TMU
Owner
Tarbiat Modares University (TMU) is the owner of HEHP.
0.8
Cite Score
Volume 11, Issue 1 (2023)
Health Educ Health Promot 2023, 11(1): 95-109 |
Back to browse issues page
History
Received: 2022/11/13 | Accepted: 2023/03/2 | Published: 2023/03/17
Received: 2022/11/13 | Accepted: 2023/03/2 | Published: 2023/03/17
How to cite this article
Bagheri M, Somi M, Dehghani G, Ghaffarifar S. Determinants of Patient-centered Communication Based on the Views of Physicians, Students, and Patients: A Qualitative Study. Health Educ Health Promot 2023; 11 (1) :95-109
URL: http://hehp.modares.ac.ir/article-4-65420-en.html
URL: http://hehp.modares.ac.ir/article-4-65420-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rights and permissions
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
1- “Medical Education Research Center†and “Health Management and Safety Promotion Research Instituteâ€, Tabriz University of Medical Sciences, Tabriz, Iran
2- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3- “Research Center for Evidence-Based Medicine†and “Health Management and Safety Promotion Research Instituteâ€, Tabriz University of Medical Sciences, Tabriz, Iran
2- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3- “Research Center for Evidence-Based Medicine†and “Health Management and Safety Promotion Research Instituteâ€, Tabriz University of Medical Sciences, Tabriz, Iran
| Abstract (HTML) (2008 Views)
Full-Text: (763 Views)
Introduction
For many years, establishing an effective Physician-Patient Relationship (PPR) has been a vital component of successful health care [1], and integration of the patient’s perceptions with a biomedical perspective has been considered suitable for the 21st century [2]. In this regard, the doctor-patient communication model has reformed from paternalism and biomedical style to individualism and Patient-Centered Communication (PCC) [3].
In PCC, medical doctors discover and unite patients’ wants, feelings, illness beliefs, concerns, preferences, and expectations [4]. Today, it is accepted that PCC is the cornerstone of clinical and medical education at all levels and areas of medical sciences [5], and many favorable health outcomes have been attributed to it [6].
Despite the informed benefits of PCC, problems in the implementation of the PCC have been reported, and it has been employed in about 45%–62% of visits [7]. The variation in reported rates of PCC implementation can be related to different attributes of patients and the health system, diverse patterns of interaction, and various perspectives in defining PCC [7]. Although PCC has been one of the preferred models for patient care [8], evidence for the influence of PCC on medical consequences has been diverse, and some interventions to develop PCC amongst medical doctors have failed to increase medical outcomes and patient satisfaction [4]. PCC has not been common practice all the time [3], and different barriers to PCC have been reported [9-11]. Similarly, despite the global emphasis on improving physicians’ clinical communication skills, opportunities have not been fully provided for communication skills training [12]. Communication skills training has not achieved its true official position at most universities of medical sciences [13]. In some cases, efforts have failed to revise the curricula and implement communication skills programs [14]. That is why maximum optimal therapeutic results and health outcomes have not been achieved, and 70% of patients' complaints are still related to the poor communication skills of physicians [15].
Several studies have been done in different settings to assess PCC and identify its barriers. In some institutions, quantitative and qualitative research approaches are combined [12]. In Indonesia, a conflict between ideal and reality has been reported regarding PPR, and additional studies have been recommended to study ways to modify the prevailing communication style into a preferred method [10]. In China, physicians’ communication skills have been surveyed, and further examination of the effectiveness of physicians' communication skills based on examining the perspectives of both patients and physicians and receiving feedback from them has been recommended [16].
The state of PPR has been analyzed in many Iranian studies. The findings of a qualitative inquiry study revealed that the physician-patient communication style in Iran is perceived as considerably physician-oriented. Integrating communication skills into medical curricula in Iran with due consideration to religious issues and ethnical and cultural concerns was recommended as a real educational need for the Iranian society [17]. Since then, given the encouraging effects of PCC and the mentioned recommendations, in many medical schools in Iran [18], medical students have been taught to apply and master communication skills in practice.
Communication barriers have been investigated in a study at the capital of Iran [9]. In Tabriz University of Medical Sciences (TUOMS), where most of the patients in the northwest of Iran receive the required medical services in teaching hospitals affiliated to it, based on the results of the assessment of communication skills of 198 medical residents by 488 patients in 2016 in the largest teaching and academic center in the northwest of Iran, the patients’ satisfaction with participating residents’ communication skills was not acceptable (the mean of the patients’ normalized total satisfaction score was 48.8±18 out of 100) [19]. However, the reasons for patients' dissatisfaction with physicians' communication skills in our institution had not been previously investigated.
It is necessary to pay attention to several important points: 1) The concerns around effective patient-physician communication and providing training related to PCC vary across societies depending on the educational context, norms, beliefs, cultures, and governing social relations; 2) A deeper understanding about the strengths, weaknesses, opportunities, and challenges in every educational context can be provided by conducting a qualitative study; 3) As qualitative research has a contextual nature, the possible transferability of its results to other sociocultural situations should be carefully and cautiously considered [20]; and 4) Up to the time of the present study, no qualitative study has been conducted to explore the perceptions of faculty members, medical students and patients about PCC at TUOMS. Hence, we intended to analyze the status of patient-physician relationships at TUOMS and explore the tips for improving PPR and PCC from the viewpoint of faculty members, students (medical residents and interns), and patients through a qualitative content analysis study.
