Patient-centered Communication Style Research Articles

Motivational interview training improves self-efficacy of GP interns in vaccination consultations: A study using the Pro-VC-Be to measure vaccine confidence determinants

ABSTRACT Immunization-specific motivational interviewing (MI), a patient-centered communication style used to encourage internal motivation for attitudinal and behavioral change, can provide healthcare professionals (HCPs) with the skills and practice required to respond to patients’ doubts and concerns related to vaccines. We sought to assess the impact of an MI-training of General Practitioner (GP) interns on the psychosocial determinants of their vaccine confidence and behaviors. French GP interns participated in a virtual three-day MI-workshop in southeastern France. We used the validated Pro-VC-Be questionnaire – before and after the MI-workshop spanning over three months – to measure the evolution of these determinants. Scores before and after workshop trainings were compared in pairs. Participants’ scores for commitment to vaccination (+10.5 ± 20.5, P = .001), perceived self-efficacy (+36.0 ± 25.8, P < .0001), openness to patients (+18.7 ± 17.0, P < .0001), and trust in authorities (+9.5 ± 17.2, P = 0.01) significantly increased after the training sessions, but not the score for confidence in vaccines (+1.5 ± 11.9, P = .14). The effect sizes of the four score improvements were moderate to large, with self-efficacy and openness to patients having the largest effect sizes (P = .83 and 0.78, respectively). This study provides evidence that certain determinants of overall vaccine confidence in HCPs, reflected respectively in the openness to patients and self-efficacy scores of the Pro-VC-Be, improve after immunization MI-training workshops. Incorporating immunization-specific MI-training in the curriculum for HCPs could improve several necessary skills to improve HCP-patient relationships and be useful for vaccination and other healthcare services.

Effective Communication Strategies and Tools for Improving Treatment Outcomes in Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation

Patients with chronic idiopathic constipation and irritable bowel syndrome with constipation experience an array of gastrointestinal symptoms. Given the subjective nature of these disorders, patient self-reporting is critical to diagnosis and monitoring response to therapy. Unfortunately, many patients are reluctant to discuss bowel symptoms with their healthcare providers. Differences in sex, health literacy, and age can influence symptom reporting. Negative patient-physician relationships and dissatisfaction with care lead patients to seek alternative treatments, switch healthcare providers, or discontinue care. Thus, adopting a patient-centered communication style can help create a shared understanding of patients' symptoms, achieve accurate symptom reporting, expedite diagnosis, and facilitate appropriate treatment plans. Currently, there are multiple symptom and quality-of-life scales available to assist healthcare providers in this endeavor. These scales also allow for the monitoring of constipation-related symptoms and symptom severity. When using patient self-assessments to measure treatment responses, scale selection may depend on the number of symptoms being assessed, the duration and frequency of assessments, and patients' comprehension and language skills.

Using motivational interviewing techniques to inform decision-making for COVID-19 vaccination.

Motivational interviewing is a patient-centered communication style used to enhance a person’s internal motivation for attitudinal change by exploring and solving inherent ambivalences. In the face of rising COVID-19 vaccine hesitancy, pharmacists and other health care professionals may use motivational interviewing to enable individuals making informed decisions with regards to the COVID-19 vaccines. The purpose of this article is to integrate theory with practice by describing a scenario that illustrates how motivational interviewing skills and strategies can be used to reduce COVID-19 vaccine hesitancy.

The effect of patient-centered communication on medication intake: an experimental study

ABSTRACT It is not only crucial to provide patients with information, but also to communicate this information in a way to enable patient participation in health decisions. Experimental studies investigating the association between the communication style of health professionals and patients’ health decisions are rare, which limits causal conclusions. This study investigated the effect of a doctor’s patient-centered communication style on the likelihood to take a medication. Healthy women (N = 120) were randomly allocated to one of three groups. They either received a medical consultation characterized by a patient-centered communication style (PC group) or by a doctor-centered communication style (DC group) or they received no consultation at all (control group). All participants were told that the study would investigate the effects of a ‘concentration-enhancing medication’. Voluntary intake of the medication (a placebo pill) served as behavioral outcome. Participants’ self-rated intention to take the medication was measured at three assessment points. Data were analyzed using a Chi-square-test and a mixed analysis of covariance. In each group, 40 participants were analyzed. Following the consultation, groups did not differ regarding the behavioral outcome, but participants’ intention to take the medication was higher in the PC group compared with the control group. Our results indicate that patient-centered communication has a beneficial influence on participants’ intention to take medication. Future studies should investigate the role of communication in individuals with health conditions that require a specified treatment plan and taking medication over the long-term.

