Context Interest in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest, relatively limited curricular time is spent on the teaching of communication skills. The limited attention to the teaching of these skills applies even more to the physicians' clinical years, when attention becomes highly focused on biomedical and technical competence. Continuing training after medical school is necessary to refresh knowledge and skills, to prohibit decline of performance and to establish further improvements. Objective This review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results. Methods CD-ROM searches were performed on MedLine and Psychlit, with a focus on effect-studies dating from 1985. Results Fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent behavioural observations and patient outcomes. Most of the studies used inadequate research designs. Overall, positive training effects on the physicians' communication behaviour are found on half or less of the observed behaviours. Studies with the most adequate designs report the fewest positive training effects. Conclusion Several reasons are discussed to explain the limited findings. Future research may benefit from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice.
ABSTRACT Electronic diaries are increasingly used to assess daily pain in many different forms and populations. This systematic review aims to survey the characteristics of studies using electronic pain diaries and to examine how these characteristics affect compliance. A literature search of 11 electronic databases was conducted. Studies were evaluated on the basis of predetermined inclusion criteria by two independent reviewers. Study characteristics were grouped into four categories: general, population, electronic diary, and sampling procedure (i.e., response, attrition, and compliance rates) including strategies to enhance compliance. The 62 included publications reported from 43 different datasets. Papers were usually written in English and published as from 2000. Samples mostly consisted of female chronic pain patients aged 19–65 years from western countries. Most diaries held less than 20 items and were completed up to 6 times daily at fixed or prompted times for 1 month at most. Less than 25% of the studies reported both response and attrition rates; however, a majority reported compliance. Compliance was generally high, and positively associated with shorter diaries, age, having a user's manual, financial compensation and using an alarm. It is important that the various study characteristics are catalogued carefully, especially response and attrition rates, because they can affect compliance. Measures of momentary pain are often developed for the purpose of a certain study; standardisation and validation of these measures is recommended. Finally, authors should mention whether they report on data that has also been used in previous studies.
To examine the effectiveness of a theory-driven self-management course in reducing cardiovascular risk in patients with screen-detected type 2 diabetes, taking ongoing medical treatment into account.A total of 196 screen-detected patients, receiving either intensive pharmacological or usual-care treatment since diagnosis (3-33 months previously), were subsequently randomized to a control or intervention condition (self-management course). A 2 x 2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usual-care), using multilevel regression modeling to analyze changes in patients' BMI, A1C, blood pressure (BP), and lipid profiles over 12 months, from the start of the 3-month course to 9-month follow-up.The self-management course significantly reduced BMI (-0.77 kg/m2) and systolic BP (-6.2 mmHg) up until the 9-month follow-up, regardless of medical treatment. However, intensive medical treatment was also independently associated with lower BP, A1C, total cholesterol, and LDL before the course and further improvements in systolic BP (-4.7 mmHg). Patients receiving both intensive medical treatment and the self-management course therefore had the best outcomes.This self-management course was effective in achieving sustained reductions in weight and BP, independent of medical treatment. A combination of behavioral and medical interventions is particularly effective in reducing cardiovascular risk in newly diagnosed patients.
The aim of this study has been to obtain more insight into the health condition of fatigued patients, their expectations when visiting the general practitioner (GP), the way they communicate, and possible gender differences.Data consisted of 579 patient questionnaires and 440 video-observations of these patients and 31 GPs.Results showed that fatigue is a common health problem but seldom on the agenda in general practice.More women indicated symptoms of fatigue than men did.Fatigued patients' health was worse than that of non-fatigued patients, and they expected more biomedical and especially psychosocial communication.Furthermore, male fatigued patients expected more biomedical communication than fatigued female patients did.While the GPs accommodated their verbal behavior to fatigued patients by giving more psychosocial information and more counseling, they were not more affective towards the fatigued than towards the non-fatigued patients.Female GPs were more affective than their male colleagues, and they used gender-specific communication strategies to explore the patient's agenda.It seems necessary to use a gender-sensitive approach in communication research.
Abstract Title. Cue‐responding behaviours of oncology nurses in video‐simulated interviews Aim. This paper is a report of a study to describe nurse–patient interactions, i.e. nurses’ cue‐responding behaviour in encounters with actors playing the role of patients. Background. Patients with cancer seldom express their concerns directly but express cues instead. Few studies empirically investigated nurses’ cue‐responding behaviour and the subsequent influence of disclosure of cues and concerns. Methods. In this descriptive observational study, conducted from April to June 2004, five oncology nurses interviewed an actor playing the role of a patient with cancer. Each nurse performed seven different interviews ( n = 35); these were videotaped and subsequently rated for cue‐responding using the Medical Interview Aural Rating Scale. Mixed model analysis was used to investigate the relation between cues and cue‐responding. Findings. Half of the patients’ cues were responded to with distancing behaviours. The other half of the cues were either explored (33%) or acknowledged (17%). In 16% of these responses, nurses used open directive questions. One out of four open directive questions were used as a distancing response, suggesting that open directive questions are not used to explore or acknowledge cues of patients. Cue‐responding influenced subsequent expression of concerns and emotions, i.e. disclosure of a concern is two times higher after exploration or acknowledging of a preceding cue than after a distancing response. Conclusion. Cue‐responding is a valuable concept which can contribute to our understanding of optimal ways of communicating. Cue‐responding behaviour facilitates the disclosure of worries and concerns of patients. Further research is needed to assess the clinical relevancy of cue‐responding.
Not knowing patient concerns can lead to misunderstandings, incomplete diagnoses, patient dissatisfaction, and nonadherence. Although many studies show relations between physician communication and patients' expression of cues or concerns, most of these studies are cross-sectional, thus limiting the interpretation of these relationships. Sequence analysis can show the immediate effects of physician communication behaviors.To show the added value of sequence analysis in finding evidence for the role of physician communication in patients' disclosure of cues and concerns.Which physician communication predicts patients' expression of cues or concerns when using 2 different types of analysis: sequence analysis and cross-sectional analysis?In a sample of 99 videotaped medical encounters with hypertensive patients in General Practice, we coded communication with Roter Interaction Analysis System and timed physician eye contact. For the cross-sectional analyses, we performed Poisson regression analyses to establish which physician communication is related to the total amount of patient cues and concerns. For the sequential analyses, we performed logistic regression analyses to establish which physician communication is directly followed by cues or concerns. We report incidence rate ratios and odds ratios (ORs), respectively.Both methods show that physicians' facilitative communication (1.21 and 2.33, respectively), eye contact (1.02 and 1.51, respectively), and psychosocial questions (2.42 and 3.50, respectively) are related to more disclosure of cues and concerns. Moreover, sequence analysis shows that patients' expression of cues or concerns is less often preceded by physician social talk (OR = 0.49), giving instructions (OR = 0.38) and providing biomedical information (OR = 0.45) or counseling (OR = 0.39). In the cross-sectional analyses, these relations are absent or-before controlling for confounding variables-even in the opposite direction. All reported results are significant at P < 0.01 or P < 0.001.Although cross-sectional analyses and sequence analyses show grossly the same results, sequence analysis is more precisely in demonstrating the direct influence of physician communication on subsequent cues and concerns by the patient. Physicians should avoid long monologues with medical information and should use facilitative communication, eye contact, and psychosocial questions to help patients express themselves.
