Measure Of Patient-Centered Communication Research Articles

Patient-centredness in primary care walk-in clinics for refugees in Hamburg

BackgroundThe huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg.MethodsVideotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients’ reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations.ResultsPatient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores.ConclusionsThe level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness.Practice implicationsWe recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.

From community to validated measure: Development and validation of the patient-informed cancer communication scale (PICCS).

159 Background: Assessing patient-centered communication (PCC) is critical to improving quality patient-centered cancer care. While shown to be reliable and valid, most PCC measures were created by researchers, likely neglecting concerns of patients, families, and community members. PCC measures should be driven, in part, by the patient population of interest, especially given disparities in clinical communication. Our objective was to develop and validate a patient-informed PCC scale to assess cancer treatment discussions. Methods: As part of a larger study on communication and minority accrual to trials, we convened a panel of black and white cancer survivors, caregivers, and advocates. Panel members (n = 11) included 5 black and 3 white men and 1 black and 2 white women. Among them were 6 survivors and 5 caregivers. Panel members met regularly over six months to observe and discuss video-recorded treatment discussions between black and white men with prostate cancer and their physicians. Through an iterative process of generating and refining a list of physician communication behaviors they considered to be critical to PCC in a diverse patient population, they produced a list of 22 items, titled Patient-Informed Cancer Communication Scale (PICCS). We then applied the list as an observational scale to a set of video-recorded treatment discussions (n = 61) from the larger study. Trained raters applied the list and had acceptable inter-rater reliability. We used findings to determine constructs using scale development and factor analysis, then validated the scale through correlation with established scales. Results: We evaluated each item for content validity and feasibility. We divided some items that were assessing multiple attributes. The result was a 28-item scale. Using Classical Test Theory, we reduced the scale to 22 items. Using factor analysis, we identified five factors, including: 1. Treatment options (10 items a =.92); 2. Clinical relationship (6-items a =.92); 3. Prognosis and goals of treatment (2-items a =.79); 4. Explanations (2-items a =.43); and 5. Context (1-item). To validate, we correlated factors with two validated scales, one measuring physician PCC and the other patient active participation. Factor 1 was positively correlated with patient active participation ( r=.46; p=.003); Factor 2 with PCC ( r=.54, p. <.001); Factor 3 with patient active participation ( r=.48; p=.002); and Factor 5 with PCC ( r=.47, p=.002). The full PICCS scale was positively correlated with patient active participation ( r=.37, p=.02). PICCS Factor 4 was not correlated to the scales. Conclusions: This community-engaged research produced a reliable and valid patient-informed scale to assess PCC during cancer clinical interactions. Next steps include translating the findings by using PICCS to train physicians to communicate effectively in a diverse patient population.

Improved detection of patient centeredness in objective structured clinical examinations through authentic scenario design

ObjectiveIn current objective structured clinical examinations (OSCEs), simulated encounters lacking realism reduce authenticity of assessment as students can take the OSCEs with a search-and-scan approach and trained empathy. Accordingly, patient-centeredness, the fundamental goal of OSCE, is not well assessed. This study evaluated the effect of a change in the OSCE scenario and checklist with respect to detecting students’ patient-centeredness. MethodsA scenario script for valid representation of a real clinical encounter was developed and defined as authenticated scenario. The OSCE scores and the measure of patient-centered communication (MPCC) scores of 79 medical students were compared between the two OSCE stations, one using the traditional scenario and another using the authenticated scenario. ResultsThe MPCC total score was higher in the OSCE station using the authenticated scenario than that of the traditional scenario (p < 0.001). For the OSCE scores, the patient satisfaction score and the patient-physician interaction score were higher in the station using the authenticated scenario than the traditional one (p < 0.001). ConclusionThe OSCE station using the authenticated scenario better detected medical student level of patient-centeredness. Practice implicationsStrengthening the authenticity of the OSCE scenario is critical for detecting the medical students’ levels of patient-centeredness.

Validation of a Standardized Patient Checklist for Patient-Centered Communication: The G-PACER.

