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


Kalet A, Earp JA, Kowlowitz V. How well do faculty evaluate the interviewing skills of medical students? J Gen Intern Med 1992 Sep-Oct;7(5):499-505.
(Communication Skills Evaluation, United States)
OBJECTIVE: To study the reliability and validity of using medical school faculty in the evaluation of the interviewing skills of medical students. DESIGN: All second-year University of North Carolina medical students (n = 159) were observed interviewing standardized patients for 5 minutes by one of eight experienced clinical faculty. Interview quality was assessed by a faculty checklist covering questioning style, facilitative behaviors, and specific content. Twenty-one randomly chosen students were videotaped and rated: by the original rater as well as four other raters; by two nationally recognized experts; and according to Roter's coding dimensions, which have been found to correlate strongly with patient compliance and satisfaction. SETTING: Medical school at a state university in the southeastern United States. PARTICIPANTS: Faculty members who volunteered to evaluate second-year medical students during an annual Objective Structured Clinical Exam. INTERVENTIONS: Interrater reliability and intrarater reliability were tested using videotapes of medical students interviewing a standardized patient. Validity was tested by comparing the faculty judgment with both an analysis using the Roter Interactional Analysis System and an assessment made by expert interviewers. MEASUREMENTS AND MAIN RESULTS: Faculty mean checklist score was 80% (range 41-100%). Intrarater reliability was poor for assessment of skills and behaviors as compared with that for content obtained. Interrater reliability was also poor as measured by intraclass correlation coefficients ranging from 0.11 to 0.37. When compared with the experts, faculty raters had a sensitivity of 80% but a specificity of 45% in identifying students with adequate skills. The predictive value of faculty assessment was 12%. Analysis using Roter's coding scheme suggests that faculty scored students on the basis of likability rather than specific behavioral skills, limiting their ability to provide behaviorally specific feedback. CONCLUSIONS: To accurately evaluate clinical interviewing skills we must enhance rater consistency, particularly in assessing those skills that both satisfy patients and yield crucial data.

Kanji N, Coe JB, Adams CL, Shaw JR. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. J Am Vet Med Assoc. 2012 Feb 15;240(4):427-36.
(Veterinary Medicine, Canada)
OBJECTIVE: To explore the relationship between veterinarian-client-patient interactions and client adherence to dental and surgery recommendations and to test the a priori hypotheses that appointment-specific client satisfaction and relationship-centered care are positively associated with client adherence. DESIGN: Cross-sectional study. SAMPLE: A subsample of 19 companion-animal veterinarians and 83 clients from a larger observational study consisting of 20 randomly recruited veterinarians and a convenience sample of 350 clients from eastern Ontario. PROCEDURES: Videotaped veterinarian-client-patient interactions containing a dentistry recommendation, surgery recommendation, or both were selected for inclusion from the larger sample of interactions coded with the Roter interaction analysis system. Client adherence was measured by evaluating each patient's medical record approximately 6 months after the videotaped interaction. The clarity of the recommendation, appointment-specific client-satisfaction score, and relationship-centered care score were compared between adhering and nonadhering clients. RESULTS: Among the 83 veterinarian-client-patient interactions, 25 (30%) clients adhered to a dentistry recommendation, surgery recommendation, or both. The odds for adherence were 7 times as great for clients who received a clear recommendation, compared with clients who received an ambiguous recommendation from their veterinarian. Moreover, adhering clients were significantly more satisfied as measured after the interview. Interactions resulting in client adherence also had higher scores for relationship-centered care than did interactions leading to nonadherence. CONCLUSIONS AND CLINICAL RELEVANCE: Veterinarian use of a relationship-centered care approach, characterized as a collaborative partnership between a veterinarian and a client with provision of clear recommendations and effective communication of the rationale for the recommendations, has positive implications for client adherence.

