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Patient-centered communication

Do patients really prefer it?

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Abstract

OBJECTIVE: To investigate patient preferences for a patient-centered or a biomedical communication style.

DESIGN: Randomized study.

SETTING: Urgent care and ambulatory medicine clinics in an academic medical center.

PARTICIPANTS: We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention.

INTERVENTION: Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements.

MEASUREMENTS AND MAIN RESULTS: Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82% [51/62] for age < 30; 68% [100/148] for ages 30–59; 55% [21/38] for age > 59; P<.03), more educated (76% [54/71] for postcollege education; 73% [94/128] for some college; 49% [23/47] for high school only; P=.003), use CAM (75% [140/188] vs. 55% [33/60] for non-users; P=.006), and have a patient-centered physician (88% [74/84] vs. 30% [16/54] for those with a biomedical physician; P<.0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a “doctor’s interest in you as a person” as “very important.”

CONCLUSIONS: Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication.

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References

  1. Lipkin M, Putnam SM, Lazare A. The Medical Interview: Clinical Care, Education, and Research. New York, NY: Springer-Verlag; 1995.

    Google Scholar 

  2. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.

    PubMed  CAS  Google Scholar 

  3. Platt FW, Gaspar DL, Coulehan JL, et al. “Tell me about yourself”: the patient-centered interview. Ann Intern Med. 2001;134:1079–85.

    PubMed  CAS  Google Scholar 

  4. Williams S, Weinman J, Dale J. Doctor-patient communication and patient satisfaction: a review. Fam Pract. 1998;15:480–92.

    Article  PubMed  CAS  Google Scholar 

  5. Kinnersley P, Stott N, Peters TJ, Harvey I. The patient-centredness of consultations and outcome in primary care. Br J Gen Pract. 1999;49:711–16.

    PubMed  CAS  Google Scholar 

  6. Kinmonth AL, Woodcock A, Griffin S, Spiegal N, Campbell MJ. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk. The Diabetes Care from Diagnosis Research Team. BMJ. 1998;317:1202–8.

    PubMed  CAS  Google Scholar 

  7. Rosenberg EE, Lussier MT, Beaudoin C. Lessons for clinicians from physician-patient communication literature. Arch Fam Med. 1997;6:279–83.

    Article  PubMed  CAS  Google Scholar 

  8. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.

    PubMed  CAS  Google Scholar 

  9. Rao JK, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes: a literature review. Arch Fam Med. 2000;9:1148–55.

    Article  PubMed  CAS  Google Scholar 

  10. Maisiak R, Austin JS, West SG, Heck L. The effect of person-centered counseling on the psychological status of persons with systemic lupus erythematosus or rheumatoid arthritis: a randomized, controlled trial. Arthritis Care Res. 1996;9:60–6.

    Article  PubMed  CAS  Google Scholar 

  11. Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(3 suppl):S110-S127.

    Article  PubMed  CAS  Google Scholar 

  12. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9.

    Article  PubMed  CAS  Google Scholar 

  13. Jackson JL, Kroenke K, Chamberlin J. Effects of physician awareness of symptom-related expectations and mental disorders. A controlled trial. Arch Fam Med. 1999;8:135–42.

    Article  PubMed  CAS  Google Scholar 

  14. Kravitz RL, Cope DW, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visits. J Gen Intern Med. 1994;9:75–81.

    Article  PubMed  CAS  Google Scholar 

  15. Kravitz RL, Callahan EJ, Azari R, Antonius D, Lewis CE. Assessing patients’ expectations in ambulatory medical practice. Does the measurement approach make a difference? J Gen Intern Med. 1997;12:67–72.

    Article  PubMed  CAS  Google Scholar 

  16. Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000;39:49–59.

    Article  PubMed  CAS  Google Scholar 

  17. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.

    PubMed  CAS  Google Scholar 

  18. Levinson W, Roter D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993;8:318–24.

    Article  PubMed  CAS  Google Scholar 

  19. Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. 2001;50:1057–62.

