Effective Physician-patient Communication Research Articles

Enhancing patient acceptance of ICD implantation through structured shared decision making: conversation is key.

Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D) are lifesaving treatments for patients at risk for sudden cardiac death. Effective physician-patient communication during the shared decision-making process is essential. Electrophysiologist-patient conversations were targeted to obtain objective data on the interaction, understand the conversation framework, and uncover opportunities for improved communication. Individuals previously identified as requiring an ICD/CRT-D but declined implantation were recruited for this four-stage interview and survey-based study. Quantitative analysis of surveys and AI analysis of conversation videos was conducted to evaluate patient participant expectations, analyze feedback about the conversations with study physicians, and gauge willingness for device implantation. The study included 27 patients (mean age 51years, 51.9% female) and 9 study physicians. Patients were significantly more willing to undergo ICD/CRT-D implantation after conversing with study physicians compared to their own physicians and pre-conversation surveys (mean scores: 5.0, 3.1, and 4.4 out of 7, respectively; p < 0.001). Patient participants had higher satisfaction with the study conversation, rating study physicians higher in effectiveness of explanations, responsiveness to questions, and overall quality of the conversation compared to their own physicians (all p < 0.001). In a cohort of patients who previously declined ICD/CRT-D implantation, patient satisfaction and willingness to undergo implantation of a guideline-directed device therapy increased significantly following a structured conversation with study physicians. Identified key elements could be integrated into user-friendly tools and educational materials to facilitate these conversations, improving patient engagement with the decision-making process and enhancing informed acceptance of indicated device therapies.

Teaching Trainees Effective Patient Communication Skills in the Clinical Environment: Best Practices Under Crisis Conditions.

Communication within the health care setting has significant implications for the safety, engagement, and well-being of patients and physicians. Evidence shows that communication training is variable or lacking in undergraduate and graduate medical education. Physician-patient communication presents a vulnerable point in patient care, which was heightened by the COVID-19 pandemic and its aftermath. Physicians have to adapt their strategies to meet new challenges, including communicating through the necessary barriers of personal protective equipment and telecommunication platforms. They also face uncharted challenges of facilitating discussions around proactive planning and scarce resources. Medical educators must be equipped to provide trainees with the skills needed to maintain empathy, facilitate trust and connection, and adapt communication behaviors under such crisis conditions. Using the Calgary-Cambridge model as a framework, the authors describe 3 new challenges to effective physician-patient communication for which COVID-19 was the impetus-face masks, visitor restrictions, and resource allocation/proactive planning discussions-and propose educational solutions.

Evaluating feasibility and acceptability of an innovative personalized hybrid longitudinal communication skills training program.

428 Background: Effective patient-physician communication plays a vital role in providing care. Improved patient satisfaction and reduced burnout are among the many benefits of effective communication. Medical training in this area through didactic lectures, group discussions, and role play with feedback can facilitate better acquisition and honing of communication skills. We aimed to create a longitudinal training program assisting residents in developing communication skills. Methods: Internal Medicine (IM) residents participated in a 6-month project as part of their training. Residents completed a baseline questionnaire to assess confidence in communication skills, followed by a curriculum comprised of 3 x 1-hour sessions every 5 weeks where expert lecturers guided didactics on pertinent topics (e.g., delivering bad news, discussing goals of care (GOC), and completing a Practitioner Orders for Life-Sustaining Treatment (POLST)). Participants completed post-session surveys after each training, and a comprehensive post-training self-assessment. Comfort level was assessed on a 1-5 scale (1 least comfortable, 5 most comfortable) throughout the surveys. Results: Pre-intervention, most residents utilized “Ask, Tell, Ask (ATA)” (46.67%) and “Setting, Perception, Invitation, Knowledge, Emotion, Summarize (SPIKES)” (40%) frameworks to facilitate conversations with patients. Post-intervention, a greater number of residents utilized SPIKES (52.08%) compared to ATA (37.5%). 1st (PGY1) and 2nd (PGY2) year residents reported completing +25.71% and +60% more POLST forms post-intervention. In the inpatient (IP) setting, resident comfort levels in initiating GOC increased by +15.8% (for PGY1s) and +6.7% in total (all classes). Comfort levels in breaking bad news to patients in the IP setting increased by +9.09% (+24.14% for PGY1s specifically). PGY2s had the most substantial increase in comfort level in completing POLST forms (+21.08% IP, +31.52% outpatient (OP)), with an overall improvement in comfort from all classes of +12.32% (IP) and 12.53% (OP) post-intervention. Conclusions: This curriculum represents a helpful tool to improve physician-patient communication among IM residents. PGY1s demonstrated the most substantial improvement in confidence following the program, which may indicate the importance of prioritizing training for first year residents. Qualitative feedback from residents included distributing sessions throughout the year (beginning, middle, end), holding sessions in the intensive care unit (ICU) for applicability to patients in real-time, and continued instruction of practical skills. These findings may allow for future curriculum planning to help bolster trainee confidence and skills when facilitating meaningful conversations with their patients.

