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Research shows that health disparities exist among patients of varying races, ethnicities, and cultures in the United States. Numerous studies have suggested that these disparities may be partly associated with physician-patient communication. The larger project that this thesis is a part of is a mixed-methods analysis of physician-patient communication across patient race, ethnicity, and culture. This thesis specifically excluded qualitative studies and focused on how such communication can affect health outcomes. Sixty-nine studies were identified and appraised for quality. Of these, only four associated physician-patient communication with the health outcomes of patients. These studies had inconsistent results, highlighting the gap in research exploring the association between communication, patient ethnicity, and health outcomes.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

Effective doctor-patient communication is critical to improving health outcomes. Good communication improves emotional health, symptom resolution, functional and physiologic status, and pain control. Conversely, ineffective communication leads to misdiagnosis, inappropriate treatment poor adherence, misuse of health services, and high patient stress. In the U.S., Hispanics are the fastest growing minority. Despite the high burden of illness among this population, Hispanics are less likely than other minorities to regularly see a health professional. This is explained in part because Hispanics navigate a health system designed for the majority, experience a mismatch between cultural values and health beliefs, and have limited English proficiency. These communication challenges contribute to health disparities among the Hispanic population living in the U.S. Despite the importance of doctor-patient communication, few communication interventions that focus on improving patient skills have been tested in this population. Therefore, the purpose of this study was to evaluate whether a patient communication intervention tailored for female Hispanic patients could be practically implemented in a practice setting. The first aim focused on adapting existing communication skills training tools for a Hispanic population. The second aim assessed the feasibility of implementing the training tool in a federally qualified health center in a US-Mexico border community. The third aim explored the extent to which trained patients were able to integrate the information provided. Results indicate that it is feasible to implement communication training when delivered by clinical staff. Patient follow-up revealed that patients valued training on how to communicate with their doctor the most. Moreover, it is feasible to sustain the intervention when it is aligned with the priorities of the clinical site. Patient communication training in medically underserved rural areas could improve barriers to improved health outcomes in communities with a high prevalence of Hispanic patients. Future funding is needed to further test, dissemination of communication training programs.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Communication between doctors and patients in clinical settings is notorious for being difficult. This problem has inspired a wealth of empirical research from a variety of academic fields on the subject of doctor-patient communication. However, very little attention has been paid to the role of modern medicine's intellectual self-image as natural science in interactions within clinical medical settings. The aim of the current study was to philosophically investigate the influence of the medical profession's intellectual self-image on communication between doctors and patients. Jürgen Habermas' work on Universal Pragmatics was used to comment on doctor-patient communication as it is described in the existing empirical research literature. Michel Foucault's work on discourse and power was used to analyse and describe medical discourse and the nature of power in doctor-patient relationships. The outcome of this philosophical analysis leads to the conclusion that modern medicine's intellectual self-image has a pervasive and negative influence on communication between doctors and patients during clinical consultations. This is because medicine's positivist world-view results in an almost exclusive focus on the physical aspects of disease in clinical medicine. The patient's mind and his/her social world are not of great significance from the natural scientific