This study sought to validate the Georgetown PAtient-CEnteredness Rating Scale (G-PACER) standardized patient (SP) checklist as a measure of patient-centered communication in patient-provider interactions. Patient centeredness is associated with improved doctor-patient communication and better health outcomes. Simulated medical encounters using SPs are an important way to teach and evaluate provider communication skills, yet validated SP scales that focus on patient-centered communication are limited. Two versions of an SP checklist of provider interaction behaviors, the G-PACER, were developed as part of a training designed to improve relationships between providers and patients who have experienced trauma. Concurrent validity of the G-PACER was assessed with Roter Interaction Analysis System (RIAS) summary scores, particularly the patient-centeredness summary score. Item-total correlations were conducted to determine which items should be retained for future versions of the scale. Scores on the G-PACER were significantly correlated with the RIAS Patient-Centeredness score. Correlation analysis also revealed significant associations between G-PACER Total Score and RIAS Global Affect Ratings. The twelve-item version of the G-PACER performed at a commensurate level with the longer version; thus, it's use is recommended in future research. This study represents an important step in the development of reliable, valid, and efficient tools to add to those available for evaluating patient-provider interactions from the SP perspective.

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations.

The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP's empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.

Psychometric evaluation and design of patient-centered communication measures for cancer care settings

ObjectiveTo evaluate the psychometric properties of questions that assess patient perceptions of patient-provider communication and design measures of patient-centered communication (PCC). MethodsParticipants (adults with colon or rectal cancer living in North Carolina) completed a survey at 2 to 3 months post-diagnosis. The survey included 87 questions in six PCC Functions: Exchanging Information, Fostering Health Relationships, Making Decisions, Responding to Emotions, Enabling Patient Self-Management, and Managing Uncertainty. For each Function we conducted factor analyses, item response theory modeling, and tests for differential item functioning, and assessed reliability and construct validity. ResultsParticipants included 501 respondents; 46% had a high school education or less. Reliability within each Function ranged from 0.90 to 0.96. The PCC-Ca-36 (36-question survey; reliability=0.94) and PCC-Ca-6 (6-question survey; reliability=0.92) measures differentiated between individuals with poor and good health (i.e., known-groups validity) and were highly correlated with the HINTS communication scale (i.e., convergent validity). ConclusionThis study provides theory-grounded PCC measures found to be reliable and valid in colorectal cancer patients in North Carolina. Future work should evaluate measure validity over time and in other cancer populations. Practice implicationsThe PCC-Ca-36 and PCC-Ca-6 measures may be used for surveillance, intervention research, and quality improvement initiatives.

Rethinking empathy decline: results from an OSCE.

The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE. Participants were medical students in their first or second year of clinical clerkships, enrolled in a required family medicine clerkship at Stanford University. Participants completed an OSCE that was directly observed by trained faculty staff, who used the Measure of Patient-Centered Communication (MPCC) instrument to measure empathic behaviours. Statistics were used to determine correlations between observed empathy and the students' year of clerkship, gender, and specialty preference. A total of 129 medical students, evenly divided by gender and clerkship year, participated. There was a possible trend towards higher MPCC scores among students in their second clerkship year compared with students in their first year (p=0.09), which became more significant when adjusted for outlier effects (p=0.05). There was no difference in performance by gender. Students interested in a 'people-oriented' specialty scored higher in 'handling the patient's frustration' compared with those who are interested in a 'technology-oriented' specialty. In our study, observed empathic behaviours were not lower in the second compared with the first year of clerkship training. More research is warranted to investigate the apparent discrepancy between self-administered empathy scores and observed empathic behaviours. New findings suggest a discrepancy between self-administered empathy scores and observed empathic behaviours.

Watchful Waiting Strategy May Reduce Low-Value Diagnostic Testing.

