Encouraging patient participation in general practice consultations: Effect on consultation length and content,patient satisfaction and health

Abstract

Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultations than those in the control group and tended to ask more questions but there was no significant effect on patient satisfaction. The doctor tended to feel that he had a better understanding of patients in the intervention group. Overall there was no significant effect on SF-36 scores but, for patients under the age of 40, and for those in higher social classes the scores of patients in the intervention group improved to a significantly greater degree than did those for the control group. The intervention did not have any effect on the number of GP visits made by patients in the subsequent year. The study results show that a relatively simple leaflet can have an impact on patients' behaviour during the consultation, even though there were no effects on patient satisfaction with the consultation or in the number of GP visits in the following year.     

Family therapy in primary health care: Skills training and outcome evaluation

Some of the theoretical tenets of family therapy such as emphasis on the activation and utilization of existing family resources and the importance it accords to context appear to have a good fit with primary health care's commitment to empowering individuals in their struggle against ill health and the circumstances in which it occurs. This paper explores the possibility of teaching a problem-solving approach to family therapy to nurses in a South African primary health care system. Training consisted of conceptual, pragmatic, and self-growth exercises, and trainees' conceptual and performance skills were compared to the skills of a group of untrained nurses.We thank Bukelwa Selema, co-trainer on the program, for her contributions to joining effectively with the nurses and enriching the experiential process. We also thank Dr. P.J. Beukes, Dr. J.H. Olivier, Dr. G.M. Louw, Matron L.C. Langley and other staff in the Soweto primary health care system for their support. In particular, we are grateful to nursing sisters Martha Nkoane and Millicent Matomela, who roleplayed clients on the videotaped training modules. We are also grateful to Edcent Williams, who was one of the videotape raters, and Mike Spruce, Ricky Snyders, Nico Cloete, Ricky Mauer, and Brenda Radebe for their inputs at various stages of designing and implementing the programme.     

Computer-mediated communication: task performance and satisfaction

The author assessed satisfaction and performance on 3 tasks (idea generation, intellective, judgment) among 75 dyads (N = 150) working through 1 of 3 modes of communication (instant messaging, videoconferencing, face to face). The author based predictions on the Media Naturalness Theory (N. Kock, 2001, 2002) and on findings from past researchers (e.g., D. M. DeRosa, C. Smith, & D. A. Hantula, in press) of the interaction between tasks and media. The present author did not identify task performance differences, although satisfaction with the medium was lower among those dyads communicating through an instant-messaging system than among those interacting face to face or through videoconferencing. The findings support the Media Naturalness Theory. The author discussed them in relation to the participants' frequent use of instant messaging and their familiarity with new communication media.     

Physician and patient: Respect for mutuality

Theoretical Medicine and Bioethics - Philosophers and physicians alike tend to discuss the physician-patient relationship in terms of physician privilege and patient autonomy, stressing the duty of...     

Response efficiency during functional communication training: effects of effort on response allocation

An analogue functional analysis revealed that the problem behavior of a young child with developmental delays was maintained by positive reinforcement. A concurrent-schedule procedure was then used to vary the amount of effort required to emit mands. Results suggested that response effort can be an important variable when developing effective functional communication training programs.     

Imagery mnemonic training in a patient with primary degenerative dementia

A visual-imagery mnemonic was used as a memory training aid for a 66-year-old patient with primary degenerative dementia. Length of retention time was used as the primary outcome measure. The application of the mnemonic procedure extended the length of retention time for name-face recall from baseline. Performance gains were sustained at one month.     

An investigation of the effects of sex of self and other on perceptions of communication satisfaction

This study examined the effects of sex of self and other on communication satisfaction. Respondents rated perceived satisfaction with a conversation they had just completed or one they recalled. Communication satisfaction was operationalized by a 60-item self-report instrument. Results indicated that a person's own gender does not influence the amount of communication satisfaction one experiences, and mixed sex dyads are slightly more satisfying for males and females.     

Gratitude reception and physical health: Examining the mediating role of satisfaction with patient care in a sample of acute care nurses

ABSTRACT

Literature examining well-being benefits of gratitude experiences is currently thriving in psychological science. However, evidence of the physical health benefits of gratitude remains limited. Research and theory in affective science suggests an indirect relationship between gratitude and physical health. This study examines how receiving expressions of gratitude predicts physical health outcomes in a sample of acute care nurses over time. Registered nurses (N = 146) practicing in Oregon completed weekly surveys over 12 consecutive weeks describing their positive and negative events, health, and work-related experiences. Multilevel mediation models revealed that being thanked more often at work was positively related to a nurse’s satisfaction with the care they provided within that week, which subsequently predicted sleep quality, sleep adequacy, headaches, and attempts to eat healthy. These findings contribute to literature demonstrating the health benefits of gratitude by indicating that benefactors may experience improvements in subjective physical health through positive domain-relative satisfaction.     

The role of participation and control in the effects of computer monitoring on fairness perceptions, task satisfaction, and performance

Procedural justice and social facilitation theories were used to investigate effects of 2 kinds of process control on fairness perceptions, task satisfaction and performance of complex, computer-monitored tasks. A laboratory study manipulated participation (high or low voice) and monitoring approach (monitoring, control over monitoring, or no monitoring). High-voice participants perceived higher justice. Monitored participants reported higher satisfaction with high voice and lower satisfaction with low voice. Task performance was poorer for monitored participants unless they had control over monitoring. Among those with control, performance was not impaired for higher baseline performers. The 2 kinds of process control had different effects on the outcome variables. Results suggest the value of considering variations in the kinds of control provided and the justice principles that may apply in predicting effects of monitoring procedures.     