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study.

Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician's ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient's quality of care. This exploratory qualitative study was conducted at the largest academic medical center in Pakistan. Purposive sampling was used to approach participants from surgery, medicine, obstetrics and gynecology, pediatrics and family medicine. Faculty, fellows and residents working in these departments and medical students in their fourth and fifth years of undergraduate education with prior experience of at least one month in these specialties during their clinical rotations were included. Focus group discussions (FGDs) lasting 45-60 minutes were conducted with each cohort of healthcare professionals separately, using a semi-structured interview guide. Sixty participants (19 males and 41 females, mean age: 32.9, SD: 10.9) took part in the study. Thematic analysis revealed five major themes. Four themes focused on residents' biases and patient disparities hindering patient-resident communication: (1) patient-resident gender discordance (2) ethnicity and language barriers, (3) differing social class of the patient, and (4) challenging patient-resident interactions (patients resistant to treatment, exceedingly inquisitive and those with multiple attendants, etc.). The fifth theme identified the need for a communication skills curriculum in postgraduate medical education. Opposite gender and discordant socioeconomic/cultural backgrounds of patients pose a challenge to effective patient-physician communication. Self-identification and awareness of residents' biases when interacting with patients can ensure their active elimination and improve their communication skills. Integrating these components in a standardized curriculum within postgraduate programs can enable resident-physicians to provide the same level of care and communicate more efficiently with patients of all backgrounds.

Navigating adalimumab biosimilars: an expert opinion.

The patent expiry of Humira® in 2018 opened up the current European market to eight adalimumab biosimilars - (in alphabetical order) Amgevita®, Amsparity®, Hulio®, Hukyndra®, Hyrimoz®, Idacio®, Imraldi®and Yuflyma® - for the treatment of various immune and inflammatory conditions. Amjevita, Hadlima®, Hyrimozand Yuflymahave recently become available in the USA, with others expected to reach this market in 2023 as the US patent protection for Humiraends. Although adalimumab biosimilars demonstrate efficacy, safety and immunogenicity similar to the originator, they may differ in product excipient(s) and preservatives, along with their device type(s). Physicians may find it both difficult and time consuming to navigate their way among the array of available adalimumab biosimilars when they need to make a treatment decision. This article explores the characteristics of various adalimumab biosimilars to help clinicians navigate the various options available across Europe and the USA. In addition to drug selection, effective patient-physician communication is needed to nurture realistic patient expectations and minimise potential nocebo effects when prescribing biosimilars.

Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis

ObjectiveUptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients’ conceptualisation of RA treatment to inform interventions improving TTT...

The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting

ABSTRACT Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.

Effective patient-physician communication in the era of neuropsychopharmacology

Effective patient-physician communication in the era of neuropsychopharmacology

Developing Clinician-Educators: a Qualitative Analysis of Structured Reflections from Participatory Teaching in the Final Year in an Integrated Medical School Program.