The results of the present study can be utilized in revising curricula, setting educational priorities, and planning for proper educational interventions. Another important point about this study is that in the current study, alongside the perspectives of patients and physicians, the perspectives of medical interns and residents have also been explored. Based on this part of the study findings, some research hypotheses can be proposed to compare the physicians’ communication skills during the education with a post-graduation period.
Participants and Methods
For many years, establishing an effective Physician-Patient Relationship (PPR) has been a vital component of successful health care [1], and integration of the patient’s perceptions with a biomedical perspective has been considered suitable for the 21st century [2]. In this regard, the doctor-patient communication model has reformed from paternalism and biomedical style to individualism and Patient-Centered Communication (PCC) [3].
In PCC, medical doctors discover and unite patients’ wants, feelings, illness beliefs, concerns, preferences, and expectations [4]. Today, it is accepted that PCC is the cornerstone of clinical and medical education at all levels and areas of medical sciences [5], and many favorable health outcomes have been attributed to it [6].
Despite the informed benefits of PCC, problems in the implementation of the PCC have been reported, and it has been employed in about 45%–62% of visits [7]. The variation in reported rates of PCC implementation can be related to different attributes of patients and the health system, diverse patterns of interaction, and various perspectives in defining PCC [7]. Although PCC has been one of the preferred models for patient care [8], evidence for the influence of PCC on medical consequences has been diverse, and some interventions to develop PCC amongst medical doctors have failed to increase medical outcomes and patient satisfaction [4]. PCC has not been common practice all the time [3], and different barriers to PCC have been reported [9-11]. Similarly, despite the global emphasis on improving physicians’ clinical communication skills, opportunities have not been fully provided for communication skills training [12]. Communication skills training has not achieved its true official position at most universities of medical sciences [13]. In some cases, efforts have failed to revise the curricula and implement communication skills programs [14]. That is why maximum optimal therapeutic results and health outcomes have not been achieved, and 70% of patients' complaints are still related to the poor communication skills of physicians [15].
Several studies have been done in different settings to assess PCC and identify its barriers. In some institutions, quantitative and qualitative research approaches are combined [12]. In Indonesia, a conflict between ideal and reality has been reported regarding PPR, and additional studies have been recommended to study ways to modify the prevailing communication style into a preferred method [10]. In China, physicians’ communication skills have been surveyed, and further examination of the effectiveness of physicians' communication skills based on examining the perspectives of both patients and physicians and receiving feedback from them has been recommended [16].
The state of PPR has been analyzed in many Iranian studies. The findings of a qualitative inquiry study revealed that the physician-patient communication style in Iran is perceived as considerably physician-oriented. Integrating communication skills into medical curricula in Iran with due consideration to religious issues and ethnical and cultural concerns was recommended as a real educational need for the Iranian society [17]. Since then, given the encouraging effects of PCC and the mentioned recommendations, in many medical schools in Iran [18], medical students have been taught to apply and master communication skills in practice.
Communication barriers have been investigated in a study at the capital of Iran [9]. In Tabriz University of Medical Sciences (TUOMS), where most of the patients in the northwest of Iran receive the required medical services in teaching hospitals affiliated to it, based on the results of the assessment of communication skills of 198 medical residents by 488 patients in 2016 in the largest teaching and academic center in the northwest of Iran, the patients’ satisfaction with participating residents’ communication skills was not acceptable (the mean of the patients’ normalized total satisfaction score was 48.8±18 out of 100) [19]. However, the reasons for patients' dissatisfaction with physicians' communication skills in our institution had not been previously investigated.
It is necessary to pay attention to several important points: 1) The concerns around effective patient-physician communication and providing training related to PCC vary across societies depending on the educational context, norms, beliefs, cultures, and governing social relations; 2) A deeper understanding about the strengths, weaknesses, opportunities, and challenges in every educational context can be provided by conducting a qualitative study; 3) As qualitative research has a contextual nature, the possible transferability of its results to other sociocultural situations should be carefully and cautiously considered [20]; and 4) Up to the time of the present study, no qualitative study has been conducted to explore the perceptions of faculty members, medical students and patients about PCC at TUOMS. Hence, we intended to analyze the status of patient-physician relationships at TUOMS and explore the tips for improving PPR and PCC from the viewpoint of faculty members, students (medical residents and interns), and patients through a qualitative content analysis study.
The results of the present study can be utilized in revising curricula, setting educational priorities, and planning for proper educational interventions. Another important point about this study is that in the current study, alongside the perspectives of patients and physicians, the perspectives of medical interns and residents have also been explored. Based on this part of the study findings, some research hypotheses can be proposed to compare the physicians’ communication skills during the education with a post-graduation period.
Participants and Methods