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Patient-Physician Communication in Oncology Care: The character of, barriers against, and ways to evaluate patient-physician communication, with focus on the psychosocial dimensions
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. (Pharmacy and Policy)
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting.

Routine oncology out-patient consultations from two different hospitals were audio-recorded. After the consultations, patients and oncologists perceptions of the content and quality of the communication were assessed using a self-report questionnaire. A nation-wide survey was performed to assess oncologists’ perceived barriers against psychosocial communication. Finally, the audio-recorded consultations were used for evaluating inter-rater reliability and feasibility of two different communication analysis instruments.

Patient-physician consultations in oncology care are focused on the physical aspects of disease and treatment, both in terms of how often these issues were discussed and in terms of the amount of time spent on discussing them. Psychosocial issues, such as the disease’s effects on patients’ emotional or social functioning, are not always discussed during consultations, and the time spent on such discussions is limited. When psychosocial issues are discussed during the medical consultations, they are most often patient-initiated. Reasons for why psychosocial aspects are seldom discussed during the medical consultations can be the barriers concerning this kind of communication perceived by a large majority (93%) of the oncologists. Barriers against psychosocial communication were identified at organizational levels (including guidelines, routines, and resources) and individual levels (including physicians’ knowledge and attitudes).

Furthermore, this thesis shows that there are methods with high feasibility and reliability for evaluating the content of patient-physician communication, in large study samples in oncology care. The method (observation/self-report) and perspective (patient, physician, and observer) used when evaluating communication affects the results. This needs to be considered when choosing evaluation methods in intervention studies.

There are reasons to continue to evaluate, promote and implement promising ways of achieving better communication in clinical practice. Research should focus on how to overcome barriers against psychosocial communication.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 91 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 167
Keyword [en]
patient-physician communication, barriers, psychosocial, content analysis systems, clinical practice, communication
National Category
Social and Clinical Pharmacy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Pharmacy
Identifiers
URN: urn:nbn:se:uu:diva-183841ISBN: 978-91-554-8543-6 (print)OAI: oai:DiVA.org:uu-183841DiVA: diva2:565030
Public defence
2012-12-21, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-11-28 Created: 2012-11-03 Last updated: 2018-01-12Bibliographically approved
List of papers
1. Patient-physician communication during oncology consultations
Open this publication in new window or tab >>Patient-physician communication during oncology consultations
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2008 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 17, no 10, 975-985 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to characterize the content of patient-physician communication in standard oncology care. METHODS: The sample consisted of 19 patients with gastrointestinal cancer. The consultations were audio-recorded, transcribed verbatim, and analyzed according to qualitative content analysis. RESULTS: The analysis resulted in seven main categories: Disease and treatment, Healthcare planning, Everyday living, Psychological well-being, Coping with disease, Expressions of concerns and feelings, and Other aspects of communication. The main focus during the consultations was on disease and treatment. Physicians tended to concentrate on response to treatment and types and severity of side effects and how to treat them. More patient-centered subjects of psychosocial character like coping and psychological well-being were discussed only briefly, if at all. CONCLUSIONS: This study adds to the information given by the existing communication analysis systems, and hence we suggest a development of the psychosocial content categories of those systems to make them more valid.

Keyword
cancer, oncology, patient-physician communication, consultation, qualitative
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-86840 (URN)10.1002/pon.1410 (DOI)000260351000003 ()18677715 (PubMedID)
Available from: 2008-12-08 Created: 2008-12-08 Last updated: 2018-01-13Bibliographically approved
2. Communication analysis in oncology care: Performance of a combination of a content analysis system and a global scale
Open this publication in new window or tab >>Communication analysis in oncology care: Performance of a combination of a content analysis system and a global scale
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2011 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 20, no 9, 992-1000 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to assess the feasibility and reliability of Velikova's Content Analysis System (VCAS) and the Medical Interaction Process System (MIPS) global scale for evaluation of communication in oncology care.

Methods: Seventy routine physician consultations with gastro-intestinal (GI) cancer patients were audio-recorded. Two coders applied VCAS and MIPS global scale to the consultations. VCAS captures aspects of communication like symptoms, side effects, functional issues (e.g. emotional, social, physical), health-related quality of life and medical decision making. MIPS global scale measures the total impression of the consultation, e.g. patient centredness and psychosocial focus.

Results: In total, 61 of 70 consultations were coded. The coding took twice the consultations' actual durations in minutes for VCAS. The time for coding MIPS global scale equalled the consultations length. However, the coder had then listened to the consultation twice before, coding for VCAS. Cohen's kappa for all aspects measured by VCAS varied between 0.20 and 1, mean 0.80. One category (Info on test) had a kappa of 0.20, the other categories were all above 0.60. Weighted Kappa for MIPS global scale varied between 0.25 and 0.73, mean 0.42.

Conclusions: VCAS and MIPS global scale is a feasible combination of tools for evaluating patient-physician communication regarding content, medical decision making and global aspects of communication. VCAS showed high reliability. The MIPS global scale showed lower reliability, due to its sensitivity to the individual coders' unique values, common for all global scales. Further development of the combination of content and global instruments would be valuable.

Keyword
oncology, cancer, patient-physician communication, content analysis systems, clinical practice
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-160203 (URN)10.1002/pon.1808 (DOI)000295122700011 ()
Available from: 2011-10-18 Created: 2011-10-18 Last updated: 2017-12-08Bibliographically approved
3. Different perspectives on communication quality and emotional functioning during routine oncology consultations
Open this publication in new window or tab >>Different perspectives on communication quality and emotional functioning during routine oncology consultations
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2012 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 88, no 1, 16-22 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To determine quality of communication in routine oncology consultations from patient, physician, and observer perspectives, and to determine agreement of emotional function content in consultations from these three perspectives.

Methods: In total, 69 consultations were included. Perceived quality of communication and whether or not emotional functioning had been discussed was evaluated with patient- and physician-reported questionnaires. Observer perspective was evaluated by content analysis of audio records of the consultations. Agreement between perspectives was analyzed and means compared using linear mixed models.

Results: The patients' ratings of communication quality differed significantly from those of both the physician and observer. Observer and physician scores did not differ significantly. Physicians rated emotional functioning as discussed more often than was reported from patient and observer perspectives.

Conclusion: The patients' view of the quality of communication differed from that of the physician and observer. Whether emotional functioning was discussed or not was also perceived differently by patients, physicians, and observer.

Practice implications: The underpinnings and implications of these results need to be further explored regarding how to move toward a higher degree of shared understanding, where different perspectives are more in alignment, and how to develop more valid methods for evaluating communication.

Keyword
Oncology, Communication, Content analysis, Emotional functioning, Communication analysis, Clinical practice
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-179580 (URN)10.1016/j.pec.2011.12.002 (DOI)000306541300004 ()
Available from: 2012-08-20 Created: 2012-08-20 Last updated: 2017-12-07Bibliographically approved
4. Barriers against psychosocial communication: Oncologists' perceptions
Open this publication in new window or tab >>Barriers against psychosocial communication: Oncologists' perceptions
2013 (English)In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 31, no 30Article in journal (Refereed) Published
Keyword
oncology, communication, clinical practice, barriers, oncologists
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pharmaceutical Sciences
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-183660 (URN)10.1200/JCO.2012.45.1609 (DOI)000330540400019 ()
Available from: 2012-10-31 Created: 2012-10-31 Last updated: 2018-01-12Bibliographically approved

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