PCPs need effective communication strategies to address patient requests for low-value testing while sustaining patient-provider partnerships. Watchful waiting - allowing a negotiated period of time to pass before making a firm testing decision - shows promise as a tool for addressing patient requests for low-value testing. Observational analysis of data from a randomized controlled trial of a communication intervention designed to boost patient-centeredness and reduce low-value test ordering among 61 resident primary care physicians. Intervention effectiveness was assessed during follow-up encounters of unannounced standardized patients (SPs) who requested low-value tests. We examined associations between five physician counseling behaviors and overall patient-centeredness (Measure of Patient-Centered Communication) and requested test ordering. During 155 SP encounters, residents most commonly used reassurance (96% of encounters), evidence-based recommendations (97%), and watchful waiting (68 %). Resident advice to pursue watchful waiting was associated with 39% lower likelihood of test ordering (adjusted marginal effect of -38.6% [95% CI -43.6 to -33.6]). When all communication behaviors were examined together, only watchful waiting was significantly associated with test ordering (marginal effect of -38% [95% CI -44.3% to -31.7%]). Overall patient-centeredness was not associated with low-value testing. Resident physician counseling to pursue watchful waiting was associated with less ordering of requested low-value diagnostic tests, while overall patient-centeredness was not.

Promoting Patient-Centered Counseling to Reduce Use of Low-Value Diagnostic Tests: A Randomized Clinical Trial.

Low-value diagnostic tests have been included on primary care specialty societies' "Choosing Wisely" Top Five lists. To evaluate the effectiveness of a standardized patient (SP)-based intervention designed to enhance primary care physician (PCP) patient-centeredness and skill in handling patient requests for low-value diagnostic tests. Randomized clinical trial of 61 general internal medicine or family medicine residents at 2 residency-affiliated primary care clinics at an academic medical center in California. Two simulated visits with SP instructors portraying patients requesting inappropriate spinal magnetic resonance imaging for low back pain or screening dual-energy x-ray absorptiometry. The SP instructors provided personalized feedback to residents regarding use of 6 patient-centered techniques to address patient concerns without ordering low-value tests. Control group physicians received SP visits without feedback and were emailed relevant clinical guidelines. The primary outcome was whether resident PCPs ordered SP-requested low-value tests during up to 3 unannounced SP clinic visits over 3 to 12 months follow-up, with patients requesting spinal magnetic resonance imaging, screening dual-energy x-ray absorptiometry, or headache neuroimaging. Secondary outcomes included PCP patient-centeredness and use of targeted techniques (both coded from visit audiorecordings), and SP satisfaction with the visit (0-10 scale). Of 61 randomized resident PCPs (31 control group and 30 intervention group), 59 had encounters with 155 SPs during follow-up. Compared with control PCPs, intervention PCPs had similar patient-centeredness (Measure of Patient-Centered Communication, 43.9 [95% CI, 42.0 to 45.7] vs 43.7 [95% CI, 41.8 to 45.6], adjusted mean difference, -0.2 [95% CI, -2.9 to 2.5]; P = .90) and used a similar number of targeted techniques (5.4 [95% CI, 4.9 to 5.8] vs 5.4 [95% CI, 4.9 to 5.8] on a 0-9 scale, adjusted mean difference, 0 [95% CI, -0.7 to 0.6]; P = .96). Residents ordered low-value tests in 41 SP encounters (26.5% [95% CI, 19.7%-34.1%]) with no significant difference in the odds of test ordering in intervention PCPs relative to control group PCPs (adjusted odds ratio, 1.07 [95% CI, 0.49-2.32]). Rates of test ordering among intervention and control PCPs were similar for all 3 SP cases. The SPs rated visit satisfaction higher among intervention than control PCPs (8.5 [95% CI, 8.1-8.8] vs 7.8 [95% CI, 7.5-8.2], adjusted mean difference, 0.6 [95% CI, 0.1-1.1]). An SP-based intervention did not improve the patient-centeredness of SP encounters, use of targeted interactional techniques, or rates of low-value test ordering, although SPs were more satisfied with intervention than control residents. clinicaltrials.gov Identifier: NCT01808664.

