![]() ![]() 39, 40 The Stewart and Roter 41 and Roter et al 42 studies involving interactional analysis showed that task behaviors were the more important contributors to patient satisfaction, but, to be effective, those behaviors needed to be couched in patient-centered terms, including not being overly directive while being attentive to the patient's receipt of information. Several studies that focused on patient satisfaction were able to outline specific behaviors associated with satisfaction, grouping them into 2 categories: task-oriented behaviors (eg, drawing out patients with active listening responses and providing detailed information), and affective behaviors (ie, socioemotional exchanges, such as responding empathically, showing caring, and addressing the patient's main concerns). 33 –, 38 Although patients may be satisfied (or dissatisfied) because of factors unrelated to communication (eg, wait times and other attributes of the encounter), the available evidence indicates that patient satisfaction is strongly associated with the communication behaviors that occur during the physician-patient interaction. Research that seeks to link physician communication skills during encounters to outcomes after those encounters has been conducted since the late 1960s, with many of these studies focusing on patient satisfaction after encounters with physicians. The physician's task is to address both agendas, resolving any conflict between the 2 by further dialogue and negotiation. One way of conceptualizing the patient-centered method for encounters is to consider both parties' agendas: (1) the physician's focus on explaining the illness in terms of the taxonomy of disease, and (2) the patient's focus, which encompasses perspectives on his or her illness, the need for information and understanding, and the desire for partnership in management. More recent empirical studies and reviews couch their findings in patient-centered terminology. Epstein and Street 31 offered an operational definition of patient-centered communication: (1) eliciting and understanding patient perspectives (concerns, ideas, expectations, needs, feelings, and functioning), (2) understanding the patient within his or her unique psychosocial and cultural contexts, and (3) reaching a shared understanding of patient problems and the treatments that are concordant with patient values. 28 Although definitions of patient-centered communication vary, 29, 30 there are common core components. This usage followed the pronouncement from the Institute of Medicine in 2001 that medical care should become more patient-centered, that is, more responsive to patient needs and perspectives, with patient values guiding decision making. The term patient-centered communication has emerged in more recent writing on the subject. In this era of milestone development, it seems timely to offer scientific support for the efficacy of good communication skills.Įarly work to define communication skills relevant to medical practice used the terms physician-patient communication or excellence in communication. 26, 27 If the medical education community is dedicated to renewing its commitment to teaching excellence in the communication skills of physicians, which some have called for, 22 there is a need for better understanding of the evidence that supports the efficacy of good communication skills, and use of that evidence to define what should be taught to medical students and residents. ![]() 21 –, 25 The decline in empathy and communication as trainees progress through programs has been well documented across multiple studies. ![]() 16 –, 20 Currently, training and role modeling of communication and interpersonal skills in medical education is relatively brief, is placed early in the curriculum, and often is not reinforced in the latter stages of training. 10, 12 –, 15Īt the same time, patients report that many of their informational and emotional needs remain unmet during encounters with their physicians. 6 –, 11 Further, the assessment of communication skills has become an explicit component of medical education curricula and of formative and summative examinations for physicians in the United States and Canada. 1 –, 5 There is a consensus about the essential elements of communication skills relevant to medical encounters and the need to teach those skills to medical trainees. ![]() For decades, medical educators and patient advocates have stressed the importance of communicating with patients and their families during medical encounters, and communication has emerged as an important physician competency. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |