Physician Communication with Patients: Research Findings and Challenges

5. How Effective Are Strategies to Improve Physician Communication?

5 | How Effective Are Strategies to Improve Physician Communication? In chapter 4, we discussed the factors that seem to be associated with the quality of physician communication. Some physician characteristics, such as age and gender, clearly are not subject to change through educational programs or skill-building efforts. Other physician characteristics associated with physician communication, such as physician knowledge and communication skills, can be altered, at least in theory, by programmatic interventions (Maguire and Pitceathly 2002). In this chapter, we discuss research ‹ndings regarding efforts to improve physician communication through education and training (see the left part of ‹g. 1.1, logic model). Studies that evaluate the effectiveness of educational programs vary widely in their scope and sophistication, as do the programs themselves. A good portion of the literature consists of studies that use a simple test of physician knowledge before and after a course. Relatively few studies measured the impact of skill-building or other educational programs on physician communications with actual patients. Studies of the impact of instructional programs on patient outcomes focused on patient-reported satisfaction with physician visits or patient adherence to treatment recommendations. We found no studies documenting a relationship between skill-building programs on physician communication and patient biologic markers of health status, selfreported health status, utilization, or costs of care. Identifying Relevant Literature We sought to identify published evaluations, in English, of programs intended to improve physician communication through knowledge and skills. We searched Medline, JSTOR, and the Cochrane Library database for review articles. We also include in this chapter individual evaluations 171 published between 2002 and 2008 but not included in review articles. We used a combination of such keywords as “physician-patient relations,” “communication,” “patient-centered care,” “education, medical, undergraduate ,” “education, medical, graduate,” “education, medical, continuing ,” and “evaluation.” Our initial search yielded over 600 unduplicated references. After eliminating articles not directly related to developing physician communication through knowledge and skills, we examined over 400 articles and abstracts.We identi‹ed a small number of additional relevant articles through examination of references at the end of the reviews and individual studies. Our search process yielded 14 review articles (which reviewed 138 studies) and 42 individual studies (in 46 articles). The studies covered in the review articles were directed at programs for medical students (80), residents (24), and practicing physicians (38), with some studies addressing programs targeting more than one category of student. Six of the 14 review articles focused on programs for medical students (undergraduate or graduate), 5 included only educational programs for experienced physicians, and 3 summarized ‹ndings from programs for both experienced physicians and students. Five of the 14 review articles addressed only educational programs for physicians treating cancer patients. Nine reviews encompassed programs seeking to upgrade the general communication skills of physicians. The other reviews addressed programs with more limited objectives with respect to improving communication skills: empathy (2), competence in the delivery of bad news (1), cultural competence (1), and emotion management (1). The Impact of Programs Directed at Improving Physician Communication In table 5.1, we summarize the evidence from review studies regarding the effectiveness of programs that are designed to improve physician communication . We discuss the evidence from reviews in two categories: 1) reviews that address evaluations of communication knowledge and skill-building programs for physicians working with all types of patients and 2) reviews that focus only on evaluations of communication programs for physicians treating cancer patients. Table 5.2 presents ‹ndings from individual evaluations of programs. The ‹ndings in this table are quite consistent overall with ‹ndings from the review articles, so we discuss only a small number of evaluations that are noteworthy because they are illustrative of the larger body of research or because of their methodological approach or the signi‹cance of the communication program that they evaluate. Physician Communication with Patients 172 Evidence from Reviews—General Programs. For the most part, the authors of the nine general reviews (addressing programs not directed speci‹cally at improving physician communication skills in treating cancer patients) reached similar conclusions. They found some evidence of improvements in knowledge and skills for programs enrolling undergraduate or postgraduate medical students, with little evidence relating to the effectiveness of programs for more experienced physicians. Evaluations of programs for practicing physicians were few. Cheraghi-Sohi and Bower (2008) reviewed the impacts of four programs, where the measure of effectiveness was patient satisfaction, and found positive effects for...