An Exploratory Study on Effects of Patient-Doctor Communication Factors to Influence on Medical Outcome: Applying RIAS

Abstract

Patient-centered care is emerging that takes the patient-doctor relationship into consideration and emphasizes patient preferences and opinions in decision-making. Physician-patient communication are important in that it is the beginning of the patient-physician relationship to understand the patient's expectations through dialogue, and they can make productive decisions through mutual agreement. In Korea, research on determinant factors such as patient's demographic factors and patient-doctor relationship factors were active however studies on the factors of communication are insufficient. Moreover, it is rare to analyze dialogue and counseling from the perspective of two-way communication. As the consequences, there has been little research on the inclusion of both the patient factor and physician factor considering satisfaction study. Very little is known about the effect of two-way communication and its determinants.

For that reasons, present study tried to find out whether there was difference between patient's and physician's perceived satisfaction and investigated the factors that affected to the satisfaction gap. In addition, study analyzed the real time medical communication and examined the result illustrated the satisfaction gap. This study aims to investigate to measure satisfaction perception gap between patient and doctor and use RIAS method to analyze the doctor and patient consultation to figure out reality of medical communication in Korea.

103 outpatients who were older than 18 years old accepted to participate in the study. Two private Orthopedics hospitals permitted to study and 5 doctors agreed to participate in this study. Recording their medical consultation and post-treatment survey was conducted at two private hospitals in Seoul. Patient questionnaires measured the patient's general information, trust toward doctor, patient's self-efficacy in communication, beliefs and patient's self-reported satisfaction. Doctor's questionnaire was asked about physician's age, gender and doctor's perceived patient satisfaction. Recording was analyzed through RIAS to extract communication factors.

Wilcoxon signed ranks test was used to determine the difference between patient self-reported patient satisfaction and doctor's predicted patient satisfaction. Spearman's correlation was used to confirm the correlation between variables. Ordinal logistic regression analysis was performed to investigate the factors affecting the satisfaction gap and RIAS was used for examining present situation of medical communication in orthopedics.

Result showed significant difference in patient satisfaction and doctor satisfaction. As expected, both patient's and doctor's factors explained the gap: Patient's age, patient's self-efficacy in communication, patient's trust, doctor' s positive talk, and doctor's open-ended questions. Notably the number of visits were positive relationship with satisfaction gap.

In addition to identifying presence of satisfaction differences, this study analyzed whether patient-doctor communication patterns differed by gap size. Consequently, high satisfaction gap group had higher percentage in doctor's closed-ended questions, doctor's information giving, doctor's facilitative talk, and patient's information giving. Group which had low satisfaction gap had higher percentage in doctor's open-ended questions, doctor's directive talk, doctor's emotional talk, doctor and patient's positive talk, patient's questions and patient's facilitative talk. Patient's emotional talk had similar percentage in two groups.

Based on the results, present study emphasized suggestions. (1) In order to improve patient satisfaction in the future, it is desirable to set the patient-doctor relationship as the unit of analysis relationship and make efforts to include it into major variables

(2) More attempts are needed to find out and measure the communication variables of the healthcare provider, including the variables identified in this study

(3) Theoretical basis is needed to explain this outcome

(4) It is necessary to identify the characteristics of the patients especially those who recognize the gap significantly and find the improvement for narrowing gap.

Even though present study has various limitations, it is a new attempt to analyze determinants of satisfaction gap. Also, it is necessary to use variety of international research approaches including RIAS. This study expects to trigger for patient centered medical care related researches.