THE INFLUENCE OF OLDER PATIENT-PHYSICIAN COMMUNICATION ON HEALTH AND HEALTH-RELATED OUTCOMES

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PATIENT EXPECTATIONS

Patient expectations of the patient-physician encounter are important in providing the experience of empowerment for patients. Can the encounter be considered successful if, at the end of the encounter, the goals of the patient are not met or if the goals of patient and physician differ? Greene et al18 found that older patients' medical encounters were significantly less concordant than those of younger patients in relation to the main goals for the visit and the main medical topics, such as

PATIENT DECISION-MAKING

The style of communication employed by the physician also affects the decision-making process of the patient. Older patients frequently present with multiple problems and also have various barriers (e.g., hearing problems, poor vision, impaired motor function, and cognitive deficits) to communication.23, 29 During each encounter, many decisions regarding their care must be made. Active participation by older patients during the medical encounter influences patients' ability and willingness to

PATIENT RECALL

Patient recall of information provided during the encounter has been found to be low.29 This is particularly evident when the patient, regardless of his or her age, receives bad news; for example, a diagnosis of breast cancer.14 Several intervention strategies have been used to improve recall: providing the patient with an audiotape of the encounter,13 for example, or training the patient to ask questions.24, 39

Even in encounters that are less fraught with emotion, older patients frequently

PATIENT ADHERENCE

As Salzman42 states, “Successful communication between the doctor and patient is necessary to help and encourage patients to participate fully in an agreed upon regimen in an informed and intelligent manner.”

Older patients face the challenges of increased comorbidity. Encouraging adherence to treatment regimens, therefore, is an important aspect of patient-physician communication in this population. Poor communication has been found to be the most important factor in determining adherence to

PATIENT SATISFACTION

Extensive evidence exists supporting the notion that when the quality of communication with the physician is rated highly, patients are more likely to be satisfied with their medical care.7 Inui and Carter as reported in Haug and Ory22 reviewed 21 studies in which communication processes were linked to satisfaction.22 A study conducted by Williams and Calnan50 in the United Kingdom found that patient satisfaction was associated more with the patient-physician relationship and the physician's

EMOTIONAL HEALTH OUTCOMES

Another outcome associated with patient-physician communication in older people is the emotional health of the patient. Several authors have suggested that the emotional health of the older patient can be influenced by the attitude of the physician. For example, if a physician portrays a hopeless attitude while communicating with a patient, especially if that patient has a life-threatening illness, then depression and a sense of isolation result.35 Furthermore, when the patient observes that he

PHYSICAL HEALTH OUTCOMES

Beisecker6 has indicated that studies of communication in relation to health, specifically for older patients, have not yet been conducted; therefore, physicians' understanding of the information relevant to this population must be taken from studies of adult patients in general. Because some issues are specific to older patients, however (i.e., cohort, the life-stage, the life context), generalizing from existing studies should be done with caution.

Of the 21 studies of communication in

HOSPITALIZATION

Older people in general have more health problems than their younger counterparts and an increased likelihood of hospitalization. This is in part because of the probability of acquiring a chronic health problem with age as well as the complexities of comorbidity, multiple medications, and end-of-life issues that are so common in the older population.23, 29

Certain aspects of the patient-physician relationship appear related to the risk of hospitalization for older patients. Important

CONCLUSIONS

This article highlights that a number of outcome measures have not been well studied in the older population in terms of their relationship with patient-physician communication, with physical health outcomes being a prime example. From the studies of the communication of older patients that were reviewed in relation to the gamut of outcomes, the key communication dimensions appear to be concordance between the patient and the physician regarding the expectations of an encounter, full patient

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References (50)

  • K. Bertakis

    The communication of information from physician to patient: A method for increasing patient retention and satisfaction

    J Fam Pract

    (1977)
  • S. Buetow

    The scope for the involvement of patients in their consultations with health professionals: Rights, responsibilities and preferences of patients

    J Med Ethics

    (1998)
  • B. Breemhaar et al.

    Perceptions and behaviour among elderly hospital patients: Description and explanation of age differences in satisfaction, knowledge, emotions and behaviour

    Soc Sci Med

    (1990)
  • J.B. Brown et al.

    Roles and influence of people who accompany patients on visits to the doctor

    Can Fam Physician

    (1998)
  • R.M. Coe et al.

    Strategies for obtaining compliance with medications regimens

    J Am Geriatr Soc

    (1984)
  • A.J. Dietrich et al.

    Does continuous care from a physician make a difference?

    J Fam Pract

    (1982)
  • J. Ende et al.

    Measuring patients' desire for autonomy: Decision making and information-seeking preferences among medical patients

    J Gen Intern Med

    (1989)
  • L.J. Fallowfield et al.

    Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer

    Br Med J

    (1986)
  • Garms-Homolova V: Not at all or too much: Patterns of inadequate use of health and social services by the elderly....
  • T.F. Garrity et al.

    Patient-physician communication as a determinant of medication misuse in older, minority women

    The Journal of Drug Issues

    (1989)
  • M.G. Greene et al.

    The effects of the presence of a third person on the physician-older patient medical interview

    J Am Geriatr Soc

    (1994)
  • M.G. Greene et al.

    Concordance between physicians and their older and younger patients in the primary care medical encounter

    Gerontologist

    (1989)
  • S. Greenfield et al.

    Patient participation in medical care: Effects on blood sugar control and quality of life in diabetes

    J Gen Intern Med

    (1988)
  • S. Greenfield et al.

    Expanding patient involvement in care: Effects on patients outcomes

    Ann Int Med

    (1985)
  • M.R. Haug et al.

    Issues in elderly patient-provider interactions

    Research on Aging

    (1987)

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    Address reprint requests to Moira Stewart, PhD Centre for Studies in Family Medicine The University of Western Ontario 245–100 Collip Circle London, Ontario, Canada N6G 4X8

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