How Can We Improve Patient Communication Skills? Assessing
the Needs of Physicians
Christa L. ArnoldUniversity of North Florida
Justin J. CoranUniversity of Florida
Melanie HagenUniversity of Florida
Why Train our Patients?
Most medical training programs address physicians’ communication skills, but few studies or training programs have addressed the communication skills of the patients.
Positive Outcomes for Training Patients
Improved trustImproved patient loyalty to physicianImproved interpersonal communication
skillsImproved patient health outcomesImproved physician & patient satisfaction
Effective relational communication requires…◦both parties to have communication skills based competency
◦co-constructed medical encounter◦understanding of each others expectations in the consultation.
◦What can we do to achieve a mutually beneficial medical encounter for BOTH physicians and patients?
Cegala suggests the PACE curriculum…
(1) Presenting detailed information(2) Asking questions(3) Checking understanding(4) Expressing concerns
(5) State preferences (Bylund, 2010)-Trains patients to tell physicians their
preferred communication style and role in decision making and treatment discussion.
Outcomes from PACE model interventions
More frequent information seeking behaviors
Improved quality of patient communication
Increased patient compliance
Our Study…
Bylund (2011)- Before beginning a patient training program, it is necessary to assess the needs of physicians in one specific community.
Purpose- To assess physician needs, in our community, for patient communication training in medical practice.
Goal- Identify the necessary components to construct patient communication workshops to be facilitated in our communities medical clinics.
Sample…
336 physicians from 28 medical specialties.◦ Internal Medicine (21%), ◦ Pediatrics (19%), ◦ Family Practice (5%), ◦ Oncology (5%), ◦ Ob/Gyn (4%),◦ Other medical specialties (46%).
Gender◦ 165 males (57%) and 123 females (43%)
Age◦ 25-35 years (n=105, 37%), ◦ 36-45 years (n=84, 29%), and ◦ 51+ (n=99, 34 %).
What we found…
“list and/or discuss three to four specific issues they would like their patients to tell them that they may not always mention or make clear during medical visits”
296 units of information for coding:◦patients lack of completeness in providing general
details about their medical history (68 units)
◦comprehension, including questions and/or concerns (59 units)
◦patients not disclosing their agenda for the medical visit (43 units)
◦Patient treatment compliance and adherence (44 units)
◦access to care/financial issues (44 units)
◦social issues that interfere with good medical practice (26 units)
Physician Responses “Patients need to communicate about their chronic med
problems (not "I'm fine," or minimize their disease severity).”
“Patients should let me know if they don't understand something I have recommended or explained.”
“Patients should discuss any fears or concerns regarding their symptoms or treatment plan being recommended.”
“Communicate why they would be unable to follow plan of care.”
“Do they have transportation problems that interfere with making appointments, picking up prescriptions, having lab tests done?”
“what three specific issues frustrate you most about
communicating with patients…”
Eight total themes (255 units):◦Highest Freq- Frustration when communicating
about patient diagnosis, treatment, or therapy (62 units).
◦Examples: Failure to take notes concerning therapy instructions.
Failure to report patient response to therapy when requested by physician.
Patient agreement to treatment plan when they have no intention or difficulty following through with the plan.
Discussion and Comments
Our needs assessment demonstrates Physicians’:
Frustration with lack of detail provided by patients
Frustration with patients’ reluctance to ask questions when they do not understand details of the medical interview
Frustration with patients’ lack of engagement in negotiation
What next…
Building upon the approach of Cegala and Bylund…◦We suggest creating interactive, visually
oriented, culturally sensitive workshops for patients in our community. Implement in medical clinics while patients wait to
see physician.
Topics will include, in addition to PACE:◦Agenda setting◦Comprehensive information seeking skills
Medical history Verifying plan
◦Disclose difficult/sensitive information◦Negotiation skills
◦Communication style
We are aiming to improve…◦patient adherence/compliance to medical advice.◦physician and patient satisfaction with medical
encounter.
References are available upon request…
We would be happy to answer any questions.