The impact of patient-centered communication on patients' decision making and evaluations of physicians: a randomized study using video vignettes.

摘要

OBJECTIVE: To assess the impact of patient-centered communication (PCC) behaviors on patients' evaluations of physicians and acceptance of clinical recommendations. METHODS: We randomized 248 patients to view video-recorded, standardized vignettes, depicting a cardiologist using a high vs. low degree of PCC while recommending bypass surgery to a patient with angina and 3-vessel coronary artery disease. We compared patients' ratings of the physician and their decision making in response to the physician's recommendation, for high vs. low PCC vignettes. RESULTS: Patients viewing high PCC vignettes rated the video physician more favorably overall (3.01 vs. 2.12, p<0.001) and as more competent (3.22 vs. 2.66, p<0.001) and trustworthy (2.93 vs. 2.28, p<0.001) than those viewing the low PCC version (0-4 range for all scales). Patients viewing the high PCC version more frequently said they would undergo bypass surgery (96% vs. 74%, p<0.001) if they were the patient in the video. CONCLUSION: Patients expressed greater confidence in physicians who used more PCC behaviors, and greater willingness to accept an evidence-based recommendation. PRACTICE IMPLICATIONS: PCC may make physicians more effective in the delivery of evidence-based care.