Katz MG, Jacobson TA, Veledar E, Kripalani S. Patient literacy and question-asking behavior during the medical encounter; a mix methods analysis. J Gen Intern Med 2007 Jun; 22(6): 782-6.
(Literacy, United States)
BACKGROUND: Although patient participation in the medical encounter confers significant benefits, many patients are reluctant to ask questions of their physicians. Patients' literacy level may affect their level of participation and question-asking behaviors. OBJECTIVE: To examine the effect of literacy on the number and types of questions asked by patients during primary care office visits. DESIGN: Convenience sample recruited between April and November 2004. Physician-patient visits were audiotaped, and patient questions from complete encounters (N = 57) were coded using an adaptation of the Roter Interaction Analysis System. PATIENTS: Participants were predominantly middle-aged (mean age = 56.7 years), female (75.4%), and African American (94.7%). Low literacy skills (< or = 6th grade reading level) were present in 38.6%. MEASUREMENTS: We hypothesized prospectively that low-literacy patients would ask fewer total questions and fewer questions about key aspects of their medical care. RESULTS: Low-literacy adults asked significantly fewer questions about medical care issues (median = 4 vs 6 among patients with higher literacy levels, p = .014). They also tended to ask fewer questions overall (median = 7 vs 10, p = .070). Low-literacy patients were more likely to ask the physician to repeat something (p = .013), indicating an initial lack of understanding. They were less likely to use medical terminology, refer to medications by name, request additional services, or seek new information. Question-asking behavior was not significantly related to patient gender, age, years of education, or physician-patient gender concordance. CONCLUSIONS: Literacy level appears to be an important determinant of patients' participation in the medical encounter. Low-literacy patients ask fewer questions about their medical care, and this may affect their ability to learn about their medical conditions and treatments.

Kilian S, Swartz L, Chiliza B. Doing their best: strategies used by South African clinicians in working with psychiatric inpatients across a language barrier. Glob Health Action. 2015 Oct 26;8:28155.
(Mental Health, Literacy/Language Barriers, South Africa)
BACKGROUND AND OBJECTIVES: South Africa has 11 official languages, but most psychiatrists can speak only English and Afrikaans and there are no formal interpreter posts in the mental healthcare system. As a result clinicians communicate with patients who have limited English language proficiency (LEP) without the use of interpreters. We present case material, constituting recordings of interactions between clinicians and LEP patients in a public psychiatric institution. The aim is to have a better understanding of how these clinical encounters operated and what communicative strategies clinicians used. DESIGN: We used the Roter interaction analysis system (RIAS) to evaluate clinicians' conversational strategies and to analyze interactions between clinicians and patients. RESULTS: Clinicians showed a high degree of tenacity in trying to engage patients in the clinical conversation, build rapport, and gather crucial diagnostic information. However, patients often responded briefly and monosyllabically, or kept quiet. In psychiatry where commonality of language cannot be assumed, it is not possible to determine the clinical significance of these responses. DISCUSSION: Clinicians went to great lengths to understand LEP patients. It is also clear that patients were often not optimally understood. Clinicians would try to gain valid information in a polite manner, but would abandon these attempts repeatedly as it became clear that proper communication was not possible. CONCLUSIONS: Our findings suggest that in the absence of interpreter services, the communication between clinicians and LEP patients is sparse and yields limited clinical information. The lack of proper language services stands in the way of optimal clinical care and requires urgent attention. KEYWORDS: Roter interaction analysis system; language barriers; lower income countries; optimal clinical care; psychiatric care.

Kim EJ. [Emergency nurse-patient interaction behavior][Article in Korean] Taehan Kanho Hakhoe Chi. 2005 Oct;35(6):1004-13.
(Emergency Medicine, Nursing, Korea)
PURPOSE: The main purpose of this study was to explore nurse-patient interaction behaviors and patient satisfaction with the interaction in the emergency department. METHOD: This study used video technology to record complete conversations between the nurse and patient, thus obtaining the interactions naturally occurring in a clinical setting. The participants were 28 nurses and 63 patients in the emergency department at one university hospital located in Seoul. The data was collected from November, 2002 to April, 2003. The video recordings were observed for 4 hours for each case and coded using an adapted version of Roter's Interaction Analysis System (RIAS), which yields frequencies of thirty-six types of interaction behaviors. RESULT: The information exchange related to therapeutic items including medications, simple orientation, and situational positive talk were characterized in the nurses' interaction behaviors. Giving information about one's own condition, questions about therapeutic regimen, and showing worry were characterized in patient interaction behaviors. The patients' satisfaction with the interaction was 37.75.9 (range 9-45). CONCLUSION: The emergency nurse-patient interaction behavior was task-related. The results suggest that identification of effective interaction behavior in the Emergency department and an interaction skill training program could increase patient satisfaction.

