Becker's Clinical Quality & Infection Control

20 PATIENT EXPERIENCE Physicians and patients differ on concept of good communication By Megan Knowles P hysicians, patients and peer clinical reviewers gave significantly different ratings for physicians' communication skills, signaling physicians may not fully know what patients consider to be good communi- cation, a study published in Annals of Family Medicine found. Here are four things to know: 1. The researchers looked at survey results from patients who had appointments with 45 family physicians across 13 practices in England. 2. For the survey, 503 pairs of physicians and patients completed a seven-item question- naire on how well information was communi- cated during medical appointments, includ- ing how well physicians explained treatments and whether they took patients' problems seriously. Additionally, clinical raters evaluat- ed a sample of 55 of the videotaped sessions using the same seven questions. 3. The researchers then compared patient, physician and rater scores using correlation coefficients. The study found physicians scored themselves lower than patients scored them on average. The average physician score was 74.5 while the average patient score was 94.4. The majority of patients — about 63 percent — gave physicians the maximum score of 100, but the average rater score was about 57 percent. 4. Due to the differences in these scores, physician communication evaluations may need to include more than patient satisfac- tion scores, the authors wrote. Patients may be wary of pointing out bad experiences on a questionnaire, which could explain why patients tend to rate physicians higher than the physicians score themselves, the authors noted. "Patient feedback is, and should remain, a central component of assessments of the quality of care," the researchers wrote. "Our findings, however, support the role of trained peer assessors in examining the communica- tion practices of physicians in any multisource assessment investigating standards of care." n Patient surveys do not measure full range of healthcare experiences, research shows By Megan Knowles T he surveys patients take aer medical appointments may not give useful information to providers, signaling a need for revised tools to measure patient experience, research published in Psychological Assessment found. "When I started looking at the instruments currently being used to assess doctor-patient relationships, it became apparent they were highly problem- atic and not providing useful information," said researcher Keith Sanford, PhD, professor of psychology and neuroscience in Baylor's College of Arts & Sciences in Waco, Texas. Dr. Sanford, a psychometrics scholar who creates assessment instruments, conducted several studies to gain insight into issues with scales used to evaluate physician-patient relationships. He then created a tool to measure patient experience during consultations. e study findings suggest the tool he created works better than others. e tool, called the Medical Consultation Experience Questionnaire, measures two aspects of patient experience — "alliance" and "confusion." It addresses the consultation itself as opposed to treatment results, the researchers said. Providers aim for a good alliance, where their patients see them as committed, competent and dedicated to understanding their desires and views. Providers also focus on avoiding confusion by ensuring a good exchange of information. By trying to measure how well those goals are being met, previous question- naires have limited options that may lead to skewed results, Dr. Sanford said. One survey, for example, gives patients a four-point scale, where answers range from "always" to "never" to such questions as "How oen did doctors listen carefully to you?" e problem with surveys like these is that most patients pick the top response for each item, with fewer than 5 percent picking the bottom op- tion, previous research found. Although these surveys can identify "highly disgruntled" patients, "it cannot make reliable distinctions between patients having experiences ranging from marginally acceptable to extremely posi- tive," the researchers wrote. e researchers conducted three studies with 576 participants to evaluate the new questionnaire. ey then compared responses to the new survey with the same participants' responses to other questionnaires. e study found the new questionnaire allowed for measuring a wider range of patient experiences with more extensive and specific responses, making for better assessment of "alliance" and "confusion" — as opposed to only finding the most dissatisfied or angry patients, Dr. Sanford said. "One of the reasons this is so important is if you don't form an alliance with your practitioner, they may give you all the wonderful advice in the world, but you might not follow it, or you might be skeptical," Dr. Sanford said. "And if you don't quite understand what you are supposed to do, that will interfere with your doing the recommended actions." n

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