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Wang YF, Lee YH, Lee CW, Lu JY, Shih YZ, Lee YK. The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting. HEALTH COMMUNICATION 2024; 39:1235-1245. [PMID: 37161370 DOI: 10.1080/10410236.2023.2210379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Chen-Wei Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University
| | - Jing-Yi Lu
- Department of Healthcare Administration, Asia University
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Yi-Kung Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Medicine, Tzu Chi University
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Queiroz NS, Vilela FC, Cavaco AM, Melo AC. Evaluation of Clinical Communication in Pharmacy Undergraduates in Brazil: A Multicentric Study. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100671. [PMID: 38360187 DOI: 10.1016/j.ajpe.2024.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To assess the clinical communication characteristics of pharmacy undergraduates, estimate differences in this specific competency, and produce recommendations for further education and training. METHODS Analysis of communication competence between 110 pharmacy students in the last graduation year from each of the 5 Brazilian regions and a simulated patient with complaints of mild allergic rhinitis passive of resolution with non-prescription medicines. The simulated appointment was recorded, and the video was analyzed using the 2 main elements: biomedical/task-focused and socio-emotional exchange of the Roter Interaction Analysis System. RESULTS The total of utterances/speech from the pharmacist to the patient was 183.4; there was a statistically significant difference according to the Brazilian region. In the consultation, the frequency with which pharmacy students returned to the segment was evaluated, with a total mean clinical history segment 2 of mean 5.60; in segment 4, which is the counseling phase, an average of 4.80. In the task codes and the socio-emotional codes, there was a statistically significant difference between the codes when compared by region. We compare by sex because it is said that women talk more than men. There was a statistically significant difference in socio-emotional code and biomedical/focused and task being higher for women. CONCLUSION The level of communication competence of students should be that desired for graduation, in all regions. There seems to be a difference between training and level of competence. Considering gender, although the consultation time is similar, it appears that the quality of communication is higher for women.
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Affiliation(s)
- Nathane S Queiroz
- Federal University of São João Del Rei (UFSJ), São João del Rei, Brazil
| | | | | | - Angelita C Melo
- Department of Clinical Pharmacy, Federal University of São João del Rei, Brazil.
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Green JA. Call for papers: special issue on innovative methods for pharmacy practice research. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2024; 32:3-4. [PMID: 37978931 DOI: 10.1093/ijpp/riad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- James A Green
- School of Allied Health and Physical Activity for Health Research Centre (Health Research Institute), University of Limerick, Ireland
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Rosburg T, von Allmen DY, Langewitz H, Weber H, Bunker EB, Langewitz W. Patient-centeredness in psychiatric work disability evaluations and the reproducibility of work capacity estimates. PATIENT EDUCATION AND COUNSELING 2024; 119:108093. [PMID: 38061142 DOI: 10.1016/j.pec.2023.108093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVES To evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates. METHODS In our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patient-centeredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant's WC on a scale from 0% to 100%. RESULTS Patient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant's emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility. CONCLUSIONS Many of the experts' questions addressed the claimant's lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. PRACTICE IMPLICATIONS Patient-centeredness in work disability evaluations should find its entry in continuing education of experts.
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Affiliation(s)
- Timm Rosburg
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland.
