Communication in medical interactions is critical and plays an important, but often overlooked role in determining quality of care. In this project we focused on patients' communication behaviors that can influence physicians' behaviors. Patients' active participatory communication behaviors include four patient communication behaviors: (1) telling the health narrative/history; (2) asking questions; (3) being assertive or making requests; and (4) expressing opinions and communicating concerns. Studies report that patients who use more active communication behaviors with their physicians are more adherent to treatment and experience more favorable biomedical outcomes. Still, patients often feel unprepared for their visits and gain benefit from pre-visit preparation. But methods for pre-visit preparation are poorly developed. To improve methods for pre-visit preparation, we need to gain an understanding the factors that impede and facilitate patients' active participatory communication behaviors.
The project examined the factors that encourage and discourage patients to use active participatory communication behaviors in medical interactions.
We conducted semi-structured qualitative interviews (focus groups) to learn about the perspective of patients with diabetes. This methodology was chosen because it provides a rich source of information by tapping into patients' perspectives. The purpose of the interviews is to obtain the patient's perspective on (1) communicating with the provider in general; (2) communicating about diabetes; and (3) communicating about medication adherence.
We conducted four focus groups with a total of 20 participants. Participants mean age was 61 years, 65% self-identified as black or African-American, 80% had high school, some college, or a college education and all patients had uncontrolled type 2 diabetes mellitus (mean hemoglobin A1c was 10.3).
Our analysis yielded several themes that patients identified as difficulties in communicating with physicians. Themes included (1) barriers to patients' active participation, (2) patient perceived conflict, tension, or antagonism between the doctor and patient, (3) doctor's use of conversational control prevents participation, (4) patient emotional or motivational issues, (5) minimizing the significance of their diabetes or their own medical needs, (6) problems in the doctor-patient relationship, (7) inadequate support from the doctor, and (8) distrust of physicians or the healthcare system.
Communication in medical encounters is a two-way street and efforts to improve communication should focus on both the physician and the patient. The results of this project may be useful for physician education and increasing physician awareness of the problems that patients' perceive when communicating with physicians. The results could be used to develop educational materials for physicians and may be used to inform the design and development of educational material for patients to improve and encourage patients' active participatory communication behaviors. Efforts to improve communication in medical encounters should not only be applied to physicians. These efforts should also be directed toward patients - patients can be taught to improve their communication with their physicians. In future research, it is our goal to design and develop an intervention to encourage patients' use of active participatory communication behaviors and we plan to incorporate findings from this study in the intervention development.
- 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.