Quality Of Physician-patient Communication Research Articles

Impact of Electronic Chronic Pain Questions on patient-reported outcomes and healthcare utilization, and attitudes toward eCPQ use among patients and physicians: prospective pragmatic study in a US general practice setting.

The Electronic Chronic Pain Questions (eCPQ) has been developed to help healthcare providers systematically capture chronic pain data. This study evaluated the impact of using the eCPQ on patient-reported outcomes (PROs) and healthcare resource utilization (HCRU) in a primary care setting, and patient and physician perceptions regarding use of, and satisfaction with, the eCPQ. This was a prospective pragmatic study conducted at the Internal Medicine clinic within the Henry Ford Health (HFH) Detroit campus between June 2017 and April 2020. Patients (aged ≥18 years) attending the clinic for chronic pain were allocated to an Intervention Group to complete the eCPQ in addition to regular care, or a control group to receive regular care only. The Patient Health Questionnaire-2 and a Patient Global Assessment were assessed at baseline, 6-months, and 12-months study visits. HCRU data were extracted from the HFH database. Telephone qualitative interviews were conducted with randomly selected patients and physicians who used the eCPQ. Two hundred patients were enrolled, 79 in each treatment group completed all 3 study visits. No significant differences (p > 0.05) were found in PROs and HCRU between the 2 groups. In qualitative interviews, physicians and patients reported the eCPQ as useful, and using the eCPQ improved patient-clinician interactions. Adding the eCPQ to regular care for patients with chronic pain did not significantly impact the PROs assessed in this study. However, qualitative interviews suggested that the eCPQ was a well-accepted and potentially useful tool from a patient and physician perspective. By using the eCPQ, patients were better prepared when they attended a primary care visit for their chronic pain and the quality of patient-physician communication was increased.

The use of 3D digital anatomy model improves the communication with patients presenting with prostate disease: The first experience in Senegal.

We hypothesized that the use of an interactive 3D digital anatomy model can improve the quality of communication with patients about prostate disease. A 3D digital anatomy model of the prostate was created from an MRI scan, according to McNeal's zonal anatomy classification. During urological consultation, the physician presented the digital model on a computer and used it to explain the disease and available management options. The experience of patients and physicians was recorded in questionnaires. The main findings were as follows: 308 patients and 47 physicians participated in the study. In the patient group, 96.8% reported an improved level of understanding of prostate disease and 90.6% reported an improved ability to ask questions during consultation. Among the physicians, 91.5% reported improved communication skills and 100% reported an improved ability to obtain patient consent for subsequent treatment. At the same time, 76.6% of physicians noted that using the computer model lengthened the consultation. This exploratory study found that the use of a 3D digital anatomy model in urology consultations was received overwhelmingly favorably by both patients and physicians, and it was perceived to improve the quality of communication between patient and physician. A randomized study is needed to confirm the preliminary findings and further quantify the improvements in the quality of patient-physician communication.

Treatment-related side effects and views about dosage assessment to sustain quality of life: Results of an advocate-led survey of patients with metastatic breast cancer (MBC).

1005 Background: Metastatic breast cancer (MBC) is generally incurable and the majority of patients with MBC will remain on treatment indefinitely. Patients usually begin each new treatment at the Recommended Starting Dose (RSD) on the FDA-approved label based on results from clinical trials. However, patients’ ability to tolerate the RSD in the real-world may differ from the clinical trial setting. While the importance of patient reported outcomes is recognized, understanding tolerability from the patient’s perspective is lacking and patients’ willingness to discuss individualized doses for MBC therapy has not been evaluated. Methods: Patient advocates from the Patient-Centered Dosing Initiative distributed a confidential online survey to patients with MBC via social media groups, organizational newsletters, and online support forums. The survey was developed by patients and medical oncologists to ascertain the prevalence and impact of patients’ treatment-related side effects, quality of patient-physician communication, management of side effects, and interest in alternative approaches to the RSD when a new treatment is initiated or adverse side effects are experienced. Results: 1,221 patients with MBC completed the survey within 15 days. The median number of lines of MBC therapy was 2.5 (range 1 - ≥5) and 46% (n = 564) of patients received their MBC diagnosis within two years of taking the survey. 86% (n = 1,051) reported experiencing at least one significant treatment-related side effect, and of these, 20% (n = 213) visited the Emergency Room/hospital and 43% (n = 454) missed at least one treatment. 98% (n = 1,026) of patients with side effects discussed them with their doctors and 82% (n = 838) were helped by their physicians. The most common (non-exclusive) mitigation strategies were dosage reductions (66%, n = 556) and prescription medications (59%, n = 494). Of the 556 patients given a dosage reduction, 83% (n = 459) reported feeling better. Notably, 92% (n = 1,127) of patients expressed willingness to discuss alternative dosing options with their physicians based upon their personal characteristics and individual preferences. Conclusions: Given that 86% of patients with MBC experienced at least one significant treatment-related side effect and 83% improved after dosage reduction, innovative dosage-related strategies are warranted to sustain Quality of Life. Patient-physician discussions in which the patient’s physical attributes and circumstances are periodically assessed may determine the right dose for the patient upon treatment initiation and afterwards, and the vast majority of patients would be receptive to such discussions.

Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial

BackgroundImproving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP).MethodsA randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus –Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests.ResultsAfter the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group.ConclusionThe educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients.Trial registrationIranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].

Does Patient-Centered Attitude Improve During Internship? A Longitudinal Study

Background The patient-centered approach improves the quality of health care. Promoting this approach will increase the patients’ satisfaction and improve interpersonal skills among health care providers. Objectives The aim of the current study was to compare the viewpoints of interns toward the patient-centered approach in the beginning and the end of the internship at the Kerman University of Medical Sciences (KUMS). Methods This longitudinal study was carried out at KUMS between March 2017 and July 2018. All medical students who had passed the internship entrance exam were selected through a census. The Persian version of the patient-practitioner orientation scale (PPOS) was completed at the start and the end of the internship. This instrument has 18 items in two 9-item subscales: sharing and caring. The minimum and maximum scores were 1 to 6, respectively. The higher the score, the more the patient-centered orientation. The data were analyzed by SPSS using independent and paired -tests, ANOVA, and multiple linear regression. Results The mean scores of PPOS were 3.92 ± 0.42 and 3.86 ± 0.37 at the beginning and the end of the internship, respectively. This difference was not statistically significant. The mean score of the caring subscale significantly increased during internship but no significant change was found in the mean score of the sharing subscale. Conclusions The results of our study showed that the patient-centered attitude toward patient caring improved during the internship in the majority of interns but no significant improvement was found in terms of patient sharing. Significant progress can be made in the quality of physician-patient communication and patient satisfaction if necessary training programs are run on patient-centeredness.

Sa1043 THE READABILITY OF LETTERS REPORTING PATHOLOGY RESULTS AND FOLLOW-UP RECOMMENDATIONS AFTER ENDOSCOPIC PROCEDURES

The quality of patient-physician communication is an important predictor of patient outcomes. Pathology results following endoscopic procedures are often conveyed via letter, however patient literacy varies and material written at higher than a 6th to 8th grade level may not be understood by a substantial proportion of patients in the United States. We therefore sought to measure the readability of letters to patients communicating pathology results and follow up recommendations and to identify predictors of letter readability. We reviewed consecutive colonoscopies performed at a tertiary care center over a five day period in April 2017 and identified cases in which pathology results and follow-up recommendations were communicated to patients by letter. The readability of the letters was determined using the Flesch-Kincaid grade level measure, in which more readable text is defined by a lower Flesch-Kincaid grade level. Mann-Whitney and Kruskal-Wallis tests were used to identify factors associated with letter readability. A total of 144 letters were reviewed. The mean Flesch-Kincaid grade level of the letters was 9.9 (SD 3.5). 125 letters (87%) were written over a 6th grade level, and 97 (67%) were written over an 8th grade level. 16 patients (11%) did not speak English as their primary language; all of these patients were sent letters written in English rather than their primary language, and letter readability did not differ between letters to primary English speakers and non-English speakers. Patient education level (college graduates versus non-graduates) also did not predict the Flesch-Kincaid grade level at which their letter was written. Procedures performed without a fellow and by attending endoscopists over 60 years old were associated with letters written at higher grade levels versus those performed by attending endoscopists under age 60 (mean Flesch-Kincaid grade level 11.6 vs 9.8, p=0.015). Colonoscopies performed with a fellow were followed by more readable letters than endoscopies not involving fellows (mean grade level 8.8 vs 10.5, p=0.016). There were no differences in letter readability based on patient age, patient gender, patient ethnicity, whether upper endoscopy was performed concurrently with colonoscopy, or procedural indication. Letters to patients reporting colonoscopy pathology results and follow up recommendations were usually written at a grade level that exceeded those recommended for communication with patients, and the language of the letters did not differ based on easily identifiable risk factors for lower literacy, including patients’ educational attainment and primary language. Interventions are necessary to improve the readability of written communication with patients following endoscopic procedures.

