BACKGROUND/RATIONALE:
Heart failure (HF) is a major chronic condition in the United States and within Veterans Affairs hospitals (VA). The burden of HF has increased and is estimated to increase further over several decades as the population ages. HF disproportionately affects black compared with white Americans. Given that HF is chronic condition, adherence to recommended lifestyle and medical treatments has a significant impact on outcomes. Studies have shown that communication in medical interactions is associated with outcomes in other conditions, but this relationship is poorly studied in HF.


OBJECTIVE(S):
The objective of this study is to assess the relationship of communication with outcomes in patients with HF. We hypothesized that outpatient medical visits with more effective patient physician communication are associated with better HF outcomes, improved patient perceptions and improved adherence. We also hypothesized that for a number of reasons black patients would have more difficulty communicating with physicians when compared with white patients.

METHODS:
Patients were recruited for a prospective observational cohort study at two VA hospitals. Eligible patients were age 25 or older and had an exacerbation of HF requiring hospital admission or an emergency room visit. Patients whose HF was secondary to an acute condition, had dementia, or were discharged to a nursing home were excluded. Data were collected at hospital admission or after release from the emergency room, at up to two subsequent outpatient visits and at approximately 6 months after discharge using questionnaires. Patient questionnaires provided demographics, HF specific functional status, ratings of patients' own and ratings of their physicians' communication, satisfaction, self-efficacy, trust in physician and VA, experiences of discrimination in healthcare, and patients' beliefs about causes of HF. An adherence questionnaire was completed by telephone approximately 4 weeks after each outpatient visit. Chart reviews collected several clinical characteristics including comorbid conditions, unscheduled visits and readmissions. Visits with consenting physicians were audio-taped. Audio-tapes were transcribed and coded for patient and physician communication behaviors. Analyses continue with appropriate statistics to explore bivariate relationships and to examine independent relationships after controlling for multiple co-variates.

FINDINGS/RESULTS:
In this cohort of heart failure patients, age, functional status, patients' trust in physician, and patients' ratings of their own and their physicians' communication were associated with adherence at four week follow-up to physicians' recommendations. However, in repeated measures linear regression analyses controlling for a number of co-variates, we found that trust was not a significant predictor adherence, while patients' rating of doctors' informativeness, age and functional status were significant (P<.05) predictors of adherence. Also and contrary to our hypothesis we did not find that race was a significant predictor of communication, trust, or adherence in these analyses.

IMPACT:
Information is an important resource for patients to self-manage their medical conditions. Our results highlight the relationship of physicians' informativeness with patients' adherence to physicians' recommendations. Research that tests interventions and educational efforts to improve the dynamics of patient-clinician communication may assist the VA in efforts to improve health and health care.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Ahluwalia SC, Levin JR, Lorenz KA, Gordon HS. "There's no cure for this condition": how physicians discuss advance care planning in heart failure. Patient education and counseling. 2013 May 1; 91(2):200-5. [view]
2. Sharf BF, Stelljes LA, Gordon HS. 'A little bitty spot and I'm a big man': patients' perspectives on refusing diagnosis or treatment for lung cancer. Psycho-oncology. 2005 Aug 1; 14(8):636-46. [view]
3. Street RL. Aiding medical decision making: a communication perspective. Medical Decision Making. 2007 Sep 1; 27(5):550-3. [view]
4. Street RL, Gordon HS. Companion participation in cancer consultations. Psycho-oncology. 2008 Mar 1; 17(3):244-51. [view]
5. Gordon HS, Pugach O, Berbaum ML, Ford ME. Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure. Patient education and counseling. 2014 Nov 1; 97(2):173-9. [view]
6. Ahluwalia SC, Levin JR, Lorenz KA, Gordon HS. Missed opportunities for advance care planning communication during outpatient clinic visits. Journal of general internal medicine. 2012 Apr 1; 27(4):445-51. [view]
7. Gordon HS, Nowlin PR, Maynard D, Berbaum ML, Deswal A. Mortality after hospitalization for heart failure in blacks compared to whites. The American journal of cardiology. 2010 Mar 1; 105(5):694-700. [view]
8. Gordon HS, Johnson ML, Wray NP, Petersen NJ, Henderson WG, Khuri SF, Geraci JM. Mortality after noncardiac surgery: prediction from administrative versus clinical data. Medical care. 2005 Feb 1; 43(2):159-67. [view]
9. Deswal A. Outcomes in Women vs. Men with Heart Failure and Preserved Ejection Fraction. Cardiology in review. 2007 Jan 1; 24:24-27. [view]
10. Street RL, Gordon HS, Ward MM, Krupat E, Kravitz RL. Patient participation in medical consultations: why some patients are more involved than others. Medical care. 2005 Oct 1; 43(10):960-9. [view]
11. Street RL, Gordon H, Haidet P. Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Social science & medicine. 2007 Aug 1; 65(3):586-98. [view]
12. Street RL, Gordon HS. The clinical context and patient participation in post-diagnostic consultations. Patient education and counseling. 2006 Dec 1; 64(1-3):217-24. [view]
13. Aguilar D, Bozkurt B, Pritchett A, Petersen NJ, Deswal A. The impact of thiazolidinedione use on outcomes in ambulatory patients with diabetes mellitus and heart failure. Journal of the American College of Cardiology. 2007 Jul 3; 50(1):32-6. [view]
14. Patel P, White DL, Deswal A. Translation of clinical trial results into practice: temporal patterns of beta-blocker utilization for heart failure at hospital discharge and during ambulatory follow-up. American heart journal. 2007 Apr 1; 153(4):515-22. [view]

