Resources
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

S

Sala F, Krupat E, Roter D. Satisfaction and the use of humor by physicians and patients. Psychology and Health 2002:17(3):269-280.
(Patient Satisfaction, United States)
The current study investigated the extent to which various types of humor are associated with high- and low-satisfaction doctor visits and whether male and female physicians and patients differ in their use of humor. A humor coding scheme, capable of distinguishing three categories (negative, positive, and general) and ten sub-types of humor, was validated against 92 audiotaped physician-patient primary care visits, half rated high and half rated low in satisfaction. Results revealed that physicians and patients used more light humor, more humor that relieves tension, more self-effacing humor, and more positive-function humor in high satisfaction than in low-satisfaction visits. In addition, the patients of female physicians used more humor than the patients of male physicians across levels of satisfaction. The results indicate a strong association between humor and satisfaction, and suggest ways in which humor and laughter help to maintain rapport in the physician-patient relationship.

Sandhu H, Dale J, Stallard N, Crouch R, Glucksman E. Emergency nurse practitioners and doctors consulting with patients in an emergency department: a comparison of communication skills and satisfaction. Emerg Med J. 2009 Jun;26(6):400-4.
(Emergency Medicine, United Kingdom)
BACKGROUND: Emergency nurse practitioners (ENPs) play an increasingly important role in UK emergency departments (EDs), but there is limited evidence about how this affects patient care and outcome. A study was undertaken to compare the content of, and satisfaction with, consultations made with patients presenting with problems of low acuity to an ED. METHODS: Patients presenting with "primary care" problems were allocated to senior house officers (SHOs, n = 10), specialist registrars/staff grades (n = 7), sessionally-employed general practitioners (GPs, n = 12) or ENPs (n = 6) randomly rostered to work in a consulting room that had a wall-mounted video camera. At the end of each consultation the doctor/ENP and the patient were asked to complete the Physician/Patient Satisfaction Questionnaire. A stratified sample of videotaped consultations (n = 296) was analysed in depth using the Roter Interaction Analysis System. The main outcome measures were length of consultation; numbers of utterances of doctor/ENP and patient talk related to building a relationship, data gathering, activating/partnering, and patient education/counselling; doctor/ENP and patient consultation satisfaction scores. RESULTS: ENPs and GPs focused more on patient education and counselling about the medical condition or therapeutic regimen than did ED doctors. There were no significant differences in consultation length. ENPs had higher levels of overall self-satisfaction with their consultations than ED doctors. Patient satisfaction with how actively they participated in the consultation was significantly associated with the amount of talk relating to building a relationship and activating and partnering, and patient satisfaction with information giving in the consultation was significantly associated with the amount of talk relating to building a relationship. CONCLUSION: These findings suggest differences between ENP and ED doctor consultations which are associated with some aspects of patient satisfaction. In contrast to previous reports, consultation length was not greater for ENPs than for doctors. There is a need for further research to test the generalisability of these findings and their impact on clinical outcome.

Sandvik M, Eide H, Lind M, Graugaard PK, Torper J, Finset A. Analyzing medical dialogues: strength and weakness of Roter's interaction analysis system (RIAS). Patient Educ Couns 2002 Apr;46(4):235-41.
(Interaction Analysis, Norway)
Roter's interaction analysis system (RIAS) is analyzed in this article. Ground rules of linguistic interaction analysis, emphasizing meaning as a product of interaction and turn taking as a basic principle for the understanding of interaction are briefly introduced. Specific aspects of the application of RIAS are discussed and a number of adjustments and/or specifications suggested: (1) utterances should be defined in terms of content and turn taking criteria; (2) the recording system should allow for registering interruptions; (3) pauses or silences should be scored on the basis of functional criteria and not as demarcation in the communication; (4) clear distinctions should be made between the categories of "backchannel" and "agree"; (5) questions should be coded according to function rather than linguistic form; (6) some of the socioemotional categories may appear too narrow, others too wide; (7) crying should be included in the coding scheme as a separate category.

Sapkota S, Brien JA, Greenfield JR, Aslani P. A Systematic Review of Interventions Addressing Adherence to Anti-Diabetic Medications in Patients with Type 2 Diabetes--Components of Interventions. PLoS One. 2015 Jun 8;10(6):e0128581.
(Adherence, Primary Care, Australia)
BACKGROUND: Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes (T2D). A range of interventions have been developed to promote anti-diabetic medication adherence. However, there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence. In this systematic review we assessed the characteristics of interventions that aimed to promote adherence to anti-diabetic medications. METHOD: Using appropriate search terms in Medline, Embase, CINAHL, International Pharmaceutical Abstracts (IPA), PUBmed, and PsychINFO (years 2000-2013), we identified 52 studies which met the inclusion criteria. RESULTS: Forty-nine studies consisted of patient-level interventions, two provider-level interventions, and one consisted of both. Interventions were classified as educational (n = 7), behavioural (n = 3), affective, economic (n = 3) or multifaceted (a combination of the above; n = 40). One study consisted of two interventions. The review found that multifaceted interventions, addressing several non-adherence factors, were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies. However, interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results, making it difficult to conclude on effective intervention strategies to promote adherence. Educational strategies have remained the most popular intervention strategy, followed by behavioural, with affective components becoming more common in recent years. Most of the interventions addressed patient-related (n = 35), condition-related (n = 31), and therapy-related (n = 20) factors as defined by the World Health Organization, while fewer addressed health care system (n = 5) and socio-economic-related factors (n = 13). CONCLUSION: There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications. However, research limitations, such as limited use of standardized methods and tools to measure adherence, lack of individually tailored adherence promoting strategies and variability in the interventions developed, reduce the ability to generalize the findings of the studies reviewed. Furthermore, this review highlights the need to develop multifaceted interventions which can be tailored to the individual patient's needs over the duration of their diabetes management.