Does Provider Gender Affect the Quality of Primary Care?

Women providers have a more patient-centered communication style than men, and some studies have found women primary care providers are more likely to meet quality performance measures. To explore gender differences in the quality of primary care process and outcome measures. Retrospective analysis of primary care performance data from 1year (2018-2019). A total of 586 primary care providers (311 women and 275 men) who cared for 241,428 primary care patients at 96 primary care clinics at 8 Veterans Affairs (VA) medical centers. Our primary outcome was a composite quality measure that averaged all thirty-four primary care performance measures that assessed performance in cancer screening, diabetes care, cardiovascular care, tobacco counseling, risky alcohol screening, immunizations, HIV testing, opiate care, and continuity. Our secondary outcomes were performance on each of the 34 measures. There was no difference in the average performance on our composite measure between men and women (75.8% vs. 76.6%, p = 0.17). Among the 34 primary care quality measures collected, there was no difference between male and female providers' performance. Using a more conservative cut-point, women were more likely to screen at-risk diabetic patients for hypoglycemia and document follow-up on risky alcohol behavior noted during patient check-in. These differences were clinically small and likely due to chance, given the multiple measures evaluated in this study. We found little evidence of difference in the performance on primary care quality measures between male and female providers.

Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians.

Pain neuroscience education (PNE) and motivational interviewing (MI) have been widely implemented and tested in the field of chronic pain management, and both strategies have been shown to be effective in the short term (small effect sizes) for the management of chronic pain. PNE uses contemporary pain science to educate patients about the biopsychosocial nature of the chronicity of their pain experience. The goal of PNE is to optimize patients' pain beliefs/perceptions to facilitate the acquisition of adaptive pain-coping strategies. MI, on the other hand, is a patient-centered communication style for eliciting and enhancing motivation for behavior change by shifting the patient away from a state of indecision or uncertainty. Conceptually, PNE and MI appear to be complementary interventions, with complementary rather than overlapping effects; MI primarily improves cognitive and behavioral awareness and, potentially, adherence to treatment principles, whereas PNE potentially increases pain knowledge/beliefs, awareness, and willingness to explore psychological factors that are potentially associated with pain. Therefore, combining PNE with MI might lead to improved outcomes with larger and longer-lasting effect sizes. The combined use of PNE and MI in patients having chronic pain is introduced here, along with a description of how clinicians might be able to integrate PNE and MI in the treatment of patients experiencing chronic pain. Clinical trials are needed to examine whether combining PNE with MI is superior to PNE or MI alone for improving pain and quality of life in patients having chronic pain.

Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information

ObjectiveThis study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking. MethodsWe analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy. ResultsHalf of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients’ online health information-seeking seriously or affirming patients’ beliefs. ConclusionThis exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients’ online health information-seeking. Practice implicationsResults of this study could guide interventions to train providers in talking about patients’ online health information-seeking.

Older Patients' Views of Health Care Interactions in Ireland.

