Physician Communication Skills Research Articles

Physician Communication Skills in Telemedicine: The Role of Eye Contact.

Gaze is an important non-verbal behavior in patient-physician communication. We examine the effect of the physician's gaze direction in video consultations on their communication and interpersonal skills ratings. 51 subjects watched videos of a physician providing the same teleconsultations while (a) looking directly at the camera and (b) looking at the computer screen. After each video, the participants rated the physician's skills. The results showed that looking at the camera is perceived as making eye contact and is associated with higher ratings on two communication skill items: (1) using empathy to communicate appreciation of the patient's feelings, and (2) providing support by expressing concern, understanding, and willingness to help. The effect of eye contact depended on the content of the consultation and on the general attitude of the physician. These results highlight the role of eye contact in video consultations and its dependency on other verbal and non-verbal behaviors.

Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory.

BackgroundResidents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios.ObjectiveWe aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app.MethodsInternal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents’ error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople.ResultsInternal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates’ and crowdsourced laypeople’s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75.ConclusionsCrowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills.

Spanish-Speaking Caregivers' Perception of Emergency Physicians' Interpersonal and Communication Skills in a Pediatric Emergency Department.

Medical communication is more than just the delivery of information; language differences between physicians and patients/caregivers create a challenge to providing effective care in the pediatric emergency department (ED). Overcoming this barrier is vital to providing high-quality care. We evaluated Spanish- versus English-speaking caregivers' perception of their pediatric ED physicians' interpersonal and communication skills. We also compared perceptions of Spanish- versus English-speaking caregivers who self-identified as Hispanic. This study is a retrospective analysis of data from surveys administered in an urban, free-standing children's hospital ED. Surveys were administered in English and Spanish to pediatric patient caregivers. In person, video, and telephonic interpretations were available during patient encounters. There were 2542 (82.4%) surveys completed in English and 543 (17.6%) in Spanish. There were significant differences in demographic data of English versus Spanish survey respondents, including level of education, insurance status, and rates of nonpublic insurance. Spanish survey respondents rated their physicians' interpersonal skills lower than English survey respondents. There were 1455 (47%) surveys completed by the respondents who self-identified as Hispanic. Within this group, 928 (63.8%) respondents completed the survey in English and 527 (36.2%) in Spanish. Among this Hispanic population, the Spanish survey respondents rated their physicians' interpersonal and communication skills lower than English survey respondents. After adjusting for education level and insurance type, these differences persisted. Language barriers have a meaningful impact on physician ability to communicate effectively in the pediatric ED. Improving physicians' ability to overcome this barrier is essential toward enriching patient outcomes and experience in the ED.

The relationship between the communication skills of intern physicians and their exposure to violence

Background/Aim: Violence against healthcare workers has become a major problem worldwide. This study aimed to examine the relationship between the communication skills of interns and their exposure to violence. Methods: This cross-sectional study comprised 287 students working as intern physicians at the Ondokuz Mayis University Faculty of Medicine within the academic year of 2018-2019. It was conducted with 234 volunteering individuals. The data were collected through a questionnaire, consisting of 33 questions in total, applied with a face-to-face interview. The Communication Skills Scale was used, as well as questions about sociodemographic characteristics and violence. The level of statistical significance was set at P<0.05. Results: Eighty-six (36.8%) intern physicians stated that they had been subjected to violence in the last year. Eighty-four (97.7%) of these participants stated that they were subjected to verbal violence and 5 (5.8%) to physical violence. While there was no significant difference between the participants in terms of being exposed to at least one type of violence or verbal violence, the mean scale score was significantly lower in those who were exposed to physical violence (P=0.032). Conclusion: The inadequacy of interns in communication was not included among the main reasons for verbal violence. Although the communication skills of interns who were exposed to physical violence were lower, it is necessary to work on larger groups to make a community-wide assessment.