The Effect of CommonGround Software and Decision Support Center

Located in a community mental health center, the first decision support center in psychiatry used peer support and an Internet-based software program, CommonGround, to assist consumers in decisional uncertainty about psychiatric medication use and to foster shared decision making between the consumer and prescriber. This study examined the impact of the decision support center on the consumer-doctor interaction in the medication consultation. A pretest/posttest design assigned consumers to either an experimental or control group for 4 months. The Measure of Patient-Centered Communication (MPCC) (Brown, Stewart, McCracken, McWhinney, & Levenstein, 1986) was used to evaluate the medication consultation. The Patient Perception of Patient-Centeredness Questionnaire (PPPC) (Stewart, Meredith, Ryan, & Brown, 2004) was used to evaluate the consumer's and prescriber's perceptions of the consultation. A one-way multivariate analysis of covariance was not significant for the combined dependent variable of the measu...

Patient-centeredness of medical students during a real patient encounter and a standardized patient encounter on the clinical performance examination

Patient-centered care is one of the most important factors of high-quality medical care. Medical educators have been increasingly interested in education for patient-centered care. This study was conducted to guide such education by assessing the patient-centeredness of medical students in a real patient encounter and a standardized patient encounter on the clinical performance examination (CPX). During the first semester of 2010 and 2011, fourth-year medical students in a clinical clerkship interviewed outpatients who visited the Department of Family Medicine. The interviews were videotaped, 25 of which were selected for study. We searched the 25 students' CPX videotapes that were recorded in the same year for comparison. The patient-centeredness of the students was assessed by measure of patient-centered communication (MPCC). The inter-rater reliability of the MPCC was 0.89 when measuring real patient encounters. MPCC scores of 25 students were very low for both real patients (mean, 28.8; range, 8.2~53.1) and for standardized patients (mean, 27.5; range, 8.2~52.7), and there was no significant difference between two groups. The component 1 MPCC scores were significantly higher for real patient encounters compared with those of CPX encounters (0.28 vs 0.18, p=0.0001). The component 2, 3 MPCC scores of two groups were not different each other. Medical educators must emphasize the importance of exploring a patient's illness and social background and involving them in making a diagnosis and treatment plan for patient-centered care. They should give students more opportunities to interview real patients and diversify scenarios for standardized patients.

Unannounced standardized patient assessment of the roter interaction analysis system: the challenge of measuring patient-centered communication.

Despite wide-spread endorsement of patient-centered communication (PCC) in health care, there has been little evidence that it leads to positive change in health outcomes. The lack of correlation may be due either to an overestimation of the value of PCC or to a measurement problem. If PCC measures do not capture elements of the interaction that determine whether the resulting care plan is patient-centered, they will confound efforts to link PCC to outcomes. To evaluate whether one widely used measure of PCC, the Roter Interaction Analysis System (RIAS), captures patient-centered care planning. RIAS was employed in the coding of unannounced standardized patient (USP) encounters that were scripted so that the failure to address patient contextual factors would result in an ineffective plan of care. The design enabled an assessment of whether RIAS can differentiate between communication behavior that does and does not result in a care plan that takes into account a patient's circumstances and needs. Eight actors role playing four scripted cases (one African American and one Caucasian for each case) in 399 visits to 111 internal medicine attending physicians. RIAS measures included composites for physician utterance types and (in separate models) two different previously applied RIAS patient-centeredness summary composites. The gold standard comparison measure was whether the physician's treatment plan, as abstracted from the visit note, successfully addressed the patient's problem. Mixed effects regression models were used to evaluate the relationship between RIAS measures and USP measured performance, controlling for a variety of design features. None of the RIAS measures of PCC differentiated encounters in which care planning was patient-centered from care planning in which it was not. RIAS, which codes each utterance during a visit into mutually exclusive and exhaustive categories, does not differentiate between conversations leading to and not leading to care plans that accommodate patients' circumstances and needs.

Assessing patient-centered communication in a family practice setting: How do we measure it, and whose opinion matters?