Kim YM, Figueroa ME, Martin A, Silva R, Acosta SF, Hurtado M, Richardson P, Kols A. Impact of supervision and self-assessment on doctor-patient communication in rural Mexico. Int J Qual Health Care. 2002 Oct;14(5):359-67.
(Primary Care, Communication Skills, Mexico)
OBJECTIVE: To determine whether supervision and self-assessment activities can improve doctor-patient communication. SETTING AND PARTICIPANTS: Six supervisors, 60 doctors in their last year of training, and 232 primary health care patients at rural health clinics in Michoacan, Mexico. DESIGN: The main evaluation compared post-intervention measures in control and intervention groups. A small panel study also examined changes from baseline to post-intervention rounds in both groups. INTERVENTION: Over a 4-month period, specially trained supervisors added 1 hour of supervision on interpersonal communication and counseling (IPC/C) to regular site visits. Doctors, who had received prior IPC/C training, periodically audiotaped and assessed their own consultations. MAIN OUTCOME MEASURES: These comprised frequency of doctors' facilitative communication, doctors' biomedical information-giving, and patients' active communication. RESULTS: The performance of all doctors improved markedly over the study period, but gains in facilitative communication and information-giving were significantly greater in the intervention than the control group. No single component of the intervention was responsible for the improvement; it resulted from the combination of activities. The doctors appreciated the more supportive relationship with supervisors that resulted from the intervention and found listening to themselves on audiotape a powerful, although initially stressful, experience. CONCLUSION: Supportive supervision and self-assessment activities can reinforce IPC/C training, prompt reflection and learning, and help novice doctors improve their interpersonal communication skills.

Kim YM, Kols A, Bonnin C, Richardson P, Roter D. Client communication behaviors with health care providers in Indonesia. Patient Educ Couns 2001 Oct;45(1):59-68.
(Decision-making, Indonesia)
Patient participation in health care consultations can improve the quality of decision making and increase patients' commitment to the treatment plan. This study examines client participation, operationally defined as client active communication, during family planning consultations in Indonesia. Data were collected on 1203 consultations in the provinces of East Java and Lampung. Sessions were audiotaped and the conversation coded using an adaptation of the roter interaction analysis system (RIAS). Culturally acceptable ways for Indonesian clients to participate in consultations include asking questions, requesting clarification, stating opinions, and expressing concerns. Factors significantly associated with client active communication were, in order of importance, providers' information giving, providers' facilitative communication, providers' expressions of negative emotion, client educational level, and province. The latter suggests the influence of culture on client participation. The results suggest that a combination of provider training and client education on key communication skills could increase client participation in health care consultations.

Kim YM, Kols A, Martin A, Silva D, Rinehart W, Prammawat S, Johnson S, Church K. Promoting informed choice: evaluating a decision-making tool for family planning clients and providers in Mexico. Int Fam Plan Perspect. 2005 Dec;31(4):162-71.
(Family Planning, Decision-Making, Mexico)
CONTEXT: The World Health Organization (WHO) has developed a decision-making tool to be used by providers and clients during family planning visits to improve the quality of services. It is important to examine the tool's usability and its impact on counseling and decision-making processes during family planning consultations. METHODS: Thirteen providers in Mexico City were videotaped with family planning clients three months before and one month after attending a training session on the WHO decision-making tool. The videotapes were coded for client-provider communication and eye contact, and decision-making behaviors were rated. In-depth interviews and focus group discussions explored clients' and providers' opinions of the tool. RESULTS: After providers began using the decision-making tool, they gave clients more information on family planning, tailored that information more closely to clients' situations and more often discussed HIV/AIDS prevention, dual protection and condom use. Client involvement in the decision-making process and client active communication increased, contributing to a shift from provider-dominated to shared decision making. Clients reported that the tool helped them understand the provider's explanations and made them feel more comfortable talking and asking questions during consultations. After one month of practice with the decision-making tool, most providers felt comfortable with it and found it useful; however, they recommended some changes to the tool to help engage clients in the decision-making process. CONCLUSIONS: The decision-making tool was useful both as a job aid for providers and as a decision aid for clients.

