Bibiliography and Abstracts of RIAS Studies through 2014

Following are abstracts of RIAS studies, listed in alphabetical order by first author. Just click on a letter below to view the abstracts by the author's last name. Monographs and doctoral theses have their own page.

A     B     C     D     E     F     G     H     I     J     K     L     M     N     O     P     Q     R     S

T     U     V     W     X     Y     Z     Monographs & Theses


Farquharson L, Noble LM, Barker C, Behrens RH. Health beliefs and communication in the travel clinic consultation as predictors of adherence to malaria chemoprophylaxis. Br J Health Psychol. 2004 May;9(Pt 2):201-17.
(Communication Skills, Adherence, United Kingdom)
OBJECTIVES: The objectives were, first, to determine whether adherence to malaria prophylaxis could be predicted by (i) health beliefs specified by the Health Belief Model and the Theory of Planned Behaviour, and (ii) communication during the consultation in a travel clinic; and secondly, to examine the impact of the consultation in changing travellers' health beliefs. DESIGN: A prospective study using regression analysis. METHODS: The participants were 130 consecutive travellers attending a travel medicine clinic. Health beliefs were measured pre- and post-consultation. The consultations were coded from audiotape using the Roter Interaction Analysis System and a content analysis method recording discussion about malaria and prophylaxis. Adherence was assessed by a follow-up telephone interview. RESULTS: Perceived susceptibility to malaria, perceived benefits of medication and intentions to adhere increased significantly as a result of the consultation, and the perceived permanent nature of side effects reduced significantly. At follow-up (N = 107), 62% reported full adherence, 25% partial adherence and 12% poor/no adherence. A multinomial logistic regression analysis revealed that perceived benefits of medication, length of stay, health professional discussion about adherence and travellers' questions and statements independently predicted reported adherence. CONCLUSIONS: Health beliefs and communication significantly predicted adherence in this setting. The findings also suggested qualitative differences between travellers who adhered fully, partially or poorly. Although the clinic consultation had a positive impact, emphasizing benefits of medication and resolving potential barriers to adherence could improve adherence in the population.

Farmer SA, Roter DL, Higginson IJ. Chest pain: communication of symptoms and history in a London emergency department. Patient Educ Couns. 2006 Oct;63(1-2):138-44. Epub 2005 Oct 20.
(Emergency Medicine, United Kingdom)
OBJECTIVE: To describe patient-provider interactions for patients in an emergency department with possible acute coronary syndrome (ACS) and to generate hypotheses about how communication might contribute to sociocultural disparities in cardiac care. METHODS: Qualitative analysis of observational data. Seventy-four consecutive patients presenting between 8 a.m. and 10 p.m. over a 4-month period. RESULTS: Participants were aged 40-85 years; 58% were male; 67% were white, 18% Afro-Caribbean, and 15% South East Asian. Observations revealed significant obstacles to communication for the majority of patients. The three most prominent impediments to effective communication were: the use of leading questions to define chest pain, patient-provider conflict as a result of, and contributor to, poor communication, and frank miscommunication due to language barriers and translational difficulties. CONCLUSION: This study documents aspects of the communication process that compromise the quality of the medical history obtained in emergency department patients with suspected ACS. Accurate diagnosis relies on an interaction that weaves both the patient's and the physician's perspective into a shared understanding of events that comprise a patient's history. When diagnostic short cuts are taken to overcome educational, cultural, or language barriers in the medical interview, they may contribute to health care disparities. PRACTICE IMPLICATIONS: Physicians should take a more attentive and careful approach to patient interviewing than was observed here and should be aware of the ways in which they shape the interview through their questions and focus. Good communication skills can be effectively taught at all levels of training and practice.

Fassaert T, van Dulmen S, Schellevis F, Bensing J. Active listening in medical consultations: Development of the Active listening observation scale (ALOS-global). Patient Education and Counseling. 2007Nov;68(3):258-64.
(Communications Skills, Netherlands)
OBJECTIVE: Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments. METHODS: Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients' perception of GPs' affective performance, GPs' verbal attention, patients' self-reported anxiety level and gender differences. RESULTS: The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The scalescore was positively related to verbal attention measured by RIAS, to patients' perception of GPs' performance and to their pre-visit anxiety level. Female GPs received higher active listening scores. CONCLUSION: The results of this study are promising concerning the psychometric properties of the ALOS-global. More research is needed to confirm these preliminary findings. PRACTICE IMPLICATIONS: After establishing how active listening differentiates between health professionals, the ALOS-global may become a valuable tool in feedback and training aimed at increasing listening skills.

Finset A, Graugaard PK, Holgersen K. Salivary cortisol response after a medical interview: the impact of physician communication behaviour, depressed affect and alexithymia. Patient Educ Couns. 2006 Feb;60(2):115-24. Epub 2005 Dec 28.
(Communication Skills, Norway)
OBJECTIVE: To explore if - and possibly how - a medical interview may affect adrenocortical activity in musculo-skeletal pain patients with and without alexithymia. METHODS: Female patients (N = 54) recruited from a patient organization for fibromyalgia completed the Toronto Alexithymia Scale (TAS-20) and subgroups with, respectively, low and high scores were selected for participation. Seven physicians conducted consultations attempting to vary their communication in accordance with given guidelines. All consultations were videotaped and analysed by The Roter Interaction Analysis System (RIAS) to evaluate the actual content of the consultations. RESULTS: An increase in depressed affect from pre- to post-interview was associated with relatively high cortisol levels 24 h after the consultation, but only in patients with alexithymia. Psychosocial questions from the physician were associated with increased depressed affect immediately following the interview, but not with cortisol responses at any time. CONCLUSION: In patients with deficient affect regulation, increase in depressed affect after a medical interview may be associated with delayed effects in adrenocortical activity, possibly mediated by rumination. PRACTICE IMPLICATIONS: Providers should be sensitive to potential deficits of affect regulation in their patients.