Evaluation of factors influencing physician–patient communication in healthcare service delivery

Physician–patient communication has received less focus in the study of healthcare service delivery in Nigeria. The majorityofcommunicationreliesonmessagedeliveryratherthaninterpersonalcommunication.Evenwhendoctors have significant knowledge to share with their patients, they frequently lack the interpersonal communication skills required to do it successfully. This quantitative study employed the analysis of 150 valid responses from practicing physicians in Lagos state. Descriptive statistics were carried out to understand the factors influencing physician–patient communication. The results revealed good communication skills among physicians as they agreed to have social conversations with patients, listen intently to them, and promote question-asking. The responses from the survey also revealed that factors such as limited consultation time and unfavorable working environmentscouldnegativelyimpactphysician–patientcommunication.Furthermore,thetesthypothesisrevealed a significant correlation between physicians’ age and gender (p &lt; 0.05), whereas physicians’ ethnicity and religion had non-significant associations. The evaluation of factors influencing physician–patient communication revealed that several individual and contextual factors contribute to effective communication, including physician communication skills, patient health literacy, and system-level factors such as time constraints and workload. Healthcare organizations and policymakers should prioritize efforts to improve physician–patient communication by addressing the identified factors that influence communication and implementing evidence-based interventions to enhance communication between physicians and patients.

Examining doctor-patient communication skills among senior medical students based on calgary cambridge observation guide.

Background: This study aimed to determine the level of communication skills in residents of Shahid Beheshti University of Medical Sciences in the final year of the main courses in accordance with the Calgary Cambridge Observation Guide for the purpose of improving their skills and improving the quality and correcting the existing problems. Methods: In this cross-sectional study, 190 residents of 14 majors were evaluated using a checklist of patient and physician communication skills based on the Calgary Cambridge Guide that has been localized in Persian language and culture using the cross-cultural adaptation standard in 6 stages. Content validity was verified by the primary author. The skills within the 71-item checklist were examined via a 3-point Likert-type rating scale, with scores ranging from 1 to 3 (good to poor) and the data were analyzed using the SPSS 16 software. Results: Of the190 residents, 161 were enrolled in the study. Of them 74 were internal and 87 surgical residents, and 89 were male and 72 were female. The mean score of the total communication skills in 14 major courses was 128.68±37.2264; it was 121.7±36.990 in the Department of Surgery, and 136.8±36.073 in the Department of Internal Medicine, with p=0.010, in female students 126.6 and in male student 130.3 with p=0.500. Conclusion: The score of 71 communication skills points in the list was prepared using the Likert scale option 3. In the overall skills, the weak score is 71 to 118.33, the average score is 118.34 to 165.66, and the good score is 165.67 to 213. Based on the findings of the study and examining the educational curriculum, it can be stated that unlike in psychiatry with an average score of 168.83, which is at a good level, the other fields are not well-developed and overall the communication skills in the residents, with a mean score of 128.68, are moderately poor and therefore further education and training is needed in these fields for resident students.

Пациент офтальмолога: психологические особенности работы в случае «катастрофических» диагнозов

Типичная ошибка терапии глаукомы сводится к тому, что врач лечит биологическую проблему, не задумываясь о ее психологическом воздействии на качество жизни пациента, о возможности пациента оценить эту проблему, об уровне социальной реадаптации и наличии у больного социальной поддержки. Все эти аспекты нужно учитывать, помня о том, что биологическая проблема останется с пациентом на всю жизнь. Часто уже с первой стадии глаукомы механизмы психологической защиты приводят к искажению информации о болезни, что влечет за собой неадекватную оценку заболевания. Как следствие, сотрудничество с пациентом начинает усложняться — формируется низкий комплайенс или полное его отсутствие. Пациенты не соблюдают режим терапии, делают попытки найти какие-либо альтернативные методы лечения. Они не верят, что, например, тот же цитиколин необходимо принимать всю жизнь, чтобы достичь эффекта, а вместо этого, не получив мгновенного результата, перестают принимать препарат. И наша задача объяснить пациентам важность правильного отношения к лечению. Таким образом, успешность психологической адаптации и терапии глаукомы будет в полной мере зависеть от того, какую информацию пациент получит от врача и сможет ли он правильно оценить эту информацию. На Западе уже давно разработан протокол сообщения «плохих новостей», который изучается в медицинских университетах Северной Америки и Европы в курсе «Коммуникативные навыки врача». В Украине мы только начали обучать этому шестиэтапному протоколу (английская аббревиатура SPIKES): 1. Воссоздание подходящих условий. 2. Оценка восприятия пациентом ситуации, в которой он оказался. 3. Приглашение. 4. Знания. Предоставление информации. 5. Эмоции и эмпатия. 6. Стратегия (план) и выводы. С учетом всего вышесказанного в статье речь пойдет о психологических проблемах глаукомы, как и чем их можно измерить, будет рассмотрен протокол сообщения «плохих новостей», остановимся на аспектах поведения врача в зависимости от особенностей его пациентов.

Oncology patients' perception of physicians who use an integrated electronic health record (EHR) during clinic visits: PRIME-EHR double-blind, randomized controlled trial.

Patients with cancer prefer and positively perceive physicians who communicate face-to-face without the use of a computer. However, the use of electronic health records (EHRs) in the examination room remains a practical necessity. On the basis of existing literature, the authors developed and tested an integration model, PRIME-EHR, that focuses on the best-practice guidelines. To their knowledge, no randomized controlled trials (RCTs) have been conducted to test the effectiveness of such models. In this double-blind, crossover RCT, 120 eligible patients with cancer were enrolled between April 1, 2019 and February 15, 2020 at The University of Texas MD Anderson Cancer Center. The objectives were to compare patients' perceptions of physicians' skills and their overall preference after they watched 2 standardized, scripted video vignettes of physicians: 1 portraying the use of a standard EHR and the other portraying the use of a PRIME-EHR. Actors and patients were blinded to the purpose of the study. Investigators were blinded to the sequence of videos watched by the patients. Validated questionnaires to rate physicians' compassion (0=best, 50=worst), communication skills (14=poor, 70=excellent), and professionalism (4=poor, 20=very good) were used. PRIME-EHR, compared with the standard EHR, resulted in better scores for physician compassion (median score, 5 [interquartile range, 0-10] vs 12 [interquartile range, 4-25]; P=.0009), communication skills (median score, 69 [interquartile range, 63-70] vs 61 [interquartile range, 50-69]; P=.0026), and professionalism (median score, 20 [interquartile range, 18-20] vs 18 [interquartile range, 14-20]; P=.0058). The majority of patients preferred physicians who used PRIME-EHR (n=70 [77%] vs n=21 [23%]; P<.0001). The PRIME-EHR approach significantly improved patients' perceptions of and preference for the physicians. This integrated model of health care delivery has the potential to improve communication and compassion in cancer care.

COMMUNICATION SKILLS FORMATION OF MEDICAL STUDENTS

The competence of the physician is determined not only by scientific and clinical knowledge, but also by excellent communication skills to ensure optimal doctor – patient interactions. Patients should be partners in the process of choosing diagnosis and treatment methods, which encourages them to be responsible for their own health and helps to improve the effectiveness of medical care. It is the responsibility of the physician to facilitate the process "joint decision – making", which promotes this partnership, using good communication skills.&#x0D; The article considers the general advice for the organization of communication of medical students in different situations and with different categories of patients, as well as mechanisms for their integration into the existing curriculum.&#x0D; One of the important parts of developing communication skills at the beginning of medical career is observing others. The student should take every opportunity to observe the interaction of doctor and patient, it is important to be present during serious conversations. The student needs to consider whether the behavior he sees should be imitated or avoided, thinking about how he can adjust his future behavior in such a situation. The student needs to choose the things he likes and use them as his own – creating his own structure of communication techniques.&#x0D; Effective communication goes a long way in building a relationship of trust between physician and patients. Patients expect doctors to support them, be compassionate, open, and honest about the details of their illness, treatment choices, side effects of medications, and the expected relief of symptoms. Non-verbal aspects of communication such as body language, eye contact, facial expression, touch, gestures and interpersonal distance have extraordinary importance in building relationships between doctor and patient.&#x0D; Studing the communication skills of medical students is an important component of the educational process, so it is recommended to incorporate them in higher medical school programs from the very beginning. One challenge with formal communication skills in higher medical schools is the gap that students observe between the communication patterns taught in training situations and the actual behavior of physicians in clinical practice. This can be a major barrier to overcome. A possible strategy to remove this barrier could be an integration of clinical and communication skills teaching in clinical situations. An important condition for teaching and assessing the communication skills of future physicians is the modeling of real professional communication conditions in order to involve each student in practical communication activities. However, the best demonstration of professional communication skills takes place in real clinical situations – "near the patient's bedside", where students learn to communicate effectively and master communication skills using their own experience.The ultimate goal is not only to teach students the particularities of communication, but also to use them throughout the practical activities.

