Abstract Objective To conduct a systematic review and meta-analysis of studies reporting associations between patients’ and clinicians’ nonverbal communication during real clinical interactions and ...clinically relevant outcomes. Methods We searched 10 electronic databases, reference lists, and expert contacts for English-language studies examining associations between nonverbal communication measured through direct observation and either clinician or patient outcomes in adults. Data were systematically extracted and random effects meta-analyses were performed. Results 26 observational studies met inclusion criteria. Meta-analysis was performed for patient satisfaction, which was assessed in 65% of studies. Mental and physical health status were evaluated in 23% and 19% of included studies, respectively. Both clinician warmth and clinician listening were associated with greater patient satisfaction ( p < 0.001 both). Physician negativity was not related to patient satisfaction ( p = 0.505), but greater nurse negativity was associated with less patient satisfaction ( p < 0.001). Substantial differences in study design and nonverbal measures existed across studies. Conclusion Greater clinician warmth, less nurse negativity, and greater clinician listening were associated with greater patient satisfaction. Additional studies are needed to evaluate the impact of nonverbal communication on patients’ mental and physical health. Practice implications Communication-based interventions that target clinician warmth and listening and nurse negativity may lead to greater patient satisfaction.
This study describes the communication-related concerns of oncology providers in addressing financial issues with patients.
We conducted semi-structured interviews with 17 providers (9 clinicians, 5 ...social workers/navigators, 3 attorneys) who addressed financial concerns with cancer patients and analyzed resulting transcripts using qualitative thematic analysis. Interview topics included cost-related concerns of patients, resources providers used, and unmet needs related to addressing financial issues. Here we present codes and content related to a cross-cutting cost communication, stratified by provider discipline.
Communication-related issues varied by provider type. Clinicians identified lack of information, lack of time, and the need for additional support as major barriers to effective cost discussions. Social workers/navigators expressed the importance of establishing a relationship before discussing costs and on the need to revisit cost concerns over time to meet patients’ changing needs. The attorneys endorsed the need for more and earlier cost communication to prevent financial hardship.
Communication concerns and strategies were central to providers’ experiences of addressing cancer patient cost concerns.
Understanding the experiences of diverse oncology providers can inform the development and implementation of interventions to prevent and mitigate financial hardship in people with cancer.
•Interventions to mitigate financial hardship in cancer patients often rely on providers to implement them.•Providers from diverse disciplines cited communication-related strategies and barriers to addressing patient cost concerns.•Understanding providers’ communication-related experiences can inform interventions to address financial hardship.
Most assessments of patient-centered communication (PCC) were created by researchers rather than through community engagement. Our objective was to develop and validate a patient-informed PCC scale.
...As part of a larger study on communication and cancer clinical trials (PACCT), we convened a racially diverse panel of cancer patients and caregivers. Panel members (n=11) included 5 black and 3 white men and 1 black and 2 white women. They met regularly over six months to observe and discuss video-recorded treatment and clinical trial discussions between black and white men with prostate cancer and their physicians. Through an iterative process of generating and refining a list of physician communication behaviors they considered critical for PCC, they produced a 22-item scale titled Patient-Informed Cancer Communication Scale (PICCS).
Trained raters then applied the scale to video-recorded treatment discussions (n=61) with acceptable inter-rater reliability. We then determined constructs using scale development and factor analysis and validated the scale through correlation with previously-validated scales assessing physician PCC and patient active participation (PAP).
The final scale included 22 items. Factor analysis identified five factors: 1. treatment options (10 items ?=.92); 2. clinical relationship (6-items ?=.92); 3. prognosis and goals of treatment (2-items ?=.79); 4. explanations (2-items ?=.43); and 5. context (1 item). Four factors were significantly correlated with previously-validated scales. Factor 1 was correlated with PAP (r=.46; p=.003); Factor 2 with PCC (r=.54, p.<.001); Factor 3 with PAP (r=.48; p=.002); and Factor 5 with PCC (r=.47, p=.002). The full scale was correlated with PAP (r=.37, p=.02). Factor 4 was not correlated with the scales.
This community-engaged research produced a reliable and valid patient-informed scale to assess PCC. Next steps include translating the Findings: by using PICCS to train physicians to communicate effectively about treatment and clinical trials in a diverse cancer patient population.
Physician racial bias and patient perceived discrimination have each been found to influence perceptions of and feelings about racially discordant medical interactions. However, to our knowledge, no ...studies have examined how they may simultaneously influence the dynamics of these interactions. This study examined how (a) non-Black primary care physicians' explicit and implicit racial bias and (b) Black patients' perceived past discrimination affected physician–patient talk time ratio (i.e., the ratio of physician to patient talk time) during medical interactions and the relationship between this ratio and patients' subsequent adherence. We conducted a secondary analysis of self-report and video-recorded data from a prior study of clinical interactions between 112 low-income, Black patients and their 14 non-Black physicians at a primary care clinic in the Midwestern United States between June, 2006 and February, 2008. Overall, physicians talked more than patients; however, both physician bias and patient perceived past discrimination affected physician–patient talk time ratio. Non-Black physicians with higher levels of implicit, but not explicit, racial bias had larger physician–patient talk time ratios than did physicians with lower levels of implicit bias, indicating that physicians with more negative implicit racial attitudes talked more than physicians with less negative racial attitudes. Additionally, Black patients with higher levels of perceived discrimination had smaller physician–patient talk time ratios, indicating that patients with more negative racial attitudes talked more than patients with less negative racial attitudes. Finally, smaller physician–patient talk time ratios were associated with less patient subsequent adherence, indicating that patients who talked more during the racially discordant medical interactions were less likely to adhere subsequently. Theoretical and practical implications of these findings are discussed in the context of factors that affect the dynamics of racially discordant medical interactions.
Physician racial bias can negatively affect Black patients' reactions to racially discordant medical interactions, suggesting that racial bias is manifested in physicians' communication with their ...Black patients. However, little is known about how physician racial bias actually influences their communication during these interactions. This study investigated how non-Black physicians' racial bias is related to their word use during medical interactions with Black patients. One hundred and seventeen video-recorded racially discordant medical interactions from a larger study were transcribed and analyzed using Linguistic Inquiry and Word Count (LIWC) software. Physicians with higher levels of implicit racial bias used first-person plural pronouns and anxiety-related words more frequently than physicians with lower levels of implicit bias. There was also a trend for physicians with higher levels of explicit racial bias to use first-person singular pronouns more frequently than physicians with lower levels of explicit bias. These findings suggest that non-Black physicians with higher levels of implicit racial bias may tend to use more words that reflect social dominance (i.e., first-person plural pronouns) and anxiety when interacting with Black patients.
Despite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the ...cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers' implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers' explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients.
Using a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses.
Findings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.
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