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Visser LNC, Bol N, Hillen MA, Verdam MGE, de Haes HCJM, van Weert JCM, Smets EMA. Studying medical communication with video vignettes: a randomized study on how variations in video-vignette introduction format and camera focus influence analogue patients' engagement. BMC Med Res Methodol 2018; 18:15. [PMID: 29351736 PMCID: PMC5775584 DOI: 10.1186/s12874-018-0472-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Video vignettes are used to test the effects of physicians' communication on patient outcomes. Methodological choices in video-vignette development may have far-stretching consequences for participants' engagement with the video, and thus the ecological validity of this design. To supplement the scant evidence in this field, this study tested how variations in video-vignette introduction format and camera focus influence participants' engagement with a video vignette showing a bad news consultation. METHODS Introduction format (A = audiovisual vs. B = written) and camera focus (1 = the physician only, 2 = the physician and the patient at neutral moments alternately, 3 = the physician and the patient at emotional moments alternately) were varied in a randomized 2 × 3 between-subjects design. One hundred eighty-one students were randomly assigned to watch one of the six resulting video-vignette conditions as so-called analogue patients, i.e., they were instructed to imagine themselves being in the video patient's situation. Four dimensions of self-reported engagement were assessed retrospectively. Emotional engagement was additionally measured by recording participants' electrodermal and cardiovascular activity continuously while watching. Analyses of variance were used to test the effects of introduction format, camera focus and their interaction. RESULTS The audiovisual introduction induced a stronger blood pressure response during watching the introduction (p = 0.048, [Formula: see text]= 0.05) and the consultation part of the vignette (p = 0.051, [Formula: see text]= 0.05), when compared to the written introduction. With respect to camera focus, results revealed that the variant focusing on the patient at emotional moments evoked a higher level of electrodermal activity (p = 0.003, [Formula: see text]= 0.06), when compared to the other two variants. Furthermore, an interaction effect was shown on self-reported emotional engagement (p = 0.045, [Formula: see text]= 0.04): the physician-only variant resulted in lower emotional engagement if the vignette was preceded by the audiovisual introduction. No effects were shown on the other dimensions of self-reported engagement. CONCLUSIONS Our findings imply that using an audiovisual introduction combined with alternating camera focus depicting patient's emotions results in the highest levels of emotional engagement in analogue patients. This evidence can inform methodological decisions during the development of video vignettes, and thereby enhance the ecological validity of future video-vignettes studies.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands.
| | - Nadine Bol
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Mathilde G E Verdam
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands
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Nguyen MH, Smets EMA, Bol N, Loos EF, Van Weert JCM. How Tailoring the Mode of Information Presentation Influences Younger and Older Adults' Satisfaction with Health Websites. JOURNAL OF HEALTH COMMUNICATION 2018; 23:170-180. [PMID: 29345531 DOI: 10.1080/10810730.2017.1421729] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although older adults are increasingly using online health information, many websites are not senior-friendly, which might lead to user-problems and dissatisfaction among older people. It has been suggested that websites targeted at older adults should take into account age-related abilities and limitations, for example by providing the opportunity to adjust the modality (i.e., "mode") of information presentation based on visual and auditory capabilities. This study investigates the effects of a mode-tailored website, allowing users to self-tailor the mode of information presentation, on younger and older adults' satisfaction with health websites. The results from a 5 (condition: tailored vs. text, text with visuals, text with audiovisual, combination) × 2 (age: younger [25-45] vs. older [≥ 65] adults) experimental study (N = 563) show that mode tailoring positively influenced satisfaction with the attractiveness and comprehensibility of the website, as compared to non-tailored conditions. These effects on website satisfaction were not different for younger and older adults. The current study provides relevant insights for researchers and practitioners in the field of digital health communication.
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Affiliation(s)
- Minh Hao Nguyen
- a Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- b Department of Medical Psychology, Academic Medical Center , University of Amsterdam, Amsterdam, The Netherlands
| | - Nadine Bol
- a Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Eugène F Loos
- a Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M Van Weert
- a Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
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Bientzle M, Fissler T, Cress U, Kimmerle J. The impact of physicians' communication styles on evaluation of physicians and information processing: A randomized study with simulated video consultations on contraception with an intrauterine device. Health Expect 2017; 20:845-851. [PMID: 27860037 PMCID: PMC5600216 DOI: 10.1111/hex.12521] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed at examining the impact of different types of physicians' communication styles on people's subsequent evaluation of physician attributes as well as on their information processing, attitude and decision making. METHOD In a between-group experiment, 80 participants watched one of three videos in which a gynaecologist displayed a particular communication style in a consultation situation on contraception with an intrauterine device. We compared doctor-centred communication (DCC) vs patient-centred communication (PCC) vs patient-centred communication with need-orientation (PCC-N). RESULTS In the PCC condition, participants perceived the physician to be more empathetic and more competent than in the DCC condition. In the DCC condition, participants showed less attitude change compared to the other conditions. In the PCC-N condition, the physician was perceived as more empathetic and more socially competent than in the other conditions. However, participants acquired less knowledge in the PCC-N condition. CONCLUSION We conclude that appropriate application of particular communication styles depends on specific consultation goals. Our results suggest that patients' needs should be addressed if the main goal is to build a good relationship, whereas a traditional PCC style appears to be more effective in communicating factual information.
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Affiliation(s)
| | - Tim Fissler
- Leibniz‐Institut fuer WissensmedienTuebingenGermany
| | - Ulrike Cress
- Leibniz‐Institut fuer WissensmedienTuebingenGermany
- Department of PsychologyUniversity of TuebingenTuebingenGermany
| | - Joachim Kimmerle
- Leibniz‐Institut fuer WissensmedienTuebingenGermany
- Department of PsychologyUniversity of TuebingenTuebingenGermany
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van Osch M, van Dulmen S, van Vliet L, Bensing J. Specifying the effects of physician's communication on patients' outcomes: A randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:1482-1489. [PMID: 28318845 DOI: 10.1016/j.pec.2017.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain. METHODS Using a 2×2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants' outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed. RESULTS Positive affect-oriented communication reduced anxiety (p<0.001), negative mood (p=0.001), and increased satisfaction (p<0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p<0.001) and outcome expectancies (p<0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p=0.02), increased outcome expectancies (p=0.01) and satisfaction (p=0.001). CONCLUSION Being empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients' outcomes for the best. PRACTICE IMPLICATIONS Continued medical training is needed to harness placebo-effects of medical communication into practice.