Studies of Physician-Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review.

Hearing loss is remarkably prevalent in the geriatric population: one-quarter of adults aged 60-69 and 80% of adults aged 80 years and older have bilateral disabling loss. Only about one in five adults with hearing loss wears a hearing aid, leaving many vulnerable to poor communication with healthcare providers. We quantified the extent to which hearing loss is mentioned in studies of physician-patient communication with older patients, and the degree to which hearing loss is incorporated into analyses and findings. We conducted a structured literature search within PubMed for original studies of physician-patient communication with older patients that were published since 2000, using the natural language phrase "older patient physician communication." We identified 409 papers in the initial search, and included 67 in this systematic review. Of the 67 papers, only 16 studies (23.9%) included any mention of hearing loss. In six of the 16 studies, hearing loss was mentioned only; in four studies, hearing loss was used as an exclusion criterion; and in two studies, the extent of hearing loss was measured and reported for the sample, with no further analysis. Three studies examined or reported on an association between hearing loss and the quality of physician-patient communication. One study included an intervention to temporarily mitigate hearing loss to improve communication. Less than one-quarter of studies of physician-elderly patient communication even mention that hearing loss may affect communication. Methodologically, this means that many studies may have omitted an important potential confounder. Perhaps more importantly, research in this field has largely overlooked a highly prevalent, important, and remediable influence on the quality of communication.

Health literacy, computer skills and quality of patient-physician communication in Chinese patients with cataract.

PurposeThe aim of the study was to assess levels of health literacy and computer skills in Chinese patients with cataract, and their impact on the doctor-patient relationship.MethodsWe undertook a cross-sectional study of cataract patients scheduled for cataract extraction procedures in Guangdong Province, China. Generic health literacy was assessed using 3 established screening questions. Adequate computer skills was determined if patients had used a computer and routinely used search engines on the Internet. Socio-demographic measures (e.g., age, sex, education) were obtained from a standardized interview. Participants who indicated that they could not understand what their doctors mean were considered to have had poor patient-physician communications.ResultsOf the 211 participants, 92 (43.6%) had inadequate health literacy and 204 (96.7%) inadequate computer skills. In multivariate analysis, females were more likely to have inadequate health literacy (odds ratio = 2.5, 95% confidence intervals [CI]: 1.3 to 4.7). People with inadequately health literacy were more likely to have a poor patient-physician communication (odds ratio = 3.5, 95% CIs: 1.3 to 9.0). Similar associations were found for inadequate computer skills.ConclusionChinese elderly patients with cataract have inadequate health literacy and very limited computer skills, which place them at high risk of misunderstanding and mismanaging their ocular conditions. Patient education information other than online materials may improve the eye care and outcomes of these patients.

Reevaluating the placebo effect in medical practice.

Recent findings on placebo research corroborate the evidence that the placebo effect represents a promising model to shed new light on the brain-mind-body interactions. In particular, this research has partially elucidated the role of how patients' expectations and the quality of physician-patient communication can influence the efficacy of interventions and overall clinical outcomes. Accordingly, the study of the placebo effect should be incorporated in the core clinical practice curriculum of all health practitioners. While the growing knowledge of the placebo effect points to it as an irreducible primary reality of the medical sciences, an ethical analysis aimed at avoiding the misuse of placebos is needed, while maximizing the opportunity for beneficial placebo effects.