Schmid Mast M, Hall JA, Roter DL. Caring and dominance affect participants' perceptions and behaviors during a virtual medical visit. J Gen Intern Med. 2008 May;23(5):523-7.
(Computer Use/Simulation, Interaction Analysis, United States)
BACKGROUND: Physician communication style affects patients' perceptions and behaviors. Two aspects of physician communication style, caring and dominance, are often related in that a high caring physician is usually not dominant and vice versa. OBJECTIVE: This research was aimed at testing the sole or joint impact of physician caring and physician dominance on participant perceptions and behavior during the medical visit. PARTICIPANTS AND DESIGN: In an experimental design, analog patients (APs) (167 university students) interacted with a computer-generated virtual physician on a computer screen. Participants were randomly assigned to 1 of 4 experimental conditions (physician communication style: high dominance and low caring, high dominance and high caring, low dominance and low caring, or low dominance and high caring). The APs' verbal and nonverbal behavior during the visit as well as their perception of the virtual physician were assessed. RESULTS: Analog patients were able to distinguish dominance and caring dimensions of the virtual physician's communication. Moreover, APs provided less medical information, spoke less, and agreed more when interacting with a high-dominant compared to a low-dominant physician. They also talked more about emotions and were quicker in taking their turn to speak when interacting with a high-caring compared to a low-caring physician. CONCLUSIONS: Dominant and caring physicians elicit different emotional and behavioral responses from APs. Physician dominance reduces patient engagement in the medical dialog and produces submissiveness, whereas physician caring increases patient emotionality.

Schoenthaler A, Kalet A, Nicholson J, Lipkin M Jr. Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence. Patient Educ Couns. 2014 Jul;96(1):3-12.
(Communication Skills/Training, Cardiology, United States)
OBJECTIVE: To conduct a systematic literature review appraising the effects of interventions to improve patient-practitioner communication on cardiovascular-related clinical outcomes. METHODS: Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults >=18 years of age. RESULTS: Fifteen papers were reviewed: the primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients' information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner's general patient-centered communication or risk communication skills. CONCLUSION: Few interventions targeting patient-practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient-practitioner communication to improve cardiovascular-related clinical outcomes. PRACTICE IMPLICATIONS: Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes. KEYWORDS: Cardiovascular diseases; Patient–practitioner communication; Systematic review

Schouten BC, Meeuwesen L. Cultural differences in medical communication: a review of the literature. Patient Educ Couns. 2006 Dec;64(1-3):21-34. Epub 2006 Jan 20.
(Intercultural Communication, Netherlands)
OBJECTIVE: Culture and ethnicity have often been cited as barriers in establishing an effective and satisfying doctor-patient relationship. The aim of this paper is to gain more insight in intercultural medical communication difficulties by reviewing observational studies on intercultural doctor-patient communication. In addition, a research model for studying this topic in future research is proposed. METHODS: A literature review using online databases (Pubmed, Psychlit) was performed. RESULTS: Findings reveal major differences in doctor-patient communication as a consequence of patients' ethnic backgrounds. Doctors behave less affectively when interacting with ethnic minority patients compared to White patients. Ethnic minority patients themselves are also less verbally expressive; they seem to be less assertive and affective during the medical encounter than White patients. CONCLUSION: Most reviewed studies did not relate communication behaviour to possible antecedent culture-related variables, nor did they assess the effect of cultural variations in doctor-patient communication on outcomes, leaving us in the dark about reasons for and consequences of differences in intercultural medical communication. Five key predictors of culture-related communication problems are identified in the literature: (1) cultural differences in explanatory models of health and illness; (2) differences in cultural values; (3) cultural differences in patients' preferences for doctor-patient relationships; (4) racism/perceptual biases; (5) linguistic barriers. It is concluded that by incorporating these variables into a research model future research on this topic can be enhanced, both from a theoretical and a methodological perspective. PRACTICE IMPLICATIONS: Using a cultural sensitive approach in medical communication is recommended.

Schouten BC, Meeuwesen L, Harmsen HA. The impact of an intervention in intercultural communication on doctor-patient interaction in The Netherlands. Patient Educ Couns. 2005 Sep;58(3):288-95.
(Intercultural Communication, Netherlands)
OBJECTIVE: Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication. METHODS: Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well. RESULTS: The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behavior of both patients and doctors, no significant changes could be detected. CONCLUSION: It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication. PRACTICE IMPLICATIONS: Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.

Schouten BC, Meeuwesen L, Tromp F, Harmsen HA. Cultural diversity in patient participation: the influence of patients' characteristics and doctors’ communicative behaviour. Patient Educ Couns. 2007 Jul;67(1-2):214-23. Epub 2007 May 4.
(Intercultural Communication, Netherlands)
OBJECTIVE: The primary goal of this study was to examine the extent to which patient participation during medical visits is influenced by patients' ethnic background, patients' culture-related characteristics (e.g. acculturation, locus of control, cultural views) and features of doctors' communicative behaviour. Furthermore, the mutual influence between patients' participatory behaviour and doctors' communicative behaviour was investigated. An additional goal was to identify the independent contribution of these variables to the degree of patient satisfaction and mutual understanding between GP and patient. METHODS: Communicative behaviour of patients (n=103) and GPs (n=29) was analysed with Roter's Interaction Analysis System, frequency of patient questions and patients' assertive utterances (e.g. making requests, suggesting alternative treatment options). Additional data were gathered using GP and patient questionnaires after the consultations. RESULTS: Results show that non-Western ethnic minority patients display less participatory behaviour during medical consultations than Dutch patients. GPs' affective verbal behaviour had most effect on degree of patient participation and patient satisfaction. Regression analyses indicate a significant mutual influence between patients' verbal behaviour and GPs' verbal behaviour. CONCLUSION: Overall, results of this study show some important differences between Dutch and non-Western ethnic minority patients in degree of patient participation. Furthermore, our results indicate that patient participation encompasses several aspects that are not necessarily interrelated. PRACTICE IMPLICATIONS: The necessity for continued education of GPs' communicative skills, particularly when dealing with non-Western ethnic minority patients, is reflected in the strong influence of GP's affective verbal behaviour on both patient participation and their satisfaction with the medical encounter.

Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Veterinarian satisfaction with companion animal visits. J Am Vet Med Assoc. 2012 Apr 1;240(7):832-41.
(Veterinary Medicine, Physician Satisfaction, Canada)
OBJECTIVE: To measure veterinarian satisfaction with companion animal visits through an adaptation of a previously validated physician visit satisfaction scale and to identify demographic, personality, appointment, and communication factors that contribute to veterinarian visit satisfaction. DESIGN: Cross-sectional descriptive study. SAMPLE: Random sample of 50 companion animal practitioners in southern Ontario, Canada, and convenience sample of 300 clients and their pets. PROCEDURES: For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed by use of the Roter interaction analysis system. The physician satisfaction scale, Rosenberg self-esteem scale, and interpersonal reactivity index were used to measure veterinarian visit satisfaction, self-esteem, and empathy, respectively. Linear regression analysis was conducted to study the relationship between factors and veterinarian visit satisfaction. RESULTS: Veterinarian visit satisfaction ranged from 1 to 5 (mean ± SD, 3.97 ± 0.99) and differed significantly between wellness appointments (mean scale score, 4.13) and problem appointments (mean scale score, 3.81). Various elements of client and veterinarian communication as well as personality measures of veterinarian self-esteem and empathy were associated with veterinarian satisfaction. The specific factors differed depending on the nature of the appointment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that veterinarian visit-specific satisfaction is enhanced through the use of communication that builds relationships with clients and is associated with degrees of veterinarian empathetic concern and veterinarian self-esteem. The implications extend to overall job satisfaction and its potential link to the health and well-being of individual veterinarians.

Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Veterinarian-client-patient communication during wellness appointments versus appointments related to a health problem in companion animal practice. J Am Vet Med Assoc. 2008 Nov 15;233(10):1576-86.
(Veterinary Medicine, Canada)
OBJECTIVE: To compare the clinical interview process, content of the medical dialog, and emotional tone of the veterinarian-client-patient interaction during wellness appointments and appointments related to a health problem in companion animal practice. DESIGN: Cross-sectional descriptive study. SAMPLE POPULATION: A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURE: For each practitioner, 6 clinical appointments (3 wellness appointments and 3 problem appointments) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes. RESULTS: Wellness appointments were characterized by a broad discussion of topics, with 50% of data-gathering statements and 27% of client education statements related to the pet's lifestyle activities and social interactions. Wellness appointments included twice as much verbal interaction with the pet as did problem appointments, and the emotional atmosphere of wellness appointments was generally relaxed. There were more social talk, laughter, statements of reassurance, and compliments directed toward the client and pet. In contrast, during problem appointments, 90% of the data gathering and client education focused on biomedical topics. Coders rated veterinarians as hurried during 30 of the 150 (20%) problem appointments; they rated clients as anxious during 39 (26%) problem appointments and as emotionally distressed during 21 (14%). Conclusions and CLINICAL RELEVANCE: Results suggested that veterinarian-client-patient communication differed between wellness and problem appointments. Owing to the emphasis on biomedical content during problem appointments, veterinarians may neglect lifestyle and social concerns that could impact patient management and outcomes, such as client satisfaction and adherence to veterinarian recommendations.

Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Use of the roter interaction analysis system to analyze veterinarian-client-patient communication in companion animal practice. J Am Vet Med Assoc. 2004 Jul 15;225(2):222-9.
(Veterinary Medicine, Canada)
OBJECTIVE: To identify specific components of veterinarian-client-patient communication during clinical appointments in companion animal practice. DESIGN: Cross-sectional descriptive study. SAMPLE POPULATION: A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURE: For each practitioner, 6 clinical appointments (3 wellness appointments and 3 appointments related to a health problem) were videotaped, and the Roter interaction analysis system (RIAS) was used to analyze the resulting 300 videotapes. Statements made during each appointment were classified by means of a communication framework reflecting the 4 essential tasks of the appointment (i.e. data gathering, education and counseling, relationship building, and activation and partnership). RESULTS: 57% of the veterinarians contacted (50/87) and 99% of the clients contacted agreed to participate in the study. Mean duration of the appointments was 13 minutes. Typically, veterinarians contributed 62% of the total conversation and clients contributed 38%. Fifty-four percent of the veterinarian interaction was with the client, and 8% was with the pet. Data gathering constituted 9% of the veterinarian-to-client communication and was primarily accomplished through closed-ended questioning; 48% of veterinarian-to-client communication involved client education and counseling, 30% involved relationship building, and 7% involved activation and partnership (the remaining 6% constituted orientation). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the RIAS was a reliable method of assessing the structure, process, and content of veterinarian-client-patient communication and that some veterinarians do not use all the tools needed for effective communication.

Shaw JR, Barley GE, Hill AE, Larson S, Roter DL. Communication skills education onsite in a veterinary practice. Patient Educ Couns. 2010 Sep;80(3):337-44. Epub 2010 Jul 6.
(Communication Skills Training, Veterinary Medicine, United States)
OBJECTIVE: To provide communication skills education to veterinary professionals in the practice setting and evaluate the training by measuring veterinarian communication pre- and post-intervention. METHODS: This is a case-based pre-test/post-test intervention study of a veterinary practice in Denver, CO. Four veterinarians from a single practice and 48 clients (selected to represent wellness and problem visits) were recruited to the study. The veterinarians took part in a training intervention consisting of a year-long curriculum, including interactive communication modules, individual coaching and communication laboratories. Six visit interactions were measured for each of the 4 veterinarians pre- and post-skill training. The Roter interaction analysis system (RIAS) was used to analyze the study's 48 videotapes. RESULTS: Compared to the pre-training visits, veterinarians gathered twice as much lifestyle-social data (p < 0.02), and used 1.5 times more partnership building (p < 0.03) and positive rapport-building (p < 0.01) communication. Clients provided 1.4 times more lifestyle/social information (p < 0.02) and expressed 1.7 times more emotional statements (p < 0.01) in post-training visits. CONCLUSION: The training intervention promoted a more client-centered approach to veterinarian-client communication. PRACTICE IMPLICATIONS: Practice-based communication training is novel to veterinary practice. As a case study, generalization of the findings are limited, however the findings support the efficacy of the communication intervention and enhanced utilization of veterinarian-client communication skills by these veterinarians.

Shaw JR, Bonnett BN, Adams CL, Roter DL. Veterinarian-client-patient communication patterns used during clinical appointments in companion animal practice. J Am Vet Med Assoc. 2006 Mar 1;228(5):714-21.
(Veterinary Medicine, Canada)
OBJECTIVE: To identify communication patterns used by veterinarians during clinical appointments in companion animal practice. DESIGN: Cross-sectional descriptive study. SAMPLE POPULATION: A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURE: For each practitioner, 6 clinical appointments (3 wellness appointments and 3 appointments related to a health problem) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes, and cluster analysis was used to identify veterinarian communication patterns. RESULTS: 175 (58%) appointments were classified as having a biomedical communication pattern, and 125 (42%) were classified as having a biolifestyle-social communication pattern. None were classified as having a consumerist communication pattern. Twentythree (46%) veterinarians were classified as using a predominantly biomedical communication pattern, 19 (38%) were classified as using a mixed communication pattern, and 8 (16%) were classified as using a predominantly biolifestyle-social communication pattern. Pattern use was related to the type of appointment. Overall, 103 (69%) wellness appointments were classified as biolifestyle-social and 127 (85%) problem appointments were classified as biomedical. Appointments with a biomedical communication pattern (mean, 11.98 minutes) were significantly longer than appointments with a biolifestyle-social communication pattern (10.43 minutes). Median relationship-centered care score (ie, the ratio of client-centered talk to veterinarian-centered talk) was significantly higher during appointments with a biolifestyle-social communication pattern (1.10) than during appointments with a biomedical communication pattern (0.40). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that veterinarians in companion animal practice use 2 distinct patterns of communication. Communication pattern was associated with duration of visit, type of appointment, and relationship-centeredness. Recognition of these communication patterns has implications for veterinary training and client and patient outcomes.