perspective. Medical professionals may thus easily regard their clinical task solely as the physical treatment of physical disorders. They are very likely to consider many communicative activities as unrelated to their clinical task. Inadequate doctor-patient communication can easily affect the quality of medical care and patient outcomes in a negative manner, as well as diminish the quality of the doctor's occupational experience. For this reason I conclude that medicine's natural scientific intellectual self-image is not appropriate for the task of providing medical care to individual patients. Two additional reasons support this conclusion, namely the misidentification of clinical medicine as a natural science and the inappropriateness of a scientific conception of truth for the context of doctor-patient interactions. The implications of these conclusions are that the intellectual self-image and world-view of modern medicine should change to better agree with the nature of clinical practice and to make room for the psychological and social dimensions of the patient's life within health care. The medical profession should also revise its conception of science to a theory that acknowledges that interpretive reasoning and knowledge without guaranteed certainty are legitimate elements of science. I advocate for consciousness among the medical profession of the reality of medical discourse and its effects on doctors, patients and on their interaction with one another. / AFRIKAANSE OPSOMMING: Kommunikasie tussen dokters en pasiënte in kliniese omgewings is daarvoor berug om moeilik te wees. Hierdie probleem het 'n magdom empiriese navorsing vanuit 'n verskeidenheid van akademiese velde omtrent dokter-pasiënt kommunikasie geïnspireer. Baie min aandag word egter gewy aan die rol van moderne geneeskunde se intellektuele selfbeeld as 'n natuurwetenskap in interaksies in kliniese mediese omgewings. Die doel van die huidige studie was om die invloed van die mediese professie se intellektuele selfbeeld op kommunikasie tussen dokters en pasiënte filosofies te ondersoek. Jürgen Habermas se werk oor Universele Pragmatiek (Universal Pragmatics) is gebruik om kommentaar te lewer oor dokter-pasiënt kommunikasie soos wat dit beskryf word in die empiriese navorsingsliteratuur. Michel Foucault se werk oor diskoers en mag is gebruik om mediese diskoers en die aard van mag in dokter-pasiënt verhoudings te ontleed en te beskryf. Hierdie filosofiese ontleding gee aanleiding tot die gevolgtrekking dat moderne geneeskunde se intellektuele selfbeeld 'n deurdringende en negatiewe invloed op kommunikasie tussen dokters en pasiënte gedurende kliniese konsultasies het. Die rede hiervoor is dat geneeskunde se positivistiese wêreldbeskouing lei tot 'n byna uitsluitlike fokus op die fisiese aspekte van siekte in kliniese geneeskunde. Die pasiënt se verstand en gees (mind) en sy/haar sosiale wêreld is nie van groot belang vanuit die natuurwetenskaplike perspektief nie. Persone in die mediese beroep mag hul kliniese taak dus maklik as bloot die fisiese behandeling van fisiese afwykings beskou. Dit is baie waarskynlik dat hulle vele kommunikatiewe aktiwiteite as onverwant tot hul kliniese taak beoordeel. Ontoereikende dokter-pasiënt kommunikasie kan die kwaliteit van mediese sorg en pasiënte se gesondheidsuitkomste maklik negatief beïnvloed, en ook die kwaliteit van die dokter se ervaring van sy/haar beroep verlaag. Om hierdie rede maak ek die gevolgtrekking dat geneeskunde se natuurwetenskaplike intellektuele selfbeeld nie toepaslik is vir die opdrag om mediese sorg aan individuele pasiënte te lewer nie. Twee verdere redes ondersteun hierdie gevolgtrekking, naamlik die verkeerdelike identifikasie van kliniese geneeskunde as 'n natuurwetenskap en die onvanpastheid van 'n wetenskaplike konsepsie van waarheid vir die konteks van dokter-pasiënt interaksies. Die implikasies van hierdie gevolgtrekkings is dat die intellektuele selfbeeld en wêreldbeskouing van moderne geneeskunde moet verander om beter ooreen te stem met die aard van die kliniese praktyk en om ruimte te maak vir die sielkundige en sosiale dimensies van die pasiënt se lewe in gesondheidsorg. Die mediese professie moet ook haar konsepsie van die wetenskap hersien na 'n teorie wat erken dat interpreterende redenasie en kennis sonder gewaarborgde sekerheid, geregverdigde elemente van die wetenskap is. Ek pleit vir bewustheid onder die mediese professie van die realiteit van mediese diskoers en die effek daarvan op dokters, pasiënte en op hul interaksie met mekaar.

