Article Figures & Data
Tables
Characteristics All Clinician Mindfulness Tertilea P Value Low Middle High Patient, No. 437 150 146 141 Age, mean (SD), y 45.4 (9.4) 44.8 (9.6) 43.9 (9.1) 47.6 (9.2) 0.41 Female, No. (%) 147 (34) 48 (32) 46 (31) 53 (36) 0.45 High school degree, No. (%) 317 (73) 44 (37) 37 (31) 39 (33) 0.74 Race/ethnicity, No. (%) <0.01 Black 254 (58) 97 (65) 61 (42) 96 (68) Hispanic 62 (14) 13 (9) 33 (23) 16 (11) White 106 (24) 37 (25) 44 (30) 25 (18) Other 15 (3) 3 (2) 8 (5) 4 (3) Active drug use, No. (%) 128 (29) 50 (33) 47 (32) 41 (22) 0.07 Depression score, mean (SD) 2.11 (0.64) 2.13 (0.69) 2.08 (0.67) 2.11 (0.56) 0.81 CD4 cell count, mean (SD) 470 (329) 458 (318) 440 (278) 513 (383) 0.37 Length of patient-physician relationship >5 year, No. (%) 144 (33) 51 (34) 53 (37) 40 (29) 0.39 Clinician, No. 45 15 15 15 Age, mean (SD), y 44.5 (8.6) 43.7 (9.7) 47.5 (6.8) 42.3 (8.6) 0.23 Female, No. (%) 25 (56) 4 (27) 8 (53) 13 (87) <0.01 Physicians, No. (%) 34 (76) 13 (38) 10 (29) 11 (32) 0.43 Race/ethnicity, No. (%) 0.05 White 30 (67) 11 (73) 12 (80) 7 (47) Asian 11 (24) 4 (27) 3 (20) 4 (27) Other 4 (9) 0 (0) 0 (0) 4 (27) -
↵a Mean mindfulness scores: low tertile = 3.53, middle tertile = 4.31, high tertile = 5.17.
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Clinician Mindfulness Tertile Clinician Evaluation Low (n=116) Middle (n=127) High (n=119) Patient-centered visit, No. (%) 23 (19.8) 38 (29.9) 51 (42.9) Unadjusted, OR (95% CI) – 1.64 (0.79–3.38) 3.76 (1.69–8.37) Adjusted for covariates, OR (95% CI) – 1.64 (0.73–3.67) 4.14 (1.58–10.86) Adjusted for covariates+visit length, OR (95% CI) – 1.30 (0.54–3.11) 3.36 (1.17–9.60) -
OR=odds ratio.
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Note: Data from 3 sites. Unadjusted and adjusted logistic regression models account for clustering of patients within clinicians using generalized estimating equations and adjust for study site; adjusted model also includes patient age, sex, race/ethnicity, and current drug use, and clinician age, sex, and race/ethnicity. Referent group for odds ratios is the low clinician mindfulness tertile.
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β Coefficient (95% CI) Clinician Mindfulness Tertilea Mean No. (SD) Adjusted for Covariatesb Adjusted for Covariatesb + Visit Length Measure Low (n=116) Middle (n=127) High (n=119) Middle vs Low High vs Low Middle vs Low High vs Low Overall measures Visit length, minutes 22.7 (9.0) 22.2 (8.9) 22.5 (10.5) 2.2 (−1.9 to 6.3) 5.8 (0.9 to 10.8) – – Verbal dominance 1.36 (0.6) 1.49 (0.5) 1.24 (0.4) 0.12 (−0.10 to 0.34) −0.09 (−0.34 to 0.15) 0.12 (−0.12 to 0.37) −0.15 (−0.45 to 0.15) Clinician behaviors Rapport-building talk 80 (37) 87 (38) 89 (44)c 17 (−3 to 38) 30 (5 to 55) 12 (−5 to 29) 15 (−5 to 36) Psychosocial talk 18 (18) 23 (27) 27 (29)c 5 (−6 to 16) 16 (3 to 29) 3 (−8 to 12) 9 (−3 to 21) Biomedical talk 120 (63) 135 (71) 111 (66) 27 (−1 to 56) 17 (−17 to 51) 16 (−8 to 40) −12 (−42 to 17) Emotional tone 11.6 (1.7) 11.8 (1.7) 11.8 (1.8) 0.69 (0.11 to 1.3) 1.17 (0.46 to 1.9) 0.60 (0.04 to 1.6) 0.92 (0.22 to 1.6) Patient behaviors Rapport-building talk 95 (48) 97 (47) 107 (59)d 14 (−4 to 33) 40 (18 to 63) 6 (−7 to 19) 19 (3 to 35) Psychosocial talk 52 (47) 62 (63) 78 (55)d 13 (−9 to 34) 46 (20 to 73) 6 (−14 to 25) 28 (4 to 52) Biomedical talk 94 (56) 91 (52) 96 (65) 8 (−14 to 29) 23 (−4 to 50) 0 (−16 to 16) 2 (−18 to 22) Emotional tone 21.1 (1.8) 21.0 (2.0) 21.3 (1.6) 0.07 (−0.53 to 0.66) 0.62 (−0.12 to 1.36) 0.04 (−0.56 to 0.64) 0.53 (−0.22 to 1.29) -
Note: Data are from 3 sites.