    PubMed  CAS  Google Scholar 

  20. Smith RC, Lyles JS, Mettler J, et al. The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med. 1998;128:118–26.

    PubMed  CAS  Google Scholar 

  21. Brown JB, Boles M, Mullooly JP, Levinson W. Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial. Ann Intern Med. 1999;131:822–9.

    PubMed  CAS  Google Scholar 

  22. McKinstry B. Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes. BMJ. 2000;321:867–71.

    Article  PubMed  CAS  Google Scholar 

  23. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993;328:246–52.

    Article  PubMed  CAS  Google Scholar 

  24. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA. 1998;280:1569–75.

    Article  PubMed  CAS  Google Scholar 

  25. Wolsko PM, Eisenberg DM, Davis RB, Ettner SL, Phillips RS. Insurance coverage, medical conditions, and visits to alternative medicine providers: results of a national survey. Arch Intern Med. 2002;162:281–7.

    Article  PubMed  Google Scholar 

  26. Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. J Gen Intern Med. 2004;19:43–50.

    Article  PubMed  Google Scholar 

  27. Foster DF, Phillips RS, Hamel MB, Eisenberg DM. Alternative medicine use in older Americans. J Am Geriatr Soc. 2000;48:1560–5.

    PubMed  CAS  Google Scholar 

  28. Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John’s Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002;136:42–53.

    PubMed  Google Scholar 

  29. Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St. John’s wort. Lancet. 2000;355:547–8.

    Article  PubMed  CAS  Google Scholar 

  30. Verhoef MJ, Hagen N, Pelletier G, Forsyth P. Alternative therapy use in neurologic diseases: use in brain tumor patients. Neurology. 1999;52:617–22.

    PubMed  CAS  Google Scholar 

  31. Paltiel O, Avitzour M, Peretz T, et al. Determinants of the use of complementary therapies by patients with cancer. J Clin Oncol. 2001;19:2439–48.

    PubMed  CAS  Google Scholar 

  32. Boon H, Brown J, Gavin A. What are the experiences of women with breast cancer as they decide whether to use complementary/alternative medicine? West J Med. 2000;173:39.

    Article  PubMed  CAS  Google Scholar 

  33. Singh N, Squier C, Sivek C, Nguyen MH, Wagener M, Yu VL. Determinants of nontraditional therapy use in patients with HIV infection. A prospective study. Arch Intern Med. 1996;156:197–201.

    Article  PubMed  CAS  Google Scholar 

  34. Burstein HJ, Gelber S, Guadagnoli E, Weeks JC. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med. 1999;340:1733–9.

    Article  PubMed  CAS  Google Scholar 

  35. Holland JC. Use of alternative medicine—a marker for distress? N Engl J Med. 1999;340:1758–9.

    Article  PubMed  CAS  Google Scholar 

  36. Perlman AI, Eisenberg DM, Panush RS. Talking with patients about alternative and complementary medicine. Rheum Dis Clin North Am. 1999;25:815–22.

    Article  PubMed  CAS  Google Scholar 

  37. Sugarman J, Burk L. Physicians’ ethical obligations regarding alternative medicine. JAMA. 1998;280:1623–5.

    Article  PubMed  CAS  Google Scholar 

  38. Eisenberg DM. Advising patients who seek alternative medical therapies. Ann Intern Med. 1997;127:61–9.

    PubMed  CAS  Google Scholar 

  39. Patterson RE, Neuhouser ML, Hedderson MM, et al. Types of alternative medicine used by patients with breast, colon, or prostate cancer: predictors, motives, and costs. J Altern Complement Med. 2002;8:477–85.

    Article  PubMed  Google Scholar 

  40. Lazar JS, O’Connor BB. Talking with patients about their use of alternative therapies. Prim Care. 1997;24:699–714.

    PubMed  CAS  Google Scholar 

  41. Brown J, Stewart M, McCracken E, McWhinney IR, Levenstein J. The patient-centred clinical method. 2. Definition and application. Fam Pract. 1986;3:75–9.

