Volume 11, Issue 1 (2023)                   Health Educ Health Promot 2023, 11(1): 95-109 | Back to browse issues page

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Bagheri M, Somi M, Dehghani G, Ghaffarifar S. Determinants of Patient-centered Communication Based on the Views of Physicians, Students, and Patients: A Qualitative Study. Health Educ Health Promot 2023; 11 (1) :95-109
URL: http://hehp.modares.ac.ir/article-5-65420-en.html
1- “Medical Education Research Center” and “Health Management and Safety Promotion Research Institute”, Tabriz University of Medical Sciences, Tabriz, Iran
2- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
3- “Research Center for Evidence-Based Medicine” and “Health Management and Safety Promotion Research Institute”, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract:   (202 Views)
Aims: Despite the benefits of Patient-Centered Communication (PCC), there are problems with its implementation. Problems are related to characteristics of patients or health systems, patterns of patient-physician interaction, or perspectives in defining PCC. This study aimed to examine determinants of PCC from the viewpoint of faculty members, medical residents and interns, and patients and recommends tips for improving Patient-Physician Relationships (PPR).
Participants & Methods: In this qualitative content analysis study in 2018 at Tabriz University of Medical Sciences, data were gathered using focus groups (62 participants), semi-structured interviews (31 participants), and participatory observations based on purposive until the saturation was achieved. The content was analyzed through a thematic, manifest summative analysis. Standards for methodological rigor were enhanced through different strategies.
Findings: The findings were classified into four categories matched with four core concepts of PCC: 1) Respect and dignity, 2) Information sharing, 3) Participation, and 4) Collaboration. Sub-categories included recognition of patients’ individuality, attention to patients’ needs, physicians’ personal characteristics, physicians’ communication competencies, patient-focused care, patients’ trust-supported attitude, physicians’ motivation, physicians’ working context, socio-cultural inductions, organizational policies, and physicians’ professional responsibility.
Conclusion: Patient-centered communication can be characterized by honoring patients’ individuality, paying attention to patients’ needs, focusing on physicians’ proper personal characteristics in continuing medical education, enhancing physicians’ communication competencies, institutionalization of patient-focused care, creating trust-supported attitudes among patients, increasing physicians’ motivation, regulating physicians’ working context, serious attention to social and cultural inductions, making supportive organizational policies, and evaluating physicians’ professional responsibilities.
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Article Type: Original Research | Subject: Health Education and Health Behavior
Received: 2022/11/13 | Accepted: 2023/03/2 | Published: 2023/03/17
* Corresponding Author Address: Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, Iran. Postal Cod: 51665-371 (ghaffarifars@tbzmed.ac.ir)

