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