Variance components of ratings of physician-patient communication: A generalizability theory analysis.

BackgroundThe ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data.ObjectiveTo examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings.MethodsVariance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions “shared decision making”, “effective and open communication” and “satisfaction” were considered.ResultsPhysician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians’ communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error).ConclusionThe ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.

Reduction of Distress and Attrition in a 6-Week Psychoeducational Group: A Pilot Study.

Purpose: The distress and unique needs of AYAs (adolescent/young adults) with an oncology diagnosis have been well explored and documented in the literature. However, effective means of reducing distress and meeting needs has been more elusive. This study explored the impact of a 6-week psychoeducational pilot group on AYA distress. Methods: Patient surveys and literature review were conducted to develop content for a 6-week psychoeducational group to reduce AYA distress through peer support and increased knowledge related to symptom management, physician communication, body image, family relationships, autonomy, sexuality, fertility, and coping skills. Distress was measured using the Hospital Anxiety and Depression Scale (HADS). Results: Twenty-one AYAs receiving oncology treatment enrolled in the group. Thirteen completed the program. Reasons for attrition included transportation, severity of symptoms, procedures, disinterest, and death. A correlated t-test demonstrated a significant decrease in HADS total score from pre- to post-test. Conclusion: This pilot study suggests that providing AYAs with information relative to their unique developmental needs and opportunities to process those needs in an environment of peers is challenging but can have benefit. nCT01817335.

Using crowdsourced analog patients to provide feedback on physician communication skills

ObjectiveEffective physician-patient communication is important, but physicians who are seeking to improve have few opportunities for practice or receive actionable feedback. The Video-based Communication Assessment (VCA) provides both. Using the VCA, physicians respond to communication dilemmas depicted in brief video vignettes; crowdsourced analog patients rate responses and offer comments. We characterized analog patients’ comments and generated actionable recommendations for improving communication. MethodsPhysicians and residents completed the VCA; analog patients rated responses and answered:“What would you want the provider to say in this situation?” We used qualitative analysis to identify themes. ResultsForty-three participants completed the VCA; 556 analog patients provided 1035 comments. We identified overarching themes (e.g., caring, empathy, respect) and generated actionable recommendations, incorporating analog patient quotes. ConclusionWhile analog patients’ comments could be provided directly to users, conducting a thematic analysis and developing recommendations for physician-patient communication reduced the burden on users, and allowed for focused feedback. Research is needed into physicians’ reactions to the recommendations and the impact on communication. Practice implicationsPhysicians seeking to improve communication skills may benefit from practice and feedback. The VCA was designed to provide both, incorporating the patient voice on how best to communicate in clinical situations.

ПРЕДСТАВЛЕНИЯ ОРДИНАТОРОВ О КОММУНИКАТИВНЫХ НАВЫКАХ ВРАЧА

Purpose: to describe the residents’ views about the communication skills of a doctor. Research question: What are the residents' perceptions of physician communication skills from the perspective of the Calgary-Cambridge Model of Medical Consultation? Methods: Qualitative Research. The data collection method was a focus group discussion. The study used qualitative-quantitative deductive content analysis and used OpenCode 4.02 to encode and categorize text units. Analytical triangulation served as a data validation strategy. Results: The study found that residents had an idea of the communication skills required by a doctor at all stages of a medical consultation using the Calgary-Cambridge model. Informants are most knowledgeable about the skills in the "start consultation", "examination" and "explain and planning" phases. Residents' knowledge of the communication skills required by the doctor at the “information gathering” and “consultation completion” stages is virtually non-existent. Practical relevance: the research results can be used in the design of communication skills training programs in a medical university.

Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer

IntroductionThe use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship.MethodsBetween March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit.ResultsOf 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio [OR] = 2.41, p = .01; OR = 3.34, p = .03, respectively).ConclusionTelemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.Implications for PracticeDuring the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.

Importance of empathy level and communication skills of intensive care unit physicians in kidney transplantation

Importance of empathy level and communication skills of intensive care unit physicians in kidney transplantation

Characteristics of acute intoxications with regard to capacity for effective doctor-patient communication and competent informed decisions

Introduction: Altered mental status caused by certain acute poisonings creates barriers for effective doctor-patient communication and compromises the process of informed consent (IC) for treatment. A categorization of toxicological patients with regard to communication capacity would be helpful for practical purposes. Aim : This article has the following aims: characterization of toxicology patients with mental status altered by poisoning according to the etiology of intoxication; discussion of the impact of cerebral toxic syndrome on the capacity for effective communication between the doctor and the patient and for IC. Materials and Methods : A retrospective study of the medical documentation of 2088 patients with acute intoxications, treated in the Clinic of Intensive Treatment of Acute Intoxications and Toxicoallergies at Naval Hospital, Varna during the 2010–2013 period: case files, IC forms, was conducted. The R program package, version 3.4.2 (2017-09-28), was used for statistics. Results : Toxic cerebral syndrome was found in 966 cases of acute intoxication, 46% of all patients, with especially high percentages in the medicament, alcohol, and narcotics intoxication groups. Regaining lucid mental state was observed within 1 hour in 21.9% of patients, and for the rest, it took from 2 hours to 7 days. Only 1211 patients, or 58%, signed the admission IC form themselves. Conclusion : Characterization of acute intoxications with regard to capacity for effective doctor-patient communication is necessary because of the great percentage of patients with cerebrotoxic syndrome. Good knowledge of the specificity of toxicology patients and good communication skills of physicians can help the proper process of informed decisions of the patient.

Paediatric oncology patients' definitions of a good physician and good nurse.

It is stated that the communication and disease experiences of paediatric patients, especially paediatric oncology patients, with healthcare professionals are completely different from those of adults. The aim of this study was to determine the definitions of a good physician and good nurse provided by elementary school-age oncology patients. In this qualitative research, data were collected through semi-structured individual interviews. The data were evaluated thorough thematic analysis. Eighteen children hospitalised due to cancer in paediatric oncology and haematology clinics of a university hospital in Turkey. Permission to conduct the study was obtained from the Institution's Ethics Committee. The objectives of this study were explained to the participants and families, and written consent was obtained from them. Also, participants were assured that necessary measures would be taken to protect their anonymity and confidentiality. The definitions of children were based on five main themes: interpersonal relationships, virtues, professional responsibility, security and individual characteristics. Children conveyed important messages to health professionals. They emphasised that a good physician and good nurse should communicate well, not only with themselves but also with their family. In addition, children were sensitive about health professionals who played with them and actively participated in the treatment by informing them about the disease. Meeting the expectations of children can be possible by improving the communication skills of physicians and nurses and by adding games and activities to the treatment and care plan.

Translation and Cultural Adaptation of the Polish Version of the Communication Assessment Tool (CAT).

