Associations between Procedural Fairness in Physician Communication and Lifestyle Behaviors in Patients with Obesity

ObjectiveTo investigate how patient perception of procedural fairness in primary care physician communication among diverse patients with obesity is associated with the patient’s willingness to follow recommendations, self-efficacy beliefs, and lifestyle behaviors. Methods We conducted a cross-sectional, secondary data analysis of 484 primary care patients (43.6% Black, 40.7% Hispanic/Latino, 56.4% Female, Mage=50 years) with a BMI ≥ 25 kg/m2 enrolled in a weight management study in two New York City healthcare systems. To evaluate direct and indirect associations between PF and outcome variables, we used ordinary least squares path analyses with bootstrapping procedures controlling for age and gender. Results Patients who perceived their primary care physician as fairer reported higher willingness to follow recommendations and higher dietary self-efficacy, which were associated with healthier dietary behaviors (willingness: indirect=.08, SE=.03; 95% CI[.04 to .14]; dietary self-efficacy: indirect=.03, SE=.01; 95% CI[.01 to .05]). Higher perceived PF was also associated with higher exercise self-efficacy, which was associated with increased physical activity (indirect=.03, SE=.01; 95% CI[.01 to .05]).ConclusionPF was associated with lifestyle behaviors via willingness to follow recommendations and self-efficacy beliefs. PF holds promise as a novel communication target to enhance patient-physician communication related to weight management in primary care.

An Impact of Patient-physician Communication Curriculum on Students of Korean Medical School

Objectives: This study aims to evaluate the impact of patient-physician communication curriculum on students of Korean medical school in terms of cognitive, affective, and psychomotor level of communication skills. Methods: A communication curriculum was developed considering COVID-19 pandemic situation. Lectures, peer role-play, open interview with standardized patient (SP), discussion and feedback were conducted by online, and face-to-face 1:1 SP-interview was performed. Scores of written test, peer role-play of medical communication, SP-interview, self-evaluation on one’s interview with real patients in clinical clerkship, and questionnaire of importance were collected and analyzed. Results: Converted to 100 point scale, the mean score of written test (cognitive level) was 91.2 while that of importance questionnaire (affective level) was 77.5. The mean scores of psychomotor level were 72.5, 77.5, and 62.5 for peer role-play, SP-interview, and real patient interview in clerkship, respectively. Conclusions: Students’ performance is lower in higher level of competence. Curriculums should provide more opportunities of practices to students, and include evaluation focusing on performance skills.

Review of interruptions in a pediatric subspecialty outpatient clinic

Introduction The objective of this study was to describe interruptions in the pediatric ambulatory setting and to assess their impact on perceived physician communication, patient satisfaction and recall of provided physician instructions. Methods An observational study was performed at the Children’s Hospital of Philadelphia, Pediatric Gastroenterology clinic. Participation consisted of video recording the clinic visit and the caregiver completed post-visit surveys on communication and satisfaction. Video recordings were coded for interruptions, which were divided into 3 main categories: Visit Associated, Pediatric Associated, and Unanticipated. An interruption rate was calculated and correlated with the following outcome variables to assess the impact of interruptions: caregiver satisfaction, caregiver perception on the quality of physician communication, and caregiver instruction recall. Results There were 675 interruptions noted in the 81 clinic visits, with an average of 7.96 (σ = 7.68) interruptions per visit. Six visits had no interruptions. The Patient was the most frequent interrupter. Significantly higher interruption rates occurred in clinic visits with younger patients (<7 years old) with most of the interruptions being Pediatric Associated interruptions. There was minimal correlation between the clinic visit interruption rate and caregiver satisfaction with the communication, caregiver perception of quality of communication, or caregiver instruction recall rate. Conclusion The effect of interruptions on the pediatric visit remains unclear. Interruptions may be part of the communication process to ensure alignment of the patient’s agenda. Additional studies are needed to help determine the impact of interruptions and guide medical education on patient communication.