Shaw JR, Bonnett BN, Roter DL, Adams CL, Larson S. Gender differences in veterinarian-client-patient communication in companion animal practice. J Am Vet Med Assoc. 2012 Jul 1;241(1):81-8.
(Veterinary Medicine, Gender, Canada) OBJECTIVE:To describe the relationship between veterinarian and client genders and veterinarian-client-patient communication. DESIGN: Cross-sectional descriptive study. SAMPLE: Random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets. PROCEDURES: For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed with the Roter interaction analysis system (RIAS). Linear regression was conducted to study the relationship between demographic factors, measures of veterinarian-client-patient communication, and gender of the veterinarian and client. RESULTS: Female veterinarians conducted more relationship-centered appointments, provided more positive and rapport-building statements, talked more to the patient, and were perceived as less hurried or rushed, compared with male veterinarians. Clients were more likely to provide lifestyle-social information to female veterinarians. Same-gender veterinarian-client interactions were relationship centered and included client provision of more lifestyle-social information. CONCLUSIONS AND CLINICAL RELEVANCE: Gender influenced veterinarian-client-patient communication, and previously described physician gender differences in medical communication were largely replicated in the veterinary context.

Shaw WS, Chin EH, Nelson CC, Reme SE, Woiszwillo MJ, Verma SK. What circumstances prompt a workplace discussion in medical evaluations for back pain? J Occup Rehabil. 2013 Mar;23(1):125-34.
(Work-Related Health, United States)
PURPOSE: To determine how frequently workplace topics emerge in the interactions between patients and providers in an evaluation for low back pain (LBP) and to determine its association with patient and provider characteristics. METHODS: Adults with work-related LBP (N = 97; 64 % male; median age = 38) completed a demographic questionnaire and a survey of disability risk factors, then agreed to audio-taping of their visits with a participating occupational healthcare provider (n = 14). Utterance-level verbal exchanges were categorized by trained coders using the Roter interaction analysis system. In addition, coders flagged any instance of workplace discussion between patients and providers. RESULTS: Workplace discussions occurred in 51 % of visits, and the most frequent topic was physical job demands. Workplace discussions were more frequent among the oldest and youngest patients and when patients were seen by providers who were more patient-centered and made more efforts to establish patient rapport and engagement. However, patients reporting numerous disability risk factors and workplace concerns in the pre-visit questionnaire were no more likely to discuss workplace topics with their providers (p > 0.05). Only the patient-centered orientations of providers and patients remained statistically significant predictors in multivariate modeling (p < 0.05). CONCLUSIONS: Workplace discussions are facilitated by a patient-centered orientation and by efforts to establish patient engagement and rapport, but workplace discussions are no more frequent among patients with the most significant workplace concerns. Screening questionnaires and other assessment tools may be helpful to foster workplace discussions to overcome possible barriers for returning to work.

Shaw WS, Pransky G, Roter DL, Winters T, Tveito TH, Larson SM. The effects of patient-provider communication on 3-month recovery from acute low back pain. J Am Board Fam Med. 2011 Jan-Feb;24(1):16-25.
(Work-Related Health, Communication, United States)
BACKGROUND: patient-provider communication has been indicated as a key factor in early recovery from acute low back pain (LBP), one of the most common maladies seen in primary care; however, associations between communication and LBP outcomes have not been studied prospectively. METHODS: working adults (n = 97; 64% men; median age, 38 years) with acute LBP completed baseline surveys, agreed to audio recording of provider visits, and were followed for 3 months. Using the Roter Interaction Analysis System, 10 composite indices of communication were compared with 1- and 3-month patient outcomes. RESULTS: patients (n = 30) with significant pain and dysfunction persisting at 3 months provided more biomedical information (t[75], 2.61; P < .05) and engaged in more negative rapport building (t[75], 2.33; P < .05) but showed no increase in psychosocial/lifestyle communication during the initial visit (P > .05). Providers asked these patients more biomedical questions (r = 0.35 with dysfunction), more psychosocial/lifestyle questions (r = 0.30), made more efforts to engage the patient (t[75], 4.49; P < .05), and did more positive rapport building (t[75], 2.13; P < .05). CONCLUSIONS: providers adapt their communication patterns to collect more information and establish greater rapport with high-risk patients, but patients focus more on biomedical than coping concerns. To better elicit psychosocial concerns from patients, providers may need to administer brief self-report measures or adopt more structured interviewing techniques.

Shaw WS, Pransky G, Winters T, Tveito TH, Larson SM, Roter DL. Does the presence of psychosocial "yellow flags" alter patient-provider communication for work-related, acute low back pain? J Occup Environ Med. 2009 Sep;51(9):1032-40.
(Work-Related Health, Psychosocial Factors, United States)
OBJECTIVE: To determine whether patterns of patient-provider communication might vary depending on psychosocial risk factors for back disability. METHODS: Working adults (N = 97; 64% men; median age = 38 years) with work-related low back pain completed a risk factor questionnaire and then agreed to have provider visits audiotaped. Verbal exchanges were divided into utterances and coded for content, then compared among low-, medium-, and high-risk patients. RESULTS: Among high-risk patients only, providers asked more biomedical questions, patients provided more biomedical information, and providers used more language to engage patients and facilitate communication. There were no group differences in psychosocial exchanges. CONCLUSIONS: Clinicians may recognize the need for more detailed assessment of patients with multiple psychosocial factors, but increases in communication are focused on medical explanations and therapeutic regimen, not on lifestyle and psychosocial factors.

