-
3. How Does Physician Communication Affect Patients?
- University of Michigan Press
- Chapter
- Additional Information
3 | How Does Physician Communication Affect Patients? The research ‹ndings described in chapter 2 identi‹ed elements of physician communication that appear problematic and, therefore, where there appears to be room for improvement. But by themselves, these ‹ndings are not suf‹cient to support the expenditure of resources on speci‹c improvement efforts. In addition, decision makers need to know if weak physician performance relating to a particular element of communication has signi‹cant impacts on patients. In the sense we use it here, the term signi‹cant means that the relationship is strong (passing conventional statistical signi‹cance tests or receiving consistent support in rigorous analyses of qualitative data) and that the effects on patients are large enough, potentially, to merit efforts to improve physician communication skills. Identifying Relevant Literature To identify the literature reviewed in this chapter, we used the same search strategy described in chapter 2. We did not include studies related to multifaceted interventions or patient health literacy unless they had a substantial component directed at physician communication issues. We found 11 review articles and 21 individual studies (not included in review articles) speci‹cally relating to the relationship between physician communication and patient outcomes (see tables 3.1 and 3.2). This topic also was addressed selectively in several of the review articles and studies summarized in tables 2.4 and 2.5. We have organized our discussion of ‹ndings according to type of patient outcome: immediate, intermediate, and longer-term (see ‹g. 1.1, logic model). We summarize ‹ndings from both review articles and individual studies pertaining to each type of outcome. Because review articles typically address a variety of outcomes, some review articles are cited under more than one category of outcome. In the 68 case of both review and individual articles, we also refer to relevant articles summarized in tables 2.4 and 2.5. Immediate Outcomes By “immediate” outcomes, we mean outcomes that occur very soon after the physician-patient encounter. For example, these outcomes include relief of anxiety, satisfaction with the visit, and understanding of the treatment plan. In the literature we reviewed, satisfaction with the visit was the most common measure employed, by a substantial margin. Evidence from Reviews. Stewart (1995) (see table 3.1) reviewed 21 studies published between 1983 and 1993 where “communication” was classi‹ed as history taking, discussion of the management plan, or“other.” Stewart found that where physicians asked questions about a patient’s anxiety level and feelings and showed support and empathy, patient anxiety levels were reduced. The same was true when patients were encouraged to ask questions and physicians were willing to share decision making . Beck, Daughtridge, et al. (2002) reviewed 22 studies where neutral observers were used to assess physician communication. They reported that 22 verbal behaviors of physicians were positively associated with patient outcomes, while 14 verbal behaviors were negatively associated with outcomes (see table 3.1). Immediate outcomes affected by verbal behaviors included short-term patient recall, trust in the physician, intention to comply with physician recommendations, and satisfaction with the encounter . Nonverbal physician behaviors also were found to affect immediate outcomes, but there was less evidence in this regard. Overall, Beck, Daughtridge, et al. (2002) concluded that there is a relative lack of research that uses researcher observations and links verbal and nonverbal physician behaviors to patient outcomes. Ong, de Haes, et al. (1995) reported that physician information-giving behaviors were signi‹cantly related to patient satisfaction. They also found that physician “patient-centeredness ,” understood as physicians allowing patients to express all of their reasons for visiting the physician, was associated with patient resolution of issues (see table 3.1). Evidence from Individual Studies In one individual study, Adams, Smith, et al. (2001) (see table 3.2) used surveys of asthma patients conducted at three-month intervals to track health outcomes and relate them to a measure of shared physician-patient decision making. They found that a greater degree of shared decision making was associated with greater paHow Does Physician Communication Affect Patients? 69 [52.90.131.200] Project MUSE (2024-03-29 07:25 GMT) tient satisfaction. In a study set in the United Kingdom, Little, Everitt, et al. (2001) surveyed patients in three practices regarding their perceptions of physician “patient centeredness” along with several immediate outcome measures. They found that patients of physicians who exhibited less “patient centeredness” were less satis‹ed, felt less enabled to carry out the treatment plan, and experienced a greater symptom...