This thesis investigates how Japanese doctors create and maintain patient-centred consultations through their verbal interaction with patients, and the extent to which features of Japanese interpersonal communication influence the institutional discourse. Audio recordings of 72 doctor-patient interactions were collected at the outpatient department of a Japanese teaching hospital. All consultations involved new cases. There were two kinds of consultations: a preliminary history-taking interview with an intern and a diagnostic consultation given by an experienced doctor. After transcribing the recordings sequences of the discourse were analysed qualitatively on a turn-by-turn basis and a corpus of the data was analysed quantitatively to establish frequencies of discourse features related to patientcentredness. A review of literature (Chapter 2) establishes the standard structure of medical consultations and the relationship of the doctor and patient during consultations in terms of the asymmetry of speaking initiative according to consultation phases. The second part of Chapter 2 is an examination of Japanese communication style, attested to be influenced by culturally specific norms of behaviour that are demonstrable through verbal interactions. Chapter 3 describes the research method, and this is followed by four chapters of analysis. Chapter 4 describes the nature of the two kinds of consultations; the phases they include, and how the participants shift from one phase to the next with phase transition markers. Particular attention is paid to opening and closing phases, as they are most relevant to the establishment and consolidation of a patient-centred relationship. Chapter 5 investigates patterns of questioning by doctors, identifying functional categories of questions to see how they are used to coax information from the patient. Chapter 6 examines how the doctor encourages the patient’s narrative through backchanneling; how the doctor accommodates the patient through sensitive explanations of treatments and procedures; and how the voice of the patient emerges through calls for clarification, and voicing concerns. Chapter 7 highlights discourse sequences that may indicate culturally specific influences, and examines the emergence of laughter as an indicator of Japanese interpersonal interaction. The features of these Japanese consultations are consistent with medical consultations described in English speaking settings regarding phases and the discourse strategies used to achieve patient-centredness. While there appear to be Japanese cultural influences in the interactions consistent with previous cross-cultural studies the author argues that the institutional setting (clinical framework) is more immediately relevant to the conversational dynamics of the interactions than the Japanese cultural setting. Finally, medical consultations involving new cases have more features of service encounters and therefore not controlled by the guidance-cooperation model of doctor-patient interaction.

There are no reliable tools that evaluate pain in adult critical care patients who cannot communicate as a result of sedation or illness. This was an observational study in which postoperative cardiothoracic intensive care patients were assessed for pain using both the newly devised Corbett Pain Scale (CPS) and the Numerical Pain Scale (NPS). The CPS was evaluated for content validity, criterion validity, construct validity, test re-test reliability and internal consistency. Thirteen male and seven female patients (n=20) were enrolled and underwent a maximum of five pain assessments each. The mean total scores of the CPS (.740, SD+1.03) and the NRS (.000, SD+1.00) were compared using a paired t-test. No significant differences were found. There was poor internal consistency (-.1225) and there was insignificant correlation between the scales. Pain measurement of sedated, non-communicative patients continues to be problematic.

After individuals sustain a spinal cord injury, all aspects of their lifestyle must change for them to manage their new life roles. One important area of recovery that is often not addressed during the rehabilitation process is sexual functioning. The purpose of this quantitative study was to examine how doctor communication about sexual health with women who have sustained spinal cord injuries predicts their levels of sexual functioning and sexual self-esteem. The theoretical framework was the sexual health model. Questionnaires were used to gather data from 45 women who had completed rehabilitation from spinal cord injuries. Level of current sexual functioning was measured using the Female Sexual Function Index. Sexual self-esteem was measured using the Multidimensional Sexual Self-Concept Questionnaire. Satisfaction with doctor-patient communication was measured using the Patient Satisfaction Questionnaire and Perceived Self-Efficacy in Patient-Physician Interactions-Sex. Findings from correlation analysis indicated a positive correlation between general satisfaction with doctor-patient communication and confidence to communicate with the doctor about sexual health. Results also indicated a negative correlation between sexual self-esteem and sexual functioning. Findings may be used to improve communication between doctors and patients about sexual health, which may reduce the stigma of talking about sexuality and may promote more holistic treatment for women recovering from spinal cord injuries.