Improved Communication Between Clinician and Patient
Conditions
Brief summary
The purpose of this study is to determine the effect of a clinician communication coaching intervention versus control on an objective measure of the quality of communication (primary outcome) and patients' perceptions of the quality of patient-centered care (secondary outcome), both overall and within Black and White patients.
Detailed description
The investigators propose a two-arm cluster randomized controlled design, in which the unit of randomization is the clinician. Up to fifty cardiology clinicians will be randomly assigned to either the coaching intervention or to a control condition. The investigators will recruit up to 50 clinicians to ensure that we have at least 40 clinicians with complete pre- and post-intervention measures. Although the unit of randomization is the clinician, the unit of evaluation is the patient: 10 patients per clinician who get cardiology care from the enrolled clinicians will consent to audio-recording of their encounters and to completing the surveys. Clinicians randomized to the intervention will obtain verbal consent from additional patients to audio-record the encounter for coaching. The intervention will be delivered in the clinic or via video-conference (Skype or Facetime), providing individual coaching and professional feedback on the communication behaviors encounters. The investigators will also measure Press Ganey scores by clinician pre- and post-intervention.
Interventions
BEHAVIORALCommunication Intervention
. The intervention will contain elements of Motivational Interviewing coaching but also will teach providers how to address patient emotion and increase the efficiency of their visits. Clinicians randomized to the intervention will receive a tailored communication coaching intervention that includes didactic elements, audio recording encounters and providing feedback, and role-playing.
Sponsors
Duke University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
Interventional: To determine the effect of a clinician communication coaching intervention versus control on an objective measure of the quality of communication (primary outcome) and patients' perceptions of the quality of patient-centered care (secondary outcome), both overall and within Black and White patients.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Patients must be 18 years or older * Must be able to read * Must speak English * Capable of providing informed consent * Must be receiving continuity care from and enrolled clinician
Exclusion criteria
* Currently hospitalized * Awaiting heart transplant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment. | One encounter, up to approximately 1 hour | WISER is based on established codebooks (i.e., Motivational Interviewing Treatment Integrity manual, and Suchman's codebook for patient emotion and physician empathic responses). Communication coaches taught five skills: 1) sitting down and making eye contact with all in the room, 2) open-ended questions, 3) reflective statements, 4) empathic statements, and 5) What questions do you have?. Reported here is the number of Reflective Statements made. |
| Ratio of Empathic Responses to Empathic Opportunities | One encounter, up to approximately 1 hour | Communication coaches taught five skills: 1) sitting down and making eye contact with all in the room, 2) open-ended questions, 3) reflective statements, 4) empathic statements, and 5) What questions do you have?. Reported here is the ratio of empathic responses to empathic opportunities. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | One encounter, up to approximately 1 hour | Global ratings represent areas of effective communication that address many domains of patient-centered communication or areas that facilitate patient satisfaction with communication. WISER is based on established codebooks (i.e., Motivational Interviewing Treatment Integrity manual, and Suchman's codebook for patient emotion and physician empathic responses. Scores of 1-5 with 3 being average, 1 being below average, 5 being above average. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Standard of Care (Provider) Control cardiology providers. Receiving no intervention. | 20 |
| Communication Intervention (Provider) The intervention will contain elements of Motivational Interviewing coaching but also will teach providers how to address patient emotion and increase the efficiency of their visits. Clinicians randomized to the intervention will receive a tailored communication coaching intervention that includes didactic elements, audio recording encounters and providing feedback, and role-playing.