Conference Presentations

1. Gordon HS, Sharf BF, Stelljes L. A little bitty spot and I'm a big man: Patients' refusals of doctors' recommendations. Paper presented at: American Academy of Physician and Patient Research and Teaching Annual Forum; 2003 Jan 1; Madison, WI. [view]
2. Gordon HS, Pugach O, Ford M. An examination of patients’ trust in physician before and after two outpatient visits in a prospective cohort of heart failure patients. Paper presented at: International Conference on Communication in Healthcare; 2013 Sep 30; Montreal, Canada. [view]
3. Deswal A. Clinical and Statistical Approaches to Optimize Predictive Models with Biomarkers. Paper presented at: International Heart Failure Biomarker Research Annual Meeting; 2007 Apr 29; Cannes, France. [view]
4. Hogan TP, Bauer ED, Ford ME, Gordon HS. Experiences of Discrimination in a Prospective Cohort of Veterans after Hospitalization for Heart Failure. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL. [view]
5. Gordon HS, Street RL, Deswal AD. Factors associated with adherence to physicians recommendations in a prospective cohort after hospitalization with heart failure. Paper presented at: Society of General Internal Medicine Annual Meeting; 2011 May 6; Phoenix, AZ. [view]
6. Ahluwalia SC, Levin JR, Lorenz KR, Gordon HS. Missed opportunities for advance care planning in primary care. Paper presented at: Society of General Internal Medicine Annual Meeting; 2011 May 6; Phoenix, AZ. [view]
7. Gordon HS, Bauer ED, Ford ME. Patient factors associated with experiences of discrimination in health care in a prospective cohort after hospitalization with heart failure. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2012 May 11; Orlando, FL. [view]
8. Deswal A. Risk Factors to Disease: Bench to Bedside. Paper presented at: Heart Failure Society of America Annual Scientific Meeting; 2007 Sep 1; Washington, DC. [view]
9. Patel P, White DL, Deswal A. Translation of Clinical Trial into Practice: Temporal Patterns of B-blocker Utilization for Heart Failure at Hospital Discharge and During Ambulatory Follow-Up. Paper presented at: Baylor College of Medicine Department of Medicine House Staff Research Annual Symposium; 2007 Apr 1; Houston, TX. [view]
10. Gordon HS, Ford M, Pugach O. What have you done for me lately: An examination of patients’ trust in physician over time. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 26; Denver, CO. [view]

DRA: none
DRE: none
Keywords: Cardiovasc’r disease, Communication -- doctor-patient, Ethnic/cultural
MeSH Terms: none