Background:Chronic and sensitive health conditions such as pain, urinary incontinence, and hearing loss are common but often untreated among older adults in Ireland, and many patients do not disclose these and other sensitive health issues to their health care provider.Objective:This study investigates the link between provider communication and older patients' perceived encouragement to talk about physical, social, sensitive, and emotional problems with their usual source of care (USC), be it a doctor or nurse.Methods:Data were from the Irish sample of the Survey of Health, Ageing and Retirement in Europe (SHARE; N = 720). Logistic regression models were used to estimate the association among (1) patient characteristics, (2) health care use, and (3) USC communication characteristics and the likelihood of feeling encouraged to talk about each health problem. Results are reported as odds ratios (OR) with confidence intervals at the 95% level.Key Results:More patients felt discouraged to talk about social (39%) and sensitive (42%) health problems with their USC compared with physical (18%) and emotional (29%) health problems. Many participants reported that their USC rarely or never explained the results of medical examinations (23.6%), explained different treatment options (26.2%), or listened to their opinions or preferences when making treatment decisions (29.1%). A USC “explaining test results” was associated with increased odds of feeling encouraged to discuss physical (OR = 2.82, 95% confidence interval [CI; 1.15, 6.91]) and social (OR = 2.02, 95% CI [1.01, 4.04]) problems. “Listening to patient preferences” was associated with increased odds of feeling encouraged to discuss physical (OR = 4.49; 95% CI [2.24–9.01]), emotional (OR = 2.31, 95% CI [1.27, 4.21]), and social (OR = 2.88, 95% CI [1.60, 5.18]) problems. Controlling for USC communication characteristics attenuated the association between lower educational attainment and perceived encouragement.Conclusions:An open and patient-centered communication style was associated with a greater sense of encouragement to discuss physical, emotional, and social health problems, particularly among older patients with lower levels of education. [HLRP: Health Literacy Research and Practice. 2018;2(4):e180–e191.]Plain Language Summary:This is the first study in Ireland to investigate the link between the communication styles used by health care providers and to what extent older patients felt encouraged to talk about physical, emotional, social, or sensitive health problems. When providers took a more patient-centered approach, these patients felt more encouraged to disclose physical, social, and emotional health problems.

A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence.

Diabetes mellitus (DM) patients with comorbid hypertension (HTN) are at a higher risk of developing microvascular and macrovascular DM complications. Through guideline-driven recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are highly recommended for these patients. Unfortunately, medication adherence to these products, though crucial to achieving therapeutic benefit, is frequently suboptimal. Motivational interviewing (MI) is a patient-centered collaborative communication style that is used to strengthen internal motivation for change that may prove effective in enhancing adherence. To examine the effect of an MI telephone intervention conducted by pharmacy students in improving adherence to ACEIs/ARBs among Medicare Advantage Plan (MAP) patients with both DM and HTN. A prospective study was conducted among patients enrolled in a Texas MAP. Medical claims data were used to identify patients with DM and HTN, and pharmacy claims were observed to recognize those who filled either an ACEI or an ARB during June 2014. Patients with a 6-month proportion of days covered (PDC) < 0.80 in the previous 6 months were determined nonadherent, and 75% of those were randomly selected to serve as potential subjects for the intervention, while 25% were randomly selected to serve as potential subjects for the control group. The intervention was a telephone call by a pharmacy student on rotation at the health plan, and 5 monthly follow-up calls. Before implementing calls, participating students attended a 3-day MI training course, where their proficiency for MI skills was evaluated. Refill data during the 6-month postintervention were evaluated to examine the intervention effect measured on 3 outcomes: PDC; PDC ≥ 0.80 versus < 0.80; and discontinuation versus continuation. Multivariate linear and logistic regression models were constructed to adjust for any imbalances in baseline characteristics, including age, gender, number of other medications, regimen complexity, health low-income subsidy status, prescriber specialty, comorbidities, 6-month previous hospitalization, baseline 6-month PDC, and Centers for Medicare & Medicaid Services risk score. A total of 11 students participated in the intervention implementation. Patients receiving calls were randomly selected from those potential subjects for the intervention arm until a target of 250 was reached; 500 controls were randomly selected from the potential subjects for the control arm. The final cohort included in multivariate models consisted of 743 patients. Patients completing the initial call and at least 2 follow-ups were less likely to discontinue (OR = 0.29; 95% CI = 0.15-0.54; P < 0.001) and more likely to be adherent in the linear regression model (β = 0.0604, P < 0.001) and the logistic regression model (OR = 1.53; 95% CI = 1.02-2.28; P = 0.009). Other factors significantly associated with better adherence included higher baseline PDC and number of medications. Depression status was significantly associated with lower adherence. Patients receiving 2 or more calls had significantly better adherence and less discontinuation during the 6 months following initial calls compared with those who did not receive calls. This finding indicates that an MI-based telephone intervention by pharmacy students may be a promising intervention to improve adherence. Future research should examine the sustainability of the intervention effect for longer time periods and its influence on associated clinical outcomes. This project was supported by the Pharmaceutical Research and Manufacturers of America Foundation (PhRMA). The content is solely the responsibility of the authors and does not necessarily represent the official views of PhRMA. The funding agency was not involved in research design, analysis, or reporting results. Funding was obtained by Abughosh. Holstad provided a consultation regarding the MI guide and provided the MI training. Study concept and design were contributed by Abughosh and Fleming, along with Serna, Esse, and Holstad. Serna, Esse, Mann, Holstad, and Masilamani collected the data, and data interpretation was performed by Abughosh, Wong, and Esse. The manuscript was written by Abughosh, Wong, and Esse and revised by Masilamani and Holstad, along with the other authors.

