How clinician–patient communication contributes to health improvement: Modeling pathways from talk to outcome
Introduction
Except in rare circumstances, the delivery of medical care is fundamentally a communicative enterprise in which clinicians, patients, and (when appropriate) families discuss a patient's health, decide on the best therapeutic action, and make plans for follow through on those decisions. This reality begs the question of whether the way in which clinicians and patients communicate with one another can contribute to the patient's health and well-being following the consultation.
In this essay, first we provide a selective review of research of clinician–patient communication (most of which has focused exclusively on physicians) and highlight a number of inconsistencies and contradictory findings in this literature. Second, we lay out two sets of challenges in studying the relationship between communication and outcomes, one centered on modeling pathways through which communication can contribute to improved health and the other on theoretical and methodological issues related to conceptualizing and measuring communication process. Finally, the essay concludes with recommendations for future research aimed at explicating relationships between clinician–patient communication and health outcomes.
Section snippets
Conundrums in communication and health outcomes research
Two of the earliest studies finding relationships between features of physician–patient communication and health outcomes were in the 1980s by Kaplan et al. [1] and Orth et al. [2]. Kaplan et al. found that diabetes patients who were more participatory in their visits (e.g., exerting control, sharing floortime with the doctor) subsequently had lower blood pressure and better metabolic control 8–12 weeks after their consultations compared to more passive patients. In the Orth et al. study,
Challenges for understanding relationships of communication with health outcomes
Our efforts to understand the relationships between clinician–patient communication and health outcomes face two major challenges, one related to modeling communication pathways to improved health and the other to measurement and theoretical challenges inherent in the study of communication processes (see Fig. 1). In the sections below, I discuss each and possible ways to address these challenges.
Conceptual and measurement challenges for studying clinician–patient communication
As noted in Fig. 1, there are a number of conceptual and measurement challenges that must be addressed if we are to better understand ways in which clinician–patient communication contributes to better health. Currently, communication research suffers from a serious lack of integration across different research program both in terms of theory and measurement. Rarely do researchers lay out the theoretical foundation for how they are approaching communication process and, when they do, they often
Conclusion
Communication in medical encounters matters. Yet, it is complex. We as a research community should do more to explain how and why. Toward this end, we need to model pathways through which we identify specific communication features that activate processes that can directly or indirectly contribute to improving a patient's health and well-being. Because these pathways will most often be indirect, we need to account for proximal and intermediate variables that link clinician–patient communication
Conflict of interest
The author report no conflicts of interest.
Acknowledgement
Dr. Street is supported by the Houston Health Services Research and Development Center of Excellence (HFP90-020) at the Michael DeBakey VA Medical Center.
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