Shaw WS, Woiszwillo MJ, Krupat E. Further validation of the Patient-Practitioner Orientation Scale (PPOS) from recorded visits for back pain. Patient Educ Couns. 2012 Nov;89(2):288-91.
(Work-Related Health, United States)
OBJECTIVE: More patient-centered communication is associated with improved patient satisfaction and health status, fewer malpractice complaints, and increased adherence. In a study of medical encounters for acute low back pain (LBP), we conducted a secondary analysis to assess the validity of the Patient Practitioner Orientation Scale (PPOS), a measure of patient-centeredness. METHODS: Fourteen clinicians and 89 of their patients with acute LBP completed the PPOS and agreed to have verbal exchanges recorded and coded using the Roter Interaction Analysis System (RIAS). We examined correlations between the PPOS and counts of patient and provider utterances within 8 RIAS verbal exchange categories. RESULTS: Providers with a more patient-centered orientation asked fewer biomedical questions, posed more lifestyle questions, gave more lifestyle advice, and did more rapport-building. Their patients shared more lifestyle information and made more attempts at rapport building and provider engagement. In contrast, the patient-centered orientation of patients showed no effect on communication. CONCLUSION: The PPOS scores of providers, but not patients, predicted significant and meaningful differences in the verbal exchanges of patients and providers. PRACTICE IMPLICATIONS: The results support the validity of the PPOS measure and provide further evidence of the extent to which provider orientation influences patient communication and exchange.

Shea CM, Halladay JR, Reed D, Daaleman TP. Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added. BMC Health Serv Res. 2012 Mar 19;12:67.
(Computer Use, Medical Records, United States)
BACKGROUND: Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients. METHODS: Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff. RESULTS: The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information. CONCLUSIONS: Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.

Sheldon LK, Ellington L, Barrett R, Dudley WN, Clayton MF, Rinaldi K. Nurse responsiveness to cancer patient expressions of emotion. Patient Educ Couns. 2008 Dec 23.[Epub ahead of print]
(Nursing, oncology, United States)
OBJECTIVE: This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient. METHODS: This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness. RESULTS: Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness. CONCLUSION: Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies. PRACTICE IMPLICATIONS: Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.

Shin DW, Roter DL, Roh YK, Hahm SK, Cho B, Park HK; Board Certification Committee of The Korean Academy of Family Medicine. Physician gender and patient centered communication: the moderating effect of psychosocial and biomedical case characteristics. Patient Educ Couns. 2015 Jan;98(1):55-60.
(South Korea, Communication Skills/Training, Gender)
OBJECTIVE: Female physicians have a more patient-centered communication style than their male counterparts; however, few studies have investigated how the biomedical or psychosocial nature of a patient diagnosis might moderate this relationship. METHODS: Seventy six 3rd year residents (50 male and 26 females) seeking board certification from the Korean Academy of Family Medicine participated in the 2013 Clinical Practice Examination by conducting two simulated patient (SP) interviews, one presenting a largely psychosocial case and the other largely biomedical. The interview recordings were coded with the Roter Interaction Analysis System (RIAS). RESULTS: Female physicians and their SPs engaged in more dialog than male physicians in both cases. Female physicians were more patient-centered than males for the psychosocial case (t = -3.24, P < 0.05), however, their scores did not differ for the biomedical case. In multivariate analysis, a significant interaction between physician gender and case (z = -3.90, P < 0.001) similarly demonstrated greater female patient-centeredness only for the predominantly psychosocial case. CONCLUSION: Case characteristics moderated the association between physician gender and patient-centeredness. PRACTICE IMPLICATIONS: Case characteristics need to be considered in future research on the association of physician gender and the patient-centered communication, as well as in the tailoring of physician communication training.

Siminoff LA, Ravdin P, Colabianchi N, Sturm CM. Doctor-patient communication patterns in breast cancer adjuvant therapy discussions. Health Expect 2000 Mar;3(1):26-36.
(Oncology, United States)
OBJECTIVE: To identify variables within the patient-oncologist communication pattern that impact overall patient comprehension and satisfaction within the breast cancer adjuvant therapy (AT) setting. SETTING AND PARTICIPANTS: Fifty patients were recruited from a number of academic and community-based oncology practices. Fifteen oncologists participated. MAIN VARIABLES: Three communication variables were identified: percentage of total utterances spoken by the patient, percentage of total physician utterances that were coded as affective (i.e. emotional), and total number of questions asked by the patient during the consultation. Knowledge and satisfaction were assessed by a variety of outcome measures, including knowledge items and satisfaction as measured by VASs, the satisfaction with decision scale and the decisional conflict scale. RESULTS: The level of patient knowledge about breast cancer and satisfaction with the clinical encounter showed a tendency to correlate with the variables measuring aspects of patient-physician communication style. Patients who spoke more or asked more questions tended to be more knowledgeable whilst patients whose physicians used more affective language tended to know less but to be more satisfied with their clinical encounter. CONCLUSIONS: In order to optimize patients' degree of comprehension and satisfaction with their breast cancer adjuvant therapy, physicians need to increase their affective participation in clinical encounters whilst encouraging patients to ask questions and to actively participate in the decision-making process.

Slort W, Blankenstein AH, Schweitzer BP, Knol DL, Deliens L, Aaronson NK, van der Horst HE. Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial. BMC Fam Pract. 2013 Jul 2;14(1):93.
(Communication Skills/Training, Palliative/Hospice, The Netherlands)
BACKGROUND: Communicating effectively with palliative care patients has been acknowledged to be somewhat difficult, but little is known about the effect that training general practitioners (GPs) in specific elements of communication in palliative care might have. We hypothesized that GPs exposed to a new training programme in GP-patient communication in palliative care focusing on availability of the GP for the patient, current issues the GP should discuss with the patient and anticipation by the GP of various scenarios (ACA), would discuss more issues and become more skilled in their communication with palliative care patients. METHODS: In this controlled trial among GPs who attended a two-year Palliative Care Peer Group Training Course in the Netherlands only intervention GPs received the ACA training programme. To evaluate the effect of the programme a content analysis (Roter Interaction Analysis System) was performed of one videotaped 15-minute consultation of each GP with a simulated palliative care patient conducted at baseline, and one at 12 months follow-up. Both how the GP communicated with the patient ('availability') and the number of current and anticipated issues the GP discussed with the patient were measured quantitatively. We used linear mixed models and logistic regression models to evaluate between-group differences over time. RESULTS: Sixty-two GPs were assigned to the intervention and 64 to the control group. We found no effect of the ACA training programme on how the GPs communicated with the patient or on the number of issues discussed by GPs with the patient. The total number of issues discussed by the GPs was eight out of 13 before and after the training in both groups. CONCLUSION: The ACA training programme did not influence how the GPs communicated with the simulated palliative care patient or the number of issues discussed by the GPs in this trial. Further research should evaluate whether this training programme is effective for GPs who do not have a special interest in palliative care and whether studies using outcomes at patient level can provide more insight into the effectiveness of the ACA training programme.