Effects of patient-centered communication on anxiety, negative affect, and trust in the physician in delivering a cancer diagnosis: A randomized, experimental study.

When bad news about a cancer diagnosis is being delivered, patient-centered communication (PCC) has been considered important for patients' adjustment and well-being. However, few studies have explored how interpersonal skills might help cancer patients cope with anxiety and distress during bad-news encounters. A prospective, experimental design was used to investigate the impact of the physician communication style during a bad-news encounter. Ninety-eight cancer patients and 92 unaffected subjects of both sexes were randomly assigned to view a video of a clinician delivering a first cancer diagnosis with either an enhanced patient-centered communication (E-PCC) style or a low patient-centered communication (L-PCC) style. Participants rated state anxiety and negative affect before and immediately after the video exposure, whereas trust in the physician was rated after the video exposure only. Main and interaction effects were analyzed with generalized linear models. Viewing the disclosure of a cancer diagnosis resulted in a substantial increase in state anxiety and negative affect among all participants. This emotional response was moderated by the physician's communication style: Participants viewing an oncologist displaying an E-PCC style were significantly less anxious than those watching an oncologist displaying an L-PCC style. They also reported significantly higher trust in the physician. Under a threatening, anxiety-provoking disclosure of bad news, a short sequence of empathic PCC influences subjects' psychological state, insofar that they report feeling less anxious and more trustful of the oncologist. Video exposure appears to be a valuable method for investigating the impact of a physician's communication style during critical encounters. Cancer 2017;123:3167-75. © 2017 American Cancer Society.

Complementary Tools to Empower and Sustain Behavior Change

Improving health behaviors is fundamental to preventing and controlling chronic disease. Healthcare providers who have a patient-centered communication style and appropriate behavioral change tools can empower patients to engage in and sustain healthy behaviors. This review highlights motivational interviewing and mindfulness along with other evidence-based strategies for enhancing patient-centered communication and the behavior change process. Motivational interviewing and mindfulness are especially useful for empowering patients to set self-determined, or autonomous, goals for behavior change. This is important because autonomously motivated behavioral change is more sustainable. Additional strategies such as self-monitoring are discussed as useful for supporting the implementation and maintenance of goals. Thus, there is a need for healthcare providers to develop such tools to empower sustained behavior change. The additional support of a new role, a health coach who specializes in facilitating the process of health-related behavior change, may be required to substantially impact public health.

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.

Teaching the essentials of "well-child care": inspiring proficiency and passion.

Before the pediatric clerkship, most medical students learn to take a patient history starting with the “chief complaint.” Upon encountering their first pediatric patients, students quickly recognize that they are not prepared to ask the appropriate follow-up questions when the chief complaint is “well-child visit.” In this article, we present a practical method for teaching medical students how to approach pediatric health supervision visits that build upon their existing clinical skills. Primary care pediatricians address the health care needs of each child in the context of their family and community. They acknowledge the important ways in which social and psychological determinants of health impact wellness. Clinical teachers of pediatrics can inspire future physicians to use patient-centered communication skills to address the needs and priorities of families by making explicit the different aspects of a pediatric health supervision visit that include the following: 1. Identifying patient and family concerns by practicing a structured communication strategy. 2. Using reliable resources to identify the established priorities for each age and access most up-to-date anticipatory guidance recommendations. 3. Delivering prioritized anticipatory guidance that is specific to each patient within his or her community. A useful strategy for approaching the conversation with parents and children is for students to: “Elicit and ask…then assess, prioritize, and advise.”1 Clinical preceptors should explain the importance of eliciting patient and family concerns by asking open-ended questions. Then, with feedback on their ability to assess the most important issues, preceptors ask students to prioritize which topics to address and then together, advise the family accordingly. Eliciting concerns through open-ended questions creates the essential foundation for the health supervision visit.2 Recent studies have demonstrated that using a patient-centered communication style with open-ended questions is not only time-effective but allows for greater adherence to the current standards for well-child … Address correspondence to Erin K. Balog, MD, CDR, MC, USN, Department of Pediatrics, Uniformed Services University of the Health Sciences. E-mail: erin.balog{at}usuhs.edu