Objective This study evaluated variables thought to influence patient's perceptions of patient-centeredness. We also compared results from two coding schemes that purport to evaluate patient-centeredness, the Measure of Patient-Centered Communication (MPCC) and the 4 Habits Coding Scheme (4HCS). Methods 174 videotaped family practice office visits, and patient self-report measures were analyzed. Results Patient factors contributing to positive perceptions of patient-centeredness were successful negotiation of decision-making roles and lower post-visit uncertainty. MPCC coding found visits were on average 59% patient-centered (range 12–85%). 4HCS coding showed an average of 83 points (maximum possible 115). However, patients felt their visits were highly patient-centered (mean 3.7, range 1.9–4; maximum possible 4). There was a weak correlation between coding schemes, but no association between coding results and patient variables (number of pre-visit concerns, attainment of desired decision-making role, post-visit uncertainty, patients’ perception of patient-centeredness). Conclusions Coder inter-rater reliability was lower than expected; convergent and divergent validity were not supported. The 4HCS and MPCC operationalize patient-centeredness differently, illustrating a lack of conceptual clarity. Practice implications The patient's perspective is important. Family practice providers can facilitate a more positive patient perception of patient-centeredness by addressing patient concerns to help reduce patient uncertainty, and by negotiating decision-making roles.

The association of visit length and measures of patient-centered communication in HIV care: A mixed methods study

ObjectivePatient centered clinical communication may be associated with longer encounters. MethodsWe used the General Medical Interaction Analysis System (GMIAS) to code transcripts of routine outpatient visits in HIV care, and create 5 measures of patient-centeredness. We defined visit length as number of utterances. To better understand properties of encounters reflected in these measures, we conducted a qualitative analysis of the 15 longest and 15 shortest visits. ResultsAll 5 measures were significantly associated with visit length (p<0.05, rank order correlations 0.21–0.44). In multivariate regressions, association of patient centeredness with visit length was attenuated for 4 measures, and increased for 1; two were no longer statistically significant (p>0.05). Black and Hispanic race were associated with shorter visits compared with White race. Some of the longest visits featured content that could be considered extraneous to appropriate care. ConclusionPatient centeredness is weakly related to visit length, but may reflect inefficient use of time in long encounters. Practice implicationsEfforts to make visits more patient centered should focus on improving dialogue quality and efficient use of time, not on making visits longer. Shorter visits for Black and Hispanic patients could contribute to health disparities related to race and ethnicity.

Measuring patient-centered communication in cancer care: A literature review and the development of a systematic approach

Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine ( Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute’s Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph ( Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.

Patient-Centered Communication in Primary Care: Physician and Patient Gender and Gender Concordance

Physicians' use of patient-centered communication (PCC) affects important outcomes of care. Although there is evidence that both patient and physician gender affect the process of care, there is limited information about their impact on PCC. Our objective was to investigate the influence of patient and physician gender, as well as gender concordance between patient and physician, on the patient centeredness of primary care visits. Participating primary care physicians (100 family physicians and internists) with clinical practices in the Rochester, New York area, had two unannounced covertly audiorecorded standardized patients' visits. Encounters were analyzed using the Measure of Patient-Centered Communication (MPCC), which measures three aspects of physician communication: Component 1 (Exploring both the disease and illness experience), Component 2 (Understanding the whole person), and Component 3 (Finding common ground). Compared with male patients, females had interactions characterized by greater PCC (total and Component 2 scores). Whereas female physicians exhibited higher Component 1 scores, male physicians had higher Component 2 scores, and gender-concordant visits also exhibited higher Component 2 scores. However, there were no significant differences in total MPCC scores for encounters of female vs. male physicians or for gender-concordant compared with discordant patient-physician dyads. These findings add further evidence that patient gender can affect the interactions between physicians and patients. More research is needed to understand why male patients are less likely to have medical encounters in which their physicians employ a patient-centered practice style.