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Affiliation(s)
- Mara van Osch
- NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Faculty of Health Science, University College of Southeast Norway, PO Box 7053, NO-3007 Drammen, Norway.
| | - Liesbeth van Vliet
- NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Jozien Bensing
- NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands
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Medendorp NM, Visser LNC, Hillen MA, de Haes JCJM, Smets EMA. How oncologists' communication improves (analogue) patients' recall of information. A randomized video-vignettes study. PATIENT EDUCATION AND COUNSELING 2017; 100:1338-1344. [PMID: 28233585 DOI: 10.1016/j.pec.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Cancer patients need information provision to cope with their disease. However, only 20-60% of information provided during consultations is remembered. This study aimed to investigate whether oncologists' use of trust-conveying communication, characterized by communicating competence, honesty and caring, enhances patients' memory. Moreover, we aimed to investigate if this hypothetical relationship is mediated by a reduction in psychophysiological arousal during the consultation. METHODS An experimental design was used, allowing for conclusion about causality. Two versions of a scripted video-taped consultation were used in which the oncologist adopted either a standard or a trust-conveying communication style. 97 cancer-naive individuals acted as analogue patients and were randomly assigned to watch one of the consultations. RESULTS Free recall, assessed 24-28h after viewing, was higher (p=0.039) in the trust-conveying condition (65.3% versus 59.5%). Recognition did not differ (p=0.502). Psychophysiological assessment during watching showed a smaller heart rate response in the trust-conveying condition (p=0.037). No mediation effect nor an effect on electrodermal activity was found. CONCLUSION These results suggest that oncologists' use of trust-conveying communication could increase patients' free recall of information and diminish their cardiovascular response. PRACTICE IMPLICATIONS The underlying mechanisms by which oncologists' communication influences information recall warrants further investigation.
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Affiliation(s)
- N M Medendorp
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - L N C Visser
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
| | - M A Hillen
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - J C J M de Haes
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Kraft-Todd GT, Reinero DA, Kelley JM, Heberlein AS, Baer L, Riess H. Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context. PLoS One 2017; 12:e0177758. [PMID: 28505180 PMCID: PMC5432110 DOI: 10.1371/journal.pone.0177758] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/03/2017] [Indexed: 01/10/2023] Open
Abstract
In medicine, it is critical that clinicians demonstrate both empathy (perceived as warmth) and competence. Perceptions of these qualities are often intuitive and are based on nonverbal behavior. Emphasizing both warmth and competence may prove problematic, however, because there is evidence that they are inversely related in other settings. We hypothesize that perceptions of physician competence will instead be positively correlated with perceptions of physician warmth and empathy, potentially due to changing conceptions of the physician’s role. We test this hypothesis in an analog medical context using a large online sample, manipulating physician nonverbal behaviors suggested to communicate empathy (e.g. eye contact) and competence (the physician’s white coat). Participants rated physicians displaying empathic nonverbal behavior as more empathic, warm, and more competent than physicians displaying unempathic nonverbal behavior, adjusting for mood. We found no warmth/competence tradeoff and, additionally, no significant effects of the white coat. Further, compared with male participants, female participants perceived physicians displaying unempathic nonverbal behavior as less empathic. Given the significant consequences of clinician empathy, it is important for clinicians to learn how nonverbal behavior contributes to perceptions of warmth, and use it as another tool to improve their patients’ emotional and physical health.
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Affiliation(s)
- Gordon T. Kraft-Todd
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Diego A. Reinero
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, New York University, New York, New York, United States of America
| | - John M. Kelley
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Endicott College, Beverly, Massachusetts, United States of America
| | - Andrea S. Heberlein
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Lee Baer
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
| | - Helen Riess
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
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Zwingmann J, Baile WF, Schmier JW, Bernhard J, Keller M. Effects of patient-centered communication on anxiety, negative affect, and trust in the physician in delivering a cancer diagnosis: A randomized, experimental study. Cancer 2017; 123:3167-3175. [PMID: 28378366 DOI: 10.1002/cncr.30694] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/19/2017] [Accepted: 03/06/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND When bad news about a cancer diagnosis is being delivered, patient-centered communication (PCC) has been considered important for patients' adjustment and well-being. However, few studies have explored how interpersonal skills might help cancer patients cope with anxiety and distress during bad-news encounters. METHODS A prospective, experimental design was used to investigate the impact of the physician communication style during a bad-news encounter. Ninety-eight cancer patients and 92 unaffected subjects of both sexes were randomly assigned to view a video of a clinician delivering a first cancer diagnosis with either an enhanced patient-centered communication (E-PCC) style or a low patient-centered communication (L-PCC) style. Participants rated state anxiety and negative affect before and immediately after the video exposure, whereas trust in the physician was rated after the video exposure only. Main and interaction effects were analyzed with generalized linear models. RESULTS Viewing the disclosure of a cancer diagnosis resulted in a substantial increase in state anxiety and negative affect among all participants. This emotional response was moderated by the physician's communication style: Participants viewing an oncologist displaying an E-PCC style were significantly less anxious than those watching an oncologist displaying an L-PCC style. They also reported significantly higher trust in the physician. CONCLUSIONS Under a threatening, anxiety-provoking disclosure of bad news, a short sequence of empathic PCC influences subjects' psychological state, insofar that they report feeling less anxious and more trustful of the oncologist. Video exposure appears to be a valuable method for investigating the impact of a physician's communication style during critical encounters. Cancer 2017;123:3167-75. © 2017 American Cancer Society.
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Affiliation(s)
- Jelena Zwingmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter F Baile
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Faculty and Academic Development, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Johann W Schmier
- Hematology, Oncology, and Rheumatology, Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürg Bernhard
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Monika Keller
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Burt J, Abel G, Elmore N, Lloyd C, Benson J, Sarson L, Carluccio A, Campbell J, Elliott MN, Roland M. Understanding negative feedback from South Asian patients: an experimental vignette study. BMJ Open 2016; 6:e011256. [PMID: 27609844 PMCID: PMC5020840 DOI: 10.1136/bmjopen-2016-011256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care. DESIGN Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP-patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16. SETTING Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling. PARTICIPANTS 564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach. MAIN OUTCOME MEASURE Mean differences in communication score (on a scale of 0-100) between White British and Pakistani participants, estimated from linear regression. RESULTS Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor. CONCLUSIONS Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gary Abel
- University of Exeter Medical School, Exeter, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Bolle S, Romijn G, Smets EMA, Loos EF, Kunneman M, van Weert JCM. Older Cancer Patients' User Experiences With Web-Based Health Information Tools: A Think-Aloud Study. J Med Internet Res 2016; 18:e208. [PMID: 27457709 PMCID: PMC4977420 DOI: 10.2196/jmir.5618] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/13/2016] [Accepted: 06/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients.