This study aimed to describe fourth-year medical students' experiences, recorded and tracked in structured reflective teaching logs (RTLs), as participants in a year-long longitudinal medical student-as-teacher elective. Thirteen (13) participants from two medical student-as-teacher elective cohorts completed 20 contact hours of self-selected teaching. Participants chose three different learning environments spanning the first 3years of the medical school curriculum. Reflections were entered into an online spreadsheet with guided prompts (RTL). Open-ended text in the RTLs was analyzed using an inductive qualitative research approach. Open coding was applied across all meaningful segments of text, identifying themes that were validated internally with three co-authors and one methodology expert without formal program involvement. Narratives revealed detailed descriptions and reflections of participant experiences. Analysis revealed eight themes: (1) Joy of Teaching; (2) Teaching Effectiveness; (3) Feedback; (4) Effective Patient-Physician Communication; (5) Assessment; (6) Differential Diagnosis Development; (7) Standardized Case Development; and (8) Training for Teaching in Residency. Fourth-year medical student participants in a longitudinal medical student-as-teacherelective effectively used RTLs from participatory teaching to help facilitate their own development as clinician-educators. Themes identified in RTLs reflect students' awareness of teaching skill requirements and readiness for the next workplace, residency. Informed by situativity theory, formal teaching opportunities in authentic learning environments bestow students with critical formative teaching experience and awareness of the roles as clinician-educators during their undergraduate years.

Internet Health Information on Patient’s Decision-Making: Implications, Opportunities and Challenges

The accessibility of online health information has changed the decision-making process for patients concerning their health. Nevertheless, concerns persist regarding the quality and reliability of the information available on the Internet. The Internet has emerged as the dominant global source of health-related information, with a significant proportion of individuals utilizing it to retrieve information on nutrition, diseases, symptoms, and treatment options. However, the unregulated nature of online health information poses challenges in terms of assessing its credibility and accuracy. Increasingly, patients are actively engaged in healthcare decision-making, empowered by the information they acquire online. Consequently, a paradigm shift from the traditional physician-centric model to a more collaborative and patient-centered approach has occurred. Patients now have access to an expanded array of healthcare professionals and possess the ability to make informed decisions regarding their treatment and care. Nonetheless, the variability in quality of online health information and patients' limited capacity to effectively evaluate it can give rise to misunderstandings, misinformation, and an elevated propensity for self-diagnosis and self-treatment. Furthermore, patients' reliance on online information can impact the patient-physician relationship, with discrepancies between online findings and physician diagnoses leading to dissatisfaction and conflicts. Barriers obstructing effective patient-physician communication on online health information include patient's apprehension about challenging physicians, perceived resistance from physicians themselves, and difficulties in comprehending and articulating the information sourced online. Addressing these barriers and enhancing the patient-physician relationship can yield positive outcomes, including timely diagnosis, effective treatment, and shared decision-making. While Internet use brings advantages such as increased accessibility to healthcare providers and enhanced patient empowerment, it also introduces certain disadvantages. The prevalence of misinformation and disinformation on the Internet engenders risks, contributing to confusion and a lack of trust in healthcare institutions. Additionally, patients may encounter challenges in interpreting and prioritizing the information they find online, which can result in heightened anxiety and uncertainty regarding their health. This review critically examines the impact of Internet use on patient decision-making and its effect on the patient-physician relationship.

Exploring the impact of patient, physician and technology factors on patient video consultation satisfaction.