    Article  PubMed  CAS  Google Scholar 

  42. Roter DL, Stewart M, Putnam SM, Lipkin M Jr, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997;277:350–6.

    Article  PubMed  CAS  Google Scholar 

  43. Brown J, Stewart M, Ryan BL. Assessing Communication Between Patients and Physicians: The Measure of Patient-centered Communication (MPCC). London, Ontario: Centre for Studies in Family Medicine; 2001.

    Google Scholar 

  44. Wolf MH, Putnam SM, James SA, Stiles WB. The Medical Interview Satisfaction Scale: development of a scale to measure patient perceptions of physician behavior. J Behav Med. 1978;1:391–401.

    Article  PubMed  CAS  Google Scholar 

  45. Hulley SB. Designing Clinical Research: An Epidemiologic Approach. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  46. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, NY: Wiley; 1989.

    Google Scholar 

  47. Krupat E, Yeager CM, Putnam SM. Patient role orientations, doctor-patient fit, and visit satisfaction. Psychol Health. 2000;15:707–19.

    Google Scholar 

  48. Parker PA, Baile WF, de Moor C, Lenzi R, Kudelka AP, Cohen L. Breaking bad news about cancer: patients’ preferences for communication. J Clin Oncol. 2001;19:2049–56.

    PubMed  CAS  Google Scholar 

  49. Benbassat J, Pilpel D, Tidhar M. Patients’ preferences for participation in clinical decision making: a review of published surveys. Behav Med. 1998;24:81–8.

    Article  PubMed  CAS  Google Scholar 

  50. Schmittdiel J, Grumbach K, Selby JV, Quesenberry CP Jr. Effect of physician and patient gender concordance on patient satisfaction and preventive care practices. J Gen Intern Med. 2000;15:761–9.

    Article  PubMed  CAS  Google Scholar 

  51. Dowsett SM, Saul JL, Butow PN, et al. Communication styles in the cancer consultation: preferences for a patient-centred approach. Psychooncology. 2000;9:147–56.

    Article  PubMed  CAS  Google Scholar 

  52. Savage R, Armstrong D. Effect of a general practitioner’s consulting style on patients’ satisfaction: a controlled study. BMJ. 1990;301:968–70.

    Article  Google Scholar 

  53. Hsu J, Schmittdiel J, Krupat E, et al. Patient choice. J Gen Intern Med. 2003;18:319–25.

    Article  PubMed  Google Scholar 

  54. Roter D, Hall JA. Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. Westport, Conn: Auburn House; 1992.

    Google Scholar 

  55. Kaplan RM, Hammel B, Schimmel LE. Patient information processing and the decision to accept treatment. J Soc Behav Pers. 1985;1:113–20.

    PubMed  Google Scholar 

  56. Greene MG, Adelman R, Charon R, Hoffman S. Ageism in the medical encounter: an exploratory study of the doctor-elderly patient relationship. Lang Commun. 1986;6:113–24.

    Article  PubMed  Google Scholar 

  57. Waitzkin H. Information giving in medical care. J Health Soc Behav. 1985;26:81–101.

    Article  PubMed  CAS  Google Scholar 

  58. Hall JA, Stein TS, Roter DL, Rieser N. Inaccuracies in physicians’ perceptions of their patients. Med Care. 1999;37:1164–8.

    Article  PubMed  CAS  Google Scholar 

  59. Golin C, DiMatteo MR, Duan N, Leake B, Gelberg L. Impoverished diabetic patients whose doctors facilitate their participation in medical decision making are more satisfied with their care. J Gen Intern Med. 2002;17:857–66.

    PubMed  Google Scholar 

  60. Tennstedt SL. Empowering older patients to communicate more effectively in the medical encounter. Clin Geriatr Med. 2000;16:61–70, ix.

    Article  PubMed  CAS  Google Scholar 

  61. Brody DS, Miller SM, Lerman CE, Smith DG, Caputo GC. Patient perception of involvement in medical care: relationship to illness attitudes and outcomes. J Gen Intern Med. 1989;4:506–11.

    Article  PubMed  CAS  Google Scholar 

  62. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Arch Intern Med. 1995;155:1877–84.

