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.     

Physician and patient communication training in primary care: effects on participation and satisfaction

OBJECTIVE: To assess the effects of a communication skills training program for physicians and patients. DESIGN: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). MAIN OUTCOME MEASURES: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. RESULTS: The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. CONCLUSION: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.     

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.     

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.     

Cancer Genetic Counseling: Communication and Counselees’ Post-Visit Satisfaction,Cognitions, Anxiety,and Needs Fulfillment

Little is known about the relation between communication during cancer genetic counseling and outcome. We assessed associations between counselor-counselee communication and counselee satisfaction, cognitions, anxiety, and fulfillment of major needs, corrected for pre-visit levels as appropriate. In total 171 consecutive new counselees, mainly referred for breast or colon cancer, received pre- and post-visit questionnaires assessing needs/fulfillment, knowledge, perceived control (PPC), anxiety (STAI), and satisfaction. Initial visits were videotaped and counselor eye gaze was recorded. Verbal communication was rated by Roter Interaction Analysis System (RIAS). Asking more medical questions was associated with lower satisfaction levels. Receiving more medical information was related to higher correct knowledge scores, higher reported fulfillment of some needs, and unrelated to perceptions of control. Receiving more psychosocial information and longer counselor eye gaze were related to higher anxiety scores. Longer visits were related to higher correct knowledge scores. Providing medical information appears the most powerful communication aspect to increase counselee satisfaction and address needs. More research is needed on how to address adequately (emotional) needs and increase feelings of control.     

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.     

Skin conductance as an indicator of anticipated concealed knowledge

The present study investigated the effects of anticipation on skin conductance while participants were answering a set of questions which included one of concealed knowledge. Two experiments were conducted. In Exp. 1, 26 participants completed one experimental session. Each participant was asked to choose one two-digit number from 10 to 99 and was presented 19 other randomly generated two-digit numbers. The list of numbers was then presented to the participant on a computer screen, with a 60-sec. interval occurring every two questions. The participant-selected number was defined as the target question which was randomly placed within the 4th to 17th item of 20 questions stated as follows: "Is your selected number?" The participant was asked to answer "No" to all questions. The skin-conductance response to each question was measured. In Exp. 2, the experimental procedure was the same as that in Exp. 1 except each participant first answered 10 nontarget questions, then answered a target question with the participant's selected number, and then answered another 10 nontarget questions. There were a total of 21 questions. Analysis indicated participants in both experiments generated the highest mean skin conductance while answering the target questions, followed by lower amplitudes to questions prior to and after the target question. The skin-conductance response pattern can be used to identify the psychological process of anticipation of concealed information.     

Communication Differences Between Physicians and Their Patients in an Oncology Setting

The physician-patient relationship has critical importance in the quality of medical care, especially in the oncology setting. Of particular interest over the past two decades has been the communication between physicians and their patients. It is understood that communication is related to patient and physician satisfaction as well as other medical outcomes. However, despite this interest and attention, investigators have only recently begun to assess the communication between physicians and patients from the patient's point of view. Additionally, previous investigations have primarily relied upon retrospective reports of the interaction from patients or physicians. The current investigation assessed physician–patient communication in an oncology setting, both as it was occurring and following the interaction. The units of analysis included participant ratings as well as those of trained observers. Findings revealed that physicians and patients disagree as to the valence of the messages which transpired. Additionally, results suggest that it is the patients who distort the messages in the positive direction. Research and clinical implications of this disagreement and positivity bias are discussed.     

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.     

Helping children correctly say "I don't know" to unanswerable questions

Adults ask children questions in a variety of contexts, for example, in the classroom, in the forensic context, or in experimental research. In such situations children will inevitably be asked some questions to which they do not know the answer, because they do not have the required information ("unanswerable" questions). When asked unanswerable questions, it is important that children indicate that they do not have the required information to provide an answer. These 2 studies investigated whether preinterview instructions (Experiment 1) or establishing a memory narrative (Experiment 2) helped children correctly indicate a lack of knowledge to unanswerable questions. In both studies, 6- and 8-year-olds participated in a classroom-based event about which they were subsequently interviewed. Some of the questions were answerable, and some were unanswerable. Results showed that preinterview instructions increased the number of younger children's appropriate "don't know" responses to unanswerable questions, without decreasing correct responses to answerable questions. This suggests that demand characteristics affect children's tendency correctly to say "I don't know." The opportunity to provide a narrative account increased children's appropriate "don't know" responses to unanswerable yes/no questions, and increased the number of younger children's correct responses to answerable questions. This suggests that cognitive factors also contribute to children's tendency correctly to say "I don't know." These results have implications for any context where adults need to obtain information from children through questioning, for example, a health practitioner asking about a medical condition, in classroom discourse, in the investigative interview, and in developmental psychology research.     

