<p>Physicians must explain medical information to patients in a way that patients can understand, and physician use of analogies is one strategy that may help patients better understand health information. The present dissertation, guided by patient-centered communication, investigated whether the use of analogies by a physician within a medical encounter enhances participants’ objective understanding, perceived understanding, and perceptions of clarity regarding information about a health condition, and perceptions of the physician in areas of liking, similarity, satisfaction, and affective communication. The experiment consisted of eight conditions with a 2 (familiar/unfamiliar health condition) x 4 (no analogies, diagnosis analogies, treatment analogies, both diagnosis and treatment analogies) design, and the conditions varied by being exposed to the familiar or unfamiliar health issue first. An actor physician delivered a 1-2 minute video-recorded message, diagnosing the participants, serving as analogue patients, with the familiar or unfamiliar health issue. After watching the video and responding to the dependent variable measures based on their perceptions of the physician and video message, U.S. adult participants read a vignette of another physician diagnosing them with the other (familiar or unfamiliar) health issue, and answered the same dependent variable measures regarding the physician and vignette message. Open-ended questions sought to understand what participants remembered from the message and whether they recalled analogies in their retelling of the physician messages, whether they (dis)liked the analogies, what they (dis)liked about the physicians and whether these perceptions differed by analogy conditions, whether they remembered any analogies from their own clinicians, and in which medical situations they found provider analogies to be useful. Findings indicated when including health literacy as a covariate, analogies did not enhance perceptions of clarity, perceived understanding, or objective understanding. Regarding positive perceptions, analogies did not influence liking, similarity, satisfaction, or affective communication. There was no significant interaction between use of analogies and health issues, nor a difference in the effectiveness of the analogies based on whether they were used to describe diagnosis or treatment. Explanations containing analogies resulted in increased objective understanding for the vignette compared to the video format. When recalling the physician’s message, participants rarely recalled analogies, nor explicitly mentioned them as something they liked or disliked. However, some participants recalled clinician use of particular analogies, and most of them indicated they found clinician analogies to be useful, especially when describing complex health issues that are difficult for patients to understand. The dissertation results indicate that healthcare providers may want to use analogies when interacting with patients, which could potentially improve the doctor-patient relationship. </p>

Prescription drug abuse is a public health problem of epidemic proportions in the United States. Provider-patient communication underpins many initiatives aimed at preventing and reducing the public health burden of prescription drug abuse. The characteristics of and factors contributing to this interpersonal process, however, have not been fully explored. The purpose of this research was to examine: 1) the overall problem of prescription drug abuse and provider-patient communication about prescription drug abuse from the patient perspective; and 2) provider-patient communication about prescription drug abuse from the prescriber perspective. In 2014-2015, semi-structured interviews were conducted with 20 patients from primary care and addiction medicine and 10 prescribers from multiple health professions and medical fields in Central and South Central Appalachia. The interviews were audio-recorded and transcribed verbatim. Thematic analysis, facilitated by qualitative data analysis software, was used to generate themes. Patients perceived prescription drug abuse as a problem, both in terms of its prevalence and contribution to negative consequences. Patients connected abuse to accessibility, identifying routes of access, routine practices, and rationales involved in the acquisition and distribution of prescription drugs for abuse. With regard to provider-patient communication, patients reported different levels of engagement in prescription drug abuse-related communication with healthcare providers—active, passive, and no/limited. Prescribers likewise reported different patterns of prescription drug abuse-related communication with patients—informative, counteractive, and supportive. Collectively, patients and prescribers described a range of factors—personal and environmental—that positively and negatively influence provider-patient communication and, by association, prescriber delivery and patient receipt of healthcare related to prescription drug abuse. When comparing the perspectives of patients and prescribers, multiple similarities in their prescription drug abuse-related communication perceptions and behaviors were identified. The findings of this research have implications for: 1) clinical practice to mitigate prescription drug abuse and improve patient prescription drug abuse-related communication behaviors; 2) patient- and prescriber-targeted interventions to improve provider-patient communication about prescription drug abuse; and 3) future research to continue to advance understanding of provider-patient communication about prescription drug abuse.

The national recommendations for use of the prostate specific antigen (PSA) test for prostate cancer screening have been modified over the years as scientific evidence emerged. Current screening recommendations discourage widespread PSA screening for men at low to average risk, but provide specific guidelines for shared-decision making between men and their health providers about the benefits and risks of PSA testing. This study was an examination of relationships between men’s assessment of the quality of their care and communication with their health providers, the extent to which providers engage men in recommended discussions about PSA testing, and factors associated with shared-decision making and PSA testing. Secondary data from the U.S. Health Information National Trends Survey 4, Cycle 2 that included men with no history of prostate cancer and in the recommended age ranges for prostate cancer screening were analyzed (N=777). Non-Hispanic white men rated their quality of care higher than men of other races (c2 (49, n=635) = 7.23, p = 0.0098), whereas Hispanic men gave the lowest ratings compared to other men (c2 (49, n=635) = 5.42, p = 0.024). Previous PSA testing was reported by 64% of the men, 56% of whom stated that they discussed screening with their provider and 80% reported that they were asked if they wanted to have the test done. However, only 21% - 39% reported having ever discussed the pros and cons of PSA testing. Discussing PSA testing with a provider was the strongest predictor of obtaining the test (OR=69.5, CI = 23.6 – 204.6) but the effect was significantly modified when providers and patients engaged in the shared-decision making process (OR = 47.42, CI = 14.91 – 150.74). Age, education level and perceived quality of care were consistent, positive predictors of PSA testing. These results indicate there is a gap in provider-patient discussions about PSA screening and suggest that health providers may not be following the recommended guidelines for the content of the discussions needed to facilitate shared-decision making. Effective provider-based interventions to increase shared-decision-making about PSA testing are needed if the national objectives for prostate cancer screening are to be met.

No description available.