Bård Fossli Jensen

Effectiveness of a short course in clinical communication skills for hospital doctors: results of a crossover randomized controlled trial (ISRCTN22153332).

OBJECTIVE To test the hypothesis that a 20-h communication skills course based on the Four Habits model can improve doctor-patient communication among hospital employed doctors across specialties. METHODS Crossover randomized controlled trial in a 500-bed hospital with interventions at different time points in the two arms. Assessments were video-based and blinded. Intervention consisted of 20 h of communication training, containing alternating plenary with theory/debriefs and practical group sessions with role-plays tailored to each doctor. RESULTS Of 103 doctors asked to participate, 72 were included, 62 received the intervention, 51 were included in the main analysis, and another six were included in the intention-to-treat analysis. We found an increase in the Four Habits Coding Scheme of 7.5 points (p = 0.01, 95% confidence interval 1.6-13.3), fairly evenly distributed on subgroups. Baseline score (SD) was 60.3 (9.9). Global patient satisfaction did not change, neither did average encounter duration. CONCLUSION Utilizing an outpatient-clinic training model developed in the US, we demonstrated that a 20-h course could be generalized across medical and national cultures, indicating improvement of communication skills among hospital doctors. PRACTICE IMPLICATIONS The Four Habits model is suitable for communication-training courses in hospital settings. Doctors across specialties can attend the same course.

Interrater reliability for the Four Habits Coding Scheme as part of a randomized controlled trial

OBJECTIVE To describe the process for developing interrater reliability (IRR) for the Four Habits Coding Scheme (4HCS) for a heterogeneous material as part of a randomized controlled trial. METHODS Videotapes from 497 hospital encounters involving 71 doctors from most clinical specialties were collected. Four experienced psychology students were trained as raters. We calculated Pearsons r and the intraclass correlation (ICC) on the total score across consecutive samples of twenty videos, and Pearsons r on single videos across items in the initial coding phase. RESULTS After 18h of training and one rating session, the total score Pearsons r and ICC exceeded .70 for all pairs of raters. Across items within single videos, the Pearsons r was never below 0.60 after the first 50 videos. At item and habit level Pearsons r remained unsatisfactory for some rater pairs mostly due to low variance on some items. CONCLUSION Based on the evaluation of the effect of communication skills training via a total score, IRR was satisfactory for the 4HCS as applied to heterogeneous material. However, good reliability at item level was difficult to achieve. PRACTICE IMPLICATIONS 4HCS may be used as an outcome measure for clinical communication skills in randomized controlled trials.

Post-recruitment confirmation of informed consent by SMS

Background To allow patients to reflect about a decision to participate in a clinical trial, guidelines suggest a 24-h delay from when they are informed about the trial to when they give consent. In certain clinical settings, this is likely to hamper recruitment. Method After oral and written information about the trial has been given in person, the patient signs the declaration of consent knowing that they will be asked again after 24 h whether they confirm or regret the decision. This procedure can be done by SMS. The investigators must document the response. The procedure was tried in a study in which the doctors were randomly assigned to receive a clinical communication skills course, and encounters with patients were videotaped before and after the course. Results 553 patients were approached, 530 (95.8%) gave initial consent, eight of these later regretted their consent. Discussion The low level of regrets suggests this is an acceptable procedure for patients. Trial registration The RCT was registered before initiation – registration # ISRCTN22153332.

Specialist physicians' sensitivity to patient affect and satisfaction.

Background:Studies indicate that physicians do not respond adequately to patients’ emotional issues. Physician sensitivity to patient affect has not been much explored. Objectives:To describe specialist physicians’ sensitivity to patient affect and satisfaction. Research Design:Cross-sectional study of physicians’ and patients’ postvisit questionnaire statements about patient affective states and satisfaction. Subjects:A representative sample of 71 physicians covering nonpsychiatric clinical specialties in a general teaching hospital were observed during 497 encounters with patients (outpatient, inpatient on rounds, emergency room, maximum 8 encounters per physician). Measures:Standardized correlations between physician and patient statements. Results:Physician statements about patient negative affect were moderately correlated with patient self-report of negative affect [r=0.379 (0.301; 0.452)]. Physician statements about patient positive affect and patient satisfaction were weakly correlated with patient self-report of positive affect [r=0.238 (0.153; 0.319)] and satisfaction [r=0.219 (0.134; 0.301)]. Internists [r=0.300 (0.161; 0.428)] were significantly less sensitive to negative affect than surgeons [r=0.500 (0.360; 0.618), P=0.038] and neurologists [r=0.621 (0.432; 0.758), P=0.007]. Physicians previously known by the patient were significantly more sensitive to negative affect than those who were not known [r=0.509 (0.391; 0.611) vs. 0.293 (0.189; 0.390), P=0.006]. We could not find differences in affective sensitivity between male and female physicians. Conclusions:Specialist physicians have moderate ability to identify patient negative affect and poor ability to identify patient positive affect and patient satisfaction.