Communication Intervention: . The intervention will contain elements of Motivational Interviewing coaching but also will teach providers how to address patient emotion and increase the efficiency of their visits. Clinicians randomized to the intervention will receive a tailored communication coaching intervention that includes didactic elements, audio recording encounters and providing feedback, and role-playing. | 20 |
| Standard of Care (Patient) Patients seen by standard of care (control) cardiology providers. | 120 |
| Communication Intervention (Patient) Patients seen by cardiologists who received the communication coaching intervention. | 120 |
| Total | 280 |
Baseline characteristics
| Characteristic | Standard of Care (Provider) | Communication Intervention (Provider) | Standard of Care (Patient) | Communication Intervention (Patient) | Total |
|---|---|---|---|---|---|
| Age, Continuous | 48 years STANDARD_DEVIATION 9 | 46 years STANDARD_DEVIATION 9 | 60 years STANDARD_DEVIATION 14 | 56 years STANDARD_DEVIATION 15 | 56.4 years STANDARD_DEVIATION 12.4 |
| Average Number of Direct Patient Care Hours per Week | 32 hours per week STANDARD_DEVIATION 14 | 29 hours per week STANDARD_DEVIATION 15 | — | — | 30 hours per week STANDARD_DEVIATION 15 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 1 Participants | 1 Participants | 1 Participants | 5 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 18 Participants | 19 Participants | 119 Participants | 119 Participants | 275 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| No prior communication training | 13 Participants | 14 Participants | — | — | 27 Participants |
| Patient Education Associate's degree from college or university | — | — | 13 Participants | 10 Participants | 23 Participants |
| Patient Education Bachelor's degree | — | — | 21 Participants | 25 Participants | 46 Participants |
| Patient Education Eighth Grade or Less | — | — | 1 Participants | 0 Participants | 1 Participants |
| Patient Education Graduate or professional degree | — | — | 20 Participants | 28 Participants | 48 Participants |
| Patient Education Missing | — | — | 3 Participants | 4 Participants | 7 Participants |
| Patient Education Some college or university but no degree | — | — | 24 Participants | 15 Participants | 39 Participants |
| Patient Education Some graduate or professional school | — | — | 6 Participants | 2 Participants | 8 Participants |
| Patient Education Some High School. Completed high school or GED. | — | — | 24 Participants | 29 Participants | 53 Participants |
| Patient Education Vocational or trade school | — | — | 8 Participants | 7 Participants | 15 Participants |
| Patient Employment | — | — | 42 Participants | 43 Participants | 85 Participants |
| Patient Income After paying the bills, you still have enough money for special things that you want | — | — | 61 Participants | 56 Participants | 117 Participants |
| Patient Income Missing | — | — | 3 Participants | 4 Participants | 7 Participants |
| Patient Income Prefer not to answer | — | — | 4 Participants | 13 Participants | 17 Participants |
| Patient Income You are having difficulty paying the bills, no matter what you do | — | — | 6 Participants | 6 Participants | 12 Participants |
| Patient Income You have enough money to pay the bills, but little spare money to buy extra or special things | — | — | 36 Participants | 33 Participants | 69 Participants |
| Patient Income You have money to pay the bills, but only because you have cut back on things | — | — | 10 Participants | 8 Participants | 18 Participants |
| Patient Insurance Medicaid | — | — | 11 Participants | 16 Participants | 27 Participants |
| Patient Insurance Medicare | — | — | 57 Participants | 38 Participants | 95 Participants |
| Patient Insurance Missing | — | — | 3 Participants | 4 Participants | 7 Participants |
| Patient Insurance None | — | — | 2 Participants | 2 Participants | 4 Participants |
| Patient Insurance Plan purchased via employer or union | — | — | 40 Participants | 49 Participants | 89 Participants |
| Patient Insurance Plan, self or family purchased | — | — | 2 Participants | 4 Participants | 6 Participants |
| Patient Insurance Some other source | — | — | 3 Participants | 1 Participants | 4 Participants |
| Patient Insurance TRICARE | — | — | 2 Participants | 6 Participants | 8 Participants |
| Patient Marital Status | — | — | 73 Participants | 66 Participants | 139 Participants |
| Practice Specialty Advanced Heart Failure | 3 Participants | 5 Participants | — | — | 8 Participants |
| Practice Specialty Cardiac Imaging | 2 Participants | 1 Participants | — | — | 3 Participants |
| Practice Specialty Congenital disease | 0 Participants | 1 Participants | — | — | 1 Participants |
| Practice Specialty Electrophysiology | 3 Participants | 4 Participants | — | — | 7 Participants |
| Practice Specialty General | 8 Participants | 6 Participants | — | — | 14 Participants |
| Practice Specialty Interventional | 4 Participants | 3 Participants | — | — | 7 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 6 Participants | 4 Participants | 0 Participants | 0 Participants | 10 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 0 Participants | 60 Participants | 58 Participants | 120 Participants |
