Brief ReportsA Scoping Review: Communication Between Emergency Physicians and Patients in the Emergency Department
Introduction
Effective communication is vital to physician–patient relationships in emergency departments (EDs), as it is in other clinical settings. In a primary clinic, it is possible for patients and doctors to have sufficient time to build the traditional type of long-term rapport. However, environmental factors in the ED are challenging: noise, lack of privacy, frequent interruptions, limited time, 24-h clinical care, staff shortages, few resources, unpredictability, overcrowding, and never-ending patient intakes 1, 2, 3, 4, 5. In addition, medical staff in the ED work with many complicated situations, such as death, violence, rape, acute illness, and accidents (6). These various environmental factors can affect interpersonal communication and patient satisfaction in the ED.
Previous studies have reported on patient satisfaction regarding communication in the ED. It was found that the quality of the patient–provider interpersonal communication in the ED influenced patient satisfaction in a way that was unrelated to length of stay or triage acuity score 7, 8. Junior physicians had slightly lower patient satisfaction scores compared with senior physicians and nurses 9, 10. In addition, in one study on communication tool development to improve patient satisfaction, the authors reconfirmed poor physician–patient communication in the ED and the resultant deficiency in patient comprehension and satisfaction (11). Other than patient satisfaction, the patient-centeredness scores using conversation analysis in the ED were investigated in a previous report (12). Most of the studies were about interpersonal communication between patients and nurses only, or a mixed group of ED staff 7, 8, 9, 10, 11, 12, 13, 14. Therefore, the specific features of physicians' communication have been scarcely outlined.
Understanding the basic qualities of communication between providers and patients could improve the communication itself (12). As emergency physicians play a central role in medical communication in the ED, it is considered more important to know the patients' perspectives on communication with physicians and the perspectives of physicians rather than patient satisfaction and communication with nurses. To the best of our knowledge, studies to date that investigate ED communication between patients and physicians have been limited in scope.
We aimed to review research regarding ED communication between patients and physicians. For that reason, a scoping review was selected rather than a systematic review. The objectives of this scoping review are to map the literature about gaps of communication between emergency physicians and patients in the ED, and make recommendations for further research.
Section snippets
Study Design
A scoping review is a form of literature review that addresses broader topics where there are many different study designs (15). Scoping reviews are comprehensive in describing the range and nature of existing evidence and form part of the preliminary investigative process, which can then guide more focused lines of research (16). Therefore, in the present study, the scoping review was conducted to review the range of studies on ED communication between patients and physicians.
Search Strategy
Pubmed, Scopus,
Characteristics of the Study
Thirteen studies were conducted in the United States, 2 in the United Kingdom, 1 in Taiwan, and 1 in France (Table 1). We searched for articles published after 1980; two were in 1997, nine were from 2000 to 2010, and six were after 2011 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 31, 32, 33. Studies regarding medical communication in the ED were actively published after 2000.
Characteristics of Study Subjects
Small sample sizes were obtained in qualitative research; quantitative studies or observational studies
Discussion
The aim of this scoping review was to give an introductory overview of the literature and provide a guide for additional research on ED communication. Most studies were conducted in the United States from 2000. The subject patients were varied, from children to older people. In more than half of the studies about physicians, residents were included. Diverse research themes were detected, such as patient-centered communication, information sharing, bad news delivery, decision making, and
Conclusions
This scoping review finds several differences regarding ED communication between emergency physicians and patients. Emergency physicians consider efficiency and beneficence in decision making from their own perspectives, but patients want greater autonomy. Emergency physicians focus on patients' physical discomfort and illness without empathy, but patients expect psychological comfort and reassurance from physicians. Patients also understand less medical information than expected. Education and
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