Physician Communication Training Research Articles

Practicing End-of-Life Conversations: Physician Communication Training Program in Palliative Care

A Physician Communication Training Program (PCTP) utilizing scripts based on actual family conferences with patients, families, and the health care team was developed at one medical center in the Northeast. The program was designed, adapted, and directed by a palliative care social worker. The primary goal of the program is to help residents and attending physicians build better communication skills in establishing goals of care and in end-of-life planning. The scripts focus on improving physicians’ basic skills in conducting family meetings, discussing advance directives, prognosis, brain death, and withdrawal of life support. Excerpts from the scripts utilized in the program are included. Feedback from participants has been positive, with all respondents indicating improvement in their capacity to take part in these challenging conversations.

The meaning of everything: communication at the end of life

Communication about end-of-life care is increasingly recognized as a core clinical skill, but doctors are often unprepared to have these conversations. Crisis situations at the end of life, such as when a hospitalized patient with a poor prognosis requests that “everything” be done, pose even greater communicative challenges. Such decisions are often regarded as a demand for care that may be burdensome or even harmful, rather than the start of an important conversation about values and goals. Situations such as this have prompted the development of prescriptive approaches to communicating with patients, which have limitations since they focus more on the physicians’ message than on developing a relationship with the patient or eliciting the meaning of the illness and its treatment. Current models of communication are less about accurate transmission of information and more about the ways in which communication constitutes our social world. Thus, the goal of communication training for physicians should be less about tools and scripts, and more about doctors learning to engage patients in conversation. We suggest strategies for promoting dialogue to more effectively explore the concerns and misunderstandings that might underlie decisions to “do everything.”

Physician gender and patient centered communication: The moderating effect of psychosocial and biomedical case characteristics

ObjectiveFemale physicians have a more patient-centered communication style than their male counterparts; however, few studies have investigated how the biomedical or psychosocial nature of a patient diagnosis might moderate this relationship. MethodsSeventy six 3rd year residents (50 male and 26 females) seeking board certification from the Korean Academy of Family Medicine participated in the 2013 Clinical Practice Examination by conducting two simulated patient (SP) interviews, one presenting a largely psychosocial case and the other largely biomedical. The interview recordings were coded with the Roter Interaction Analysis System (RIAS). ResultsFemale physicians and their SPs engaged in more dialog than male physicians in both cases. Female physicians were more patient-centered than males for the psychosocial case (t=−3.24, P<0.05), however, their scores did not differ for the biomedical case. In multivariate analysis, a significant interaction between physician gender and case (z=−3.90, P<0.001) similarly demonstrated greater female patient-centeredness only for the predominantly psychosocial case. ConclusionCase characteristics moderated the association between physician gender and patient-centeredness. Practice implicationsCase characteristics need to be considered in future research on the association of physician gender and the patient-centered communication, as well as in the tailoring of physician communication training.

Study protocol for improving asthma outcomes through cross-cultural communication training for physicians: a randomized trial of physician training.

BackgroundMassive resources are expended every year on cross-cultural communication training for physicians. Such training is a focus of continuing medical education nationwide and is part of the curriculum of virtually every medical school in America. There is a pressing need for evidence regarding the effects on patients of cross-cultural communication training for physicians. There is a need to understand the added benefit of such training compared to more general communication. We know of no rigorous study that has assessed whether cross-cultural communication training for physicians results in better health outcomes for their patients. The current study aims to answer this question by enhancing the Physician Asthma Care Education (PACE) program to cross cultural communication (PACE Plus), and comparing the effect of the enhanced program to PACE on the health outcomes of African American and Latino/Hispanic children with asthma.Methods/DesignA three-arm randomized control trial is used to compare PACE Plus, PACE, and usual care. Both PACE and PACE Plus are delivered in two, two-hour sessions over a period of two weeks to 5–10 primary care physicians who treat African American and Latino/Hispanic children with asthma. One hundred twelve physicians and 1060 of their pediatric patients were recruited who self-identify as African American or Latino/Hispanic and experience persistent asthma. Physicians were randomized into receiving either the PACE Plus or PACE intervention or into the control group. The comparative effectiveness of PACE and PACE Plus on clinician’s therapeutic and communication practices with the family/patient, children’s urgent care use for asthma, asthma control, and quality of life, and parent/caretaker satisfaction with physician performance will be assessed. Data are collected via telephone survey and medical record review at baseline, 9 months following the intervention, and 21 months following the intervention.DiscussionThis study aims to reduce disparities in asthma outcomes among African American and Latino/Hispanic children through cross-cultural communication training of their physicians and assessing the added value of this training compared to general communication. The results of this study will provide important information about the value of cross-cultural training in helping to address persistent racial disparities in outcomes.Trial registrationClinicalTrials.gov: NCT01251523 December 1, 2010