Sondell K, Palmqvist S, Söderfeldt B. The dentist's communicative role in prosthodontic treatmentInt Journ Prosthodont. 2004 Nov-Dec;17(6):666-71.
(Dentistry, Sweden)
PURPOSE: Dentist-patient verbal communication is important for patient satisfaction. The aim of this study was to investigate the dentist's role in the provider-patient relationship as to verbal communication and patient satisfaction with the treatment outcome in prosthetic dentistry. The dentist-specific properties were analyzed in random coefficient modeling. MATERIALS AND METHODS: Sixty-one dentist-patient pairs were followed through 61 prosthodontic treatment periods. The treatment performed was fixed prosthodontic restorations on teeth or implants. One encounter at the end of each treatment period was tape recorded. The verbal communication on the recordings was analyzed using an interaction analysis instrument. Various measures of communication were used, summarizing the variational pattern of verbal interaction. Two different aspects of the patient satisfaction concept were used as dependent variables: cure (overall patient satisfaction with prosthodontic treatment), and care (patient satisfaction with a particular dental encounter during the prosthodontic treatment period). RESULTS: In the multilevel model for care, the dentist variance was mostly explained by the communication variables. In the cure model, there was no dentist variance. The communication patterns used by the dentists thus influenced patient satisfaction in a short-term perspective but not in an intermediate perspective. CONCLUSION: Patient evaluation of the care during an encounter is dependent on the dentist's verbal communication activity during the encounter, but this communication has no impact on the patient evaluation of overall prosthetic treatment outcome in the intermediate time perspective.

Sondell K, Sonderfeldt B, Palmqvist S. A method for communication analysis in prosthodontics. Acta Odontol Scand 1998 Feb;56(1):48-56
(Outside Primary Care, Sweden)
Particularly in prosthodontics, in which the issues of esthetic preferences and possibilities are abundant, improved knowledge about dentist patient communication during clinical encounters is important. Because previous studies on communication used different methods and patient materials, the results are difficult to evaluate. There is, therefore, a need for methodologic development. One method that makes it possible to quantitatively describe different interaction behaviors during clinical encounters is the Roter Method of Interaction Process Analysis (RIAS). Since the method was developed in the USA for use in the medical context, a translation of the method into Swedish and a modification of the categories for use in prosthodontics were necessary. The revised manual was used to code 10 audio recordings of dentist patient encounters at a specialist clinic for prosthodontics. No major alterations of the RIAS manual were made during the translation and modification. The study shows that it is possible to distinguish patterns of communication in audio-recorded dentist patient encounters. The method also made the identification of different interaction profiles possible. These profiles distinguished well among the audio-recorded encounters. The coding procedures were tested for intra-rater reliability and found to be 97% for utterance classification and lambda = 0.76 for categorization definition. It was concluded that the revised RIAS method is applicable in communication studies in prosthodontics.

Sondell K, Soderfeldt B, Palmqvist S. Dentist-patient communication and patient satisfaction in prosthetic dentistry. Int J Prosthodont 2002 Jan-Feb;15(1):28-37
(Outside Primary Care, Sweden)
PURPOSE: Dentist-patient verbal communication dimensions on patient satisfaction were investigated in a prosthodontic context, controlling for the age and gender of patients and dentists and the amount of delivered prosthodontic treatment. Two concepts of satisfaction were defined, one for the single visit (satisfaction with care), and one for the overall result (satisfaction with treatment outcome). MATERIALS AND METHODS: Audio recordings of 61 patients meeting 15 dentists were made in three specialist clinics of prosthetic dentistry. The prosthodontic treatment periods with fixed tooth- or implant-supported prostheses, on average 20 months, were monitored by questionnaires. One visit near the end of each treatment period was audio recorded. The recorded verbal communication was analyzed with the Roter Interaction Analysis System-Dental. RESULTS: Bivariate analysis showed that patients of female dentists were more satisfied in the long-term perspective than patients of male dentists. In logistic multivariate regression models, the verbal communication dimensions "information-dentist horizon" and "information-patient horizon," together with the mouth involvement of the prosthodontics, influenced patient satisfaction with treatment outcome. CONCLUSION: Patients undergoing extensive prosthodontic rehabilitation should be given the opportunity to ask and talk about their dental health, and dentists should minimize their question-asking and orientating behavior during the encounters to help improve patient satisfaction with treatment outcome.

Sondell K, Soderfeldt B, Palmqvist S. Underlying dimensions of verbal communication between dentists and patients in prosthetic dentistry. Patient Educ Couns. 2003 Jun;50(2):157-65.
(Outside Primary Care, Sweden)
The study explores whether the task-focused and socio-emotional dimensions of clinical communication is recognizable in the verbal communication context of prosthetic dentistry, as well as if there are other dimensions of communication in that context. Sixty-one audio recordings were made at three specialist clinics of prosthetic dentistry in Sweden. Sixty-one patients and 15 dentists participated. Sixty-one prosthetic rehabilitation periods were followed. Tooth- or implant-supported fixed prostheses were placed during this time. One visit near the end of each rehabilitation period was audiorecorded. The verbal communication was analyzed with the Roter Interaction Analysis System (RIAS)-dental. The categories were subjected to exploratory factor analysis. Patient and dentist verbal behavior could not be defined exclusively as socio-emotional or task-focused but had to be defined in other dimensions; Emotional exchange, information exchange-patient horizon, relation building exchange, information exchange-dentist horizon, and administrative and counseling exchange. Since the 'emotional exchange' factor was found to capture the largest share of the variance in the communicated patterns, the present study suggests that prosthetic care in dentistry is basically a human relationship with strong emotional communicative content.