Big Pros and Big Cons: Factors Influencing Utilization of Shared Decision- Making in Low Back Pain from a Surgeon’s Perspective

Abstract Study design: Qualitative study design, using semi-structured interviews. Objective: To characterize the shared decision-making (SDM) process from the perspective of orthopedic and neurosurgical physicians treating patients with low back pain (LBP). Summary of background data: Unwarranted variations in quality and cost of healthcare for LBP persist. SDM is a process of informed consent that could improve patient education and outcomes. Its success depends on the quality of patient-physician communication. Lack of monolithic, cross-specialty, clinical guidelines for physicians treating LBP makes SDM especially important for this preference-sensitive condition. Therefore, further study of physician perceptions of the SDM process is warranted. Methods: We conducted semi-structured, in-depth interviews in a sample of thirteen orthopedic and neurosurgeons that treated patients with LBP. Interviews were then transcribed, coded and qualitatively analyzed using a grounded theory approach. Results: Detailed narratives of surgeons’ experiences and perspectives revealed varying interpretations of SDM. Some limited it to the patient-physician dyad, describing it as a process of educating patients about their illness, treatment options and optimum treatment goals. Others included inter-practitioner and systemic dimensions, hospital environment, physician-patient characteristics, physician-patient relationships and financial considerations as influential in SDM. Although physicians indicated SDM as beneficial in theory, patient expectations, the experience and attitude of the physician, and time pressure influenced the actual practice of it. Conclusions: Patient-related barriers to SDM were unrealistic expectations, hidden motives, multiple morbid conditions and older age, while facilitators were fewer illnesses and younger age. Physician-level facilitators included younger age and SDM-related training or experience, while time constraints and specialty biases toward treatment options were barriers. The physician-patient relationship was deemed critical to SDM, but insurance coverage and treatment affordability limited the available choices.

Abstract A11: A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race.

Abstract Purpose: Oncologist-patient communication clearly influences patients' decisions about participating in clinical trials (Albrecht 2008; Eggly 2008). Black-White differences in the quality of patient-physician communication exist in oncology interactions (Eggly 2011), but no prior study has used real-time data from actual clinical interactions to investigate whether there are also Black-White differences in communication about clinical trials. The purpose of this study was to compare communication during offers to participate in cancer clinical trials in oncology visits with Black and with White patients. Patients and Methods: Data were taken from an archive of 47 transcribed, video recorded oncology interactions that included the explicit offer of a cancer clinical trial (Albrecht 2008). All visits with Black patients (n=11) were identified and matched with a sample of visits with White patients (n=11). We used linguistic discourse analysis to analyze the visits (n=22) with specific focus on discussions of clinical trials and the five basic elements of consent (purpose, risks and benefits of the trial, alternatives to participating, and the voluntary nature of trial participation). We used word count as an objective measure of the amount of actual face-to-face discussion that occurred during the visits. We assessed Black-White differences in word count of the entire visits; the number of times clinical trials or any of the elements of consent were mentioned by oncologists, patients, or patients' companions; and word count of discussions during mentions of each of these topics. Results: Mean word count of the entire visit was less for Black than White patients (m=4877.73Blacks vs. 7247.18Whites, d=.8740). Clinical trials were mentioned less frequently during visits with Black than White patients (M=2.73Blacks vs. 4.27Whites, d=1.2099). Mean word count during mentions of clinical trials was also less for Black patients (1089.64Blacks vs. 1867.09Whites, d=1.0618). Regarding the elements of consent, mean word count was less for Black patients during discussions of purpose (M=90.91 Blacks vs. 181.22 Whites, d=.9272) and risks (M=211.900Blacks vs. 390.27Whites, d=.6477). Risks were also mentioned less frequently for Black patients (M=1.91Blacks vs. 3.18Whites, d=.5782). However, voluntary participation was mentioned more frequently (M=2.18Blacks vs. 1.55Whites, d=.4139) for White than Black patients. Conclusion: Black patients, as compared to White patients, may make decisions about clinical trial participation based on less overall discussion with oncologists and less discussion of the purpose and risks of participation. One possible explanation is a less active communication style of Black patients in medical visits, which has been shown in other research (Gordon 2006; Eggly 2011). Other possibilities include oncologist concerns about patient mistrust and/or nonconscious racial bias (van Ryn 2011). Possible communicative strategies to overcome these disparities include more conscious attention to mentioning and developing the topic of clinical trials with Black patients, with particular attention to the purpose and risks of trial participation. Citation Format: Susan Eggly, Ellen Barton, Andrew Winckles, Louis A. Penner, Terrance L. Albrecht. A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A11.