Capsule Commentary on Price-Haywood et al., Comparative Effectiveness of Audit-Feedback Versus Additional Physician Communication Training to Improve Cancer Screening for Patients with Limited Health Literacy

Price-Haywood et al.1 compared audit-feedback vs. audit-feedback plus physician communication training [including standardized patient (SP) feedback] to improve cancer screening rates among patients with limited health literacy. Intervention physicians were rated higher in general communication about cancer risks and shared decision making related to colorectal cancer screening by the SPs who delivered the intervention. However, the intervention did not improve cancer screening rates or patient cancer screening knowledge. Three important methodological limitations impact interpretation of the study results. First, SPs both delivered the intervention and evaluated the physicians at follow-up. Individuals delivering the intervention should not be involved in the evaluation process because of potential biases that may affect the outcome.2 This study could have instead recorded the SP visits and had the recordings reviewed by individuals blinded to study condition. Second, although the investigators appropriately designed a group (cluster) randomized trial (GRT) to evaluate the intervention, they failed to appropriately power or analyze the data to account for this design. In a GRT, it is expected that outcomes from the same group (e.g., clinic) will be more similar than outcomes from other groups. The analyses presented do not account for the within-clinic (or physician) correlation. Ignoring positive correlation within groups leads to inaccurately small p values.3 Thus, the statistically significant difference in mammography screening rates at follow-up (favoring the control condition) may not be statistically significant. Finally, the study was poorly designed to assess improvement in screening rates. Recruiting patients who are ineligible for some screening tests (e.g., men for breast and cervical cancer) provides no information on the impact of the intervention on screening compliance. A study of this size should have focused on one particular cancer screening and recruited only patients eligible for such screening. The study of interventions to improve cancer screening rates especially among individuals with limited health literacy is important.4 Unfortunately, design and analytic flaws in this study may have overstated the impact of the intervention on all outcomes measured. The methodological issues raised by this study must be addressed in future studies to allow accurate conclusions about effectiveness of such interventions.

Selected conditions for endometrial acceptance and preferred forms of psychological asistance

Abstract A study of 41 patients was conducted in order to provide an empirical basis for cooperation between a psychologist and a support group of patients with endometriosis. Our aim was to identify psychological variables which have a connection with the disease’s acceptance. The patients’ ages and duration of their illness were taken into account. We demonstrated that there is a positive relationship in accepting the illness through: perceived control and the ability to reduce pain, a declared ability to cope, a sense of harmony with one’s body, and disclosure of negative emotions - mostly anger and sadness. A significantly negative association was shown for: the disease’s duration, coping style with stress concentrating on the emotions, alienation from the body, and “catastrophizing”. Preference for the form of psychological support was also studied. Most preferred were: physician communication training, and individual consultations with a psychologist.

Comparative Effectiveness of Audit-Feedback Versus Additional Physician Communication Training to Improve Cancer Screening for Patients with Limited Health Literacy

We designed a continuing medical education (CME) program to teach primary care physicians (PCP) how to engage in cancer risk communication and shared decision making with patients who have limited health literacy (HL). We evaluated whether training PCPs, in addition to audit-feedback, improves their communication behaviors and increases cancer screening among patients with limited HL to a greater extent than only providing clinical performance feedback. Four-year cluster randomized controlled trial. Eighteen PCPs and 168 patients with limited HL who were overdue for colorectal/breast/cervical cancer screening. Communication intervention PCPs received skills training that included standardized patient (SP) feedback on counseling behaviors. All PCPs underwent chart audits of patients' screening status semiannually up to 24 months and received two annual performance feedback reports. PCPs experienced three unannounced SP encounters during which SPs rated PCP communication behaviors. We examined between-group differences in changes in SP ratings and patient knowledge of cancer screening guidelines over 12 months; and changes in patient cancer screening rates over 24 months. There were no group differences in SP ratings of physician communication at baseline. At follow-up, communication intervention PCPs were rated higher in general communication about cancer risks and shared decision making related to colorectal cancer screening compared to PCPs who only received performance feedback. Screening rates increased among patients of PCPs in both groups; however, there were no between-group differences in screening rates except for mammography. The communication intervention did not improve patient cancer screening knowledge. Compared to audit and feedback alone, including PCP communication training increases PCP patient-centered counseling behaviors, but not cancer screening among patients with limited HL. Larger studies must be conducted to determine whether lack of changes in cancer screening were due to clinic/patient sample size versus ineffectiveness of communication training to change outcomes.