Kim YM, Kols A, Mwarogo P, Awasum D. Differences in counseling men and women: family planning in Kenya. Patient Educ Couns. 2000 Jan;39(1):37-47
(Gender, Family Planning, Kenya)
A comparison of family planning sessions with male and female clients in Kenya found distinct gender differences. Most men came for information, while women wanted to adopt, continue, or change contraceptive methods. Consultations with men and couples were more than twice as long as consultations with women. Men communicated actively (for example, by volunteering extra information, asking questions, and expressing worries) during 66% of their turns to speak, compared with 27% for women. Providers offered men more detailed information than women, asked them fewer questions, issued fewer instructions, and responded more supportively. These communication patterns may be seen as a reflection of Kenyan gender roles and men's and women's different reasons for seeking family planning services. Kenyan providers need to improve the quality of their interactions with women. They also need to anticipate men's outspokenness and understand the male agenda if they are to counsel men effectively. PIP: This study analyzes and compares transcripts of family planning consultations collected from two different family planning associations in Kenya to explore the possible differences in counseling women and men. A comparison of 358 family planning sessions at 25 service delivery sites in urban and rural areas found distinct gender differences. Most men came for information, while women opted to adopt, continue, or change contraceptive methods. Men participated more actively in the sessions during 66% of their turns to speak, compared with 27% for women. Men were offered more detailed information than women, were asked fewer questions, were issued fewer instructions, and were given more support by the providers. Such communication patterns may be seen as a reflection of Kenyan gender roles and men's and women's different reasons for seeking family planning services. The findings indicate that Kenyan providers need to improve the quality of their interactions with women, and that they also need to anticipate men's outspokenness and understand the male agenda for effective counseling.

Kim YM, Kols A, Prammawat S, Rinehart W. Sequence analysis: responsiveness of doctors to patient cues during family planning consultations in Mexico. Patient Educ Couns. 2005 Jul;58(1):114-7.
(Interaction Analysis, Family Planning, Mexico)
(Abstract not available.)

Kim YM, Putjuk F, Basuki E, Kols A. Increasing patient participation in reproductive health consultations: an evaluation of "Smart Patient" coaching in Indonesia. Patient Educ Couns. 2003 Jun;50(2):113-22.
(Patient Education, Indonesia)
Paternalistic models of health care, social distance between patients and providers, and cultural norms discourage patients from playing an active role in health consultations. This study tested whether individual coaching can give family planning patients the confidence and communication skills to talk more openly and more vigorously with providers. Educators met with 384 Indonesian women in clinic waiting rooms and coached them on asking questions, expressing concerns, and seeking clarification. An analysis of audiotaped consultations found that patients who received coaching articulated significantly more questions and concerns than others. Coaching narrowed differentials in active communication by patient type, age, and assertiveness, but it widened differentials by patient education and socioeconomic class. The discontinuation rate at 8 months was lower in the intervention than the control condition, but the difference was only marginally significant.

Kindler CH, Szirt L, Sommer D, Hausler R, Langewitz W. A quantitative analysis of anaesthetist-patient communication during the pre-operative visit. Anaesthesia. 2005 Jan; 60(1):53-9.
(Communication Skills, Anesthesia, Switzerland)
Previous communication research in general medical practice has shown that effective communication enhances patient compliance, satisfaction and medical outcome. It is expected that communication is equally important in anaesthesia, since patients often suffer from anxiety and lack of knowledge about anaesthetic procedures. However, little is known about the nature of communication during routine anaesthetic visits. The present study of 57 authentic anaesthetic visits provides the first results on the structure and content of communication in the pre-operative setting using the Roter Interaction Analysis System (RIAS). Patient-centred communication behaviours of anaesthetists and the extent of patient involvement were particularly investigated. From the 57 pre-operative visits, 18 267 utterances were coded. The mean (SD) [range] duration of the visit was 16.1 (7.8) [3.7-42.7] min. Anaesthetists provided 169 (68) and patients 153 (82) utterances per visit (53.5% vs. 46.5%). Physician and patient gender had no impact on the distribution of utterances and the duration of the visit. Conversation mainly focussed on biomedical issues with little psychosocial discussion (< 0.1% of all anaesthetist utterances). However, anaesthetists quite frequently used emotional comments toward patients (7%) and involved them in the conversation. The use of facilitators, open questions and emotional statements by the anaesthetist correlated with high patient involvement. The amount of patient participation in anaesthetic decisions was assessed with the Observing Patient Involvement Scale (OPTION). Compared with general practitioners, anaesthetists offered more opportunities to discuss treatment options (mean (SD) OPTION score 26.8 (16.8) vs. 16.8 (7.7)).