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↵a Visit-level data for each variable. Verbal dominance is the ratio of clinician to patient talk. Talk variables are numbers of statements. Emotional tone is sum of scaled ratings by coders listening to audiotaped dialogue.
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↵b Results from linear regression models using generalized estimating equations to account for clustering of patients within clinicians and adjusting for study site; patient age, sex, race/ethnicity, and current drug use; and clinician age, sex, and race/ethnicity. Referent group for β coefficients is the low clinician mindfulness tertile.
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↵c P <.05.
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↵d P <.01, for comparisons of middle or high- vs low-mindfulness tertile, accounting for clustering of patients within clinicians and adjusting for study site.
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Clinician Mindfulness Tertile Patient Evaluation Low (n=150) Middle (n=146) High (n=141) High clinician communication score, No. (%)a 62 (41.3) 67 (46.5) 79 (56.8) Prevalence ratio (95% CI) Unadjusted – 1.23 (0.92–1.64) 1.47 (1.15–1.87) Adjusted for covariates – 1.27 (0.98–1.65) 1.51 (1.21–1.87) Adjusted for covariates + visit length – 1.26 (0.96–1.66) 1.48 (1.17–1.86) Highest patient satisfaction, No. (%)b 82 (54.7) 91 (63.2) 95 (68.4) Prevalence ratio (95% CI) Unadjusted – 1.23 (0.97–1.55) 1.36 (1.05–1.76) Adjusted for covariates – 1.25 (1.00–1.55) 1.46 (1.16–1.83) Adjusted for covariates + visit length – 1.26 (1.01–1.58) 1.45 (1.15–1.84) -
Note: Unadjusted and adjusted regression models account for clustering of patients within clinicians using generalized estimating equations and adjust for study site; adjusted models also include patient age, sex, race/ethnicity, and current drug use, and clinician age, sex, and race/ethnicity. Referent group is the low clinician mindfulness tertile.
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↵a High clinician communication score defined as higher than median patient ratings of clinician communication.
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↵b High patient satisfaction defined as overall quality of care rated as excellent vs all other responses.
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Additional Files
The Article in Brief
A Multicenter Study of Physician Mindfulness and Health Care Quality
Mary Catherine Beach , and colleagues
Background Mindfulness refers to a person?s tendency to remain attentive to their own experience, thoughts and feelings. Over the past decade, it has been recommended that physicians enhance their own capacities for mindfulness when practicing medicine and interacting with patients. This study assesses whether clinician self-rated mindfulness is associated with quality of patient care.
What This Study Found Physicians rating themselves as more mindful have more patient-centered communication and more satisfied patients. Measuring the mindfulness of 45 clinicians and later assessing the quality of their interactions with patients infected with the human immunodeficiency virus, researchers found mindful clinicians were more likely to be patient-centered in their communications, more positive in their emotional tone with patients and more likely to be rated highly on communication and overall satisfaction by patients.
Implications
- Mindfulness may be an important pathway to a more humanistic, effective and satisfying practice of medicine. The highly reciprocal influence of patients and clinicians on one another, the authors add, is in itself a powerful and positive medical tool--perhaps in some situations more powerful than other interventions that can be offered to patients. They call for future research to determine whether improving clinician mindfulness can also improve patient health outcomes.