Brief Reports
A Scoping Review: Communication Between Emergency Physicians and Patients in the Emergency Department

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Abstract

Background

Understanding the basic qualities of communication between emergency physicians and patients could improve communication in the emergency department.

Objective

The objectives of this scoping review are to map the literature about the gaps in communication between emergency physicians and patients in the emergency department and make recommendations for further research.

Methods

A scoping review of literature published since 1980 and written in English was undertaken using the following databases: Pubmed, Scopus, and SocINDEX. The articles were searched for using two-keyword combinations of the following keywords joined by “AND”: “communication,” “patient,” “emergency physician,” “emergency department/emergency room/accident,” and “emergency room.” Seventeen articles were included in the final review.

Results

Five research issues were covered by the 17 papers: patient-centered communication, information sharing, bad news delivery, shared decision making, and physicians' perspectives on communication. Emergency physicians have several communication characteristics: doctor-driven decision making, focusing on efficient information gathering, immature communication techniques, and obstacles to overcoming miscommunication. Patients also have several communication characteristics: active participation in medical encounters, expectation of physician as a reliable guide, understanding physicians' difficulties, and factors that contribute to understanding.

Conclusions

Several conclusions about emergency department communication between patients and emergency physicians were drawn. Additional research is required to consider diverse patient needs in the emergency department. Furthermore, training programs for emergency physicians to improve the quality of communication should be developed and implemented in line with our research findings.

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

References (48)

  • R. Knopp et al.

    Physician-patient communication in the emergency department, part 1

    Acad Emerg Med

    (1996)
  • E. Redfern et al.

    Identifying vulnerabilities in communication in the emergency department

    Emerg Med J

    (2009)
  • E.M. Eisenberg et al.

    Transforming emergency medicine through narrative: qualitative action research at a community hospital

    Health Commun

    (2006)
  • E.M. Eisenberg et al.

    Communication in emergency medicine: implications for patient safety

    Commun Monogr

    (2005)
  • M.M. Reever et al.

    Emergency room communication issues: dealing with crisis

    Top Emerg Med

    (2002)
  • K.A. Rutherford et al.

    Adolescents' perceptions of interpersonal communication, respect, and concern for privacy in an urban tertiary-care pediatric emergency department

    Pediatr Emerg Care

    (2010)
  • R. Locke et al.

    Optimizing patient caregiver satisfaction through quality of communication in the pediatric emergency department

    Pediatr Emerg Care

    (2011)
  • H. Sandhu et al.

    Emergency nurse practitioners and doctors consulting with patients in an emergency department: a comparison of communication skills and satisfaction

    Emerg Med J

    (2009)
  • J.A. Hall et al.

    Satisfaction, gender, and communication in medical visits

    Med Care

    (1994)
  • S.A. Simmons et al.

    Implementation of a novel communication tool and its effect on patient comprehension of care and satisfaction

    Emerg Med J

    (2013)
  • D.M. McCarthy et al.

    Understanding patient–provider conversations: what are we talking about?

    Acad Emerg Med

    (2013)
  • D. Watt et al.

    Patient expectations of ED care: phase I—a focus group study

    CJEM

    (2005)
  • H. Arksey et al.

    Scoping studies: towards a methodological framework

    Int J Soc Res Methodol

    (2005)
  • R.S. Benenson et al.

    Evaluation of emergency medicine resident death notification skills by direct observation

    Acad Emerg Med

    (2003)
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