Assessment of the physician–caregiver relationship scales (PCRS)☆
Received 12 March 2007; received in revised form 3 August 2007; accepted 9 August 2007.
Abstract
Objective
The physician–caregiver relationship affects patients’ health outcomes, but measures of this important relationship are lacking. We develop and validate the physician–caregiver relationship scales (PCRS), incorporating three relationship domains (liking, understanding, dominance).
Methods
Videotapes of 100 children's visits were coded for verbal and nonverbal communication. Roter interaction analysis system utterance categories (personal remarks, laughter, agreements, approvals, concerns, reassurances, back channels and empathy) and summary measures (physician proportion of total talk and of number of questions) along with nonverbal measures (touch initiations, upright postures and leaning toward a participant) were used as indicators. Model fit was evaluated with confirmatory factor analysis (CFA). Validity was evaluated by associations of the PCRS with visit characteristics and global affect ratings.
Results
PCRS domains incorporating verbal and nonverbal indicators demonstrated good model fit (RMSEA<0.05; SRMR<0.12; TLI and CFI>0.95). Construct and predictive validity were demonstrated with PCRS domains relating to visit characteristics and affect ratings as predicted.
Conclusions
CFA supported the multi-dimensional PCRS with three domains—liking, understanding and dominance. Such measures are valuable tools for investigations of physician–caregiver relationships.
Practice implications
Models suggest specific indicators of the physician–caregiver relationship and inform interventions to improve these relationships.
aCenter for Women's Health Research, University of Wisconsin School of Medicine and Public Health, United States
bDepartment of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States
cDepartment of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, United States
dSchool of Nursing, University of Wisconsin School of Medicine and Public Health, United States
eCollege of Arts and Sciences, University of South Carolina, United States
Corresponding author at: Dept of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Box 41087 Clinical Science Center-H4/444, 600 Highland Ave., Madison, WI 53792, United States. Tel: +1 608 263 9104.
☆ Portions of this work were previously presented at the Third International Shared Decision Making Conference in Ottawa, Canada, 14–16 June 2005; the Child Health Services Research Annual Meeting in Boston, MA, 25 June 2005; the International Conference on Communication in Healthcare in Chicago, IL, 6–8 October 2005; the Pediatric Academic Societies’ Annual Meeting in San Francisco, CA, 29 April–2 May 2006.
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