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Affiliation(s)
- Sifra Bolle
- Amsterdam School of Communication Research/ ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands.
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Hillen MA, de Haes HCJM, van Tienhoven G, van Laarhoven HWM, van Weert JCM, Vermeulen DM, Smets EMA. Oncologists' non-verbal behavior and analog patients' recall of information. Acta Oncol 2016; 55:671-9. [PMID: 27031166 DOI: 10.3109/0284186x.2015.1120884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Information in oncological consultations is often excessive. Those patients who better recall information are more satisfied, less anxious and more adherent. Optimal recall may be enhanced by the oncologist's non-verbal communication. We tested the influence of three non-verbal behaviors, i.e. eye contact, body posture and smiling, on patients' recall of information and perceived friendliness of the oncologist. Moreover, the influence of patient characteristics on recall was examined, both directly or as a moderator of non-verbal communication. Material and methods Non-verbal communication of an oncologist was experimentally varied using video vignettes. In total 194 breast cancer patients/survivors and healthy women participated as 'analog patients', viewing a randomly selected video version while imagining themselves in the role of the patient. Directly after viewing, they evaluated the oncologist. From 24 to 48 hours later, participants' passive recall, i.e. recognition, and free recall of information provided by the oncologist were assessed. Results Participants' recognition was higher if the oncologist maintained more consistent eye contact (β = 0.17). More eye contact and smiling led to a perception of the oncologist as more friendly. Body posture and smiling did not significantly influence recall. Older age predicted significantly worse recognition (β = -0.28) and free recall (β = -0.34) of information. Conclusion Oncologists may be able to facilitate their patients' recall functioning through consistent eye contact. This seems particularly relevant for older patients, whose recall is significantly worse. These findings can be used in training, focused on how to maintain eye contact while managing computer tasks.
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Affiliation(s)
- Marij A. Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geertjan van Tienhoven
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C. M. van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle M. Vermeulen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van Bruinessen IR, van den Ende ITA, Visser LNC, van Dulmen S. The impact of watching educational video clips on analogue patients' physiological arousal and information recall. PATIENT EDUCATION AND COUNSELING 2016; 99:243-249. [PMID: 26427309 DOI: 10.1016/j.pec.2015.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/21/2015] [Accepted: 08/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Investigating the influence of watching three educational patient-provider interactions on analogue patients' emotional arousal and information recall. METHODS In 75 analogue patients the emotional arousal was measured with physiological responses (electrodermal activity and heart rate) and self-reported arousal. RESULTS A moderate increased level of physiological arousal was measured but not too much to inflict emotional distress. Recall of information was within the pursued range. CONCLUSION Hence, physiological arousal is not expected to hinder the goals we pursue with our online intervention. PRACTICE IMPLICATIONS Still, developers and researchers should remain attentive to the self-reported (conscious) and hidden (subconscious) emotions evoked by the content of educational video clips presented in self-help interventions. A moderate increased level of arousal is preferred to increase the learning capacity. However, too much arousal may decrease the learning capacity and may cause distress, which should obviously be avoided for ethical reasons.
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Affiliation(s)
- I R van Bruinessen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | - I T A van den Ende
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - L N C Visser
- AMC Medical Research, Academic Medical Center/University of Amsterdam, The Netherlands
| | - S van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
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Visser LNC, Hillen MA, Verdam MGE, Bol N, de Haes HCJM, Smets EMA. Assessing engagement while viewing video vignettes; validation of the Video Engagement Scale (VES). PATIENT EDUCATION AND COUNSELING 2016; 99:227-235. [PMID: 26395312 DOI: 10.1016/j.pec.2015.08.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/13/2015] [Accepted: 08/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES In health communication research using video vignettes, it is important to assess viewers' engagement. Engagement scores can indicate ecological validity of the design, and help distinguish between different engagement types. Therefore, we aimed to develop and validate a scale assessing viewers' engagement with video vignettes. METHODS Based on an existing question set, the 15-item, five-dimensional Video Engagement Scale (VES) was developed. The VES was validated in two video-vignettes studies to investigate patient-physician communication. In addition to engagement, we assessed its presumed correlates, e.g., perceived realism of the video and identification with the patient. RESULTS Internal consistency and test-retest reliability were adequate in both studies (N=181 and N=228). Positive correlations between the VES and perceived realism of the video, credibility of and identification with the patient suggested good content validity. Confirmatory factor analysis suggested a four-dimensional model fit, largely resembling our hypothesized model. CONCLUSIONS The VES reliably and validly measures viewers' engagement in health communication research using video vignettes. It can be employed to assess ecological validity of this design. Further testing of the scale is needed to more solidly establish its dimensionality. PRACTICE IMPLICATIONS We recommend that researchers use the VES, to ensure ecological validity of future video-vignettes studies.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mathilde G E Verdam
- Department of Medical Psychology-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Nadine Bol
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Gordon HS, Street RL. How Physicians, Patients, and Observers Compare on the Use of Qualitative and Quantitative Measures of Physician-Patient Communication. Eval Health Prof 2016; 39:496-511. [PMID: 26755527 DOI: 10.1177/0163278715625737] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to compare several different measures of physician-patient communication. We compared data derived from different measures of three communication behaviors, patient participation, physician information giving, and physician participatory decision-making (PDM) style, from 83 outpatient visits to oncology or thoracic surgery clinics for pulmonary nodules or lung cancer. Communication was measured with rating scales completed by patients and physicians after the consultation and by two different groups of external observers who used rating scales or coded the frequency of communication behaviors, respectively, after listening to an audio recording of the consultation. Measures were compared using Pearson's correlations. Correlations of patients' and physicians' ratings of patient participation (r = .04) and physician PDM style (r = .03) were low and not significant (p > .0083, Bonferroni-adjusted). Correlations of observers' ratings with patients' or physicians' ratings for patient participation and physician PDM style were moderate or low (r = .15, .27, .07, and .01, respectively) but were not statistically significant (p > .0083, Bonferroni-adjusted). Correlations between observers' ratings and frequency measures were .31, .52, and .63 and were statistically significant with p values .005, <.0001, and <.0001, respectively, for PDM style, information giving, and patient participation. Our findings highlight the potential for using observers' ratings as an alternate measure of communication to more labor intensive frequency measures.