Kinsman H, Roter D, Berkenblit G, Saha S, Korthuis PT, Wilson I, Eggly S, Sankar A, Sharp V, Cohn J, Moore RD, Beach MC. "We'll do this together": the role of the first person plural in fostering partnership in patient-physician relationships. J Gen Intern Med. 2010 Mar;25(3):186-93. Epub 2009 Dec 22.

(Communication Skills, HIV/AIDS, United States)
BACKGROUND: Partnership is integral to therapeutic relationships, yet few studies have examined partnership-fostering communication behaviors in the clinic setting. We conducted this study to better understand how statements in which physicians use the first person plural might foster partnership between patient and provider. METHODS: We audio-recorded encounters between 45 HIV providers and 418 patients in the Enhancing Communication and HIV Outcomes (ECHO) Study. We used the Roter Interaction Analysis System (RIAS) to code for statements made by the physician that used the first person plural to refer to themselves and their patient. Using multiple logistic regression, we examined the associations between the occurrence of one or more first person plural statements with patient ratings of provider communication. To better understand the meaning of first person plural statements, we conducted a qualitative analysis. MAIN RESULTS: Providers were mostly white (69%) and Asian (24%); 57% were female. Patients were black (60%), white (25%), and Hispanic (15%); 33% were female. One or more first person plural statements occurred in 92/418 (22%) of encounters. In adjusted analyses, encounters with first person plural statements were associated with younger patient age (OR 0.97, 95% CI 0.94-0.99), higher patient depression scores (highest tertile compared to lowest tertile: OR 1.89, 95% CI 1.01-3.51), the patient not being on anti-retroviral therapy (OR 0.53, 95% CI 0.29-0.93), and older provider age (OR 1.05, 95% CI 1.00-1.09). After adjustment, patients were less likely to highly rate their provider's communication style if first person plural statements were used (AOR 0.57, 95% CI 0.33-0.96). There were 167 first person plural statements made by physicians in the 418 encounters. Qualitative analysis revealed that many first person plural features had at least one negative feature such as being overtly persuasive ("That's going to be our goal"), indirect ("What can we do to improve your diet?"), or ambiguous ("Let's see what we can do"), although there were also positive statements that involved patients in the health-care process, contributed to a mutual understanding, and addressed the patients' goals. CONCLUSIONS: Contrary to our hypotheses, use of first person plural was not associated with higher ratings of provider communication, probably because some of these statements were overtly persuasive, indirect, or ambiguous. Physicians should become aware of benefits and pitfalls of using the first person plural with patients. Further research is needed to determine the most effective methods through which providers can build alliances with patients.

Kirimlioglu N, Elcioglu O, Yildiz Z. Client participation and provider communication in family planning counselling and the sample study from Turkey. Eur. J Contracept. Reprod. Health Care. 2005 Jun;10(2):131-141.
(Family Planning, Turkey)
Background The family planning program in Turkey was established in 1965 to curb the rapid increase in population growth. The last Demographic and Health Survey showed that about 64 % of married women in Turkey used contraception. OBJECTIVES: This study examines of behavior of family planning clients and provider in Eskisehir/Turkey, to see whether they can achieve this ideal partnership. METHODS: Consultation between 83 physicians, 222 nurses and 324 clients requesting family planning methods were audio-taped and analyzed for physicians and nurses communication style. Data were collected from 3 hospital and 14 small health units that give services in Eskisehir. The audio-taped consultations were coded using an adaptation of the RIAS which has been used extensively in both developed and developing countries and in statistical analyzing chi(2) and t test were utilized. RESULTS AND CONCLUSIONS: The single strongest factor was providers giving biomedical and technical information. The qualitative analysis of audiotapes found that most of clients' questions concern contraceptive side effects and symptoms. The next category social talk, consisted largely of greetings. Most of the providers (87.6 %) are women. The results show that providers dominate most counseling session and clients rarely take on active role.

