospital work environment on social support from physicians in breast cancer care

Objective

Research on determinants of a good patient–physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians’ provision of social support to patients.

Methods

Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians’ social resources as well as job demands and control and patients’ perceived support from physicians have been studied in multilevel models.

Results

Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians.

Conclusion

The results highlight the importance of the work environment for a good patient–physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care.

Practice implications

Health policy and hospital management could create conditions conducive to better patient–physician interaction by strengthening the social capital and by increasing job security for physicians.