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Affiliation(s)
- Howard S Gordon
- Jesse Brown Veterans Affairs (VA) Medical Center, Chicago, IL, USA .,VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA.,Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA.,Center for Health Care Quality and Utilization Studies, Baylor College of Medicine, Houston, TX, USA
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Porensky EK, Carpenter BD. Breaking bad news: Effects of forecasting diagnosis and framing prognosis. PATIENT EDUCATION AND COUNSELING 2016; 99:68-76. [PMID: 26238257 DOI: 10.1016/j.pec.2015.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Research to support guidelines for breaking bad news is lacking. This study used an experimental paradigm to test two communication strategies, forecasting bad news and framing prognosis, in the context of cancer. METHODS In a 2×2 design, 128 participants received bad news in a hypothetical consultation. A videotaped physician presented diagnostic and prognostic information, varying warning (warning shot vs. no warning), and framing (positive vs. negative). Effects on psychological distress, recall accuracy, and subjective interpretations of the news were assessed. RESULTS Warning was not associated with lower psychological distress or improved recall. Individuals who heard a positively-framed prognosis had significantly less psychological distress, rated their prognosis better, and were more hopeful than those who heard a negatively-framed prognosis. However, they also showed a trend toward reduced accuracy in recalling prognostic statistics. CONCLUSIONS Results contribute to a growing body of literature exploring optimal approaches for communicating bad news in health care. PRACTICE IMPLICATIONS Although research in clinical settings is needed to bolster results, findings suggest that when providers use positive framing to reduce distress about prognosis, they should also consider ways to overcome potential reductions in recall accuracy, such as repeating statistical information or supplementing with written information.
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Affiliation(s)
- Emily K Porensky
- Department of Psychology, Washington University in St. Louis, St. Louis, USA.
| | - Brian D Carpenter
- Department of Psychology, Washington University in St. Louis, St. Louis, USA
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Rimondini M, Mazzi MA, Deveugele M, Bensing JM. How do national cultures influence lay people's preferences toward doctors' style of communication? A comparison of 35 focus groups from an European cross national research. BMC Public Health 2015; 15:1239. [PMID: 26666340 PMCID: PMC4678640 DOI: 10.1186/s12889-015-2559-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 12/02/2015] [Indexed: 12/30/2022] Open
Abstract
Background The evidence that inspires and fosters communication skills, teaching programmes and clinical recommendations are often based on national studies which assume, implicitly, that patients’ preferences towards doctors’ communication style are not significantly affected by their cultural background. The cross-cultural validity of national results has been recognized as a potential limitation on how generally applicable they are in a wider context. Using 35 country-specific focus group discussions from four European countries, the aim of the present study is to test whether or not national cultures influence lay people’s preferences towards doctors’ style of communication. Methods Lay people preferences on doctor’s communication style have been collected in Belgium, the Netherlands, the United Kingdom and Italy. Each centre organized between eight and nine focus groups, where participants (n = 259) were asked to comment on a video of a simulated medical interview. The discussions were audiotaped, transcribed and coded using a common framework (Guliver Coding System) that allowed for the identification of different themes. Results The frequency distribution of the topics discussed highlights lay people’s generally positive views towards most part of doctors interventions. The regression model applied to the Guliver categories highlighted slight national differences and the existence of a cross-cultural appreciation, in particular, of five types of intervention: Doctors attitudes (both Task-Oriented and Affective/Emotional), Summarizing, Structuring and Providing solution. Conclusion Lay panels valued doctors’ communication style in a similar manner in the countries selected. This highlights the existence of a common background, which in the process of internationalization of heath care, might foster the implementation of cross-national teaching programmes and clinical guidelines.
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Affiliation(s)
- Michela Rimondini
- Department of Public Health and Community Medicine, University of Verona, P.le LA Scuro 10-, 37100, Verona, Italy. .,Policlinico G.B.Rossi, UO Psicosomatica e Psicologia Clinica, P.le LA Scuro 10-, 37100, Verona, Italy. .,Section of Clinical Psychology, Department of Neurological,Biomedical and Movement Sciences, University of Verona, Verona, 37100, Italy.
| | - Maria Angela Mazzi
- Department of Public Health and Community Medicine, University of Verona, P.le LA Scuro 10-, 37100, Verona, Italy. .,Policlinico G.B.Rossi, UO Psicosomatica e Psicologia Clinica, P.le LA Scuro 10-, 37100, Verona, Italy. .,Section of Clinical Psychology, Department of Neurological,Biomedical and Movement Sciences, University of Verona, Verona, 37100, Italy.
| | - Myriam Deveugele
- Department of General Practice and Primary Health Care, Ghent University, De Pintelaan 185 6K3, 9000, Gent, Belgium.
| | - Jozien M Bensing
- NIVEL (Netherlands Institute for Health Services Research), Utrecht University, Otterstraat 118-124, 3513, CR, Utrecht, The Netherlands. .,Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.
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Hillen MA, de Haes HCJM, van Tienhoven G, Bijker N, van Laarhoven HWM, Vermeulen DM, Smets EMA. All eyes on the patient: the influence of oncologists' nonverbal communication on breast cancer patients' trust. Breast Cancer Res Treat 2015; 153:161-71. [PMID: 26227472 PMCID: PMC4536267 DOI: 10.1007/s10549-015-3486-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022]
Abstract
Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients’ trust. We were the first to experimentally examine (1) how the oncologist’s nonverbal behavior influences trust, and (2) individual differences in breast cancer patients’ trust. Analogue patients (APs) viewed one out of eight versions of a video vignette displaying a consultation about chemotherapy treatment. All eight versions varied only in the oncologist’s amount of eye contact (consistent vs. inconsistent), body posture (forward leaning vs. varying), and smiling (occasional smiling vs. no smiling). Primary outcome was trust in the observed oncologist (Trust in Oncologist Scale). 214 APs participated. Consistent eye contact led to stronger trust (β = −.13, p = .04). This effect was largely explained by lower educated patients, for whom the effect of consistent eye contact was stronger than for higher educated patients (β = .18, p = .01). A forward leaning body posture did not influence trust, nor did smiling. However, if the oncologist smiled more, he was perceived as more friendly (rs = .31, p < .001) and caring (rs = .18, p = .01). Older (β = .17, p = .01) and lower educated APs (β = −.25, p < .001) were more trusting. Trust was weaker for more avoidantly attached APs (β = −.16, p = .03). We experimentally demonstrated the importance of maintaining consistent eye contact for breast cancer patients’ trust, especially among lower educated patients. These findings need to be translated into training for oncologists in how to optimize their nonverbal communication with breast cancer patients while simultaneously managing increased time pressure and computer use during the consultation.