Koerber A, Gajendra S, Fulford RL, BeGole E, Evans CA. An exploratory study of orthodontic resident communication by patient race and ethnicity. J Dent Educ. 2004 May;68(5):553-62.
(Race, Dentistry, United States)
Race has been shown to affect the quality of physician-patient relations. In view of this, dentistry must consider whether race also affects dentist-patient relations. The purpose of this study was to explore whether orthodontic residents showed more social connection and concern for European ancestry patients, were more negative to minority patients, and appropriately used interventions designed to overcome cultural differences. Communications in sixty-eight dentist-patient encounters were analyzed using the Roter Interaction Analysis System (RIAS). The frequencies of each type of utterance were examined according to the patient's race/ethnicity. The race/ethnic groups were European (nineteen), African American (eleven), Latino (thirty-four), and Asian (four). In 90 percent of the sessions, the resident and the patient were of different ethnicity. Residents used social connection utterances more with European ancestry patients, but used personal utterances more with Latino patients. Residents did not use open-ended questions or probes for patient understanding more with minority patients. The communication patterns observed in this study were similar to those reported in the literature. This study has limitations, but additional research may confirm that residents communicate differently with patients by race and could use more appropriate methods of dealing with cross-cultural situations. More research on cross-cultural communication is needed.

Korthuis PT, Saha S, Chander G, McCarty D, Moore RD, Cohn JA, Sharp VL, Beach MC. Substance use and the quality of patient-provider communication in HIV clinics. AIDS Behav. 2011 May;15(4):832-41.
(HIV, United States)
The objective of this study was to estimate the influence of substance use on the quality of patient-provider communication during HIV clinic encounters. Patients were surveyed about unhealthy alcohol and illicit drug use and rated provider communication quality. Audio-recorded encounters were coded for specific communication behaviors. Patients with vs. without unhealthy alcohol use rated the quality of their provider's communication lower; illicit drug user ratings were comparable to non-users. Visit length was shorter, with fewer activating/engaging and psychosocial counseling statements for those with vs. without unhealthy alcohol use. Providers and patients exhibited favorable communication behaviors in encounters with illicit drug users vs. non-users, demonstrating greater evidence of patient-provider engagement. The quality of patient-provider communication was worse for HIV-infected patients with unhealthy alcohol use but similar or better for illicit drug users compared with non-users. Interventions should be developed that encourage providers to actively engage patients with unhealthy alcohol use.

Kruijver IP, Kerkstra A, Bensing JM, van de Wiel HB. Communication skills of nurses during interactions with simulated cancer patients. J Adv Nurs. 2001 Jun;34(6):772-9.
(Oncology, Netherlands)
AIM: In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. RATIONALE: The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancer patients. METHODS: For this purpose, admission interviews between 53 ward nurses and simulated cancer patients were videotaped and analysed using the Roter Interaction Analysis system, in which a distinction is made between instrumental and affective communication. RESULTS: The results reveal that more than 60% of nurses' utterances were of an instrumental nature. Affective communication occurred, but was more related to global affect ratings like giving agreements and paraphrases than to discussing and exploring actively patients feelings by showing empathy, showing concern and optimism. CONCLUSION: In future, nurses should be systematically provided with (continuing) training programmes, in which they learn how to communicate effectively in relation to patients' emotions and feelings, and how to integrate emotional care with practical and medical tasks.

Kruijver IP, Kerkstra A, Francke AL, Bensing JM, van de Wiel HB. Evaluation of communication training programs in nursing care: a review of the literature. Patient Educ Couns. 2000 Jan;39(1):129-45.
(Nursing, Netherlands)
An important aspect of nursing care is communication with patients. Nurses' major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients' concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables as described by Francke et al. [8]. In this way not only is the training program taken into account as a variable which may be responsible for nurses' behavioural change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program's degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses' skills, on nurses' behavioural changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design. The use of experimental research designs should be pursued in future studies in order to eliminate the influence of confounding variables.

