Effects of examination room computer on cancer patients perception of physician's compassion, communication skills, and professionalism: A randomized clinical trial.

Abstract

26 Background: The use of electronic health records (EHR) continues to rise in various clinical settings. The full effects of EHR use on physician-patient interactions remain unclear. This study aims to compare patient perception of physician’s compassion, communication skills, and professionalism between a traditional face to face clinic visit with a visit where an examination room computer is used by the physician to access and document patient information. Methods: RCT was conducted at an outpatient supportive care center. 120 English speaking adults with advanced cancer were recruited. Patients were randomized to watch 2 standardized, 3-minute video vignettes depicting a routine physician-patient clinical encounter. Both videos had identical script. In one video, physician communicated face to face while in the other video physician used the examination room computer during conversation. Both actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. After viewing each video, patients completed validated questionnaires rating their perception of physician’s compassion (0 = best, 50 = worst), communication skills (0 = poor, 70 = excellent) and professionalism (0 = poor, 20 = very good). Patients were also asked to rate their overall physician preference. Results: After watching the first video, the face to face clinical encounter resulted in better compassion scores (median [interquartile range], 9[0-18] vs 20[6-28]; P = .0003), communication skills 65[54-70] vs 54[41-63]; P = .0001) and professionalism 19[5-20] vs 14[11-17]; P = .013). After crossover analysis, we found a significant period ( P = .004) and sequence ( P = .005) effect favoring the second video on compassion scores. After watching the second video, 86 (72%) of the patients preferred face to face communication. Conclusions: Patientsperceived physicians who communicated face to face without the use of computer as more compassionate, professional and with better communication skills. Moreover they preferred face to face physician to be their provider. Clinical trial information: NCT02957565.