Implementing a comprehensive physician-communication-skills improvement initiative: The Cleveland Clinic experience.

186 Background: Physician communication skills are associated with important outcomes, including medical results, treatment adherence, malpractice claims, patient safety, and physician satisfaction. Recently, patient satisfaction with physicain communication became a factor influencing Medicare reimbursement. In 2010, the Cleveland Clinic began building a physician communication training program to improve doctor communication skills. Methods: Following a literature review and a survey of communication skills programs at a variety of U.S. hospitals, we collaborated with the American Academy of Communication in Healthcare (AACH) to develop a full-day course based on Frankel and Stein’s Four Habits model. The model emphasizes skills related to initiating the encounter, eliciting the patient’s story, expressing empathy, educating the patient and collaboratively developing a plan. The course was designed to be taught by physicians and was highly experiential and skills based, making extensive use of role-play exercises. An AACH consultant trained 15 physicians to teach the course during several 7-day train-the-trainer courses. Results: Between September 2011 and May 2013, over 800 physicians took the course. It became very popular and has been consistently oversubscribed. For the first 450 physicians trained, we reviewed patient satisfaction survey scores for the 6 months before and after they took the course. For all 13 items on the Press Ganey ambulatory patient survey used, scores were higher after taking the course. For 7 of the 13, the difference was statistically significant (p values ranging from .003 to .044). Conclusions: Our experience with communication skills training indicates that such training can be well received by physicians if it is high quality. Key elements of our program that we believe contributed to its success are the following: it was developed by physicians for physicians; it is taught by physicians with substantial clinical practices so that the atmosphere is colleagues teaching colleagues; and it is skills based rather than cognitive in focus so that participants have tangible tools that they can use in their practice.

"How Do You Feel about Antibiotics for This?" A Qualitative Study of Physician Attitudes towards a Context-Rich Communication Skills Method.

To explore experiences with and views of general practitioners (GPs) on a physician communication training method in primary care and its applicability and implementation in daily practice, we performed a semi-structured qualitative study of GPs’ experience of training in and implementing a communication skills training program for managing lower respiratory tract infection (LRTI) which included a seminar, simulated patient consultation together with providing and receiving feedback on ones own transcript, and a seminar in a structured approach to the LRTI consultation. Seventeen out of 20 eligible GPs who had participated in the IMPAC3T trial and were allocated to receiving enhanced physician communication training for managing lower respiratory tract infection participated. GPs’ experiences with the physician communication training method and its specific components were positive. The method gave GPs additional tools for managing LRTI consultations and increased their sense of providing evidence-based management. During the study, GPs reported using almost all communication items covered in the training, but some GPs stated that the communication skills diluted over time, and that they continued to use a selected set of the skills. The general communication items were most regularly used. Implementation of the method in daily practice helped GPs to prescribe fewer antibiotics in LRTI with the only perceived disadvantage being time-pressure. This study suggests that GPs felt positive about the physician communication training method for enhanced management of LRTI in primary care. GPs continued to use some of the communication items, of which general communication items were the most common. Furthermore, GPs believed that implementation of the communication skills in daily practice helped them to prescribe fewer antibiotics. The context-rich communication method could have wider application in common conditions in primary care.