Flickinger TE, Saha S, Roter D, Korthuis PT, Sharp V, Cohn J, Moore RD, Ingersoll KS, Beach MC. Respecting patients is associated with more patient-centered communication behaviors in clinical encounters. Patient Educ Couns. 2016 Feb;99(2):250-5.
(HIV/AIDS, Communication Skills, United States)
OBJECTIVE: Attitudes towards patients may influence how clinicians interact. We investigated whether respect for patients was associated with communication behaviors during HIV care encounters. METHODS: We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes. RESULTS: When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)]. CONCLUSIONS: Respect is associated with positive and patient-centered communication behaviors during encounters. PRACTICE IMPLICATIONS: Clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. Educators should consider methods to enhance trainees' respect in communication skills training. KEYWORDS: HIV/AIDS; Patient–clinician communication; Respect

Flickinger TE, Saha S, Roter D, Korthuis PT, Sharp V, Cohn J, Eggly S, Moore RD, Beach MC. Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. Patient Educ Couns. 2016 Feb;99(2):220-6.
(HIV/AIDS, Communication Skills, Adherence, United States)
OBJECTIVE: We examined associations of clinicians' empathy with patient-clinician communication behaviors, patients' rating of care, and medication self-efficacy. METHODS: We analyzed 435 adult patients and 45 clinicians at four outpatient HIV care sites in the United States. Negative binomial regressions investigated associations between clinician empathy and patient-clinician communication, assessed using the Roter Interaction Analysis System (RIAS). Logistic regressions investigated associations between clinician empathy and patient ratings of clinician communication, overall satisfaction, and medication self-efficacy. RESULTS: Clinicians in the highest vs. lowest empathy tertile engaged in less explicitly emotional talk (IRR 0.79, p<0.05), while clinicians in the middle vs. lowest engaged in more positive talk (IRR 1.31, p<0.05), more questions (IRR 1.42, p<0.05), and more patient activating talk (IRR 1.43, p<0.05). Patients of higher empathy clinicians disclosed more psychosocial and biomedical information. Patients of clinicians in both the middle and highest (vs. lowest) empathy tertiles had greater odds of reporting highest medication self-efficacy (OR 1.80, 95% CI 1.16-2.80; OR 2.13, 95% CI 1.37-3.32). CONCLUSIONS: Clinician empathy may be expressed through addressing patient engagement in care, by fostering cognitive, rather than primarily emotional, processing. PRACTICE IMPLICATIONS: Clinicians should consider enhancing their own empathic capacity, which may encourage patients' self-efficacy in medication adherence.

Ford S, Fallowfield L, Lewis S. Doctor-patient interactions in oncology. Soc Sci Med 1996 Jun;42(11):1511-9.
(Oncology, United Kingdom)
Studies which apply content analysis techniques to the cancer consultation are few. This descriptive study examines the structure and content of the bad news cancer consultations of 117 outpatients newly referred to the Medical Oncology Department of a large London teaching hospital. From previous communication research three main hypotheses are formed: (i) the cancer consultation is clinician-dominated rather than patient-centred; (ii) the level of psychosocial discussion between clinicians and patients is low and (iii) patient characteristics such as sex, age and prognostic category influence clinician behaviours. Each patient had two consultations with one of 5 oncologists. Both these were audiotaped with the patients' consent. The tapes were content coded using the Roter Interaction Analysis System. Results showed that clinicians tended to use closed rather than open questions. Patients asked few questions and were seldom given space to initiate discussion. Thus, the level of patient-centredness was low. Despite the fact that consultations concerned life threatening disease and often contained information regarding toxic treatment which is known to provoke psychological dysfunction, the number of questions relating to patients' psychological health were few. The amount of discussion concerning medical topics from both parties was 2.5 times greater than the amount of psychosocial discussion. Although there was a suggestion in the data that 3 clinicians showed variations in behaviour according to patient age and prognostic group, the number of patients for each doctor was small. Patients were well informed about their diagnosis, prognosis and treatment options, but their emotional well-being was rarely probed.

Ford S, Hall A, Ratcliffe D, Fallowfield L. The Medical Interaction Process System (MIPS): an instrument for analyzing interviews of oncologists and patient with cancer. Soc Sci Med 2000, 50(4): 553-566.
(Oncology, United Kingdom)
The increase in communication skills training for doctors has led to the need for more effective means of evaluation. Analysis of video and audio taped consultation using systems of interaction analysis can provide the trainee with in-depth feedback about their communication skills. Most interaction process systems were designed for use in primary care and recent research has questioned the applicability of these systems in medical specialties such as oncology. We describe the development of a new instrument, the Medical Interaction Process System (MIPS) for use in teaching communication skills and empirical research in medical encounters, particularly, between doctors and patients with cancer. A comparison of the MIPS and comparable behavior categories of another widely used system (the Roter Interaction Analysis System) was made to test convergent validity. Pearson correlation coefficients suggested a good level of concurrence between the two systems. Intercoder reliability tests were carried out between two coders at two separate time periods. Both of these indicated good reliability for the majority of categories. The two major advantages of the MIPS over other coding systems are: (1) the system allows for sequential and parallel coding, thus avoiding major coding conflicts and (2) the design of the coding sheet results in a multidimensional view of the consultation without data loss. We believe that the MIPS yields useful information for teaching doctors communication skills and also provides an objective method for evaluating the effectiveness of communication skills courses.

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