1. How Can We Improve Patient
Communication Skills? Assessing the
Needs of Physicians
Christa L. Arnold Justin J. Coran
University of North Florida University of Florida
Melanie Hagen
University of Florida

2. Why Train our Patients?
 Most medical training programs address
physicians’ communication skills, but few
studies or training programs have
addressed the communication skills of the
patients.

3. Positive Outcomes for Training
Patients
 Improved trust
 Improved patient loyalty to physician
 Improved interpersonal communication
skills
 Improved patient health outcomes
 Improved physician & patient satisfaction

4.  Effective relational communication
requires…
◦ both parties to have communication skills
based competency
◦ co-constructed medical encounter
◦ understanding of each others expectations
in the consultation.
◦ What can we do to achieve a
mutually beneficial medical
encounter for BOTH physicians and
patients?

5. Cegala suggests the PACE
curriculum…
(1) Presenting detailed information
(2) Asking questions
(3) Checking understanding
(4) Expressing concerns
(5) State preferences (Bylund, 2010)
-Trains patients to tell physicians their
preferred communication style and role in
decision making and treatment discussion.

6. Outcomes from PACE model
interventions
 More frequent information seeking
behaviors
 Improved quality of patient
communication
 Increased patient compliance

7. Our Study…
 Bylund (2011)- Before beginning a patient
training program, it is necessary to assess the
needs of physicians in one specific community.
 Purpose- To assess physician needs, in our
community, for patient communication training in
medical practice.
 Goal- Identify the necessary components to
construct patient communication workshops to be
facilitated in our communities medical clinics.

8. Sample…
 336 physicians from 28 medical specialties.
◦ Internal Medicine (21%),
◦ Pediatrics (19%),
◦ Family Practice (5%),
◦ Oncology (5%),
◦ Ob/Gyn (4%),
◦ Other medical specialties (46%).
 Gender
◦ 165 males (57%) and 123 females (43%)
 Age
◦ 25-35 years (n=105, 37%),
◦ 36-45 years (n=84, 29%), and
◦ 51+ (n=99, 34 %).

9. What we found…
 “list and/or discuss three to four specific
issues they would like their patients to tell
them that they may not always mention
or make clear during medical visits”

10.  296 units of information for coding:
◦ patients lack of completeness in providing general
details about their medical history (68 units)
◦ comprehension, including questions and/or concerns
(59 units)
◦ patients not disclosing their agenda for the medical
visit (43 units)
◦ Patient treatment compliance and adherence (44
units)
◦ access to care/financial issues (44 units)
◦ social issues that interfere with good medical
practice (26 units)

11. Physician Responses
 “Patients need to communicate about their chronic med
problems (not "I'm fine," or minimize their disease
severity).”
 “Patients should let me know if they don't understand
something I have recommended or explained.”
 “Patients should discuss any fears or concerns regarding
their symptoms or treatment plan being recommended.”
 “Communicate why they would be unable to follow plan of
care.”
 “Do they have transportation problems that interfere with
making appointments, picking up prescriptions, having lab
tests done?”

12. “what three specific issues
frustrate you most about
communicating with patients…”

13.  Eight total themes (255 units):
◦ Highest Freq- Frustration when communicating
about patient diagnosis, treatment, or therapy (62
units).
◦ Examples:
 Failure to take notes concerning therapy
instructions.
 Failure to report patient response to
therapy when requested by physician.
 Patient agreement to treatment plan when
they have no intention or difficulty
following through with the plan.

14. Discussion and Comments
Our needs assessment demonstrates
Physicians’:
 Frustration with lack of detail provided by
patients
 Frustration with patients’ reluctance to ask
questions when they do not understand
details of the medical interview
 Frustration with patients’ lack of
engagement in negotiation

15. What next…
 Building upon the approach of Cegala and
Bylund…
◦ We suggest creating interactive, visually
oriented, culturally sensitive workshops for
patients in our community.
 Implement in medical clinics while patients wait to
see physician.

16.  Topics will include, in addition to PACE:
◦ Agenda setting
◦ Comprehensive information seeking skills
 Medical history
 Verifying plan
◦ Disclose difficult/sensitive information
◦ Negotiation skills
◦ Communication style
 We are aiming to improve…
◦ patient adherence/compliance to medical advice.
◦ physician and patient satisfaction with medical
encounter.

17.  References are available upon request…
 We would be happy to answer any
questions.