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Affiliation(s)
- Marij A Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Leone D, Lamiani G, Vegni E, Larson S, Roter DL. Error disclosure and family members' reactions: does the type of error really matter? PATIENT EDUCATION AND COUNSELING 2015; 98:446-452. [PMID: 25630608 DOI: 10.1016/j.pec.2014.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/03/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe how Italian clinicians disclose medical errors with clear and shared lines of responsibility. METHODS Thirty-eight volunteers were video-recorded in a simulated conversation while communicating a medical error to a simulated family member (SFM). They were assigned to a clear responsibility error scenario or a shared responsibility one. Simulations were coded for: mention of the term "error" and apology; communication content and affect using the Roter Interaction Analysis System. SFMs rated their willingness to have the patient continue care with the clinician. RESULTS Clinicians referred to an error and/or apologized in 55% of the simulations. The error was disclosed more frequently in the clear responsibility scenario (p<0.02). When the "error" was explicitly mentioned, the SFM was more attentive, sad and anxious (p≤0.05) and less willing to have the patient continue care (p<0.05). Communication was more patient-centered (p<0.05) and affectively dynamic with the SFMs showing greater anxiety, sadness, attentiveness and respectfulness in the clear responsibility scenario (p<0.05). CONCLUSIONS Disclosing errors is not a common practice in Italy. Clinicians disclose less frequently when responsibility is shared and indicative of a system failure. PRACTICE IMPLICATIONS Training programs to improve disclosure practice considering the type of error committed should be implemented.
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Affiliation(s)
- Daniela Leone
- Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy.
| | - Giulia Lamiani
- Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy.
| | - Elena Vegni
- Department of Health Science, University of Milan, San Paolo University Hospital, Milan, Italy.
| | - Susan Larson
- Department of Public Health, John Hopkins University, Baltimore, USA.
| | - Debra L Roter
- Department of Public Health, John Hopkins University, Baltimore, USA.
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Abstract
OBJECTIVE Despite the availability of several effective treatments, many children with ADHD do not receive adequate services. A variety of factors may influence help-seeking behavior among families of children with ADHD. This study explores two factors that may influence help-seeking decisions: knowledge and misconceptions of ADHD and treatment acceptability. METHOD A total of 196 participants completed measures of ADHD knowledge and use of information sources prior to rating the acceptability of two interventions: stimulant medication and sugar elimination diets. RESULTS Higher levels of ADHD misconceptions were associated with lower acceptance of medication and higher acceptance of dietary interventions. However, analysis of individual misconceptions suggests that specific misconceptions are differentially related to perceptions of individual treatments. CONCLUSION It may be important for clinicians to assess and deliberately target specific misconceptions as part of treatment for ADHD.
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Shin DW, Roter DL, Roh YK, Hahm SK, Cho B, Park HK. Physician gender and patient centered communication: the moderating effect of psychosocial and biomedical case characteristics. PATIENT EDUCATION AND COUNSELING 2015; 98:55-60. [PMID: 25457177 DOI: 10.1016/j.pec.2014.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/02/2014] [Accepted: 10/11/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Female physicians have a more patient-centered communication style than their male counterparts; however, few studies have investigated how the biomedical or psychosocial nature of a patient diagnosis might moderate this relationship. METHODS Seventy six 3rd year residents (50 male and 26 females) seeking board certification from the Korean Academy of Family Medicine participated in the 2013 Clinical Practice Examination by conducting two simulated patient (SP) interviews, one presenting a largely psychosocial case and the other largely biomedical. The interview recordings were coded with the Roter Interaction Analysis System (RIAS). RESULTS Female physicians and their SPs engaged in more dialog than male physicians in both cases. Female physicians were more patient-centered than males for the psychosocial case (t = -3.24, P < 0.05), however, their scores did not differ for the biomedical case. In multivariate analysis, a significant interaction between physician gender and case (z = -3.90, P < 0.001) similarly demonstrated greater female patient-centeredness only for the predominantly psychosocial case. CONCLUSION Case characteristics moderated the association between physician gender and patient-centeredness. PRACTICE IMPLICATIONS Case characteristics need to be considered in future research on the association of physician gender and the patient-centered communication, as well as in the tailoring of physician communication training.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea; Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Republic of Korea.
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Yong Kyun Roh
- Department of Family Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea.
| | - Sang Keun Hahm
- Department of Family Medicine & Health Promotion Center, KEPCO Medical Center, Seoul, Republic of Korea.
| | - BeLong Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea; Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Republic of Korea.
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Medical Education, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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Street RL, Liu L, Farber NJ, Chen Y, Calvitti A, Zuest D, Gabuzda MT, Bell K, Gray B, Rick S, Ashfaq S, Agha Z. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. PATIENT EDUCATION AND COUNSELING 2014; 96:315-9. [PMID: 24882086 PMCID: PMC4339111 DOI: 10.1016/j.pec.2014.05.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. METHODS Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. RESULTS The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. CONCLUSIONS PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously managing data in the EHR. PRACTICE IMPLICATIONS EHR activity consumes an increasing proportion of clinicians' time during consultations. To ensure effective communication with their patients, clinicians may benefit from using communication strategies that maintain the flow of conversation when working with the computer, as well as from learning EHR management skills that prevent extended periods of gaze at computer and long periods of silence. Next-generation EHR design must address better usability and clinical workflow integration, including facilitating patient-clinician communication.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Department of Medicine, Baylor College of Medicine, Houston, USA; Houston VA Center for Innovations in Quality, Effectiveness and Safety, USA.