Video consultations (VCs) were made available to the general population during the COVID-19 pandemic to compensate for the cutback of face-to-face doctor-patient interactions. However, little is known about what patient-related (e.g. age), physician-related (e.g. patient-physician relationship) and technology-related (e.g. online privacy concerns) factors contribute to video consultation satisfaction among patients. This study aims to gain a better understanding of what makes patients satisfied with video consultations. A total of 180 patients who recently engaged in a video consultation were invited to answer questions about patient-, physician- and technology-related variables and their satisfaction with the video consultation. To examine which factors predict patient video consultation satisfaction, a multiple hierarchical regression analysis was performed. Overall, patients were satisfied with their video consultation. The final hierarchical model, including all patient-related, physician-related and technology-related factors, significantly contributed to patient video consultation satisfaction. Predictors of higher patient video consultation satisfaction were experiencing less technical issues, having higher general positive attitudes towards online communication, reporting higher importance of less travel time and being more satisfied with physicians' affective and instrumental communication. Video consultations can be appropriate in a variety of situations, provided that technical issues can be minimized, patients have a positive attitude towards online communication and attach value to reduced travel time and online patient-physician interactions can be experienced as affective and instrumental. Findings from this study contribute to understanding how video consultations can be best utilized for effective patient-physician communication.

Experiences of Medical Residents and Faculty Members on Adhering to Professional Commitments and Training during Covid Pandemic: A Qualitative Study

&#x0D; Introduction: During the COVID-19 pandemic era, adhering to professional commitments can be a major challenge. This study aims to document the experiences of medical residents and faculty members on the challenges of adhering to professional commitments during the COVID-19 pandemia and its impacts on clinical education.&#x0D; Methods: This qualitative study (using a descriptive phenomenology and purposive sampling method) was conducted in 2020, comprising 14 participants (faculty members and infectious diseases residents of Qazvin University of Medical Sciences) to share their experiences on the challenges of strict adherence to professional behavior. Data were collected through in-depth semi-structured interviews. The transcribed interviews were analyzed based on the Colaizzi approach.&#x0D; Result: Ninety extracted primary codes are classified to two main areas: problems in adherence to professional commitments and the impact of COVID-19 pandemia on educational and research activities mandatory for professionalism. In the first area, the three main themes includes reducing effective patient-physician communication, non-maleficence and violating justice, and the second, two main themes includes a rise in non-professional behavior when dealing with patients (cutting down the quantity and quality of training, reducing supervision and decreased clinical engagement with patients) and a rise in non-professional behaviors in the research area.&#x0D; Conclusion: The most important problem negatively affecting professional commitments during corona epidemy is role overload and the deterioration of physician-patient relationship. Due to the influence of role modeling on student professional behavior, it is helpful to include the training of related skills that can reduce the incidence of these problems in the clinical settings.

My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity.

BackgroundPatient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration.ObjectiveWe sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity.DesignWe conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery.ParticipantsOf 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience.Key ResultsFacilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients’ psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.ConclusionsPhysicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.

Reducing Implicit Bias in Maternity Care: A Framework for Action

Reducing Implicit Bias in Maternity Care: A Framework for Action

Compassionate and standard operating procedure-based counseling and practice are essential in high-risk infantile anesthesia and managing death in eye surgery.

Physicians have to play the role of a team leader and counselor and take written informed consent for high-risk surgeries in many cases. This is the first step toward initiating a mutually trustworthy relationship with the patient and family. The situation is more sensitive when vulnerable patients like small premature babies or the elderly are under consideration. In the event of a death, leadership and processes in place become extremely critical. We share our experience and practice pattern during this process, especially suited to India, but the broad principles would apply to most human situations. Hopefully, some of these can be incorporated into the existing training curriculum for team building and the art of effective physician-patient communication that should be intricately woven into the curriculum for the Science of Ophthalmic care.

A Holistic Approach of Personality Traits in Medical Students: An Integrative Review.