| | - David Y von Allmen
- University of Basel Hospital, Department of Clinical Research, EbIM Research & Education, Basel, Switzerland
| | - Helena Langewitz
- Johannes Gutenberg University Mainz, Institute of Art History and Musicology, Mainz, Germany
| | - Heidemarie Weber
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
| | | | - Wolf Langewitz
- University of Basel Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
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Wang YF, Lee YH, Lee CW, Shih YZ, Lee YK. Differences in patient-physician communication between the emergency department and other departments in a hospital setting in Taiwan. BMC Health Serv Res 2023; 23:1279. [PMID: 37986078 PMCID: PMC10662510 DOI: 10.1186/s12913-023-10311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Communication fosters trust and understanding between patients and physicians, and specific communication steps help to build relationships. Communication in the emergency department may be different from that in other departments due to differences in medical purposes and treatments. However, the characteristics of communication in the clinical settings of various departments have not been explored nor compared. OBJECTIVES This study aimed to construct the steps in patient-physician communication based on the Roter Communication Model and compare communication performance between the emergency department and three other clinical settings-internal medicine, surgery, and family medicine departments. METHODS Both qualitative and quantitative approaches were adopted. First, in-depth interviews were used to analyze clinical communication steps and meanings. Then, a quantitative questionnaire was designed based on the interview results to investigate differences in communication between the emergency department and the other three departments. Qualitative and quantitative data were analyzed from 20 interviews and 98 valid questionnaires. RESULTS Patient-physician communication consists of four steps and ten factors. The four steps-greeting and data gathering, patient education and counseling, facilitation and patient activation, and building a relationship-had significant progressive effects. Patient education and counseling had an additional significant effect on building a relationship. The emergency department performed less well in the facilitation and patient activation, building a relationship step and the evaluation method, enhancement method, and attitude factors than the other departments. CONCLUSIONS To improve the quality of patient-physician communication in the emergency department, physicians should strengthen the steps of facilitation and patient activation to encourage patients' active engagement in their health care.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Chen-Wei Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University, Chiayi, Taiwan
| | - Yi-Kung Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Correia AR, Costa M, Monteiro J, Cavaco P, Falcão F, Cavaco AM. Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations. HEALTH COMMUNICATION 2023; 38:480-489. [PMID: 34289767 DOI: 10.1080/10410236.2021.1956069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This exploratory study aimed to identify communication trends typical of pharmacists' clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist's talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients' questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist's rapport-building with the relative was higher when the patient's age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = -0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners' interviews, indicating a lack of clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.
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Affiliation(s)
| | | | | | - Patrícia Cavaco
- Pharmacy Department, Hospital de S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE
| | - Fátima Falcão
- Faculty of Pharmacy, University of Lisbon
- Pharmacy Department, Hospital de S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental EPE
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Wang YF, Lee YH, Lee CW, Hsieh CH, Lee YK. Patient-physician communication in the emergency department in Taiwan: physicians’ perspectives. BMC Health Serv Res 2022; 22:152. [PMID: 35123459 PMCID: PMC8817560 DOI: 10.1186/s12913-022-07533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background Effective patient-physician communication promotes trust and understanding between physicians and patients and reduces medical disputes. In this study, the Roter Interaction Analysis System was used to explore physician-patient communication behaviors in the emergency departments of Taiwanese hospitals. Method Data was collected from the dialogues between 8 emergency physicians and 54 patients through nonparticipant observation, and 675 pieces of data were quantitatively and qualitatively analyzed. Results The results showed that: 1. Emergency physicians’ communication behaviors are task-focused. They usually ask closed-ended questions to collect data to identify the symptoms quickly and provide medical treatment. 2. Socioemotion-oriented physician-patient communication behaviors are less common in the emergency department and only serve as an aid for health education and follow-up. Due to time constraints, it is difficult to establish relationships with patients and evoke their positivity. Conclusions It is suggested that future education programs on physician-patient communication in the emergency department should focus on strengthening physicians’ ability to communicate with patients in a more open way. They should adopt socioemotional-oriented communication skills, expressing respect and kindness, and allowing patients to briefly describe their symptoms and participate in the treatment process to achieve physician-patient consensus.
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Murry LT, Reist JC, Fravel MA, Knockel LE, Witry MJ. An Exploratory Mixed Methods Study of Standardized Patient Comments on Empathy and Student Communication Scores. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8642. [PMID: 34301573 PMCID: PMC8887057 DOI: 10.5688/ajpe8642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Objective. To quantify student pharmacists' communication ability based on scores from standardized patient (SP) communication rubrics, describe and categorize SP comments about student empathy, and test the relationship between students' communication scores and empathy.Methods. A concurrent mixed methods research design was used to assess a graded performance-based assessment (PBA) of student pharmacists that had been conducted at one college of pharmacy. The PBA rubrics (n=218) completed by SPs contained 20 assessment items and space for open-ended feedback. Scoring categories for communication assessment included: yes, inconsistent, no, and not applicable (N/A). Descriptive statistics were calculated for rubric scores. Feedback from standardized patients was analyzed and used to categorize student interactions during the encounter as reflecting high empathy, mixed empathy, or low empathy. Kruskal-Wallis ANOVA was used to test the relationship between empathy category and communication score.Results. Standardized patients had written comments on 141 of the 218 rubrics (64.7%). The mean communication score was 39.0±1.6 (range, 31-40) out of a maximum 40 points. The total scores for the low, mixed, and high empathy category transformations were 6 (4.3%), 95 (67.4%), and 40 (28.4%), respectively. The results of the Kruskal-Wallis ANOVA were significant, suggesting that communication scores were different between empathy categories.Conclusion. There was a positive association between students' scores on communication rubrics and student empathy categorization, with student pharmacists exhibiting different levels of clinical empathy. While the PBA of interest was not specifically focused on empathy, SPs frequently provided feedback about empathy to students, suggesting that showing empathy during the encounter was important.