Insight Into Advance Care Planning for Patients on Dialysis

ContextAdvance care planning is not included in regular clinical care for patients on dialysis. Insight into life-sustaining treatment preferences and communication about end-of-life care is necessary to develop interventions to improve advance care planning for patients on dialysis. ObjectivesThis cross-sectional observational study aimed to understand the preferences for life-sustaining treatments of outpatients on dialysis and to study the quality of patient-physician communication about end-of-life care and barriers and facilitators to this communication. MethodsThe following outcomes were assessed in 80 clinically stable dialysis patients: demographics, clinical characteristics, life-sustaining treatment preferences (cardiopulmonary resuscitation and mechanical ventilation, and Willingness to Accept Life-Sustaining Treatment instrument), preference for site of death, quality of communication (Quality of Communication Questionnaire), and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire). ResultsPatients were able to indicate their preferences for life-sustaining treatments and site of death. Preferences for life-sustaining treatments depend on the specific treatment, the expected outcome of treatment, and likelihood of an adverse outcome. Life-sustaining preferences were discussed with the nephrologist by 30.3% of the patients. Quality of the patient-physician communication about end-of-life care was rated poor. This study identified several barriers and facilitators to end-of-life care communication. ConclusionPatients should receive information about treatment burden, expected outcome, and the likelihood of an adverse outcome when discussing life-sustaining treatments. Quality of patient-physician communication about end-of-life care needs to improve. Barriers and facilitators to communication about end-of-life care provide direction for future interventions to facilitate advance care planning for patients on dialysis.

Computer analysis system of the physician‐patient consultation process

Measurements of the quality of physician-patient communication are important in assessing patient outcomes, but the quality of communication is difficult to quantify. The aim of this paper is to develop a computer analysis system for the physician-patient consultation process (CASC), which will use a quantitative method to quantify and analyze communication exchanges between physicians and patients during the consultation process. CASC is based on the concept of narrative-based medicine using a computer-mediated communication (CMC) technique from a cognitive dialog processing system. Effective and ineffective consultation samples from the works of Saito and Kleinman were tested with CASC in order to establish the validity of CASC for use in clinical practice. After validity was confirmed, three researchers compared their assessments of consultation processes in a physician's office with CASCs. Consultations of 56 migraine patients were recorded with permission, and for this study consultations of 29 patients that included more than 50 words were used. Transcribed data from the 29 consultations input into CASC resulted in two diagrams of concept structure and concept space to assess the quality of consultation. The concordance rate between the assessments by CASC and the researchers was 75 percent. In this study, a computer-based communication analysis system was established that efficiently quantifies the quality of the physician-patient consultation process. The system is promising as an effective tool for evaluating the quality of physician-patient communication in clinical and educational settings.

An Evaluation of Patient-Physician Communication Style During Telemedicine Consultations

Background The quality of physician-patient communication is a critical factor influencing treatment outcomes and patient satisfaction with care. To date, there is little research to document the effect of telemedicine (TM) on physician-patient communication.Objective The objectives of this study are to measure and describe verbal and nonverbal communication during clinical TM consultations and to compare TM with in-person (IP) consultations in terms of the quality of physician-patient communication.Methods Veteran patients (n = 19) requiring pulmonary medicine consultations were enrolled into the study. The study group included 11 patients from the Iron Mountain Veterans Affairs Hospital (VAMC) remote site. Patients had individual TM consultations with a pulmonary physician at the Milwaukee VAMC hub site. A control group of 8 patients had IP consultations with a pulmonary physician at the Milwaukee VAMC. Video recordings of medical consultations were coded for patient-physician verbal and nonverbal communication patterns using the Roter Interaction Analysis System (RIAS).Results There were no differences in the length of TM consultations (22.2 minutes) and IP consultations (21.9 minutes). Analysis of visit dialogue indicated that the ratio of physician to patient talk was 1.45 for TM and 1.13 for IP consultations, indicating physician verbal dominance. Physicians were more likely to use orientation statements during IP consultations (P = .047). There were greater requests for repetition from patients during TM consultations (P = .034), indicating perceptual difficulties.Conclusions The study findings indicate differences between TM and IP consultations in terms of physician-patient communication style. Results suggest that, when comparing TM and IP consultations in terms of physician-patient communication, TM visits are more physician centered, with the physician controlling the dialogue and the patient taking a relatively passive role. Further research is needed to determine whether these differences are significant and whether they have relevance in terms of health outcomes and patient satisfaction with care.

What Makes Individuals With Gastroesophageal Reflux Disease Dissatisfied With Their Treatment?