Background and ObjectiveAdequate communication skills are the core competency of healthcare providers for optimal patient interaction and relationships based on mutual trust. Unfortunately, there are still few publications assessing the type and effectiveness of therapeutic communication, and there are no tools to facilitate the standard, regular evaluation of the process. The objective of this study was the translation and cultural adaptation of a Polish version of the 14-item Communication Assessment Tool (CAT) to assess the interpersonal and communication skills of physicians and to identify determinants influencing the quality of communication.DesignIt is an exploratory and cross-sectional survey design. The patients completed a survey consisted of the CAT. Socio-demographic data were obtained from the hospital register.SettingHypertension clinic at the clinical hospital in Wrocław.ParticipantsA total of 300 patients with diagnosed hypertension were selected. Of these, 50 patients were excluded (mental illness, cognitive impairment, resignation). A total of 250 people (61.23±14.34 years) participated in the study. Qualification for the study was carried out by a trained doctor, who is an internal medicine specialist.Main Measure OutcomeTranslation and cultural adaptation of Polish CAT.ResultsCronbach’s alpha for the CAT is 0.96 and does not require the exclusion of any items to increase its value. The loadings of the individual items ranged from 0.725 to 0.894. At the item level, results ranged from 28.4% to 50.4% “excellent”, the highest scores were given to “let me talk without interruptions” (50.4%) and “talked in terms I could understand” (47.6%). The correlation analysis showed a modestly positive statistical effect of the duration of a medical visit (r=0.225) and the time spent on talking about patient’s problems (r=0.23) with the general result of the CAT questionnaire (p<0.001).ConclusionThe CAT is a very good tool for assessing the quality of communication in Polish-speaking settings and can be recommended for use in everyday practice.

Psychosocial Predictors of Self-Efficacy Related to Self-Reported Adherence in Older Chronic Patients Dealing with Hypertension: A European Study.

PurposeNon-adherence to clinical prescriptions is widely recognized as the most common cause of uncontrolled hypertension, contributing to develop acute and chronic cardiovascular diseases. Specifically, patients’ unintentional non-adherence is related to psychosocial factors as beliefs about medications, perceived physician’s communication effectiveness and medication-specific social support. The aim of this study was to observe the impact of these factors on self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence among older chronic patients with hypertension.Patients and MethodsThis research had a cross-sectional, observational and multicentre study design. Italian inpatients under rehabilitation, and Polish inpatients/outpatients were recruited. Following a cognitive screening, socio-demographic and clinical characteristics were obtained. Data on clinical and behavioral adherence (i.e., pharmacological adherence, adherence to refill medicines, intentional non-adherence) and psychosocial factors related to treatment adherence (i.e., beliefs about medicines, physician’s communication skills, medication-specific social support, psychological antecedents and self-efficacy) were collected with self-report questionnaires.ResultsA total of 458 patients were recruited. Fischer’s LSD post hoc test revealed significant differences between Italian and Polish samples in all measures (p<0.001). Multiple linear regression analysis showed low self-reported intentional non-adherence (β = −.02, p=0.031), high self-reported adherence to refill medications (β=−.05, p=0.017), high levels of perceived physician’s communication effectiveness (β=0.11, p<0.001), positive beliefs about medications (β=0.13, p<0.001), and high perceived medication-specific social support (β=0.05, p<0.001) to predict significantly high patients’ self-efficacy in relation to pharmacological and non-pharmacological self-reported adherence.ConclusionThe observed psychosocial and behavioral factors revealed to positively impact on self-efficacy in relation to treatment adherence among older chronic patients dealing with hypertension. In a prevention framework, future studies and clinical practice may consider these factors in order to improve assessment and intervention on adherence in this population.

Completing the picture on student performances in OSCEs: A mixed-methods study on integration of a standardized patient rating

ObjectiveGood physician communication skills increase patient satisfaction and improve healing processes. Although physicians and patients appear to value communicative competencies differently, students are often evaluated solely by physicians. This study examines whether additional assessment of students by ‘standardized patients’ (SPs) is useful. MethodsDuring their Objective Structured Clinical Examination (OSCE) 238 medical students were additionally rated by SPs at 9 stations according to two items that defined the ‘physician–patient relationship’ and ‘communication’. SPs were informed that their assessment was for research purposes only, with no impact on the assessment of the students. SPs also had the opportunity to comment on their rating of the students. ResultsThe SPs rated the communicative competencies of students differently than physicians. The two parts of the SP rating are closely related. Inclusion of SP rating in the OSCE would provide higher measurement precision, with more students failing. SPs considered five factors relevant in their rating: ‘human connection’, ‘information flow’, ‘professionalism’, ‘competence’, and ‘exam situation’. ConclusionOur study suggests inclusion of SP rating as additional assessment of student communication skills. Practice ImplicationsAddition of SP rating in assessments is worthwhile, as it appears to complete the picture of the student performance in their OSCEs.