Sondell K, Sonderfeldt B, Palmqvist S, Adell A. Communication during prosthodontic treatment—dentist, patient, and dental nurse. Int J Prosthodont 2000 Nov-Dec;13(6):506-12.
(Outside Primary Care, Sweden)
PURPOSE: This study described and explored verbal communication during prosthodontic treatment. MATERIALS AND METHODS: Sixty-one patients and 15 dentists participated. Sixty-one prosthetic treatment periods, during which fixed tooth- or implant-supported prostheses were placed, were followed. One visit during each treatment period was audio recorded. The recorded verbal communication was analyzed with the Roter Interaction Analysis System-dental. The inter-rater reliability was 95% to 97% for utterance classification and kappa = 0.71 to 0.78 for categorization definition. RESULTS: There were 43,663 utterances available for analysis. Of those, 59% was dentist communication, 28% was patient communication, and 10% was dental nurse communication. Other persons, e.g., dental technicians, contributed with 3%. The dentist-patient communication contained more task-focused than socioemotional behaviors. Female patients used socioemotional talk to a greater extent than did the male patients. Dentists and patients of different genders communicated more overall, especially male dentists with female patients. The age difference between dentist and patient had no effect on the amount or type of communication. The dental nurse talked slightly more with male patients. CONCLUSION: When different genders met there was more communication, and the talk was more socioemotional when the patient was female.

Sonntag U, Henkel J, Renneberg B, Bockelbrink A, Braun V, Heintze C. Counseling overweight patients: analysis of preventive encounters in primary care. Int J Qual Health Care. 2010 Dec;22(6):486-92.
(Communication Skills, Primary Care, Germany)
OBJECTIVE: The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI >= 30 kg/m² would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI < 30 kg/m².DESIGN: Cross sectional comparison of audiotaped encounters of patients with a BMI >= 30 kg/m² and those with a BMI < 30 kg/m². SETTING: Twelve GP surgeries in Berlin, Germany. PARTICIPANTS: Fifty patients who agreed to have preventive check-up encounters audiotaped. MAIN OUTCOME MEASURES: Based on the Roter Interaction Analysis System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. RESULTS: An increased BMI was found to be a predictor for the length of encounters (P = 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P > 0.05). CONCLUSIONS: Our results indicate that GPs rarely use the check-up program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.

Sonntag U, Henkel J, Renneberg B, Bockelbrink A, Braun V, Heintze C. Counseling overweight patients: analysis of preventive encounters in primary care. Int J Qual Health Care. 2010 Dec;22(6):486-92. Epub 2010 Oct 17.
(Primary Care, Prevention, Germany)
OBJECTIVE: The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI > to 30 kg/m² would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI < 30 kg/m². DESIGN: Cross sectional comparison of audiotaped encounters of patients with a BMI > 30 kg/m² and those with a BMI < 30 kg/m². SETTING: Twelve GP surgeries in Berlin, Germany. PARTICIPANTS: Fifty patients who agreed to have preventive check-up encounters audiotaped. MAIN OUTCOME MEASURES: Based on the Roter Interaction Analysis System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. RESULTS: An increased BMI was found to be a predictor for the length of encounters (P = 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P > 0.05). CONCLUSIONS: Our results indicate that GPs rarely use the check-up program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.

Spelten ER, Martin L, Gitsels JT, Pereboom MT, Hutton EK, van Dulmen S. Introducing video recording in primary care midwifery for research purposes: Procedure, dataset, and use. Midwifery. 2014 Jul 1. pii: S0266-6138(14)00175-2.
(The Netherlands, Genetic Counseling, Video)
BACKGROUND: Video recording studies have been found to be complex; however very few studies describe the actual introduction and enrolment of the study, the resulting dataset and its interpretation. In this paper we describe the introduction and the use of video recordings of health care provider (HCP)-client interactions in primary care midwifery for research purposes. We also report on the process of data management, data coding and the resulting data set. METHODS: We describe our experience in undertaking a study using video recording to assess the interaction of the midwife and her client in the first antenatal consultation, in a real life clinical practice setting in the Netherlands. Midwives from six practices across the Netherlands were recruited to videotape 15-20 intakes. The introduction, complexity of the study and intrusiveness of the study were discussed within the research group. The number of valid recordings and missing recordings was measured; reasons not to participate, non-response analyses, and the inter-rater reliability of the coded videotapes were assessed. Video recordings were supplemented by questionnaires for midwives and clients. The Roter Interaction Analysis System (RIAS) was used for coding as well as an obstetric topics scale. FINDINGS: At the introduction of the study, more initial hesitation in co-operation was found among the midwives than among their clients. The intrusive nature of the recording on the interaction was perceived to be minimal. The complex nature of the study affected recruitment and data collection. Combining the dataset with the questionnaires and medical records proved to be a challenge. The final dataset included videotapes of 20 midwives (7-23 recordings per midwife). Of the 460 eligible clients, 324 gave informed consent. The study resulted in a significant dataset of first antenatal consultations involving recording 269 clients and 194 partners. CONCLUSION: Video recording of midwife-client interaction was both feasible and challenging and resulted in a unique dataset of recordings of midwife-client interaction. Video recording studies will benefit from a tight design, and vigilant monitoring during the data collection to ensure effective data collection. We provide suggestions to promote successful introduction of video recording for research purposes.

Steinwachs DM, Roter DL, Skinner EA, Lehman AF, Fahey M, Cullen B, Everett AS, Gallucci G. A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers. Psychiatr Serv. 2011 Nov;62(11):1296-302.
(Online/Web-Based, Mental Health, United States)
OBJECTIVE: This study evaluated a Web-based tool to help patients with schizophrenia communicate with clinicians about evidence-based treatments. METHODS: Fifty patients used an interactive Web-based intervention featuring actors simulating a patient discussing treatment concerns (intervention group; N=24) or were shown an educational video about schizophrenia treatment before an appointment for routine follow-up care (control group; N=26). The visits were recorded and analyzed by using the Roter Interaction Analysis System. RESULTS: Visits by patients in the intervention group were longer (24 versus 19 minutes, p<.05) and had a proportionately greater patient contribution to the dialogue (288 versus 229 statements, p<.05) and a smaller ratio of clinician to patient talk (1.1 versus 1.4, p<.05) compared with visits by the control group. Patients in the intervention group asked more questions about treatment (2 versus .9, p<.05), disclosed more lifestyle information (76 versus 53 statements, p<.005), and more often checked that they understood information (3.6 versus 2.1 checks, p<.05). Clinicians asked more questions about treatment (7.5 versus 5.1, p<.05) and the medical condition (7.8 versus 4.7, p<.05) to control group patients but made more statements of empathy (1.3 versus .4, p<.03) and cues of interest (48 versus 22, p<.05) with the intervention group. The patient-centeredness ratio was greater for visits by patients in the intervention group than by the control group (8.5 versus 3.2, p<.05). Patients' tone was more dominant and respectful (p<.05) and clinicians' tone was more sympathetic (p<.05) during visits by patients in the intervention. CONCLUSIONS: The Web-based tool empowered persons with schizophrenia to engage more fully in a patient-centered dialogue about their treatment.