An information seeking disposition in child surgery patients

Several studies in the last decade have demonstrated the importance of considering an information seeking versus information avoiding coping dimension in adult medical patients. However, there have been few empirical demonstrations of such a dimension in children. The present study utilized the Coping Strategies Interview to assign an information seeking score to child elective surgery patients. This information seeking score was related to several parent-rated variables, including the child's historical success in coping with medical procedures, the child's typical preference for information acquisition, and the child's typically emitted coping behaviors. In addition, the information seeking score was related to question asking and discussion of medical procedures as rated by an objective observer during the blood test, by the nurse during anesthesia induction, and by the parent during recovery from surgery. It was strongly related to the information acquired prior to hospitalization. Information seeking was also related to stress responses, such that high information seeking scores predicted more adaptive behaviors prior to the blood test. This cross-rater and cross-situation validation suggests the existence of an information seeking dimension in children and the utility of considering this dimension in future research.     

Information giving and involvement in treatment decisions: Is more really better? Psychological effects and relation with adherence

Objectives : The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence.

Design : Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management.

Results : Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety.

Conclusions : Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

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.     

Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.     

PROMOTING PARENT-PROVIDER INTERACTION DURING YOUNG CHILDREN'S HEALTH-SUPERVISION VISITS

We prompted parents to increase their interactions with health-care providers during their children's health-supervision visits. Before scheduled appointments we asked parents of 32 infants and young children if they had specific child health questions or concerns. Sixteen parents randomly assigned to the prompted group were then prompted to initiate discussions of their concerns. Sixteen control parents discussed unrelated topics before their appointments. Prompted parents initiated significantly more interactions with health-care providers and more health and behavioral topics were discussed during their appointments. Both parent groups reported satisfaction with health-care services. Further research is needed to determine the clinical significance of outcomes associated with enhanced parent-provider interaction during children's health-supervision visits. These visits are ideal settings for behavioral research on improving health care for children and their families.     

多媒体技术在医患沟通中的临床应用实践——以胸外科患者为例

伴随着网络信息技术的飞速发展,医学卫生行业正在跨入信息化时代,本课题采用多媒体技术的多样性、集成性、交互性和实时性的特点,使用自制多媒体术前谈话课件进行医患沟通.通过将胸外科拟手术患者随机分为试验组及对照组,试验组采用多媒体课件进行医患沟通,对照组采用传统方式沟通,分别统计分析两组患者沟通质量满意度,来探讨多媒体技术在胸外科医患沟通中的临床应用.采用多媒体技术进行医患沟通可以显著提高患者满意度,值得在临床工作中进一步推广.     

Satisfaction and the Use of Humor by Physicians and Patients

The current study investigated the extent to which various types of humor are associated with high- and low-satisfaction doctor visits and whether male and female physicians and patients differ in their use of humor. A humor coding scheme, capable of distinguishing three categories (negative, positive, and general) and ten sub-types of humor, was validated against 92 audiotaped physician-patient primary care visits, half rated high and half rated low in satisfaction. Results revealed that physicians and patients used more light humor, more humor that relieves tension, more self-effacing humor, and more positive-function humor in high satisfaction than in low-satisfaction visits. In addition, the patients of female physicians used more humor than the patients of male physicians across levels of satisfaction. The results indicate a strong association between humor and satisfaction, and suggest ways in which humor and laughter help to maintain rapportin the physician-patient relationship.     

EFFECTS OF APPLICANT RACE, SEX, SUITABILITY, AND ANSWERS ON INTERVIEWER'S QUESTIONING STRATEGY AND RATINGS

Impression formation research (Snyder & Swann, 1978) suggests that people engage in information seeking strategies designed to confirm their impressions of others. In an extension of this work to the selection interview, Sackett (1982) found, however, that subjects did not consistently adopt a confirmatory information seeking strategy. This study is a further examination of Snyder and Swann's theory. In simulated interviews 170 subjects (1) read resumes of hypothetical applicants, (2) selected ten questions to ask each applicant, (3) received written responses to each question immediately on its selection, and (4) rated each applicant's suitability. An interaction accounting for 73% of variance indicated that applicant ratings were based primarily on the content of applicants' responses, but initial impressions also played a part. No clear-cut, confirmatory information seeking strategy was observed.