Primary Care Research

Clinical setting and physician communication style predict patient participation during medical consultations

The more that patients actively participate in medical consultations about their care, the more likely they are to have better health outcomes and quality of care. Although educated and white patients tend to be more active participants than other patients, the strongest predictors of patient participation are situation-specific, namely the clinical setting and the physician's communication style, concludes a new study supported in part by the Agency for Healthcare Research and Quality (HS10876).

Researchers analyzed 279 physician-patient interactions from 3 clinical sites: primary care patients in Sacramento, patients with systemic lupus erythematosis (SLE) from the San Francisco Bay area, and patients with lung cancer from a Veterans Administration hospital in Texas. They found that patients with at least some college education tended to be more active communicators (for example, asking questions, expressing concern, and being assertive) than patients with less education (a mean of 17.4 vs. 13.8 verbal expressions of active participation per consultation). Patients with lung cancer were more active participants than patients with SLE and primary care patients (a mean of 24.4 vs. 11.2 and 11.3 verbal expressions). Finally, Asian American, black, and Latino patients were less active participants than white patients (a mean of 10.5, 10.7, and 14.9 vs. 17.5 verbal expressions).

Active patient participation was 7 times more likely to have been patient-initiated than physician prompted (14 vs. 2 verbal expressions). However, patients were more active participants when their physicians used partnership-building and offered verbal support via praise, reassurance, and empathy. Doctors engaged in partnering behavior at least once in 83 percent of the consultations, but supportive talk occurred in only 38 percent of the interactions (and more often with lung cancer than SLE or primary care patients). Female physicians offered significantly more supportive talk than male doctors and physicians generally used more supportive talk with white patients than they did with Asian American, black, or Latino patients.

See "Patient participation in medical consultations: Why some patients are more involved than others," by Richard L. Street Jr., Ph.D., Howard S. Gordon, M.D., Michael M. Ward, M.D., and others, in the October 2005 Medical Care 43(10), pp. 960-969.

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