How Does Your Doctor Talk with You? Preliminary Validation of a Brief Patient Self-Report Questionnaire on the Quality of Physician–Patient Interaction

The quality of physician-patient interaction is increasingly being recognized as an essential component of effective treatment. The present article reports on the development and validation of a brief patient self-report questionnaire (QQPPI) that assesses the quality of physician-patient interactions. Data were gathered from 147 patients and 19 physicians immediately after consultations in a tertiary care outpatient setting. The QQPPI displayed good psychometric properties, with high internal consistency and good item characteristics. The QQPPI total score showed variability between different physicians and was independent of patients' gender, age, and education. The QQPPI featured high correlations with other quality-related measures and was not influenced by social desirability, or patients' clinical characteristics. The QQPPI is a brief patient self-report questionnaire that allows assessment of the quality of physician-patient interactions during routine ambulatory care. It can also be used to evaluate physician communication training programs or for educational purposes.

Effectiveness of Simulation Training on Anesthesia Provider Communication Skills

Review Objective: The objective of the review is to identify the best available evidence related to the effects of simulation training on communication skills of Anaesthesia providers Review questions: • What is the effectiveness of simulation training on communication and clarified roles in the operating room environment for Anaesthesia providers? • What is the effectiveness of simulation training on decreasing errors related to miscommunication in the operating room environment for Anaesthesia providers? Inclusion criteria: Types of participants: This review will consider studies that include simulation training utilizing communication and team training for anaesthesia providers, nurses or physicians as study participants that can be transferred to the hospital setting. Types of intervention(s)/phenomena of interest: The review will consider studies of any type of simulation training for anaesthesia providers, nurses or physicians utilizing communication and team training. Types of outcomes: Improved communication among team members is the primary outcome of interest. This can be measured by tools such as the Kramer and Schmalenberg Nurse-Physician Scale11 that rates physician-nurse interactions or the hand-off form 1 used in PACU to ensure critical information is included. A secondary outcome is decreases in errors related to miscommunication in the operating room environment for Anaesthesia providers.

Physician Communication and Patient Adherence to Treatment

Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians' communication skills. Calculation and analysis of "r effect sizes" and moderators of the relationship between physician's communication and patient adherence, and the effects of communication training on adherence to treatment regimens for varying medical conditions. Thorough search of published literature (1949-August 2008) producing separate effects from 106 correlational studies and 21 experimental interventions. Determination of random effects model statistics and the detailed examination of study variability using moderator analyses. Physician communication is significantly positively correlated with patient adherence; there is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well. Training physicians in communication skills results in substantial and significant improvements in patient adherence such that with physician communication training, the odds of patient adherence are 1.62 times higher than when a physician receives no training. Communication in medical care is highly correlated with better patient adherence, and training physicians to communicate better enhances their patients' adherence. Findings can contribute to medical education and to interventions to improve adherence, supporting arguments that communication is important and resources devoted to improving it are worth investing in. Communication is thus an important factor over which physicians have some control in helping their patients to adhere.

“Physician and patient communication training in primary care: Effects on participation and satisfaction”: Correction.

“Physician and patient communication training in primary care: Effects on participation and satisfaction”: Correction.

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.

Physician and patient communication training in primary care: Effects on participation and satisfaction.

To assess the effects of a communication skills training program for physicians and patients. A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. Implications for improving physician-patient relationship outcomes through communication skills training are discussed.

Disentangling physician sex and physician communication style: Their effects on patient satisfaction in a virtual medical visit

Objective The present study aimed to investigate the effect of physician sex and physician communication style on patient satisfaction. In real medical visits, physician sex and physician communication style are confounded variables. By using the virtual medical visit paradigm, we were able to disentangle the two variables and study their separate and/or joint effects on patient satisfaction. Method In an experimental design, analogue patients (167 students) interacted with a computer-generated virtual physician on a computer screen. The patients’ satisfaction during the visit was assessed. Results Depending on the sex composition of the dyad, physician communication style affected analogue patients’ satisfaction differently. For instance, in male–male dyads, physician communication style did not affect the patients’ satisfaction, whereas in female–female dyads, analogue patients were more satisfied when the physician adopted a caring as opposed to a non-caring communication style. Conclusion Sex of the physician and sex of the patient moderate how different physician communication styles affect patient satisfaction. In particular, a female-sex role congruent communication style leads to higher patient satisfaction when women see a female physician. Practice implications Physician communication training cannot be one size fits all. Rather female and male physicians should obtain different training and they need to be made aware of the fact that female and male patients harbor different expectations toward them.