Despite the efficacy of proton pump inhibitors (PPIs) as therapeutics for patients with gastroesophageal reflux disease (GERD) in randomized controlled trials, a number of studies have shown that a proportion of patients with GERD are not satisfied with their treatment. This article reviews the possible reasons why patients are dissatisfied with the way their disease is managed. Studies published between 1970 and 2007 were identified from PubMed, EMBASE, and the author's existing database. The 2708 publications were reviewed, and irrelevant ones were excluded. Eleven studies were found to be appropriate for use in this review. Patients who are given prescriptions for PPIs tend to be more satisfied than those given H(2)-receptor antagonists. Partial responders are likely to be more dissatisfied than patients whose symptoms are fully resolved. A decrease in health-related quality of life is associated with greater dissatisfaction. Patients are more likely to be satisfied if they are taken seriously by their physician and if their symptoms are investigated. They are also more likely to be satisfied if the patient-physician consultation is interactive. Patient satisfaction is a complex issue that depends on many factors. Patient satisfaction can be influenced by treatment regimen, general level of well-being, the bedside manner of the physician, and the quality of patient-physician communication. Improvements in recognition of GERD can improve management of the disease as well as patient satisfaction with their care and treatment.

Communication practices of physicians with high patient-satisfaction ratings.

How do primary care physicians with outstanding patient-satisfaction ratings communicate with their patients? Which specific practices distinguish them from less effective communicators on the basis of measured performance? To answer this question, we videotaped 92 adult primary care visits in Southern California and Hawaii and interviewed both physicians and patients separately. Each participating physician and patient viewed the tapes of the visit and shared their perceptions of the communication aspects of the visit. We also audiotaped these debriefing sessions. To identify successful physician communication practices, exam room visit behaviors and comments from the postvisit debriefs were coded and compared with each physician's panel-level patient satisfaction. In the final section, we describe communication strategies reported by physicians with high patient-satisfaction ratings. The quality of physician-patient communication in primary care visits is related to patient satisfaction,1 adherence,2,3 litigation,4 quality of data collection,5 utilization patterns, and clinical outcomes.6 There is evidence that communications between physicians and patients are sometimes inadequate.7–9 In addition, disruptive communications reduce the quality of worklife for physicians. Thus, improvement in physician communication skills has great potential for both the quality of medical care and for the physician work environment.

The value of the marginalia as an adjunct to structured questionnaires: Experiences of men after prostate cancer surgery

In both research and clinical settings, men who survive prostate cancer emphasize the need for more open communication about the challenges they face. They explain that symptomatic dysfunction associated with treatment is grounded in complex social situations and relationships. Yet, structured quality of life questionnaires preclude expressions of the elaborate accounts they often evoke. We explore this in the case of prostate cancer. Seventy-one patients who had undergone radical prostatectomy at a mid-Atlantic University Medical Center, a Veterans Affairs medical center affiliated with the same university, or were US members of an international prostate cancer support group completed a survey protocol including assessments of urinary morbidity, psychosocial adjustment to illness (PAIS), and health status (SF-36). At the conclusion, a single open-ended item was offered; 48 offered an extended response. The open-ended item was recorded and analyzed qualitatively. Data were summarized according to four main themes: (1) quality of patient-physician communication; (2) change in sexual identity; (3) fear of cancer; and (4) the humiliation of urinary incontinence. Future research on outcomes of treatment and clinical inquiry must focus on methods that systematically capture patients' experiences.

Physician-patient communication in HIV disease: the importance of patient, physician, and visit characteristics.