| | - Lin Liu
- Department of Family and Preventive Medicine, University of California, San Diego USA
| | - Neil J Farber
- Department of Medicine, University of California, San Diego USA
| | - Yunan Chen
- Department of Informatics, University of California, Irvine, USA
| | | | | | - Mark T Gabuzda
- Department of Medicine, University of California, San Diego USA
| | - Kristin Bell
- Department of Internal Medicine, VA San Diego Health Care System, USA
| | - Barbara Gray
- Veterans Medical Research Foundation, VASDHS, USA
| | - Steven Rick
- Veterans Medical Research Foundation, VASDHS, USA
| | | | - Zia Agha
- Department of Medicine, University of California, San Diego USA; West Health Policy Center, West Health Institute, San Diego, California, USA
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Hall JA, Roter DL, Blanch-Hartigan D, Mast MS, Pitegoff CA. How patient-centered do female physicians need to be? Analogue patients' satisfaction with male and female physicians' identical behaviors. HEALTH COMMUNICATION 2014; 30:894-900. [PMID: 25175277 DOI: 10.1080/10410236.2014.900892] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Previous research suggests that female physicians may not receive appropriate credit in patients' eyes for their patient-centered skills compared to their male counterparts. An experiment was conducted to determine whether a performance of higher (versus lower) verbal patient-centeredness would result in a greater difference in analogue patient satisfaction for male than female physicians. Two male and two female actors portrayed physicians speaking to a patient using high or low patient-centered scripts while not varying their nonverbal cues. One hundred ninety-two students served as analogue patients by assuming the patient role while watching one of the videos and rating their satisfaction and other evaluative responses to the physician. Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians. This pattern is consistent with the hypothesis that the different associations between patient-centeredness and patients' satisfaction for male versus female physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care. If this is the case, high verbal patient-centered behavior by female physicians is not recognized as a marker of clinical competence, as it is for male physicians, but is rather seen as expected female behavior.
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Affiliation(s)
- Judith A Hall
- a Department of Psychology , Northeastern University
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Hillen MA, de Haes HCJM, Verdam MGE, Smets EMA. Does source of patient recruitment affect the impact of communication on trust? PATIENT EDUCATION AND COUNSELING 2014; 95:226-230. [PMID: 24534265 DOI: 10.1016/j.pec.2014.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 12/20/2013] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate how comparable outcomes of medical communication research are when using different patient accrual methods by comparing cancer patients organization members with outpatient clinic patients. METHODS In an experimental video-vignettes study, the impact of oncologist communication on trust was tested. Background characteristics (socio-demographics, trait anxiety, health locus of control and attachment style), reported trust, and the impact of communication on trust were compared between the two groups. RESULTS Cancer patient organization members (n=196) were younger and higher educated than clinical patients (n=148). Members felt more personal control over their health (p<.01) but were also more anxious (p<.05). They reported lower trust in general health care (p<.05), in their own oncologist (p<.001) and in the oncologist in the videos (p<.05). The impact of oncologist communication on trust was similar for both groups. CONCLUSIONS Despite considerable differences in trust levels, both groups appear equally affected by oncologist communication. Thus, although including cancer patient organization members may impact the generalizability of some findings, using these participants to investigate communication appears justified. PRACTICE IMPLICATIONS Cancer patient organization members may regard their oncologist more critically. Research including both members and patients recruited through hospital clinics could take group membership into account as a possible confounder. Nonetheless, communicating competence, honesty and caring may benefit the relation with these patients similarly as with other patients.
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Affiliation(s)
- Marij A Hillen
- Department of Medical Psychology - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Hanneke C J M de Haes
- Department of Medical Psychology - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mathilde G E Verdam
- Department of Medical Psychology - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Hillen MA, de Haes HCJM, Stalpers LJA, Klinkenbijl JHG, Eddes EH, Butow PN, van der Vloodt J, van Laarhoven HWM, Smets EMA. How can communication by oncologists enhance patients' trust? An experimental study. Ann Oncol 2014; 25:896-901. [PMID: 24615411 DOI: 10.1093/annonc/mdu027] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Cancer patients need to trust their oncologist to embark in the process of oncologic treatment. Yet, it is unclear how oncologist communication contributes to such trust. The aim of this study was to investigate the effect of three elements of oncologists' communication on cancer patients' trust: conferring competence, honesty, and caring. METHODS Eight videotaped consultations, 'vignettes', were created, reflecting an encounter between an oncologist and a patient with colorectal cancer. All vignettes were identical, except for small variations in the oncologist's verbal communication. Cancer patients (n = 345) were randomly assigned to viewing two vignettes, asked to identify with the patient and afterwards to rate their trust in the observed oncologist. The effects of competence, honesty, and caring on trust were established with multilevel analysis. RESULTS Oncologist's enhanced expression of competence (β = 0.17, 95% CI 0.08, 0.27; P < 0.001), honesty (β = 0.30, 95% CI 0.20, 0.40; P < 0.001), as well as caring (β = 0.36, 95% CI 0.26, 0.46; P < 0.001) resulted in significantly increased trust. Communication of honesty and caring also increased patients' expectation of operation success and reported willingness to recommend the oncologist. CONCLUSION(S) As hypothesized, oncologists can influence their patients' trust by enhanced conveyance of their level of competence, honesty, and caring. Caring behavior has the strongest impact on trust. These findings can be translated directly into daily clinical practice as well as in communication skills training.
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Affiliation(s)
| | | | | | - J H G Klinkenbijl
- Surgery, Academic Medical Center, University of Amsterdam, Amsterdam
| | - E H Eddes
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | - P N Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED) - School of Psychology, University of Sydney, Sydney, Australia
| | | | - H W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Sep MSC, van Osch M, van Vliet LM, Smets EMA, Bensing JM. The power of clinicians' affective communication: how reassurance about non-abandonment can reduce patients' physiological arousal and increase information recall in bad news consultations. An experimental study using analogue patients. PATIENT EDUCATION AND COUNSELING 2014; 95:45-52. [PMID: 24485947 DOI: 10.1016/j.pec.2013.12.022] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/29/2013] [Accepted: 12/29/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The diagnosis of incurable cancer may evoke physiological arousal in patients. Physiological arousal can negatively impact patients' recall of information provided in the medical consultation. We aim to investigate whether clinicians' affective communication during a bad news consultation will decrease patients' physiological arousal and will improve recall. METHODS Healthy women (N=50), acting as analogue patients, were randomly assigned to watch one out of the two versions of a scripted video-vignette of a bad news consultation in which clinician's communication differed: standard vs. affective communication. Participants' skin conductance levels were obtained during video-watching, and afterwards their recall was assessed. RESULTS While the diagnosis increased skin conductance levels in all analogue patients, skin conductance levels during the remainder of the consultation decreased more in the affective communication condition than in the standard condition. Analogue patients' recall was significantly higher in the affective condition. CONCLUSION Breaking bad news evokes physiological arousal. Affective communication can decrease this evoked physiological arousal and might be partly responsible for analogue patients' enhanced information recall. PRACTICE IMPLICATIONS Although our findings need to be translated to clinical patients, they suggest that clinicians need to deal with patients' emotions before providing additional medical information.
