Diabetes is a common and expensive chronic condition in VA patients. Poor control of diabetes may be related to poor adherence to medical regimens. Adherence to recommended care is related to active communication in medical encounters. Encouraging patients to use more active communication with physicians leads to better adherence to treatment and to better biomedical outcomes.
This pilot project evaluated the acceptability and feasibility of using video to encourage patients' active participatory communication behaviors in medical interactions and (2) pilot tested the video among patients with poorly controlled type 2 diabetes.
We developed a video intervention to encourage patients' participatory communication behaviors. We pilot tested the acceptability and feasibility of the video in primary care clinic patients with poorly controlled type 2 diabetes mellitus with glycohemoglobin of 8.0 or higher: (i) by conducting qualitative interviews to obtain feedback from patients about the video; and (ii) by showing the video to patients in a busy clinic.
In the qualitative interviews participants' comments reflected a clear understanding of the aims and main messages of the video. Participants indicated recognition of why active communication is important and that they believed it was acceptable and appropriate role for patients in their medical visits. After watching the video, participants were able to identify principles of competent communication and were able to distinguish passive and active communication behaviors. Participants acknowledged barriers to communicating with their doctor and were able to indicate that they could overcome those barriers. Participants were engaged with watching the video, identified with the actors in the video, and found video an acceptable method to learn about communication. The video was considered valuable in encouraging patients to change behavior and encourage active communication. Patients found the video acceptable and it was feasible to show the video in a busy primary care clinic.
Efforts to improve patient-physician communication should recognize that communication is a two-way street. Because of norms of communication, patients who use active communication behaviors (e.g., ask questions) are more likely to influence their physicians' communication (e.g., get answers). Passive patients may not point out their needs, concerns, and beliefs. Passive communication limits the physicians' ability to identify and meet the patients' needs for information, support, and reassurance, to make accurate diagnoses, and to formulate the most appropriate and personalized treatment plans.
Our development of a video targeting black patients with diabetes to encourage them to be more active in their visits with physicians ("Speak Up") is a promising step toward an intervention that could be translated to practice. Patients found the video to be acceptable and it was feasible to show the video to patients prior to visits with their physician. We need to continue efforts to develop and evaluate culturally sensitive interventions to improve patient and physician communication.
The methods and the focus on communication behaviors in this project have potential for wide application and could be a paradigm for other medical conditions, and for other medical populations.
- Gordon HS, Street RL. How Physicians, Patients, and Observers Compare on the Use of Qualitative and Quantitative Measures of Physician-Patient Communication. Evaluation & the health professions. 2016 Dec 1; 39(4):496-511.
- Gordon HS, Gerber BS. What we've got here is a failure to communicate. Journal of general internal medicine. 2011 Feb 1; 26(2):104-6.
HSR&D or QUERI Articles
- Gordon HS. The Importance of Clinician-Patient Communication Behaviors. FORUM. 2010 Aug 1; 5.
- Gordon HS. Speak Up!: An intervention designed to activate diabetes patients’ communication with physicians. Paper presented at: University of Illinois at Chicago Diabetes and Obesity Annual Research Day; 2016 Oct 18; Chicago, IL.