Individual and organizational level moderators of physician communication skills training.

摘要

The current study was part of a much larger investigation known as the Bayer Institute for Health Care Communication and University of California Health Systems Collaborative Research Outcome Study. The parent study examined the effectiveness of two complementary interventions targeted at enhancing physician and patient communication on issues related to patients' satisfaction with the medical encounter. The present study assessed the moderating role of physician and organizational characteristics, including physician stress, burnout, and attitudes, on treatment benefits following a series of physician communication skills interventions.;Two-hundred physicians and 1455 patients were recruited from a university-based medical center and a staff model HMO and completed surveys measuring satisfaction, stress, and attitudes towards health care. Half of the physicians were selected to participate in interactive workshops designed to enhance clinical communication skills. These physicians received three communication skills training courses over a four-month period; the other half received no training. Five randomly selected patient visits with each physician were audio taped during the first, fifth, and tenth month of the study. Half of the patients selected for the study were randomly chosen to receive a short patient advocacy intervention immediately preceding their taped visit. Verbal content analysis of audiotapes was conducted on 200 interviews. Two patient visits were randomly selected within fifty randomly selected physicians at both the baseline and five-month followup occasions.;Results indicate that, contrary to prediction, physician readiness to change and perceived behavioral control were associated with significantly less patient and physician talk and lower judge ratings of communication skills. Further, positive physician attitudes were found to negatively moderate training related gains in verbal interviewing behaviors.;Contrary to prediction, negative (a) attitudes toward patients and (b) physician burnout (depersonalization and emotional exhaustion, respectively) were generally associated with more positive physician interviewing behaviors. Physicians who perceived more occupational stressors and experienced more emotional exhaustion also demonstrated larger training benefits in patient self report, physician self report, and specific verbal interviewing behaviors. These findings are consistent with the Trait Theory of Burnout and research on the cognitive and motivational effects of negative affect. Implications of these results and future research directions are discussed.