A Method to Quantify and Compare Clinicians' Assessments of Patient Understanding During Counseling of Standardized Patients

Overview

Journal Patient Educ Couns

Publisher Elsevier

Specialties Health Services
Nursing

Date 2009 Apr 22

PMID 19380210

Citations 13

Authors

Michael H Farrell

Pramita Kuruvilla

Kerry L Eskra

Stephanie A Christopher

Rebecca S Brienza

Affiliations

Soon will be listed here.

Abstract

Objective: To introduce a method for quantifying clinicians' use of assessment of understanding (AU) questions, and to examine medicine residents' AU usage during counseling of standardized patients about prostate or breast cancer screening.

Methods: Explicit-criteria abstraction was done on 86 transcripts, using a data dictionary for 4 AU types. We also developed a procedure for estimating the "load" of informational content for which the clinician has not yet assessed understanding.

Results: Duplicate abstraction revealed reliability kappa=0.96. Definite criteria for at least one AU were found in 68/86 transcripts (79%). Of these, 2 transcripts contained a request for a teach-back ("what is your understanding of this?"), 2 contained an open-ended AU, 46 (54%) contained only a close-ended AU, and 18 (21%) only contained an "OK?" question. The load calculation identified long stretches of conversation without an AU.

Conclusion: Many residents' transcripts lacked AUs, and included AUs were often ineffectively phrased or inefficiently timed. Many patients may not understand clinicians, and many clinicians may be unaware of patients' confusion.

Practice Implications: Effective AU usage is important enough to be encouraged by training programs and targeted by population-scale quality improvement programs. This quantitative method should be useful in population-scale measurement of AU usage.

Citing Articles

Association of Limited Health Literacy With Clinical and Patient-Reported Outcomes in Individuals With Systemic Lupus Erythematosus.

Maheswaranathan M, Boan A, Ramakrishnan V, Johnson H, Rose J, Dismuke-Greer C ACR Open Rheumatol. 2024; 6(11):780-789.

PMID: 39155276 PMC: 11557983. DOI: 10.1002/acr2.11719.

Assessment of parent understanding in conferences for critically ill neonates.

Barks M, Schindler E, Ubel P, Jiao M, Pollak K, Huffstetler H Patient Educ Couns. 2021; 105(3):599-605.

PMID: 34130892 PMC: 8664893. DOI: 10.1016/j.pec.2021.06.013.

Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach.

Stuij S, Drossaert C, Labrie N, Hulsman R, Kersten M, van Dulmen S BMC Med Educ. 2020; 20(1):135.

PMID: 32357886 PMC: 7195777. DOI: 10.1186/s12909-020-1985-0.

Benefit of Report Card Feedback After Point-of-Care Assessment of Communication Quality Indicators.

Farrell M, Sprenger C, Sullivan S, Trisler B, Kram J, Ruppel E J Patient Cent Res Rev. 2019; 4(1):7-17.

PMID: 31413965 PMC: 6664361. DOI: 10.17294/2330-0698.1283.

Health Literacy and Clear Bedside Communication: A Curricular Intervention for Internal Medicine Physicians and Medicine Nurses.

Allenbaugh J, Spagnoletti C, Rack L, Rubio D, Corbelli J MedEdPORTAL. 2019; 15:10795.

PMID: 30800995 PMC: 6376895. DOI: 10.15766/mep_2374-8265.10795.

References

Qaseem A, Snow V, Sherif K, Aronson M, Weiss K, Owens D . Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007; 146(7):511-5. DOI: 10.7326/0003-4819-146-7-200704030-00007. View

White J, Carlston D . Consequences of schemata for attention, impressions, and recall in complex social interactions. J Pers Soc Psychol. 1983; 45(3):538-49. DOI: 10.1037//0022-3514.45.3.538. View

Farrell M, Murphy M, Schneider C . How underlying patient beliefs can affect physician-patient communication about prostate-specific antigen testing. Eff Clin Pract. 2002; 5(3):120-9. View

Lang F, Everett K, McGowen R, Bennard B . Faculty development in communication skills instruction: insights from a longitudinal program with "real-time feedback". Acad Med. 2000; 75(12):1222-8. DOI: 10.1097/00001888-200012000-00022. View

Bylund C, Brown R, Lubrano di Ciccone B, Levin T, Gueguen J, Hill C . Training faculty to facilitate communication skills training: development and evaluation of a workshop. Patient Educ Couns. 2008; 70(3):430-6. DOI: 10.1016/j.pec.2007.11.024. View

Smith R, Cokkinides V, Eyre H . Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin. 2007; 57(2):90-104. DOI: 10.3322/canjclin.57.2.90. View

Allison J, Wall T, Spettell C, Calhoun J, Fargason Jr C, Kobylinski R . The art and science of chart review. Jt Comm J Qual Improv. 2000; 26(3):115-36. DOI: 10.1016/s1070-3241(00)26009-4. View

Lim L, Sherin K . Screening for prostate cancer in U.S. men ACPM position statement on preventive practice. Am J Prev Med. 2008; 34(2):164-70. DOI: 10.1016/j.amepre.2007.10.003. View

Farrell M, La Pean A, Ladouceur L . Content of communication by pediatric residents after newborn genetic screening. Pediatrics. 2005; 116(6):1492-8. DOI: 10.1542/peds.2004-2611. View

10.

Miller G . The magical number seven, plus or minus two: some limits on our capacity for processing information. 1956. Psychol Rev. 1994; 101(2):343-52. DOI: 10.1037/0033-295x.101.2.343. View

11.

Lerman C, Daly M, WALSH W, Resch N, Seay J, Barsevick A . Communication between patients with breast cancer and health care providers. Determinants and implications. Cancer. 1993; 72(9):2612-20. DOI: 10.1002/1097-0142(19931101)72:9<2612::aid-cncr2820720916>3.0.co;2-f. View

12.

Kindig D, Stoddart G . What is population health?. Am J Public Health. 2003; 93(3):380-3. PMC: 1447747. DOI: 10.2105/ajph.93.3.380. View

13.

Donabedian A . The quality of care. How can it be assessed?. JAMA. 1988; 260(12):1743-8. DOI: 10.1001/jama.260.12.1743. View

14.

Hulsman R, Ros W, Winnubst J, Bensing J . Teaching clinically experienced physicians communication skills. A review of evaluation studies. Med Educ. 1999; 33(9):655-68. DOI: 10.1046/j.1365-2923.1999.00519.x. View

15.

Jencks S, Huff E, Cuerdon T . Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001. JAMA. 2003; 289(3):305-12. DOI: 10.1001/jama.289.3.305. View

16.

Farrell M, Kuruvilla P . Assessment of parental understanding by pediatric residents during counseling after newborn genetic screening. Arch Pediatr Adolesc Med. 2008; 162(3):199-204. DOI: 10.1001/archpediatrics.2007.55. View

17.

Cegala D, Lenzmeier Broz S . Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ. 2002; 36(11):1004-16. DOI: 10.1046/j.1365-2923.2002.01331.x. View

18.

Ransohoff D, Harris R . Lessons from the mammography screening controversy: can we improve the debate?. Ann Intern Med. 1997; 127(11):1029-34. DOI: 10.7326/0003-4819-127-11-199712010-00016. View

19.

Stillman P, Sabers D, Redfield D . The use of paraprofessionals to teach interviewing skills. Pediatrics. 1976; 57(5):769-74. View

20.

. Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002; 137(11):915-6. DOI: 10.7326/0003-4819-137-11-200212030-00013. View