    Article  PubMed  CAS  Google Scholar 

  63. Lo B. Resolving Ethical Dilemmas: A Guide for Clinicians. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000.

    Google Scholar 

  64. Lazare A, Putnam SM, Lipkin M. The three functions of the medical interview. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview: Clinical Care, Education, and Research. New York, NY: Springer-Verlag; 1995:3–19.

    Google Scholar 

  65. Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101:692–6.

    PubMed  CAS  Google Scholar 

  66. Burack RC, Carpenter RR. The predictive value of the presenting complaint. J Fam Pract. 1983;16:749–54.

    PubMed  CAS  Google Scholar 

  67. Floyd M, Lang F, Beine KL, McCord E. Evaluating interviewing techniques for the sexual practices history. Use of video trigger tapes to assess patient comfort. Arch Fam Med. 1999;8:218–23.

    Article  PubMed  CAS  Google Scholar 

  68. Gmel G, Lokosha O. Self-reported frequency of drinking assessed with a closed- or open-ended question format: a split-sample study in Switzerland. J Stud Alcohol. 2000;61:450–4.

    PubMed  CAS  Google Scholar 

  69. Ivis FJ, Bondy SJ, Adlaf EM. The effect of question structure on self-reports of heavy drinking: closed-ended versus open-ended questions. J Stud Alcohol. 1997;58:622–4.

    PubMed  CAS  Google Scholar 

  70. Devine DA, Fernald PS. Outcome effects of receiving a preferred, randomly assigned, or non-preferred therapy. J Consult Clin Psych. 1973;41:104–7.

    Article  CAS  Google Scholar 

  71. Oberst MT. Methodology in behavioral and psychosocial cancer research. Patients’ perceptions of care. Measurement of quality and satisfaction. Cancer. 1984;53(10 suppl):2366–75.

    PubMed  CAS  Google Scholar 

  72. Brown R, Dunn S, Butow P. Meeting patient expectations in the cancer consultation. Ann Oncol. 1997;8:877–82.

    Article  PubMed  CAS  Google Scholar 

  73. Gerbert B, Berg-Smith S, Mancuso M, et al. Video study of physician selection: preferences in the face of diversity. J Fam Pract. 2003;52:552–9.

    PubMed  Google Scholar 

  74. Baddeley AD. The Psychology of Memory. New York, NY: Basic Books; 1976.

    Google Scholar 

  75. Capitani E, Della Sala S, Logie RH, Spinnler H. Recency, primacy, and memory: reappraising and standardising the serial position curve. Cortex. 1992;28:315–42.

    PubMed  CAS  Google Scholar 

  76. Yunker RM, Levine MK, Sajid AW. Freestanding emergency centers and the patient population of internists. South Med J. 1986;79:424–7.

    PubMed  CAS  Google Scholar 

  77. Yunker RM, Levine MK, Sajid AW. Free-standing emergency centers and the patient population of family physicians. J Fam Pract. 1985;21:63–9.

    PubMed  CAS  Google Scholar 

  78. Rylko-Bauer B. The development and use of freestanding emergency centers: a review of the literature. Med Care Rev. 1988;45:129–63.

    Article  PubMed  CAS  Google Scholar 

  79. Lo B, Quill T, Tulsky J. Discussing palliative care with patients. ACP-ASIM End-of-life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 1999;130:744–9.

    PubMed  CAS  Google Scholar 

  80. Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999;319:766–71.

    PubMed  CAS  Google Scholar 

  81. Sheridan SL, Harris RP, Woolf SH. Shared decision making about screening and chemoprevention. A suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004;26:56–66.

    Article  PubMed  Google Scholar 

  82. Platt FW, Gordon GH. Field Guide to the Difficult Patient Interview. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999.

    Google Scholar 

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Correspondence to Sara L. Swenson MD.

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This work was supported by the Robert Wood Johnson Foundation Initiative on Strengthening the Patient-Provider Relationship.

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Swenson, S.L., Buell, S., Zettler, P. et al. Patient-centered communication. J GEN INTERN MED 19, 1069–1079 (2004). https://doi.org/10.1111/j.1525-1497.2004.30384.x

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