Although previous work that considered a variety of chronic conditions has shown that higher quality physician-patient communication care is related to better health outcomes, the quality of physician-patient communication itself for patients with HIV disease has not been well studied. To determine the relationship of patient, visit, physician, and physician practice characteristics to two measures of physician-patient communication for patients with HIV disease. Cross-sectional survey of physicians and patients. Cohort study enrolling patients from throughout eastern Massachusetts. 264 patients with HIV disease and their their primary HIV physicians (n = 69). Two measures of physician-patient communication were used, a five-item general communication measure (Cronbach's alpha = 0.93), and a four-item HIV-specific communication measure that included items about alcohol, drug use, and sexual behaviors (Cronbach's alpha = 0.92). The mean age of patients was 39. 5 years, 24% patients were women, 31.1% were nonwhite, and 52% indicated same-sex contact as their principal HIV risk factor. The mean age of physicians was 39.1 years, 33.3% were female, 39.7% were specialists, and 25.0% self-identified as gay, lesbian, or bisexual. In multivariable models relating patient and visit characteristics to general communication, longer reported visit length (p<.0001), longer duration of the physician-patient relationship (p =.02), and female gender (p =.04) were significantly associated with better communication. The interaction of patient gender and visit length was also significant (p =.02); longer visit length was more strongly associated with better general communication for male than female patients. In similar models relating patient and visit characteristics to HIV-specific communication, longer visit length (p <.0001) and less advanced disease stage (p =.009) were associated with better communication. In multivariable models relating physician and practice characteristics to general communication no variables were significant. However, both female physician gender (p =.002) and gay/lesbian/bisexual sexual preference (p =.003) were significantly associated with better HIV-specific communication. In this study, female and homosexual physicians provided higher quality HIV-specific communication than male and heterosexual physicians. Better understanding the processes by which female and homosexual physicians achieve higher quality communication may help other physicians communicate more effectively. Health care providers and third-party payers should be aware that shorter visits may compromise physician-patient communication, and that this effect may be more consequential for male patients.

Brief Reports

Background: Although previous work that considered a variety of chronic conditions has shown that higher quality physician-patient communication care is related to better health outcomes, the quality of physician-patient communication itself for patients with HIV disease has not been well studied. Objective: To determine the relationship of patient, visit, physician, and physician practice characteristics to two measures of physician-patient communication for patients with HIV disease. Design: Cross-sectional survey of physicians and patients. Setting: Cohort study enrolling patients from throughout eastern Massachusetts. Study subjects: 264 patients with HIV disease and their their primary HIV physicians (n = 69). Measurements: Two measures of physician-patient communication were used, a five-item general communication measure (Cronbach's α = 0.93), and a four-item HIV-specific communication measure that included items about alcohol, drug use, and sexual behaviors (Cronbach's α = 0.92). Results: The mean age of patients was 39.5 years, 24% patients were women, 31.1% were nonwhite, and 52% indicated same-sex contact as their principal HIV risk factor. The mean age of physicians was 39.1 years, 33.3% were female, 39.7% were specialists, and 25.0% self-identified as gay, lesbian, or bisexual. In multivariable models relating patient and visit characteristics to general communication, longer reported visit length (p < .0001), longer duration of the physician-patient relationship (p = .02), and female gender (p = .04) were significantly associated with better communication. The interaction of patient gender and visit length was also significant (p = .02); longer visit length was more strongly associated with better general communication for male than female patients. In similar models relating patient and visit characteristics to HIV-specific communication, longer visit length (p < .0001) and less advanced disease stage (p = .009) were associated with better communication. In multivariable models relating physician and practice characteristics to general communication no variables were significant. However, both female physician gender (p = .002) and gay/lesbian/bisexual sexual preference (p = .003) were significantly associated with better HIV-specific communication. Conclusions: In this study, female and homosexual physicians provided higher quality HIV-specific communication than male and heterosexual physicians. Better understanding the processes by which female and homosexual physicians achieve higher quality communication may help other physicians communicate more effectively. Health care providers and third-party payers should be aware that shorter visits may compromise physician-patient communication, and that this effect may be more consequential for male patients.

Barriers to communication about end-of-life care in AIDS patients

Patients and physicians do not adequately discuss patients' preferences for medical care at the end of life. Our objective was to perform a qualitative study using focus groups to identify barriers and facilitators to communication about end-of-life medical care for patients with AIDS and their physicians. Patients with AIDS and physicians with moderate or extensive HIV experience were recruited from clinics and community-based settings using network sampling. A total of 47 patients participated in six focus groups and 19 physicians participated in three groups. Patients or physicians identified 29 barriers and facilitators to communication about end-of-life care. Many patients and physicians expressed discomfort talking about death and dying, and some felt that discussing end-of-life care could cause harm or even hasten death. Several patients expressed the view that a living will obviated the need for discussion with their physician. Previous experience of discrimination from the health care system was a strong barrier to end-of-life communication for some patients with AIDS. Some patients hesitate to bring up end-of-life issues because they want to protect their physicians from uncomfortable discussions. Many patients identified the quality of communication as an important facilitator to these difficult discussions. Improving the quality of patient-physician communication about end-of-life care will require that physicians identify and overcome the barriers to this communication. To improve the quality of medical care at the end of life, we must address the quality of communication about end-of-life care.