Krupat E, Frankel R, Stein T, Irish J. The Four Habits Coding Scheme: Validation of an instrument to assess clinicians' communication behavior. Patient Educ. Couns. 2006 Jul;62(1):38-45.
(Communication Skills, United States)
OBJECTIVE: To present preliminary evidence for the reliability and validity of the Four Habits Coding Scheme (4HCS), an instrument based on a teaching model used widely throughout Kaiser Permanente to improve clinicians' communication skills. METHODS: One hundred videotaped primary care visits were coded using the 4HCS, and the data were assessed against a previously available data set for these visits, including the Roter Interaction Analysis System (RIAS), back channel responses, measures of nonverbal behavior, length of visit, and patients' post-visit assessments. RESULTS: Levels of inter-rater reliability were acceptable, and the distribution of ratings across items indicated that physicians' modal responses varied widely. Correlations between 4HCS ratings, RIAS, back channel responses, and non-verbal measures provided evidence of the instrument's construct validity. CONCLUSIONS: The Four Habits Coding Scheme, an instrument that combines both evaluative and descriptive elements of physician communication behavior and is derived from a conceptually based teaching model, has the potential to be of utility to researchers and evaluators as well as educators and clinicians. PRACTICE IMPLICATIONS: The Four Habits Coding Scheme provides a template for both guiding and measuring physician communication behaviors.

Kubota Y, Yano Y, Seki S, Takada K, Sakuma M, Morimoto T, Akaike A, Hiraide A. Assessment of pharmacy students' communication competence using the Roter Interaction Analysis System during objective structured clinical examinations. Am J Pharm Educ. 2011 Apr 11;75(3):43.
(Pharmacy, Communication Skills, Japan)
OBJECTIVE: To determine the value of using the Roter Interaction Analysis System during objective structured clinical examinations (OSCEs) to assess pharmacy students' communication competence. METHODS: As pharmacy students completed a clinical OSCE involving an interview with a simulated patient, 3 experts used a global rating scale to assess students' overall performance in the interview, and both the student's and patient's languages were coded using the Roter Interaction Analysis System (RIAS). The coders recorded the number of utterances (ie, units of spoken language) in each RIAS category. Correlations between the raters' scores and the number and types of utterances were examined. RESULTS: There was a significant correlation between students' global rating scores on the OSCE and the number of utterances in the RIAS socio-emotional category but not the RIAS business category. CONCLUSIONS: The RIAS proved to be a useful tool for assessing the socio-emotional aspect of students' interview skills.

Kumar R, Korthuis PT, Saha S, Chander G, Sharp V, Cohn J, Moore R, Beach MC. Decision-making role preferences among patients with HIV: associations with patient and provider characteristics and communication behaviors. J Gen Intern Med. 2010 Jun;25(6):517-23. Epub 2010 Feb 24.
(Decision-making, HIV/AIDS, United States)
BACKGROUND: A preference for shared decision-making among patients with HIV has been associated with better health outcomes. One possible explanation for this association is that patients who prefer a more active role in decision-making are more engaged in the communication process during encounters with their providers. Little is known, however, about patient and provider characteristics or communication behaviors associated with patient decision-making preferences in HIV settings. OBJECTIVE: We examined patient and provider characteristics and patient-provider communication behaviors associated with the decision-making role preferences of patients with HIV. DESIGN: Cross-sectional analysis of patient and provider questionnaires and audio recorded clinical encounters from four sites. PARTICIPANTS: A total of 45 providers and 434 of their patients with HIV. MEASURES: Patients were asked how they prefer to be involved in the decision-making process (doctor makes all/most decisions, patients and doctors share decisions, or patients make decisions alone). Measures of provider and patient communication behaviors were coded from audio recordings using the Roter Interaction Analysis System. MAIN RESULTS: Overall, 72% of patients preferred to share decisions with their provider, 23% wanted their provider to make decisions, and 5% wanted to make decisions themselves. Compared to patients who preferred to share decisions with their provider, patients who preferred their provider make decisions were less likely to be above the age of 60 (ARR 0.09, 95% CI 0.01-0.89) and perceive high quality provider communication about decision-making (ARR 0.41, 95% CI 0.23-0.73), and more likely to have depressive symptoms (ARR 1.92, 95% CI 1.07-3.44). There was no significant association between patient preferences and measures of provider or patient communication behavior. CONCLUSION: Observed measures of patient and provider communication behavior were similar across all patient decision-making role preferences, indicating that it may be difficult for providers to determine these preferences based solely on communication behavior. Engaging patients in open discussion about decision-making preferences may be a more effective approach.

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