Self-Report Adherence Measures in Chronic Illness

Patient-centered communication (PCC) is associated with more appropriate treatment of depression in primary care. Aside from patient presentation, little is known about other influences on PCC. We investigated whether PCC is influenced by personality dispositions of primary care providers, independent of patient presentation.Forty-six primary care providers completed personality scales from the NEO-Personality Inventory, revised and provided care to 88 standardized patients presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the measure of PCC, assessing physicians' ability to explore the patient's illness experience (component 1), understand the patient's psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3).Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient's experience of illness more (P = 0.05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient's psychosocial and life circumstances (P = 0.04), but involved the patient less in treatment discussions (P = 0.03). Physicians reporting more anxious vulnerability also involved the patient less (P = 0.03). Physician demographics, training, and patient presentation explained 4-7% of variance in the measure of patient-centered communication components, with personality explaining an additional 4-7% of the variance.Understanding of personality dispositions that promote or detract from PCC may help medical educators better identify trainees of varying aptitude, facilitate medical career counseling, and address individual training needs in a tailored fashion.

Communication with Breast Cancer Survivors

Breast cancer survivors must manage chronic side effects of original treatment. To manage these symptoms, communication must include both biomedical and contextual lifestyle factors. Sixty breast cancer survivors and 6 providers were recruited to test a conceptual model developed from uncertainty in illness theory and the dimensions of a patient-centered relationship. Visits were audio-taped, then coded using the Measure of Patient-Centered Communication (Brown, Stewart, & Ryan, 2001). Consultations were found to be 52% patient-centered. Chi-square Automatic Interaction Detection (CHAID) analysis showed that survivor self-reported fatigue level and conversation about symptoms were associated with survivor uncertainty, mood state, and survivor perception of patient-centered communication. Survivors may want to discuss persistent symptom concerns with providers, due to concerns about recurrence, and discuss lifestyle contextual concerns with others.

Physicians’ Responses to Patients’ Medically Unexplained Symptoms

To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS). After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux disease (GERD) with nausea and insomnia (the GERD role) and poorly characterized chest pain with fatigue and dizziness (the MUS role). The visits were surreptitiously audiorecorded and analyzed using the Measure of Patient-Centered Communication (MPCC), which scores physicians on their exploration of the patients' experience of illness (component 1) and psychosocial context (component 2), and their attempts to find common ground on diagnosis and treatment (component 3). In multivariate analyses, MUS visits yielded significantly lower scores on MPCC component 1 (p = .01). Subanalysis of component 1 scores showed that patients' symptoms were not explored as fully and that validation was less likely to be used in response to patient concerns in the MUS than in the GERD visits. Component 2 and component 3 were unchanged. Physicians' inquiry into and validation of symptoms in patients with MUS was less common compared with more medically straightforward patient presentations. Further research should study the relationship between communication variables and poor clinical outcomes, misunderstandings, mutual distrust, and inappropriate healthcare utilization in this population, and test interventions to address this problem.

Rochester Participatory Decision-Making Scale (RPAD): Reliability and Validity

We wanted develop a reliable and valid objective measure of patient-physician collaborative decision making, the Rochester Participatory Decision-Making Scale (RPAD). Based on an informed decision-making model, the RPAD assesses physician behavior that encourages patient participation in decision making. Data were from a study of physician-patient communication of 100 primary care physicians. Physician encounters with 2 standardized patients each were audio recorded, resulting in 193 useable recordings. Transcribed recordings were coded both with RPAD and the Measure of Patient-Centered Communication (MPCC), which includes a related construct, Finding Common Ground. Two sets of dependent variables were derived from (1) surveys of the standardized patients and (2) surveys of 50 patients of each physician, who assessed their perceptions of the physician-patient relationship. The RPAD was coded reliably (intraclass correlation coefficient [ICC] = 0.72). RPAD correlated with Finding Common Ground (r = 0.19, P < .01) and with the survey measures of standardized patient's perceptions of the physician-patient relationship (r = 0.32 - 0.36 [P < .005]) but less with the patient survey measures (r = 0.06 to 0.07 [P < .005]). Multivariate, hierarchical analyses suggested that the RPAD made a more robust contribution to explaining variance in standardized patient perceptions than did the MPCC Finding Common Ground. The RPAD shows promise as a reliable, valid, and easy-to-code objective measure of participatory decision making.