AssessmentTaking into account patients’ communication preferences: Instrument development and results in chronic back pain patients
Introduction
One central aspect of patient-centered care is responding to patients’ preferences for communication with the provider [1]. The patient's communication preferences are a factor in determining what provider behavior is perceived as positive or negative by the patient and influence the relationship between physician communication behavior and patient-reported outcomes [2]. The preference for a traditional biomedical versus a patient-centered, participative communication style has often been studied (e.g. [3], [4]). Many studies also examine preferences regarding conveying information [5], emotional support [6], and establishing a relationship [7]. A key result of the research is that patients display relatively high inter-individual and intra-individual variability regarding the preference for certain communication styles (e.g. patient participation). Physicians must therefore individualize their communication style [8], [9], [10], [11]. There is no one style of communication that is appropriate for every patient.
What is needed is matching between the patient's communication preferences and the provider's communication behavior. There is some empirical proof of the positive influence of preference-matching on relevant outcomes such as adherence, emotional well-being or self-reported health behavior [12], [13].
As Kiesler and Auerbach [13] report, studies on patient preference-matching should be distinguished from studies that examine the congruence between the communication preferences of patients and providers (concordance studies, cf. e.g. [14], [15]). A mere congruence of communication preferences does not necessarily say anything about whether the provider is really concentrating on the patient's needs in a concrete situation.
Concerning measurement of agreement between patient communication preferences and provider communication behavior Kiesler and Auerbach arrive at two areas where future research is needed: 1. Instruments with identical contents that are directly related to each other should be used to assess patient preferences and provider behavior so that matching can be validly determined. One example of this is the Control Preference Scale [16], which however, was limited to measuring one particular aspect of patient–provider communication. 2. The method should include a prospective survey. This means that the patient should be asked about his preferences before treatment. Any other method could lead to bias due to the experience with the provider and recall deficiencies.
The objective of our study is to implement these two requirements and thus develop an instrument that
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Takes various essential aspects of patient–provider communication into consideration (cf. e.g. [17], [18]) (for example in addition to patient involvement also facilitating the exchange of information and establishing a good interpersonal relationship).
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Satisfies psychometric requirements (unidimensionality, reliability, meeting the requirements of item response theory (IRT) [19]).
Such an instrument is not yet available. With the help of the instrument developed, a descriptive analysis of matching between patient communication preferences and physician communication behavior will be conducted for patients with chronic back pain. For this patient group, which is highly relevant for epidemiology and health care costs [20], [21], patient–physician communication has thus far been studied infrequently in comparison with other chronic illnesses (e.g. cancer, cf. [22]). There are studies that show that when interacting with the physician, patients with chronic back pain place a great deal of importance on understanding information, receiving reassurance, and discussing psychosocial issues [22] and that they are often not very satisfied with the information received from the physician [23]. However, to the best of our knowledge, nothing has been published thus far on matching between communication preferences and physician communication behavior in patients with chronic back pain.
Section snippets
Instrument development
The KOPRA questionnaire [24], an instrument for measuring communication preferences that was described in a recently published study, includes essential aspects of patient–provider interaction and has good psychometric properties. The KOPRA questionnaire consists of 32 items categorized in four scales – “Patient participation and patient orientation” PPO, “Effective and open communication” EOC, “Emotionally supportive communication” ESC, and “Communication about personal circumstances” CPC. To
KOVA questionnaire
Response frequency and ceiling/floor effects: With one exception, the percentage of missing values was always under 5% (range 0.8–3.7%). There were no ceiling or floor effects for the KOVA items. Due to the good distribution properties, no KOVA item was selected in this evaluation step.
Unidimensionality: To ensure unidimensionality, two items from each of the four scales had to be selected. The model fit values for testing unidimensionality before and after item selection are shown in Table 3.
KOVA questionnaire
The strengths of the KOVA questionnaire are that, because the contents are related to the patient-oriented KOPRA questionnaire (cf. [24]), the instrument is also considered patient oriented. That is, it covers the communication aspects that are important for chronically ill patients. In addition, after item selection, the instrument has good psychometric properties – the scales are unidimensional, reliable, and satisfy the requirements of the Rasch model. The correlations between the KOVA
Acknowledgments
The study was conducted in the project “Patient–provider communication for chronically ill patients: gender- and age-specific preferences of patients,” which is funded in Germany by the Federal Ministry of Education and Research (Grant no.: 01 GX 0740) as part of the funding priority for “Chronic Illnesses and Patient Orientation” (www.forschung-patientenorientierung.de). We wish to thank the cooperating rehabilitation centers for their support in data collection: Eisenmoorbad Bad Schmiedeberg
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