Patient question asking in physician-patient interaction

Patient question asking may be regarded as not only a method of information seeking but as a mechanism of patient participation in the medical dialogue. As such, the study of question asking behavior provides insight into the physician-patient communication process. Presented is an analysis of data gathered as part of an experimental intervention designed to increase patient question asking during routine medical visits. Audiotape recordings of two physicians in 123 medical visits were content analyzed to identify the number, content, and form of patient questions, as well as a variety of other interaction variables. These measures were then related to patient satisfaction with care. Findings indicate that the experimental intervention had significant effect on increasing the number of direct questions asked and that these were asked outside of their usual interaction pattern. Further, the relationship between question asking and satisfaction differed in the two groups. The study contributes to our understanding of physician-patient communication dynamics and the information seeking process.     

鼓励条件下幼儿提问的发展

以7所幼儿园的141名3～6岁儿童为被试,采用实验方法,探讨幼儿在8种新异刺激条件下提问的发展.结果表明:(1)3～6岁幼儿提问生成的数量随着年龄的增长而提高;(2)幼儿在对当前刺激产生陌生感或出现认知混乱时更容易生成问题;(3)立体刺激材料和平面刺激材料在引发幼儿提问生成上不存在差异;(4)3～6岁幼儿提问元认知随年龄的增长而提高.3～4岁期间是提问原因元认知快速发展时期.     

Training two severely retarded adolescents to ask questions

Two retarded boys were taught to discriminate items they knew how to label (training items) from items they did not know (probe items), to respond appropriately by naming any training items, and to ask a question about any probe items. The boys did not learn to question when appropriate questioning was modelled by the experimenter; however, when they were prompted and rewarded for asking questions about some training items, they then began asking questions about probe items. Both the modelling-and prompting-reinforcement procedures were introduced in an across-subject, multiple baseline design.     

GENERALIZATION OF STUDENT QUESTION ASKING FROM SPECIAL CLASS TO REGULAR CLASS SETTINGS

This study investigated the use of videotaped exemplars taken from a regular education mathematics class to teach generalization of question asking. Three mildly handicapped fourth-grade students who asked few questions in the regular education class served as subjects. Measures of the frequency of question asking and percentage of accuracy on assignments were obtained in the regular class. Treatment included showing the videotapes to the subjects, structuring opportunities for rehearsing question asking, and providing feedback. The results showed training procedures implemented in the learning resource room were effective in increasing the level of participants' question asking and in improving their scores on assignments in the regular mathematics class.     

Knowledge and question asking

The ability and the motivation for question asking are, or should be, some of the most important aims of education. Unfortunately, students neither ask many questions, nor good ones. The present paper is about the capacity of secondary school pupils for asking questions and how this activity depends on prior knowledge. To examine this, we use texts containing different levels of information about a specific topic: biodiversity. We found a positive relationship between the amount of information provided and the number of questions asked about the texts, supporting the idea that more knowledgeable people ask more questions. Some students were warned that there would be an exam after the reading, and this led to a diminishing number of questions asked, and yet this still did not significantly improve their exam scores. In such a case, it seems that reading was more concerned with immediacy, hindering critical thinking and the dialog between their previous ideas and the new information. Thus, question asking seems to be influenced not only by the amount of knowledge, but also by the reader's attitude towards the information.     

PREG: Elements of a Model of Question Asking

PREG is a conceptual model of human question asking. The model contains a set of production rules that specify the conditions under which children and adults ask questions when they read expository texts. The essence of PREG's question-asking mechanism is the existence of discrepancies between the representation of text information and the reader's world knowledge, with a mediating role of pragmatics and metacognition. Both the explicit text and the world knowledge are represented in the form of a conceptual graph structure. Comparisons between text representations and readers' knowledge are carried out by examining the 3 components of conceptual graph structures: words, statements, and links between statements. Some of the predictions of PREG were tested on a corpus of questions generated by 8th-grade and 12th-grade students who read short scientific texts. These predictions were empirically supported when assessed on 2 criteria. First, the model was sufficient because it was able to account for nearly all of the questions produced by the students. Second, the model was discriminating; when signal detection analyses were applied to the data, PREG could identify the conditions in which particular classes of questions are or are not generated.     