Stiefel F, Bourquin C, Layat C, Vadot S, Bonvin R, Berney A. Medical students' skills and needs for training in breaking bad news. J Cancer Educ. 2013 Mar;28(1):187-91.
(Bad News Delivery, Communication Skills/Training, Switzerland)
This study assessed medical students' perception of individual vs. group training in breaking bad news (BBN) and explored training needs in BBN. Master-level students (N = 124) were randomised to group training (GT)-where only one or two students per group conducted a simulated patient (SP) interview, which was discussed collectively with the faculty—or individual training (IT)-where each student conducted an SP interview, which was discussed during individual supervision. Training evaluation was based on questionnaires, and the videotaped interviews were rated using the Roter Interaction Analysis System. Students were globally satisfied with the training. Still, there were noticeable differences between students performing an interview (GT/IT) and students observing interviews (GT). The analysis of the interviews showed significant differences according to scenarios and to gender. Active involvement through SP interviews seems required for students to feel able to reach training objectives. The evaluation of communication skills, revealing a baseline heterogeneity, supports individualised training.

Street RL Jr, Marengo MF, Barbo A, Lin H, Gonzalez AG, Richardson MN, Suarez-Almazor ME. Affective tone in medical encounters and its relationship with treatment adherence in a multiethnic cohort of patients with rheumatoid arthritis. J Clin Rheumatol. 2015 Jun;21(4):181-8.
(Adherence, Race/Cross-Culture, United States)
BACKGROUND: Tone of voice in communication between patients and rheumatologists may offer insight into problems of treatment adherence in patients with rheumatoid arthritis. OBJECTIVE: The aim of this study was to evaluate physician-patient affective vocal tone within the medical encounter and its relationship to treatment adherence in ethnically diverse patients with rheumatoid arthritis. METHODS: The consultations of 174 patients with rheumatoid arthritis were audio recorded at a baseline visit. Of these, 135 completed follow-up adherence measures at 3 months. The positive and negative affective tones of patients, physicians, and interpreters (and distressed tones of patients and interpreters) were assessed using the Roter Interaction Analysis System affective communication scale. Treatment adherence was evaluated at baseline and at 3 months using the Compliance Questionnaire Rheumatology. RESULTS: A total of 117 baseline consultations were in English (n = 42, 36, and 39 white, African American, and Hispanic patients, respectively), 24 in Spanish, and 33 with an interpreter (total = 174). Patients reporting poorer adherence were rated as having more distressed affect and less positive affect than patients reporting greater adherence. Physicians expressed more positive affect to more educated patients. Physicians and patients reciprocated one another's positive and negative affect. Controlling for baseline adherence, physician negative affect predicted greater adherence at 3 months for Hispanic patients, regardless of language choice, compared with white patients. CONCLUSIONS: Patients' affective tones offer clues to problems patients may have with treatment adherence and well-being. More research is needed regarding why physicians' expression of negative affect may facilitate adherence for some groups of patients.

Suchman AL, Roter D, Green M, Lipkin M Jr. Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care 1993 Dec;31(12):1083-92.
(Primary Care, Physician Satisfaction, United States)
To study encounter-specific physician satisfaction we collected exit questionnaires from patients and physicians following 550 primary care office visits. The physicians' questionnaire included 20 items pertaining to satisfaction with the visit, one of which was an assessment of global satisfaction. Using a boot-strap technique, we factor analyzed the satisfaction questions in 10 repeated samples. Four distinct dimensions of physician satisfaction emerged: satisfaction with the patient-physician relationship, with the data collection process, with the appropriateness of the use of time, and with the absence of excessive demands on the part of the patient. Each scale was found to be reliable; global satisfaction was most closely related to the relationship factor. Satisfaction with use of time and the adequacy of data collection tended to be stable for individual physicians across a range of patients whereas global satisfaction and satisfaction with the relationship and the demanding nature of the patient and were more variable, hence most unique to each encounter. This study of physician satisfaction represents an effort to incorporate knowledge about physicians' subjective experiences into a systematic understanding of the dynamics of the medical interview.

Sugarman J, Roter D, Cain C, Wallace R, Schmechel D, Welsh-Bohmer KA. Proxies and consent discussions for dementia research. J Am Geriatr Soc. 2007 Apr;55(4):556-61.
(Informed Consent, Geriatrics, United States)
OBJECTIVES: To better understand the nature of informed consent encounters for research involving patients with dementia that requires proxy consent. DESIGN: Audiotaping of informed-consent encounters for a study of genetic markers for sporadic Alzheimer's disease. SETTING: Outpatients at an Alzheimer's disease research center. PARTICIPANTS: Patients with dementia and their companions. MEASUREMENTS: Audiotapes were analyzed to characterize communication style and coverage of the standard elements of informed consent and, using the Roter Interaction Analysis System, to capture the dynamics of three-way interaction between the patient, their companion, and the physician investigator. RESULTS: Of 26 informed consent encounters, all involved a patient, a companion, and a physician. Patients had a mean Mini-Mental State Examination (MMSE) score of 21.8. For patients, 49% of their interactions involved agreement and approval (positive statements), 16% psychosocial information, 7% biomedical information, 7% asking questions, and 7% expressing emotion. Companion interactions involved 37% positive statements and 19% biomedical information. Physician interactions involved emotional expressiveness (30%) and positive statements (19%). Discussion length was positively related to MMSE score (Spearman rho=0.45; P < .02). Coverage of required elements of informed consent was fairly comprehensive and had no relationship to patients' MMSE scores. CONCLUSION: These data should inform policies regarding the ethically appropriate ways of conducting research with cognitively impaired adults. For example, patients in this study were more silent than their companions and the physician, but when patients spoke, they primarily agreed with what was said. Although this might first seem to signal assent, such an interpretation should be made with caution for persons with dementia. In addition, previous work on informed consent has focused on its cognitive aspects, but these data reveal that the emotional and social dimensions warrant attention.

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