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Affiliation(s)
- Logan T Murry
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | - Jeffrey C Reist
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | | | - Laura E Knockel
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
| | - Mathew J Witry
- The University of Iowa, College of Pharmacy, Iowa City, Iowa
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Pizarro Â, Martins M, Simões J. Exploring the Policies Applied to Pharmaceutical Care Practice for Type 2 Diabetes over the Last Decade in European Community Pharmacies. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000519498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In the last decade (2010–2020), more than half of European countries have improved their health policies within the primary care for type 2 diabetes mellitus. Community pharmacies have been and could continue to be essential actors in this evolution of fighting the disease by providing a set of pharmacotherapeutic follow-up services for the person with diabetes. These services, designated by the Pharmaceutical Group of the European Union as “diabetes management” and “glucose measurement”, have aimed to optimize adherence to therapy and improve health outcomes. However, to follow the European guidelines of Good Pharmacy Practice, providing these services implies having a normative framework or a legal basis. Thus, this study sought to analyze the normative and regulatory framework on which community pharmacies in 28 European countries were based on providing this health care over the last decade.
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Kerr A, Strawbridge J, Kelleher C, Barlow J, Sullivan C, Pawlikowska T. A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training. BMC MEDICAL EDUCATION 2021; 21:325. [PMID: 34092216 PMCID: PMC8180382 DOI: 10.1186/s12909-021-02776-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training. METHODS A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men's and women's health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories. RESULTS Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated. CONCLUSIONS SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.
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Affiliation(s)
- Aisling Kerr
- School of Pharmacy and Biomolecular Sciences, RCSI School of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, 1st floor Ardilaun House Block B, 111 St, Stephen's Green, Dublin 2, Ireland.
| | - Judith Strawbridge
- School of Pharmacy and Biomolecular Sciences, RCSI School of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, 1st floor Ardilaun House Block B, 111 St, Stephen's Green, Dublin 2, Ireland
| | - Caroline Kelleher
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - James Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Clare Sullivan
- Department of Simulation, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre (HPEC), RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
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van Eikenhorst L, van Dijk L, Cords J, Vervloet M, de Gier H, Taxis K. Pharmacists' responses to cues and concerns of polypharmacy patients during clinical medication reviews-A video observation study. PATIENT EDUCATION AND COUNSELING 2020; 103:930-936. [PMID: 31859122 DOI: 10.1016/j.pec.2019.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/28/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The research questions of this study are 1) How do pharmacists respond to negative emotions of patients during a clinical medication review (CMR)? 2) How do patients express negative emotions during a CMR? 3) Who (pharmacist or patient) initiates a negative emotion to be discussed during a CMR? METHODS We used video-recordings to observe 132 CMR interviews of 49 pharmacists. Videos were coded with the Verona coding definitions on emotional sequences(-provider responses) (VR-CoDES(-P)). RESULTS In total 2538 negative emotions were identified, mainly expressed as cues (95.0 %). Often cues were expressed as verbal hints to hidden concerns (33.2 %) or were related to cognitive or physical causes (28.3 %).Three-quarters of the negative emotions were elicited by patients. 2670 pharmacists' responses were coded. The most common response was non-explicit providing space (77.6 %) and the least common response was explicit reducing space (5.8 %). CONCLUSION Pharmacists are mainly non-explicitly providing space in their responses. While this hinders their ability to capture patients' problems it also may enable patients to initiate topics. PRACTICE IMPLICATIONS Pharmacists are able to respond to patients' negative emotions. Training should focus on developing pharmacist's skills to be more explicit in their responses to get more in-depth knowledge of patients' problems.
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Affiliation(s)
- Linda van Eikenhorst
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.
| | - Liset van Dijk
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands; Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jasper Cords
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Han de Gier
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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Howe LC, Leibowitz KA, Crum AJ. When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Front Psychiatry 2019; 10:475. [PMID: 31333518 PMCID: PMC6619399 DOI: 10.3389/fpsyt.2019.00475] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.
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Affiliation(s)
- Lauren C. Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Kari A. Leibowitz
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Alia J. Crum
- Department of Psychology, Stanford University, Stanford, CA, United States
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