Communication study
Respecting patients is associated with more patient-centered communication behaviors in clinical encounters

https://doi.org/10.1016/j.pec.2015.08.020Get rights and content

Highlights

  • We studied links between clinicians’ respect for patients and communication behaviors.

  • We analyzed visits between 413HIV-infected patients and 45 primary HIV care providers.

  • When clinicians had higher respect for a patient, they used more positive behaviors.

  • Visits with clinicians with higher respect for patients were more patient-centered.

  • Fostering respect for patients may improve patient–clinician communication quality.

Abstract

Objective

Attitudes towards patients may influence how clinicians interact. We investigated whether respect for patients was associated with communication behaviors during HIV care encounters.

Methods

We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes.

Results

When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92–4.59)], more positive patient emotional tone [2.71 (1.75–4.21)], less clinician verbal dominance [0.81 (0.68–0.96)] and more patient-centeredness [1.28 (1.09–1.51)].

Conclusions

Respect is associated with positive and patient-centered communication behaviors during encounters.

Practice Implications

Clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. Educators should consider methods to enhance trainees’ respect in communication skills training.

Introduction

Communication training of health professionals emphasizes the acquisition of specific skills, yet attitudes towards patients may also influence how healthcare practitioners interact. An attitude of respect towards patients is placed at the center of bioethics and medical professionalism, and can be understood as having both a cognitive or emotional component (a belief intrinsic within a clinician that the patient has value) and a behavioral component (acting on this belief with observable behaviors) [1]. Prior studies have found that respectful clinician communication behaviors as reported by patients are associated with improved patient adherence to therapeutic regimens [2], [3] and improved health outcomes in chronic disease management [4], [5], [6], [7], [8]. When patients feel “known as a person” by their HIV care clinician, they are more likely to receive antiretroviral therapy (ART), adhere to ART, and have undetectable HIV viral loads [9]. Although being known as a person is not a measure that specifically uses the word, ‘respect’, it evokes the essence of respect as acknowledgment of the patient as a person. From the patient perspective, PLWH who report that their clinician always treats them with dignity and respect are also more likely to keep their clinic appointments [10].

The extent to which better patient experiences represent more respectful attitudes on the part of clinicians is unclear, in part because such attitudes can be challenging to measure and far fewer studies have attempted to do so. In the primary care context, one study found that respect for particular patients varied and was associated with more positive clinician communication behaviors [11]. These findings have not been replicated until now. Furthermore, clinician respect for patients may be particularly relevant in HIV care due to several factors such as racial/ethnic differences between patients and clinicians [12], [13], [14], [15], [16], [17], [18], [19], HIV-related stigma [20], [21], [22], and stigma towards substance use disorders [23], [24], [25]. Patients with active substance abuse perceive less respect from clinicians and demonstrate less engagement in HIV care [10].

No prior studies have assessed clinicians’ respect for patients with HIV or the observable clinician behaviors that convey respect to patients. To address this gap, we aimed to investigate whether clinician-reported respect for patients varied with patient or clinician characteristics and whether respect was associated with communication behaviors during clinical encounters. This understanding is needed to inform efforts of optimize patient–clinician relationships, in HIV care and beyond.

Section snippets

Study design, subjects, and setting

We conducted a cross-sectional analysis of data from the Enhancing Communication and HIV Outcomes (ECHO) Study, which was designed to assess possible racial/ethnic disparities in communication in HIV care and to determine which interactions are associated with more positive outcomes among patients with HIV [12], [13], [26], [27], [28], [29]. Study subjects were HIV care practitioners and patients at four HIV outpatient sites in the United States (Baltimore, Detroit, New York, and Portland). The

Clinician respect

The independent variable was clinician-reported respect for that particular patient assessed immediately following the encounter with the item, “Compared to other patients, I have a great deal of respect for this patient” (5-point Likert scale from strongly agree to strongly disagree). Responses were dichotomized to compare those who strongly agreed/agreed (higher respect) with those who were neutral or disagreed (lower respect). This measure has been used in prior studies in primary care to

Participant characteristics

Table 1 shows patient and clinician characteristics in the study sample. Patients were predominantly male (66%) and African-American (57%), while clinicians were predominantly female (58%) and white (71%). In total, there were 435 patients and 45 clinicians in the study sample. After excluding those with missing data for respect, 413 patient–clinician interactions were included in the analysis. Each patient–clinician pair had 1 audio-recorded encounter. On average, there were 9 patients per

Discussion

Respect is associated with more positive and patient-centered communication behaviors during medical encounters by both clinicians and patients. When clinicians reported higher respect for patients, both clinicians and patients had more positive affect, engaged in more rapport-building, more social chitchat, and more positive talk. Patients who were highly respected by clinicians gave more psychosocial information. Overall, their encounters had less clinician verbal dominance, indicating that

Conflict of interest

None, for all authors.

Acknowledgements

This research was supported by a contract from the Health Resources Service Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). In addition, Dr. Korthuis was supported by the National Institute of Drug Abuse (K23 DA019808). Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08HS013903-05) and both Drs. Beach and Saha were supported by Robert Wood Johnson Generalist Physician Faculty Scholars Awards. Preliminary findings of this

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