Tabor E Flickinger1, Somnath Saha2, Debra Roter3, P Todd Korthuis4, Victoria Sharp5, Jonathan Cohn6, Richard D Moore3, Karen S Ingersoll7, Mary Catherine Beach3. 1. Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA. Electronic address: TES3J@hscmail.mcc.virginia.edu. 2. Department of Medicine, Portland VA Medical Center, Portland, OR, USA; Department of Medicine, Oregon Health and Science University, Portland, OR, USA. 3. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. 4. Department of Medicine, Oregon Health and Science University, Portland, OR, USA. 5. Department of Medicine, St. Luke's Roosevelt, New York, NY, USA. 6. Department of Medicine, Wayne State University, Detroit, MI, USA. 7. Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
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.
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-infectedpatients 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.
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