Patient-physician communication assessment instruments:: 1986 to 1996 in review

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Abstract

This paper provides a comprehensive review and comparison of instruments used to assess patient-doctor interaction over the past decade. Instruments were identified from papers indexed by MEDLINE from 1986 to 1996 using the medical subject headings `physician-patient relations', `physician-patient communication', and `education, medical', as well as requests for instruments currently in use by colleagues. Each instrument was reviewed under the following categories: name of the instrument; description; number of items; reliability; validity; current use and special notes. Overall, 44 instruments were obtained and reviewed. Of these, 21 were used in only one published study each in the last decade and 15 have never been validated. While most instruments have been shown to be reliable (usually inter-rater reliability), very few instruments have been directly compared with another instrument designed to assess patient-doctor interactions. We suggest that further validation of existing instruments and incorporation of assessment of non-verbal communication between the patient and the doctor are needed.

Introduction

There is increasing awareness among doctors, patients, researchers and educators that effective patient-doctor communication is important in achieving desired health outcomes. Aspects of the patient-doctor interaction have been shown to influence a variety of patient outcomes including adherence to treatment 1, 2, 3, 4, 5, recall and understanding of medical advice 3, 6, 7, and health outcomes 3, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. Partly as a response to these research findings, educators are beginning to take a more active role in teaching communication skills to medical students 19, 20, 21, 22, 23, 24, 25. As interest in this area has increased, so has the number of instruments developed by researchers and educators for assessing patient-doctor communication. The large variety of instruments, coupled with the fact that many have never been validated, make it difficult to compare the findings of different studies and different protocols for assessing medical students. A comprehensive review and comparison of existing instruments is necessary to provide an opportunity to select from existing instruments rather than to continue to `reinvent the wheel'. This paper attempts a comprehensive review of the instruments used to assess patient-doctor communication over the past decade.

Section snippets

Review of the literature

Several recent articles reviewing the literature on the topic of patient-doctor interactions have focused on such areas as: defining `good' patient-doctor communication 3, 26; correlation of communication assessment with patient outcomes 3, 8, 10; theoretical concepts for understanding patient-doctor interactions 3, 27, 28, 29, 30and design issues in the assessment of patient-doctor communication including reliability and validity 31, 32, 33, 34. Authors have pointed out several difficulties in

Data sources

A MEDLINE search for papers published from 1986 to 1996 using the medical subject headings (MeSH) `physician-patient relations'; `physician-patient communication'; `education, medical' and at least one of the following as a major aspect of the article: `communication', `interviews', and `outcome and process assessment (health care)' was conducted. Retrieval was limited to articles in English and excluded letters, editorials and news items. The papers were reviewed to determine which instruments

Method

Published papers were reviewed to identify the instruments used to assess patient-doctor communication. References cited by the author as pertaining to the instrument were retrieved. If the measurement instrument itself was not published in the literature, the authors were contacted in an effort to obtain the original instrument for review. In addition, colleagues across North America were invited to provide unpublished instruments for review. The following information was collected for each

Results

We have obtained and evaluated 44 instruments for assessing patient-physician communication: 16 in the Medical Education category (see Table 1) and 28 in the Research category (see Table 2). The results will be organized according to the method of data collection required by each instrument: real-time assessment by an observer; standardized patients; video-taped interactions; audio-taped interactions; and self-report from both patients and physicians. Some instruments may be used to assess data

Discussion

Our search for instruments used to assess patient-doctor interactions over the last decade (1986–1996) has revealed a large number and a wide variety of instruments which depend on various data collection techniques. These data collection techniques are associated with specific advantages and disadvantages. Those instruments which permit observation and analysis in real-time offer the advantage of being flexible and well-suited to providing immediate feedback in teaching situations; however,

Summary and implications

The growing interest in the field of patient-doctor communication has resulted in a proliferation of communication assessment instruments. However, few are widely used and many have never been demonstrated to be reliable or valid, making it difficult to compare the findings of different studies. Rather than continuing to develop instruments for each new research project, it is suggested that clinicians and researchers work together to document the reliability and validity of existing scales.

Acknowledgements

We wish to thank the following individuals for reviewing our compilation of instruments: Greg Makoul, Debra Roter, Danielle Saucier and Rick Botello. Dr. Boon is supported by a post-doctoral fellowship from the Medical Research Council of Canada (MRC). This review was supported, in part, by the Adult Health Division, Health Canada.

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