Patient-oriented interventions to improve communication in a medical office visit

Examined a simple intervention to improve the patient's contribution to communication in a medical office visit. In the first study, women awaiting a medical appointment were randomly assigned either to a group that was asked to list three questions to ask their physician or to a control group. Women who listed questions asked more questions in the visit and reported being less anxious. In the second study, a third group that received a message from their physician encouraging question asking was added. Both experimental groups asked more of the questions they had wished to, had greater feelings of control, and were more satisfied with the visit in general and with the information they received. The two experimental groups did not differ significantly, suggesting that the effect may be attributed either to thinking one's questions out ahead of time or to the perception that one's physician is open to questions.     

Text-Based and Knowledge Based Questioning by Children

Three studies investigated the ability of elementary school children to ask and recognize educationally productive questions. Knowledge-based questions formulated in advance of instruction were found to be of a higher order than text-based questions produced after exposure to text materials. Depending on familiarity of the topic, knowledge-based questions varied between basic questions asking for information needed for orientation to a topic and "wonderment" questions often aimed at explanation or at resolving discrepancies in knowledge. Children's questions are seen as a potentially valuable resource in education but one that requires a different kind of classroom community from the several kinds commonly found. The potential of a computer-based medium, computer-supported intentional learning environments, for supporting a knowledge-building community is briefly considered.     

Cognitive burden of survey questions and response times: A psycholinguistic experiment

An important objective in survey question design is to write clear questions that respondents find easy to understand and to answer. This contribution identifies the factors that influence question clarity. Theoretical and empirical evidence from psycholinguistics suggests that specific text features (e.g., low‐frequency words (LFRWs), left‐embedded syntax) cause comprehension difficulties and impose a high cognitive burden on respondents. To examine the effect of seven different text features on question clarity, an online experiment was conducted in which well‐formulated questions were compared to suboptimal counterparts. The cognitive burden of the questions was assessed with response times. Data quality was compared in terms of drop‐out rates and survey satisficing behaviour. The results show that at least six of the text features are relevant for the clarity of a question. We provide a detailed explanation of these text features and advise survey designers to avoid them when crafting questions. Copyright © 2009 John Wiley & Sons, Ltd.     

Towards a theory of question asking

Summary An outline of a theory of question asking is presented. Explicit information questions are conceived as possible means used by a questioner to reach actual goals. The information sought by the question is fundamentally related, and even dependent upon, knowledge already available to the person. Contradictory knowledge and knowledge about which the person is not sufficiently confident are seen as special cases of missing knowledge. Experimental evidence in support of these and related postulates is presented. Intrinsic to the theory is the conception of the psychological aspects involved in the asking of a question: the perceived need to ask in relation to the concurrent goals of the person, the alternative means of inferring rather than asking, knowing whom to ask, and tolerance for not (yet) asking.An elaborated version of a paper presented to XXIIND INTERNATIONAL CONGRESS OF PSYCHOLOGY, Leipzig, July 6–11, 1980     

Order of question presentation and correlation between judgments of comparative and own risk

Unrealistic optimism is often assessed using a single question asking for an estimate of comparative risk. However, it has been proposed that individuals treat such a question essentially as though it were only about their own risk. This proposal leads to the prediction that, when the questions about own risk and comparative risk are asked in sequence, the correlation between the resulting estimates should be lower if the question about own risk comes first than if the question about comparative risk comes first. This prediction was tested using a student sample (N=68). Participants answered the two types of question in sequence, with order of presentation being counterbalanced. Results were in accord with the prediction. Possible reasons are advanced for individuals' answering questions about comparative risk as if the questions concerned their own risk.     

The cause of stuttering: What''s the question?

There is a consensus among speech-language pathologists that the cause of stuttering is unknown. This lack of understanding is not due to the lack of research effort, but it may be due to asking an unanswerable question. We may already know the causes of many of those behaviors that make up the general concept, stuttering, if we would ask more specific questions.     

Question asking and eye tracking during cognitive disequilibrium: Comprehending illustrated texts on devices when the devices break down

The PREG model of question asking assumes that questions emerge when there is cognitive disequilibrium, as in the case of contradictions, obstacles, and anomalies. Participants read illustrated texts about everyday devices (e.g., a cylinder lock) and then were placed in cognitive disequilibrium through a breakdown scenario (e.g., the key turns but the bolt does not move). The participants asked questions when given the breakdown scenario, and an eyetracker recorded their fixations. As was predicted, deep comprehenders asked better questions and fixated on device components that explained the malfunction. The eye fixations were examined before, during, and after the participants' questions in order to trace the occurrence and timing of convergence on faults, causal reasoning, and other cognitive processes.     

FORGIVENESS WITHOUT GOD?

