Department of Communication, University of Kentucky, 263 Blazer Dining Hall, Lexington, KY, 40506, USA.
Department of Medicine, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA; Department of Public Health Sciences, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA.
Soc Sci Med. 2024 Oct;358:117199. doi: 10.1016/j.socscimed.2024.117199. Epub 2024 Aug 8.
The purpose of the present study was to investigate the quality of patient/clinician communication as one potential factor that impacts colorectal cancer screening behavior. As part of a larger randomized controlled trial conducted between 2011 and 2016 in the setting of community and academic family medicine or internal medicine practices in Michigan, USA, patients completed a pre-encounter survey, completed their regularly scheduled visit with their primary care clinician (which was audio-recorded), completed a post-encounter survey, and allowed 6-month follow-up chart audit. We trained 10 coders to rate 216 of the audio-recorded conversations between 216 patients and their primary care physicians for 6 specific features of communication quality (using 7-point scales), including the extent to which participants enacted attention to medical content, engagement, emotional expression, relationships, face, and accommodation. At least 3 coders rated each conversation, and intraclass correlations (i.e., reliability assessment) were in the good to excellent range. We found that patient and clinician attention to face (an identity goal) was a significant predictor of colorectal cancer screening at 6 months follow up. Measuring communication in terms of attention to multiple goals reveals unexpected findings about the aspects of communication that impact colorectal cancer screening behavior. The focus of many interventions to improve colorectal cancer screening rates is on the content (i.e., task goals) of clinicians' communication (such as presenting the different options for screening), yet the content of communication was not a significant predictor of screening in the present study. Rather, clinicians' and patients' attention to identity goals predicted screening behavior, which suggests that interventions may not need to be overly complex and that simply improving the quality of attention to identity goals in clinician communication might be one of the most straightforward yet impactful ways to improve colorectal cancer screening uptake among patients.
本研究旨在探讨医患沟通质量作为影响结直肠癌筛查行为的潜在因素之一。作为 2011 年至 2016 年间在美国密歇根州社区和学术家庭医学或内科实践中进行的一项更大的随机对照试验的一部分，患者完成了预接触调查，与他们的初级保健临床医生进行了定期就诊（该就诊被录音），完成了接触后调查，并允许进行 6 个月的随访图表审核。我们培训了 10 名编码员，对 216 名患者及其初级保健医生之间的 216 次录音对话进行了 6 个特定沟通质量特征（使用 7 分制）的评分，包括参与者关注医疗内容、参与度、情感表达、关系、面子和适应性的程度。至少有 3 名编码员对每段对话进行了评分，组内相关系数（即可靠性评估）处于良好到优秀的范围内。我们发现，患者和临床医生对面子（身份目标）的关注是 6 个月随访时结直肠癌筛查的一个重要预测因素。从关注多个目标的角度衡量沟通，可以揭示出影响结直肠癌筛查行为的沟通方面的意外发现。许多旨在提高结直肠癌筛查率的干预措施的重点是临床医生沟通的内容（即任务目标）（例如，提出不同的筛查选择），但在本研究中，沟通的内容并不是筛查的显著预测因素。相反，临床医生和患者对身份目标的关注预测了筛查行为，这表明干预措施可能不需要过于复杂，而只是提高临床医生沟通中对身份目标的关注质量，可能是提高患者结直肠癌筛查率的最直接但最具影响力的方法之一。