1. Shumway JM, Harden R. AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician. Med Teach. 2003;25(6):569-84. [Link] [DOI:10.1080/0142159032000151907]
2. Roter D. The enduring and evolving nature of the patient-physician relationship. Patient Educ Couns. 2000;39(1):5-15. [Link] [DOI:10.1016/S0738-3991(99)00086-5]
3. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43. [Link]
4. Swenson SL, Buell S, Zettler P, White M, Ruston DC, Lo B. Patient-centered communication. J Gen Intern Med. 2004;19(11):1069-79. [Link] [DOI:10.1111/j.1525-1497.2004.30384.x]
5. Kurtz SM. Doctor-patient communication: principles and practices. Can J Neurol Sci. 2002;29 Suppl 2:S23-9. [Link] [DOI:10.1017/S0317167100001906]
6. Shafati M, Zahedi MJ. Physician-patient relationship: ethnography of multiple patient visits at private offices of doctors. J Qual Res Health Sci. 2013;2(1):46-61. [Persian] [Link]
7. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008;20(12):600-7. [Link] [DOI:10.1111/j.1745-7599.2008.00360.x]
8. Siebinga VY, Driever EM, Stiggelbout AM, Brand PLP. Shared decision making, patient-centered communication and patient satisfaction - A cross-sectional analysis. Patient Educ Couns. 2022;105(7):2145-50. [Link] [DOI:10.1016/j.pec.2022.03.012]
9. Ghaffarifar S, Ghofranipour F, Ahmadi F, Khoshbaten M. Barriers to effective doctor-patient relationship based on PRECEDE PROCEED model. Glob J Health Sci. 2015;7(6):24-32. [Link] [DOI:10.5539/gjhs.v7n6p24]
10. Claramita M, Utarini A, Soebono H, Van Dalen J, Van der Vleuten C. Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality. Adv Health Sci Educ Theory Pract. 2011;16(1):69-80. [Link] [DOI:10.1007/s10459-010-9242-7]
11. Guo C, Yan J, Zhao Y. Analysis of barriers on doctor-patient communication in China. Chinese Med Ethic. 2018;(6):845-50. [Link]
12. Møller JE, Kjaer LB, Helledie E, Nielsen LF, Malling BV. Transfer of communication teaching skills from university to the clinical workplace - does it happen? A mixed methods study. BMC Med Educ. 2021;21(1):433. [Link] [DOI:10.1186/s12909-021-02834-1]
13. Beran T. Advances in medical education: the importance of communication and collaboration. Can Med Educ J. 2012;3(1):e1-3. [Link] [DOI:10.36834/cmej.36593]
14. Ghaffarifar S, Khoshbaten M, Ghofranipour F, Kompani Mohammadi J. Residents' communication skills evaluation by OSCE: What Changes should be done in educational system? Shiraz E-Med J. 2013;14(4):e93961. [Link] [DOI:10.17795/semj16658]
15. Laidlaw TS, Kaufman DM, Macleod H, Sargeant J, Langille DB. Patients' satisfaction with their family physicians' communication skills: a Nova Scotia survey. Acad Med. 2001;76(10 Suppl):S77-9. [Link] [DOI:10.1097/00001888-200110001-00026]
16. Guo A, Wang P. The current state of doctors' communication skills in Mainland China from the perspective of doctors' self-evaluation and patients' evaluation: A cross-sectional study. Patient Educ Couns. 2021;104(7):1674-80. [Link] [DOI:10.1016/j.pec.2020.12.013]
17. Tavakol M, Murphy R, Torabi S. A needs assessment for a communication skills curriculum in Iran. Teach Learn Med. 2005;17(1):36-41. [Link] [DOI:10.1207/s15328015tlm1701_7]
18. Ministry of Health and Medical Education. The educational program of the general medical doctorate course [Internet]. Tehran: Educational Vice Site; 2017 [cited 2022 Nov 11]. Available from: https://hcmep.behdasht.gov.ir/uploads/369/doc/pezeshkiomoomi_96.pdf. [Link]
19. Nouri M, Ghaffarifar S, Sadeghi Bazargani H, Ghaffari R. Patients' satisfaction with medical residents'communication skills at the largest teaching and treatment center in North West Iran in 2016. Shiraz E-Med J. 2017;18(4):e60032. [Link]
20. Kuper A, Lingard L, Levinson W. Critically appraising qualitative research. BMJ. 2008;337:a1035. [Link] [DOI:10.1136/bmj.a1035]
21. Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016;2:8-14. [Link] [DOI:10.1016/j.npls.2016.01.001]
22. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88. [Link] [DOI:10.1177/1049732305276687]
23. Shaheen M, Pradhan S. Sampling in qualitative research. In: Gupta M, Shaheen M, Reddy KP, editors. Qualitative techniques for workplace data analysis. IGI Global; 2019. p. 25-51. [Link] [DOI:10.4018/978-1-5225-5366-3.ch002]
24. Mahoney J, Goertz G. The possibility principle: Choosing negative cases in comparative research. Am Polit Sci Rev. 2004;98(4):653-69. [Link] [DOI:10.1017/S0003055404041401]
25. Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545-7. [Link] [DOI:10.1188/14.ONF.545-547]
26. Stalmeijer RE, Mcnaughton N, Van Mook WNIKKA. Using focus groups in medical education research: AMEE Guide No. 91. Med Teach. 2014;36(11):923-39. [Link] [DOI:10.3109/0142159X.2014.917165]
27. Institute for Patient- and Family-Centered Care. What is PFCC? [Internet]. Tehran: Institute for Patient- and Family-Centered Care; 2013 [cited 2022 Nov 11]. Available from: https://ipfcc.org/about/pfcc.html [Link]
28. Johnson JL, D. Adkins D, Chauvin S. A review of the quality indicators of rigor in qualitative research. Am J Pharm Educ. 2020;84(1):7120. [Link] [DOI:10.5688/ajpe7120]
29. Gómez G, Aillach E. Ways to improve the patient-physician relationship. Curr Opin Psychiatry. 2013;26(5):453-7. [Link] [DOI:10.1097/YCO.0b013e328363be50]
30. Pellegrini CA. Trust: the keystone of the patient-physician relationship. J Am Coll Surg. 2017;224(2):95-102. [Link] [DOI:10.1016/j.jamcollsurg.2016.10.032]
31. Rees C, Sheard C, McPherson A. Medical students' views and experiences of methods of teaching and learning communication skills. Patient Educ Couns. 2004;54(1):119-21. [Link] [DOI:10.1016/S0738-3991(03)00196-4]
32. Deniz S, Akbolat M, Çimen M, Ünal Ö. The mediating role of shared decision-making in the effect of the patient-physician relationship on compliance with treatment. J Patient Exp. 2021;8:23743735211018066. [Link] [DOI:10.1177/23743735211018066]
33. Donahue KE, Ashkin E, Pathman DE. Length of patient-physician relationship and patients' satisfaction and preventive service use in the rural south: a cross-sectional telephone study. BMC Fam Pract. 2005;6:40. [Link] [DOI:10.1186/1471-2296-6-40]
34. Kilbride MK, Joffe S. The new age of patient autonomy: implications for the patient-physician relationship. JAMA. 2018;320(19):1973-4. [Link] [DOI:10.1001/jama.2018.14382]
35. Paez KA, Allen JK, Beach MC, Carson KA, Cooper LA. Physician cultural competence and patient ratings of the patient-physician relationship. J Gen Intern Med. 2009;24(4):495-8. [Link] [DOI:10.1007/s11606-009-0919-7]
36. Siu JY-M. Communicating under medical patriarchy: gendered doctor-patient communication between female patients with overactive bladder and male urologists in Hong Kong. BMC Women Health 2015;15(1):44. [Link] [DOI:10.1186/s12905-015-0203-4]
37. Ishikawa H, Yamazaki Y. How applicable are western models of patient‐physician relationship in Asia? Changing patient‐physician relationship in contemporary Japan Int J Japanese Sociol. 2005;14(1):84-93. [Link] [DOI:10.1111/j.1475-6781.2005.00070.x]
38. Jeffrey D, Downie R. Empathy - can it be taught? J R Coll Physicians Edinb. 2016;46(2):107-12. [Link] [DOI:10.4997/jrcpe.2016.210]
39. Christie D, Glew S. A clinical review of communication training for haematologists and haemato-oncologists: a case of art versus science. Br J Haematol. 2017;178(1):11-9. [Link] [DOI:10.1111/bjh.14606]

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