Of the many forgiveness‐related questions that she takes up in her novels, the one with which Iris Murdoch wrestles most often is the question, “Is forgiveness possible without God?” The aim of this essay is to show, in the first instance, why the question Murdoch persistently raises is a question worth asking. Alongside this primary aim stands a secondary one, which is to consider how one might glean moral insights from the Christian tradition even if one does not (any longer) endorse its theological commitments.     

False memories of having said the unsaid: some new demonstrations

In a series of four studies, subjects who were naive as to the true purpose of the research were asked if they had said aloud things that, at most, they had only intended to say. Often, subjects reported (incorrectly) that they had said them. Specifically, the procedures involved: showing a series of phrases, each being followed by a command to say it aloud or not (Study 1); asking a series of questions, each being followed by a request to answer it aloud or not (Study 2); asking a series of questions in a public polling situation and interrupting the subject before one of the questions was answered (Study 3); and having each subject participate in a debate, during the course of which the participant was induced to plan to use a particular point, but was prevented from doing so (Study 4). Subjects were confident of such erroneous reports; they had a lower tendency to make such errors for material that had not actually been presented, and such errors depended upon certain details of the manner in which such ‘source-monitoring’ searches were initiated. © 1997 John Wiley & Sons, Ltd.     

Why don't health professionals check patient understanding? A questionnaire-based study

Checking patient understanding, by asking questions about information presented in a medical consultation, is a core communication skill but its use is not frequently assessed. The newborn hearing screening commenced in England with a pilot of its implementation in January 2002. Because it is a new screening test, it provided an opportunity for studying the effective communication of novel information. A randomized controlled trial of training newborn hearing screeners to present information about the screening test and to ask questions to check understanding was commenced but had to be prematurely ended as the majority of the screeners did not ask the questions. The aim of this study was to understand why the screeners did not ask questions to check understanding of the information provided. Questionnaires were sent to screeners who participated in the study to elicit their responses to the use of the questions to check understanding. A response rate of 87% (26/30) was achieved. Screeners who reported not asking the questions were more likely to express a lack of confidence in their ability to ask questions, and to perceive asking questions as an ineffective way of increasing patient understanding. The study suggests that the ability and willingness of healthcare professionals to use simple communication skills may have been overestimated and training needs to target skills as well as beliefs about the effectiveness of using them.     

The influence of a reading task on children’s eye movements during reading

In the present study, second graders (n= 23), fourth graders (n= 16), sixth graders (n= 24) and adults (n= 21) read texts adopted from children’s science textbooks either with the task to answer a “why” question presented as the title of the text or for comprehension when their eye movements were recorded. Immediately after reading, readers answered a text memory and an integration question. Second graders showed an effect of questions as increased processing during first-pass reading, whereas older readers showed the effect in later look-backs. For adult readers, questions also facilitated first-pass reading. Text memory or integration question-answering was not influenced by the reading task. The results indicate that questions increase the standards of coherence for text information and that already young readers do modify their reading behaviour according to task demands.     

Heuristics and biases in diagnostic reasoning: II. Congruence,information, and certainty

Six experiments were carried out to examine possible heuristics and biases in the evaluation of yes-or-no questions for the purpose of hypothesis testing. In some experiments, the prior probability of the hypotheses and the conditional probabilities of the answers given each hypothesis were elicited from the subjects; in other experiments, they were provided. We found the following biases (systematic departures from a normative model), and interviews and justifications suggested that each was the result of a corresponding heuristic: Congruence bias. Subjects overvalued questions that have a high probability of a positive result given the most likely hypothesis. This bias was apparently reduced when alternative hypotheses or probabilities of negative results are explicitly stated. Information bias. Subjects evaluated questions as worth asking even when there is no answer that can change the hypothesis that will be accepted as a basis for action. Certainty bias. Subjects overvalued questions that have the potential to establish, or rule out, one or more hypotheses with 100% probability. These heuristics are explained in terms of the idea that people fail to consider certain arguments against the use of questions that seem initially worth asking, specifically, that a question may not distinguish likely hypotheses or that no answer can change the hypothesis accepted as a basis for action.     

Designer Theology: A Feminist Perspective

This is a critical look at the question of design from a feminist theological perspective. The author analyzes James Moore's 1995 Zygon article, "Cosmology and Theology: The Reemergence of Patriarchy." Then she looks at the relationship between science and religion from a feminist perspective, focusing on the kyriarchal nature of theology itself in light of the myriad power issues at hand. Finally, she suggests that, instead of pondering the notion of design, scientists and theologians might more fruitfully look for new ground for dialogue since feminist scholars are asking very different questions, not just answering questions differently.