Search

This JAMA Insights discusses the importance of effective patient-clinician communication and provides strategies for clinicians that can enhance accurate information gathering and exchange, encourage patient engagement, enhance comprehension, and ensure retention of the information. [ABSTRACT FROM AUTHOR]

Objective: To identify predictors of participation of patients with advanced cancer in clinical encounters with oncologists and to assess the impact of patient and caregiver participation on perceptions of physician support.Methods: This is a secondary data analysis from the Values and Options in Cancer Care study, a cluster randomized clinical trial of a patient-centered communication intervention. Patients and caregivers completed pre-visit and post-visit health and communication measures. Audio recorded patient-caregiver (when present)-physician encounters were coded for active patient/caregiver participation behaviors (eg, question asking, expressing concern) and for physicians' facilitative communication (eg, partnership-building, support). Mixed linear regression models were used to identify patient, physician, and situational factors predicting patient and patient plus caregiver communication behaviors and post-visit outcomes.Results: Physician partnership building predicted greater expressions of concern and more assertive responses from patients and patient-caregiver pairs. Patients' perceptions of greater connectedness with their physician predicted fewer patient expressions of concern. Patient perceptions of physician respect for their autonomy were lower among patients accompanied by caregivers. Caregiver perceptions of physician respect for patient autonomy decreased with increasing patient age and varied by site.Conclusions: In advanced cancer care, patient and caregiver communication is affected by ecological factors within their consultations. Physicians can support greater patient participation in clinical encounters through facilitative communication such as partnership-building and supportive talk. The presence of a caregiver complicates this environment, but partnership building techniques may help promote patient and caregiver participation during these visits. [ABSTRACT FROM AUTHOR]

The article discusses the relationship of physician and patient by understanding its concordance. It stresses the concordance by race and sex in physician-patient relationships that has been associated with patient ratings of better care. However, it notes that a mechanism which concordance leads to better outcomes remains unknown. It emphasizes that the latter relationship can be strengthened when patients has similar beliefs, values, and communication to their physicians.