Understanding and improving communication in healthcare

Abstract

Physician–patient communication plays a crucial role in healthcare as it is directly linked to patients’ well-being and outcomes. The focus of this dissertation is on communication in healthcare. More specifically, it comprises three manuscripts on understanding and improving physician–patient communication at the beginning (i.e., history-taking) and at the end of an emergency department consultation (i.e., discharge communication). Manuscript one evaluates the usability of a web-based software for medical history-taking. We found excellent usability for emergency patients not in need of immediate medical care. However, the gathered medical history was not able to substitute medical history-taking by physicians but rather to provide ancillary information. Manuscript two investigates in a laboratory setting the effect of three different information-structuring measures (i.e., advance organiser, structure, post organiser) on proxy-patients’ recall of discharge information, and their satisfaction with the physician. We show that pre-existing medical knowledge had a positive effect on participants’ recall, and that structured discharge communication complemented by an advance organiser (i.e., the so-called book metaphor) was beneficial in individuals with lower pre-existing medical knowledge. Additionally, in the information-structuring conditions, proxy-patients perceived information as more structured, and they recommended the physician to family and friends more strongly in comparison to a natural conversation condition. Manuscript three studies the effects of communication training for physicians in information structuring compared to communication training in responding to emotions in the real-life setting of an emergency department. In this cluster randomized clinical trial, we show that explicit structure of discharge information was beneficial for patients’ recall and adherence to recommendations without a trade-off on patients’ satisfaction. In sum, this dissertation sheds light on effective communication between patients and physicians by investigating verbal and electronic communication aids.