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Affiliation(s)
- Milou S C Sep
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mara van Osch
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Liesbeth M van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Jozien M Bensing
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
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76
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Hostile Sexist Male Patients and Female Doctors: A Challenging Encounter. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 7:37-45. [DOI: 10.1007/s40271-013-0025-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bol N, Smets EMA, Rutgers MM, Burgers JA, de Haes HCJM, Loos EF, van Weert JCM. Do videos improve website satisfaction and recall of online cancer-related information in older lung cancer patients? PATIENT EDUCATION AND COUNSELING 2013; 92:404-412. [PMID: 23820196 DOI: 10.1016/j.pec.2013.06.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/22/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study investigated the effects of personalized audiovisual information in addition to text on website satisfaction and recall of cancer-related online information in older lung cancer patients. METHODS An experiment using a 3 (condition: text only vs. text with nonpersonalized video vs. text with personalized video) by 2 (age patient: younger [<65 yrs] vs. older [≥65 yrs]) between-subjects factorial design was conducted. Patients were randomly assigned to one of the three information conditions stratified by age group. RESULTS Patients were more satisfied with the comprehensibility, attractiveness, and the emotional support from the website when information was presented as text with personalized video compared to text only. Text with personalized video also outperformed text with nonpersonalized video regarding emotional support from the website. Furthermore, text with video improved patients' recall of cancer-related information as compared to text only. Older patients recalled less information correctly than younger patients, except when we controlled for Internet use. CONCLUSION Text with personalized audiovisual information can enhance website satisfaction and information recall. Internet use plays an important role in explaining recall of information. PRACTICE IMPLICATIONS The results of this study can be used to develop effective health communication materials for cancer patients.
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Affiliation(s)
- Nadine Bol
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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78
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Cousin G, Schmid Mast M, Jaunin-Stalder N. When physician-expressed uncertainty leads to patient dissatisfaction: a gender study. MEDICAL EDUCATION 2013; 47:923-931. [PMID: 23931541 DOI: 10.1111/medu.12237] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/21/2013] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Communication guidelines often advise physicians to disclose to their patients medical uncertainty regarding the diagnosis, origin of the problem, and treatment. However, the effect of the expression of such uncertainty on patient outcomes (e.g. satisfaction) has produced conflicting results in the literature that indicate either no effect or a negative effect. The differences in the results of past studies may be explained by the fact that potential gender effects on the link between physician-expressed uncertainty and patient outcomes have not been investigated systematically. OBJECTIVES On the basis of previous research documenting indications that patients may judge female physicians by more severe criteria than they do male physicians, and that men are more prejudiced than women towards women, we predicted that physician-expressed uncertainty would have more of a negative impact on patient satisfaction when the physician in question was female rather than male, and especially when the patient was a man. METHODS We conducted two studies with complementary designs. Study 1 was a randomised controlled trial conducted in a simulated setting (120 analogue patients Analogue patients are healthy participants asked to put themselves in the shoes of real medical patients by imagining being the patients of physicians shown on videos); Study 2 was a field study conducted in real medical interviews (36 physicians, 69 patients). In Study 1, participants were presented with vignettes that varied in terms of the physician's gender and physician-expressed uncertainty (high versus low). In Study 2, physicians were filmed during real medical consultations and the level of uncertainty they expressed was coded by an independent rater according to the videos. In both studies, patient satisfaction was assessed using a questionnaire. RESULTS The results confirmed that expressed uncertainty was negatively related to patient satisfaction only when the physician was a woman (Studies 1 and 2) and when the patient was a man (Study 2). CONCLUSIONS We believe that patients have the right to be fully informed of any medical uncertainties. If our results are confirmed in further research, the question of import will refer not to whether female physicians should communicate uncertainty, but to how they should communicate it. For instance, if it proves true that uncertainty negatively impacts on (male) patients' satisfaction, female physicians might want to counterbalance this impact by emphasizing other communication skills.
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Affiliation(s)
- Gaetan Cousin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX4 1SZ, UK.
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van Vliet LM, van der Wall E, Plum NM, Bensing JM. Explicit prognostic information and reassurance about nonabandonment when entering palliative breast cancer care: findings from a scripted video-vignette study. J Clin Oncol 2013; 31:3242-9. [PMID: 23940230 DOI: 10.1200/jco.2012.45.5865] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE When discussing the transition to palliative care for patients with breast cancer, oncologists have to find a balance between giving explicit information while not overwhelming patients and being realistic while remaining hopeful. It is unclear whether patients prefer more or less explicit prognostic information, and reassuring patients that they will not be abandoned may provide realistic hope. We assessed the effect of explicit prognostic information and reassurance about nonabandonment at the transition to palliative care. PATIENTS AND METHODS An experimental 2 × 2 study was used. Four scripted videos of a bad news conversation were created that differed only in the level of "explicitness of prognosis" and "reassurance about nonabandonment" (high v low). Patients with and survivors of breast cancer (n = 51) and healthy women (n = 53) watched the video-vignettes. The effects of the different communications on participants' anxiety, uncertainty, self-efficacy, and satisfaction were assessed by using multilevel analyses that explored the moderating influences of monitoring/blunting scores. RESULTS The highly explicit/highly reassuring video yielded the most positive outcomes, and the less explicit/less reassuring video, the most negative (P ≤ .05 for all outcome measures except anxiety). The main effects found were that explicitness and reassurance decreased participants' uncertainty (P < .001 and P = .002, respectively) and anxiety (only after reassurance; P = .001) while increasing self-efficacy (P = .004 and P < .001, respectively) and satisfaction (P < .001 and P < .001, respectively). High monitors seemed least positive, mainly following explicitness. CONCLUSION Explicit prognostic information may lead to better outcomes than general information. In addition, reassurance about nonabandonment might provide realistic hope but should be lived up to. More research is needed to translate these findings into clinical care.
