Variance components of ratings of physician-patient communication: A generalizability theory analysis

Abstract

Background The ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data. Objective To examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings. Methods Variance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions “shared decision making”, “effective and open communication” and “satisfaction” were considered. Results Physician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians’ communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error). Conclusion The ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.

Clinical Decision Support with or without Shared Decision Making to Improve Preventive Cancer Care: A Cluster-Randomized Trial

“…The impact of simpler v. more complex SDMTs, and the impact of various types of SDM training on SDMT use and patients' decision making, is an ongoing area of active research. [38][39][40][41] As reported in other studies, PCPs do not have enough time to address preventive care services, 68 and as reported by Solberg et al, improving prevention care in busy primary care settings is difficult. 53,54,[64][65][66]69 Limitations Several factors limit the interpretation of these data.…”

“…SDMTs have received much attention over the past decade. 38–42,57 Many studies of the use of SDMT in primary care settings have reported improved knowledge and decisional processes, but effects on clinical outcomes have been mixed. 42,58,59 Two studies on SDMTs for colorectal cancer screening showed no increase in screening, whereas 1 study reported a small effect.…”

“…[18][19][20][21][22][23][24] Current research suggests that shared decision making (SDM) using decision aids may engage patients in productive discussion of treatment options with PCPs, but the impact of decision aids used in SDM on cancer preventive care is incompletely understood. 26,[38][39][40][41][42] Essentially, SDM involves a discussion between the patient and their provider that presents risks and benefits of alternative treatments/ tests or none in a balanced manner, elucidates the patient's preferences and goals, and engages the patient in decision making. Patient decision aids are tools to facilitate patients and providers in SDM.…”

Determining the Development Strategy and Suited Adoption Paths for the Core Competence of Shared Decision-Making Tasks through the SAA-NRM Approach

“…The antecedent factors influencing communication and developed communication climates may directly affect how treatment options are mutually selected in the SDM process [ 85 ]. Röttele et al observed that using generalizability theory to rate doctor-patient communication minimally indicates a doctor’s communication skills [ 86 ]. There are significant differences between doctors and patients regarding perceived SDM, effective and open communication, and satisfaction with communication.…”

“…Doctors tend to overrate the extent to which they apply SDM. Therefore, doctors should engage their patients more in SDM, even if they believe they have done so adequately [ 86 ].…”