Show MoreDoctor Patient Communication The main purpose of the medical interview is to collect historical information that can be used to make a diagnosis of the disease and to understand the patient’s problem. (Henderson, 11) This is the beginning of the physician – patient relationship. The interview generally begins by the doctor greeting the patient, introducing himself/herself, and defines his/her professional role. Common courtesy dictates that the physician learns the patient’s name and refers to them with the proper title. Last name is proper for adults, while the use of the first name is comforting to children. The physician inquires about how the patient is and begins the…show more content…
Review of the Major Studies of Physician – Patient Communication
One of the most important parts of the physician – patient communication is the patients’ perception of the communication in the consultation. Patients’ adherance and satisfaction are directly linked to the way that they perceive and interpret the consultation. (Street, 977) This is demonstrated in the article, “Analyzing Communication in Medical Consultations, Do Behavioral Measures Correspond to Patient’s Perceptions?”. This investigation of 115 pediatric consultations examined this issue and yielded several notable conclusions. First, less satisfied patients received more directives and proportionally less patient – centered utterances from physicians than did more satisfied parents. Second, findings were mixed regarding the degree to which behavioral measures related to analogue measures of the parent’s perceptions. For example, the doctors’ use of patient – centered statements was predictive of parents’ perceptions of the physicians’ interpersonal sensitivity and partnership building, but the amount of information physicians provided parents was unrelated to judgments of the doctors’ informativeness. Third, with some important exceptions, relationships between behavioral measures and parents’ evaluations did not vary for the parents differing in education and anxiety for the child’s health. Finally, behavioral measures in the form of tended to be better predictors
Literature search and study selection
Electronic searches identified 7508 records. The secondary search yielded another 94 records, 92 studies were identified from citation and reference tracking and two studies by the authors' personal knowledge. Duplicates were removed and of the 6001 remaining records, 5765 records were excluded based on title- and abstract screening. The full-texts of 245 records were assessed for eligibility. 219 records did not fulfill the inclusion criteria (see Table 1) and were excluded. This led to the inclusion of 26 studies. The main reasons for exclusion were that the measured construct was not communication (N = 67) or that the aim of study was not to test psychometric properties of an instrument (N = 51) or to measure communication skills within a medical education setting (N = 51). The study selection procedure and reasons for exclusion are displayed in Fig. 1.
The initial studies on the development of the following three instruments – could not be included in this review. For the Classification System of Byrne and Long and the Roter Interaction Analysis System (RIAS) , no study on the original development was published in a peer reviewed journal and the publication on the original development study of the VR-MICS was only available in Italian . For three studies, we only extracted one part of the study since these articles described more than only a physicians' version of the measure –. For one study , no data extraction was conducted for the reason that we found the structure of the study not transparent and neither COSMIN nor the criteria of Terwee et al. could be applied. Therefore, data on methodological quality and quality of psychometric properties was extracted for 25 studies only.
Characteristics of included studies
More than half of the studies were conducted in Europe –, , –, seven in the USA , , –, one in Canada , one in Japan  and one in Kenya . Study settings were mostly outpatient practices, but a few were conducted in (outpatient) departments of hospitals or medical care centers. Sixteen studies were initial studies on the psychometric properties of an instrument –, –, , , –, eight studies conducted further examination of psychometric properties of a previously developed instrument –, –, , . Characteristics of the included studies are displayed in Table 2.
Characteristics of included instruments
In total, we included 20 measures in the review. Four measures were not clearly named by the authors; we therefore used the description from the title or abstract to abbreviate the instruments in our description, the Physicians-patient communication patterns (PPCP), the Classification System of Byrne and Long (CSBL), the Matched-pair instrument (MPI) and the Generic peer feedback instrument (GPFI). We found eleven measures that use observer coding or rating systems –, , , , , , , , . Five measures are patient-reported , , , , . Another two instruments use both physician- and patient-reports , . Only one measure solely measures the physician's rating  and a last measure is a computer based analysis . Characteristics of the identified measures are displayed in Table 3.
Methodological quality of the included studies
The results of COSMIN ratings are displayed in Table 4. Not all studies reported on all psychometric properties; thus, not each COSMIN criterion could be applied for each study. The studies assessed a median of 3 out of the nine COSMIN criteria. None of the included studies used the Item-Response-Theory. Internal consistency (Box A) was reported for fourteen studies , , , , , –, . Only two studies received an excellent  or good score  respectively, while the other studies received either a fair , , , ,  or a poor score , , , , –.
The second COSMIN box, Reliability (Box B), could be applied to eighteen studies , , , , –, , , –, –, . This box was particularly relevant for the observer instruments, which in many cases reported on inter-rater- or/and intra-rater-reliability. Fourteen studies reported on one form of reliability and received one score for box B. One study received a good score , six studies received a fair score , , , , ,  and seven studies received a poor score , , , , , , . Three studies reported on two forms of reliability and therefore received two scores for box B. Makoul  received a good score for inter-rater-reliability and a poor score for intra-rater-reliability. Del Piccolo et al.  scored fair for both inter-rater-reliability and intra-rater-reliability. Scholl et al.  were rated good for inter-rater-reliability and fair for intra-rater-reliability. Enzer et al.  used two samples to examine reliability. This study received two scores, poor for the first sample and good for the second sample.
Measurement error (Box C) was not reported in any of the studies. The content validity box (Box D) was applied to all studies that were conducted on the initial development of the measures. Thus, eighteen studies were rated , –, –, , , –. The majority of the studies scored poorly , , –, , , , , –. The study on the SEGUE framework was the only one that was rated as excellent , while two studies were rated as either good  or fair . Eleven studies assessed structural validity (Box E) , , , , , , , , , , . Two studies ,  were rated as excellent, one study scored good , six studies , , , , ,  scored fair and two studies ,  received a poor score. Hypotheses testing rating (Box F) was assessed in twelve studies , , , , , , , , , –. Three studies were rated as fair , , , eight studies received a poor score only , , , , , , , . The study on the PCBI  received a good rating for the physician scale and a poor rating for its patient scale.
Cross-cultural validity (Box G) was only assessed in one study  and rated as poor. Three studies , ,  translated instruments, but did not assess cultural validity. For these studies, the translation procedure was rated with the items 4 to 11 of Box G. Criterion validity (Box H) and Responsiveness (Box I) were not analyzed by any of the studies. The detailed COSMIN ratings on item level are shown in S1 Table and S2 Table in S2 File.
Quality of psychometric properties
The evaluation of the quality of psychometric properties of the identified measures was conducted with the criteria of Terwee et al. and results are shown in Table 5. Content validity received a positive score in eight studies , , , , , , , . Four studies , , ,  were rated as intermediate, and six studies , , , , ,  received a negative rating. The other studies did not give any information on content validity. For internal consistency, positive ratings were found for seven studies , , , , , , , six studies received intermediate ratings , , , – and one study received a negative score . For half of the studies, no information was available on internal consistency. The majority of the studies also did not provide information on construct validity. Nevertheless, five studies received a positive score , , , ,  and five studies an intermediate score , , , , . Two studies scored negative on construct validity , . Information on reproducibility (reliability) was rated as positive for five studies , , , , , intermediate for ten studies , , , , , , , , , , and negative for one study . The study on the LIV-MAAS  was rated as positive and intermediate, because this study examined reliability in two different samples and therefore one rating for each sample was conducted. Scores were positive and negative for the study on the PBCI  due to its two dimensions (1.facilitating, 2. inhibiting). Scorings on interpretability were either intermediate or no information was available. None of the studies gave information on criterion validity, reproducibility (agreement), responsiveness or floor and ceiling effects.