Abstract
BACKGROUND: Relatively few studies have directly addressed the interaction dynamics and consequences of a companion’s presence in the medical visit, and their findings have been contradictory.
OBJECTIVES: To examine how patient’s contribution to the medical dialogue, with or without the presence of a visit companion, is related to the perception of the medical visit as patient-centered.
DESIGN: Observational study using pre- and postvisit questionnaires and audiotape recording of medical visits.
PARTICIPANTS: One hundred and fifty-five patients aged 65 or over; 63 in medical visits that included the presence of a companion and 82 in visits that did not include a companion.
MAIN OUTCOME MEASURE: Patient ratings of visit patient-centeredness.
RESULTS: Long visits (greater than 10 minutes long) and visits in which patients were verbally active were rated as more patient-centered by patients than other visits. Since patients were generally less verbally active in visits that included a companion, accompanied visits, especially if they were less than 10 minutes long, received lower patient-centered ratings than others. The presence of a companion was not related to length of the visit, suggesting that the verbal activity of the companion was off-set by decreased verbal activity of the patient.
CONCLUSIONS: Our results have suggested that patients are more likely to perceive their physician and visit as patient-centered when they have an opportunity to engage directly in the medical dialogue. A minimal amount of “talk-time” for patients themselves should be safe-guarded even in a short visit, when a companion is present.
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References
Little P, Everitt H, Williamson I, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908–11.
Mead N, Bower P. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Couns. 2002;48:51–61.
Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.
Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.
Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: TRANSFORMING the Clinical Method. Thousand Oaks, CA: Sage Publications; 1995.
Adelman RD, Greene MG, Charon R. The physician-elderly patient-companion triad in the medical encounter: the development of a conceptual framework and research agenda. Gerontologist. 1987;27:729–34.
Beisecker AE. The influence of a companion on the doctor-elderly patient interaction. Health Commun. 1989;1:55–70.
Brown JB, Brett P, Stewart M, Marshall JN. Roles and influence of people who accompany patients on visits to the doctor. Can Fam Physician. 1998;44:1644–50.
Prohaska TR, Glasser M. Patients’ views of family involvement in medical care decisions and encounters. Res Aging. 1996;18:52–69.
Clayman ML, Roter D, issow LS, Bandeen-Roche K. Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits. Soc Sci Med. 2005;60:1583–91.
Ishikawa H, Roter DL, Yamazaki Y, Takayama T. Physician-elderly patient-companion communication in Japanese geriatric encounters. Soc Sci Med. 2005;60:2307–20.
Schilling LM, Scatena L, Steiner JF, Albertson GA, Lin CT, Cyran L, et al. The third person in the room: frequency, role, and influence of companions during primary care medical encounters. J Fam Pract. 2002;51:685–90.
Labrecque MS, Blanchard CG, Ruckdeschel JC, Blanchard EB. The impact of family presence on the physician-cancer patient interaction. Soc Sci Med. 1991;33:1253–61.
Botelho RJ, Lue BH, Fiscella K. Family involvement in routine health care: a survey of patients’ behaviors and preferences. J Fam Pract. 1996;42:572–6.
Baker PS, Yoels WC, Clair JM, Allman RM. Laughter in triadic geriatric medical encounters: a transcript-based analysis. Social Perspectives Emotion. 1997;4:179–207.
Coe RM, Prendergast RM. Research note: the formation of coalitions: interaction strategies in triads. Sociol Health Illness. 1985;7:237–47.
Greene MG, Adelman RD, Friedmann E, Charon R. Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med. 1994;38:1279–88.
Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol. 1998;51:1037–44.
Ishikawa H, Takayama T, Yamazaki Y, Seki Y, Katsumata N. Physician-patient communication and patient satisfaction in Japanese cancer consultations. Soc Sci Med. 2002;55:301–11.
Wissow LS, Roter D, Larson SM, et al. Mechanisms behind the failure of residents’ longitudinal primary care to promote disclosure and discussion of psychosocial issues. Arch Pediatr Adolesc Med. 2002;156:685–92.
Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.
Greenfield S, Kaplan S, Ware JE, Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520–8.
Mead N, Bower P, Hann M. The impact of general practitioners’ patient-centredness on patients’ post-consultation satisfaction and enablement. Soc Sci Med. 2002;55:283–99.
Wolf KH. The Sociology of Georg Simmel. New York: Free Press; 1950.
Haug MR, Ory MG. Issues in elderly patient-provider interactions. Res Aging. 1987;9:3–44.
Stoeckle JD. Encounters Between Patients and Doctors. Cambridge, MA: The MIT Press; 1987.
Coe RM, Prendergast CG, Psathas G. Strategies for obtaining compliance with medications regimens. J Am Geriatr Soc. 1984;32:589–94.
Ishikawa H, Roter DL, Yamazaki Y, Hashimoto H, Yano E. Patient perceptions of companion helpfulness during geriatric medical visits. Patient Educ Couns (forthcoming).
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This research was supported by a grant from the Pfizer health research foundation.
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Ishikawa, H., Hashimoto, H., Roter, D.L. et al. Patient contribution to the medical dialogue and perceived patient-centeredness. J GEN INTERN MED 20, 906–910 (2005). https://doi.org/10.1111/j.1525-1497.2005.0200.x
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DOI: https://doi.org/10.1111/j.1525-1497.2005.0200.x