Personality is one of the most crucial aspects of human life, since it influences all human behaviours in both personal and social life, and might also trigger important conflicts with a person’s surroundings in the setting of incompatible traits and characteristics. It is true that ‘one must be born’ for a certain medical specialty, but several components of personality might be educated with proper training. Increased levels of Conscientiousness, Agreeableness, and Openness associated with lower levels of Neuroticism might represent the key combination for achieving professional satisfaction in the medical profession. Medical students should receive proper interprofessional education, since effective interprofessional relationships among healthcare providers definitely improve patients’ safety. Empathy contributes to effective patient–physician communication, improving patient trust, compliance, and satisfaction, being positively correlated with Openness, Agreeableness, Conscientiousness and Extraversion. Emotional intelligence—the capacity to respond to one’s own and others’ emotions—was proven to contribute, in a synergistic way with empathy, to increasing empathic ability. Clinical communication skills represent a key component in medical students in order to achieve the best patient care, and they are certainly related and/or influenced by empathy, interprofessional collaboration skills, emotional intelligence and, especially, personality traits. Taking into account the complex interactions mentioned above, the implementation of effective courses based on these concepts in medical students, intending to promote the development of clinical communication skills, represents a real emergency, since it might result in a reduction in medical errors and subsequent related deaths. A thorough understanding of students’ personality is mandatory before designing these courses in order to provide a training tailored to their personality styles.

Preferences for healthcare services among hypertension patients in China: a discrete choice experiment

ObjectivesOur study aimed to support evidence-informed policy-making on patient-centred care by investigating preferences for healthcare services among hypertension patients.DesignWe identified six attributes of healthcare services for a discrete choice experiment...

Physician-patient agreement on physicians’ communication skills and visit satisfaction in dermatology clinics: a one-with-many design

IntroductionThere is limited research on physician–patient communication skills that covers both sides of the relationship. The aim of this study was to explore two indicators of effective physician-patient communication: the agreement of physicians’ and patients’ perspectives of physicians’ communication skills in outpatient visits to dermatology clinics and the relationship of these perceptions of the consultation with their visit satisfaction.Material and methodsDermatologists (n = 8) and their patients (n = 122) completed post-consultation dyadic measures of the content (what the physician communicates) and process (how the physician communicates) of the communication and satisfaction with a single office visit. Multilevel modelling was used to investigate the patient and doctor variance components at both the dyad and the doctor levels.ResultsThe patients rated the communication content skills higher than the physicians did; however, the doctors rated themselves as better skilled at the process of communication. There was disagreement between the physicians’ and the patients’ ratings of the both physicians’ content and process skills. In contrast, there was a high level of consensus amongst patients of the same doctor about the content and process of the doctor’s communication skills, while the physicians did not perceive themselves as consistent in communication between one patient and another. However, both the physicians and the patients who reported uniquely the highest physicians’ communication skills had higher visit satisfaction. Moreover, the patients who perceived their physicians as having good communication process skills on average had higher visit satisfaction.ConclusionsAlthough the perspectives of the same visit differed, self-rated behaviour affected satisfaction with visit.

Entrustment in physician-patient communication: a modified Delphi study using the EPA approach

BackgroundCompetency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs.MethodsA modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds.ResultsExpert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families.ConclusionsThe EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.

Physician-Patient Communication and Satisfaction in Spanish-Language Primary Care Visits

ABSTRACT Language discordance poses a barrier to effective physician-patient communication, and health care outcomes, such as patient satisfaction, can be associated with language barriers experienced by Spanish-speaking patients. This exploratory study assessed specific aspects of communication between 128 Spanish-speaking primary care patients and their physicians (primary English speakers without an interpreter present). The rating scale developed for this study was used by five raters, who listened to audiotapes of each of these medical visits. Patients and physicians completed measures of visit satisfaction. Results indicated physicians with better Spanish-language skills were less frustrated with medical visit communication and more connected to their patients; patients whose physicians were rated as having better Spanish-speaking ability reported having greater choice in their medical care. Patients whose physicians spoke more Spanish were more satisfied with the information given by their physicians. Physicians rated as having better Spanish-speaking ability were more likely to say they could not understand all the patients wanted to tell them. These data support the importance of language concordance in physician-patient communication and awareness of potential communication barriers between physicians and patients.