Talking about depression: An analogue study of physician gender and communication style on patient disclosures

ObjectivesTo disentangle the effects of physician gender and patient-centered communication style on patients’ oral engagement in depression care. MethodsPhysician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS). ResultsBoth male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p<.05). APs were more willing to continue treatment with gender-discordant HPC physicians (p<.05). No effects were evident in the LPC condition. ConclusionsFindings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender. Practice implicationsHigh patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.

Communication preferences in patients with fibromyalgia syndrome: descriptive results and patient characteristics as predictors

BackgroundCommunication with patients with fibromyalgia syndrome (FMS) is often considered difficult. The primary objective of this explorative study was to describe the communication preferences of FMS patients in comparison with other chronic diseases, and the secondary objective was to identify patient-related predictors of those communication preferences.MethodsA total of 256 FMS patients were asked to fill out the KOPRA [(Kommunikationspraeferenzen), communication preferences of patients with chronic illness] questionnaire at the beginning of their rehabilitation, answering questions about their communication preferences. The KOPRA’s descriptive parameters were calculated and compared with other diagnosis groups. In order to include as many influencing factors as possible, data on patient-related sociodemographic, medical, pain impact and psychologic variables were gathered. A hierarchical regression analysis with four steps was performed to identify patient-related predictors of patients’ communication preferences.ResultsFMS patients consider an open and patient-centered communication style to be especially important. Emotionally supportive communication and communication about personal circumstances are important for FMS patients, but the preferences of individual patients vary widely. FMS patients reveal higher values in all the subdimensions of communication preferences compared with patients with low back pain or chronic ischemic heart disease. Only a few variables appear to predict patient communication preferences. The explained variance ranged from 3.1% to 9.7%. Psychologic variables have been identified as predictors in conjunction with all communication preferences.ConclusionHealth care providers who communicate with FMS patients should employ an open and patient-centered communication style, and affective communication components should be adapted to accommodate each patient.

Is the Scale for Measuring Motivational Interviewing Skills a valid and reliable instrument for measuring the primary care professionals motivational skills?: EVEM study protocol

BackgroundLifestyle is one of the main determinants of people’s health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors’ communication skills, and more specifically the Motivational Interviewing.Methods/DesignThe hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. –Scope: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change (Pearson product–moment correlation coefficient).DiscussionThe verification of the hypothesis that EVEM is a valid and reliable tool for assessing motivational interviewing would be a major breakthrough in the current theoretical and practical knowledge, as it could be used to assess if the providers put into practice a patient centered communication style and can be used both for training or researching purposes.Trials registration Dislip-EM studyNCT01282190 (ClinicalTrials.gov)

Fibromyalgia Patients' Communication of Cues and Concerns

Clinicians' recognition of patients' concerns is an important component of effective treatment and care. During a consultation, patients often do not express their concerns directly, but rather present them indirectly as hints or cues. The aim of this study was to explore the types of concerns and cues patients expressed in an initial consultation with a nurse at a pain clinic, how and who initiated these cues and concerns, and predictors of these expressions. Initial consultations between patients with fibromyalgia [n=58, 85% female, duration 30 minutes, mean age 47.8 y (SD 10.7)] and clinical nurse specialists (n=5) were videotaped. Patients' cues and concerns were coded using the Verona Coding Definitions of Emotional Sequences. Nurses' responses to patients' cues and concerns were evaluated using the Hierarchical Coding Scheme of Comforting Strategies. In addition, pain intensity and duration, overall evaluation of health, affect at the start of the consultation, and psychological distress were evaluated. Patients expressed more cues than concerns, mostly about pain, interpersonal relationships, and/or emotional reactions. Both the lack of empathic responding and unspecific empathic responding were associated with the expression of an increased number of cues in the consultation, whereas higher evaluation of health was associated with less cues. More concerns were expressed by patients when nurses exhibited a high level of empathic responding and when the patient entered the consultation with a higher level of negative effect. Findings from this study highlight the importance of a patient centered communication style to facilitate the expression of cues and concerns.