Linking resident behavior to dementia care communication: effects of emotional tone

Care for older adults with dementia is complicated by behaviors such as verbal and physical aggression and withdrawal that disrupt and increase the costs of providing care. These behaviors, referred to as resistiveness to care (RTC), have been linked to staff elderspeak communication, measured by behaviorally coded explicit behaviors. This study examined videotapes of nursing home (NH) residents with dementia interacting with staff during bathing to explore the relationships between implicit messages communicated by nursing staff and resident RTC behavior.Implicit messages in nursing staff communication were rated using the Emotional Tone Rating Scale by naïve coders. Associations between implicit ratings of care, respect, and control were analyzed in relation to RTC scale scores. Highly controlling communication was significantly correlated with increased resident RTC (r = .49, p < .05). Associations between the care and respect dimensions of communication were not significantly correlated with RTC; however, trends in hypothesized directions were identified. The association between emotional tone and RTC found in this study suggests that it is an important factor in care. Understanding affective messages is a first step in modifying these implicit messages conveyed during staff-resident communication. Research is needed to confirm these findings and to identify and test interventions to teach staff to reduce controlling messages that will to reduce RTC and improve care.     

Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.     

Interpersonal communication in the health professions: A focus on training

The field of Health Psychology has enjoyed a prodigious growth over the past 15 years. The interpersonal dynamic of the practitioner-patient relationship is one of the areas which has been illuminated thereby accentuating its contribution to effective levels of health care. This paper examines the concepts of interpersonal communication and communication skill. The contribution of skilful communication by health workers to the success with which they discharge their professional duties is considered and present standards of practice critically assessed. Specific areas of inadequacy are identified and possible causative factors postulated. Amongst such factors would appear to be a relative neglect of the interpersonal dimension of the work of the health practitioner during training. A case is made for increased attention being devoted to promoting this facet of professional competence. The major thrust of the paper develops this theme by elaborating a systematic and structured framework for instruction, Communication Skills Training, as an approach to promoting interpersonal efficiency in the health care context.     

Evaluating the effects of functional communication training in the presence and absence of establishing operations

We conducted functional analyses of aberrant behavior with 4 children with developmental disabilities. We then implemented functional communication training (FCT) by using different mands across two contexts, one in which the establishing operation (EO) that was relevant to the function of aberrant behavior was present and one in which the EO that was relevant to the function of aberrant behavior was absent. The mand used in the EO-present context served the same function as aberrant behavior, and the mand used in the EO-absent context served a different function than the one identified via the functional analysis. In addition, a free-play (control) condition was conducted for all children. Increases in relevant manding were observed in the EO-present context for 3 of the 4 participants. Decreases in aberrant behavior were achieved by the end of the treatment analysis for all 4 participants. Irrelevant mands were rarely observed in the EO-absent context for 3 of the 4 participants. Evaluating the effectiveness of FCT across different contexts allowed a further analysis of manding when the establishing operations were present or absent. The contributions of this study to the understanding of functional equivalence are also discussed.     

Priming and communication: Social determinants of information use in judgments of life satisfaction

Two experiments examined the effects of answering a question about a specific component of life satisfaction on respondents' assessment of their overall satisfaction with life. The results suggest that the use of primed information in forming subsequent judgments is determined by Grice's conversational norms. In general, answering the specific question increases the accessibility of information relevant to that question. However, the effect that this has on the general judgment depends on the way in which the two questions are presented. When the two questions are merely placed in sequence without a conversational context, the answer to the subsequent general question is based in part on the primed specific information. As a result, the answer to the general question becomes similar to that for the specific question (i.e. assimilation). However, this does not occur when the two questions are placed in a communication context. Conversational rules dictate that communicators should be informative and should avoid redundancy in their answers. Therefore, when a specific and a general question are perceived as belonging to the same conversational context, the information on which the answer to the specific question was based is disregarded when answering the general one. This attenuates the assimilation effect. The conditions under which these different processes occur are identified and experimentally manipulated, and the implications of these findings for models of information use in judgment are discussed.     

Assessing the impact of organizational communication on job satisfaction and job performance

The present paper analyses the impact of organizational communication on job satisfaction and job performance. Data were collected from 380 employees working at different managerial levels in various organizations in India by using Organizational Communication Scale (Roberts & O’Reilly, 1974), Job Satisfaction Survey scale (Spector, 1985), and Job Performance scale (Rodwell, Kienzle & Shadur, 1998). It was found that organizational communication had a significant effect on job satisfaction and job performance of the employees. The analysis further indicated that the employees at different levels perceived job satisfaction differently. Thus, it can be inferred that in Indian organizations, job satisfaction and performance are very much dependent on the communication behavior of the organization.     

Rose-colored priming effects: Life satisfaction and affective priming

The authors hypothesized that individual differences in life satisfaction would be systematically related to memory networks favoring positive to negative affective priming. To examine this prediction, three studies involving a total of 198 undergraduate participants were conducted. Four tasks were used in the three studies, and each task was fairly distinct in nature. In all tasks, positive and negative affective priming effects were calculated by examining facilitation in relation to consecutive positive stimuli (i.e., a positive priming effect) vs. consecutive negative stimuli (i.e., a negative priming effect). In all studies, life satisfaction interacted with the relative magnitude of positive and negative priming effects, such that higher levels of life satisfaction were associated with a larger positive priming effect and a smaller negative priming effect. The studies significantly extend the view that there is an intimate relationship between life satisfaction and the mental organization of positive vs. negative concepts in memory.