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.