PS3-30: The Group Health Plain Language Network: A System-wide Initiative to Improve Communication from the Ground Up

Background/Aims: Limited health literacy negatively impacts health care costs, quality, and outcomes. Complex language and other communication barriers prevent 93 million U.S. adults from finding, understanding, and acting on essential health information—leading to medication and treatment errors, failure to seek preventive care or manage chronic illness effectively, increased use of emergency rooms for primary care, and higher health care costs. The Group Health Plain Language Network is a staff-driven initiative to reduce these barriers by establishing a standard of clear communication with patients throughout the system. Methods: The Group Health Plain Language Network was founded in 2007 by a small group of multidisciplinary staff interested in system-level communication improvements to advance health literacy. The Network’s overarching strategy is promotion of plain language—a concise, patient-centered communication style that achieves clarity through common vocabulary and straightforward organization. Network leaders set annual goals tied to organizational priorities and emerging health literacy innovations. We also meet at least quarterly to monitor projects carried out by subgroups of the now 30+-member coalition. Results: Network membership tripled in just two years, thanks to successful engagement of dozens of individuals and departments in a leadership-endorsed plain language initiative. Primary outcomes include: creating a plain language charter and securing executive-level buy-in; developing an online plain language toolkit for all staff; providing plain language training for subgroups of staff; revising dozens of print and Web-based health education materials; and partnering with the Group Health legal department to revise consent templates for medical procedures—many of which went from >15th-grade reading level to <7th grade. Formal evaluation of improvements to consent templates is planned for 2010. Conclusions: The Network’s many accomplishments have occurred without allocating additional resources—demonstrating that system-level communication improvements are possible even when resources are scarce. We attribute the Network’s early success to our focus on a solution-oriented approach that facilitates wide-ranging buy-in: plain language clearly aligns with other organizational goals, cuts across system silos, and engages staff who may not otherwise feel connected to or see the impact of low health literacy. We hope our experience can serve as a helpful example for other health systems striving to advance health literacy through improved communication.

Nurse Practitioner/Patient Communication Styles in Clinical Practice

Nurse practitioners (NPs) spend more than two thirds of patient-encounter clinical time in intrapersonal communication. The NP literature has little on NP/patient communication styles. The purpose of this study was to examine and document the most common verbal communication style used by NPs in patient interactions. Content analysis was used to analyze 53 NP/patient transcripts for communication style. Based on the transcript analysis, only a minority of NPs used a patient-centered communication style.

Nurse practitioners’ communication styles and their impact on patient outcomes: An integrated literature review

The purpose of this review was to examine the published research from 1999 to 2005 describing nurse practitioner (NP)-patient interactions and to determine the best practice to enhance patient outcomes. Databases searched included Academic Search Elite, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source Consumer Edition, Health Source Nursing/Academic Edition, Medline, and PsychInfo. Two communication styles described in the literature and determined by authors were (a) biomedical and (b) biopsychosocial. The biopsychosocial style is identified as patient-centered communication. Seven studies were then analyzed for NPs' communication styles and the impact that they had on patient outcomes. The studies analyzed demonstrated that biopsychosocial (patient-centered) communication style positively influences patient outcomes as evidenced by (a) improved patient satisfaction, (b) increased adherence to treatment plans, and (c) improved patient health. The results of this review indicate that patient-centered communication incorporated into the NPs' practice is associated with improving patient outcomes such as (a) improved patient satisfaction, (b) increased adherence to treatment plans, and (c) improved patient health. Future research needs to be performed in order to fully study the relationship between NPs using patient-centered communication style and its impact on patient outcomes. Clinical recommendations are made based on findings of the integrated literature review.