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Affiliation(s)
- Liesbeth M van Vliet
- Liesbeth M. van Vliet and Jozien M. Bensing, Netherlands Institute for Health Services Research (NIVEL); Elsken van der Wall, Nicole M. Plum, and Jozien M. Bensing, Utrecht University, Utrecht, the Netherlands
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Hillen MA, van Vliet LM, de Haes HCJM, Smets EMA. Developing and administering scripted video vignettes for experimental research of patient-provider communication. PATIENT EDUCATION AND COUNSELING 2013; 91:295-309. [PMID: 23433778 DOI: 10.1016/j.pec.2013.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/23/2013] [Accepted: 01/29/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Scripted video-vignette studies enable experimental investigation of specific elements of patient-provider communication, separating cause and effect. However, scripted video vignettes are infrequently used to this end. Resultantly, few guidelines are available for their design, development and administration. We aim to suggest guidelines enabling more informed decisions when designing and conducting these studies. METHODS Based on the available methodological literature, we discuss methodological considerations when developing and administering scripted video vignettes. RESULTS Developing and using valid video vignettes requires: (I) deciding if using video vignettes is appropriate, (II) developing a valid script, (III) designing valid manipulations, (IV) converting the scripted consultation to video, and (V) administering the videos. We provide a first checklist of the methodological considerations in each phase. Advantages and pitfalls of possible approaches are discussed. CONCLUSIONS No 'gold standard' exists for most methodological issues, as literature testing the consequences of different approaches is lacking. The best approach when developing and implementing video vignettes depends upon the aims and practical limitations of a particular study. PRACTICE IMPLICATIONS Our checklist may serve as a starting point for further study of scripted video vignettes methodology. More detailed methodological reporting would yield new knowledge, thus allowing the research field to progress.
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Affiliation(s)
- Marij A Hillen
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands.
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van Vliet LM, Hillen MA, van der Wall E, Plum N, Bensing JM. How to create and administer scripted video-vignettes in an experimental study on disclosure of a palliative breast cancer diagnosis. PATIENT EDUCATION AND COUNSELING 2013; 91:56-64. [PMID: 23219482 DOI: 10.1016/j.pec.2012.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 10/19/2012] [Accepted: 10/27/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Scripted consultations provide the opportunity to vary and study the effect of specific elements of medical communication. These scripted consultations are role-played, videotaped and then judged by analogue patients. Most studies applying this methodology have provided little insight into how they created internally and externally valid written and role-played scripts. In this paper we aim to address this gap by providing a detailed description of a scripted video-vignette study's methodology. METHODS Following the five phases of creating and implementing scripted video-vignettes the current study's methodology is described: (1) deciding if video-vignettes are appropriate, (2) developing a valid script, (3) designing valid manipulations, (4) converting the scripted consultations to video, (5) administering the videos in an experiment. RESULTS Following these phases and four validation steps internally and externally valid vignettes were developed. CONCLUSIONS The detailed description of the current study's methodology produced general recommendations for scripted video-vignette studies, such as the importance of validating both the written as well as the role-played scripts and involving both experts and lay people in validating the scripts. For other choices no golden standard exists. PRACTICE IMPLICATIONS The presented methodology and recommendations may serve as a source of inspiration for future scripted video-vignette studies.
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Affiliation(s)
- Liesbeth M van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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The Effect of an Educating versus Normalizing Approach on Treatment Motivation in Patients Presenting with Delusions: An Experimental Investigation with Analogue Patients. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:261587. [PMID: 24260715 PMCID: PMC3821927 DOI: 10.1155/2013/261587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/01/2013] [Accepted: 09/12/2013] [Indexed: 11/18/2022]
Abstract
Until recently a widespread recommendation for clinicians was not to respond to the content of patients' delusions but to stress at an early time point that the patient has a mental illness (educating approach). An opposed recommendation is to validate the patients' symptoms and normalize them (normalizing approach). This study used an experimental design to compare the impact of these two approaches on treatment motivation (TM). A cover story about a person who develops persecutory delusions was used to guide a sample of 81 healthy participants who served as analogue patients into imagining experiencing delusions. This was followed by a random assignment to either an educating or a normalizing consultation with a fictive clinician. Consultations only differed in content. Finally, we assessed the participants' motivation to accept medication (Medication TM), psychological treatment (Psychological TM), and treatment offered by this particular clinician independent of the kind of treatment (Clinician-related TM). Participants in the normalizing condition showed higher Clinician-related and Psychological TM than those in the educating condition. Medication TM was unaffected by condition. Following our results using a normalizing approach seems to be advisable in a first-contact situation with patients with delusions and favourable to a simple educating approach.
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83
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Butalid L, Verhaak PFM, Boeije HR, Bensing JM. Patients' views on changes in doctor-patient communication between 1982 and 2001: a mixed-methods study. BMC FAMILY PRACTICE 2012; 13:80. [PMID: 22873783 PMCID: PMC3460773 DOI: 10.1186/1471-2296-13-80] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/02/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Doctor-patient communication has been influenced over time by factors such as the rise of evidence-based medicine and a growing emphasis on patient-centred care. Despite disputes in the literature on the tension between evidence-based medicine and patient-centered medicine, patients' views on what constitutes high quality of doctor-patient communication are seldom an explicit topic for research. The aim of this study is to examine whether analogue patients (lay people judging videotaped consultations) perceive shifts in the quality of doctor-patient communication over a twenty-year period. METHODS Analogue patients (N = 108) assessed 189 videotaped general practice consultations from two periods (1982-1984 and 2000-2001). They provided ratings on three dimensions (scale 1-10) and gave written feedback. With a mixed-methods research design, we examined these assessments quantitatively (in relation to observed communication coded with RIAS) and qualitatively. RESULTS 1) The quantitative analyses showed that biomedical communication and rapport building were positively associated with the quality assessments of videotaped consultations from the first period, but not from the second. Psychosocial communication and personal remarks were related to positive quality assessments of both periods; 2) the qualitative analyses showed that in both periods, participants provided the same balance between positive and negative comments. Listening, giving support, and showing respect were considered equally important in both periods. We identified shifts in the participants' observations on how GPs explained things to the patient, the division of roles and responsibilities, and the emphasis on problem-focused communication (first period) versus solution-focused communication (last period). CONCLUSION Analogue patients recognize shifts in the quality of doctor-patient communication from two different periods, including a shift from problem-focused communication to solution-focused communication, and they value an egalitarian doctor-patient relationship. The two research methods were complementary; based on the quantitative analyses we found shifts in communication, which we confirmed and specified in our qualitative analyses.
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Affiliation(s)
- Ligaya Butalid
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands
| | - Peter F M Verhaak
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands
- Department of General Practice, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Hennie R Boeije
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jozien M Bensing
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands
- Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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