| Race (NIH/OMB) More than one race | 3 Participants | 0 Participants | 0 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 9 Participants | 16 Participants | 60 Participants | 62 Participants | 147 Participants |
| Sex: Female, Male Female | 4 Participants | 3 Participants | 65 Participants | 61 Participants | 133 Participants |
| Sex: Female, Male Male | 16 Participants | 17 Participants | 55 Participants | 59 Participants | 147 Participants |
| Type of visit Non-procedural | 13 Participants | 12 Participants | — | — | 25 Participants |
| Type of visit Procedural | 7 Participants | 8 Participants | — | — | 15 Participants |
| Years in Practice 11-15 Years | 3 Participants | 6 Participants | — | — | 9 Participants |
| Years in Practice 1-5 Years | 3 Participants | 0 Participants | — | — | 3 Participants |
| Years in Practice 6-10 Years | 2 Participants | 5 Participants | — | — | 7 Participants |
| Years in Practice Less than a Year | 1 Participants | 0 Participants | — | — | 1 Participants |
| Years in Practice More than 15 Years | 11 Participants | 9 Participants | — | — | 20 Participants |
| Years in Practice Prefer not to answer | 0 Participants | 0 Participants | — | — | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 20 | 0 / 20 | 0 / 120 | 0 / 120 |
| other Total, other adverse events | 0 / 20 | 0 / 20 | 0 / 120 | 0 / 120 |
| serious Total, serious adverse events | 0 / 20 | 0 / 20 | 0 / 120 | 0 / 120 |
Outcome results
Primary
Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment.
WISER is based on established codebooks (i.e., Motivational Interviewing Treatment Integrity manual, and Suchman's codebook for patient emotion and physician empathic responses). Communication coaches taught five skills: 1) sitting down and making eye contact with all in the room, 2) open-ended questions, 3) reflective statements, 4) empathic statements, and 5) What questions do you have?. Reported here is the number of Reflective Statements made.
Time frame: One encounter, up to approximately 1 hour
Population: Only applies to Patient groups. Data not collected on 10 participants.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Standard of Care - Patients | Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment. | 11.95 Number of Reflective Statements | Standard Deviation 8.81 |
| Communication Intervention - Patients | Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment. | 13.15 Number of Reflective Statements | Standard Deviation 9.96 |
Primary
Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment.
WISER is based on established codebooks (i.e., Motivational Interviewing Treatment Integrity manual, and Suchman's codebook for patient emotion and physician empathic responses). Communication coaches taught five skills: 1) sitting down and making eye contact with all in the room, 2) open-ended questions, 3) reflective statements, 4) empathic statements, and 5) What questions do you have?. Reported here is the number of Open-ended Questions asked.
Time frame: One encounter, up to approximately 1 hour
Population: Only applies to Patient groups. Data not collected on 10 participants.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Standard of Care - Patients | Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment. | 3.41 questions asked | Standard Deviation 2.84 |
| Communication Intervention - Patients | Cardiologist Behavior as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment. | 3.28 questions asked | Standard Deviation 2.89 |
Primary
Ratio of Empathic Responses to Empathic Opportunities
Communication coaches taught five skills: 1) sitting down and making eye contact with all in the room, 2) open-ended questions, 3) reflective statements, 4) empathic statements, and 5) What questions do you have?. Reported here is the ratio of empathic responses to empathic opportunities.
Time frame: One encounter, up to approximately 1 hour
Population: Participants with encounters in which the clinician had at least one empathic response. Only applies to Patient groups.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Standard of Care - Patients | Ratio of Empathic Responses to Empathic Opportunities | 0.20 ratio of responses to opportunities | Standard Deviation 0.36 |
| Communication Intervention - Patients | Ratio of Empathic Responses to Empathic Opportunities | 0.50 ratio of responses to opportunities | Standard Deviation 0.47 |
Secondary
Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment
Global ratings represent areas of effective communication that address many domains of patient-centered communication or areas that facilitate patient satisfaction with communication. WISER is based on established codebooks (i.e., Motivational Interviewing Treatment Integrity manual, and Suchman's codebook for patient emotion and physician empathic responses. Scores of 1-5 with 3 being average, 1 being below average, 5 being above average.
Time frame: One encounter, up to approximately 1 hour
Population: Only applies to Patient groups. Data not collected on 10 participants.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Standard of Care - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Flow | 2.9 score on a scale | Standard Deviation 1.1 |
| Standard of Care - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Respect | 3.8 score on a scale | Standard Deviation 1 |
| Standard of Care - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Concern | 4.0 score on a scale | Standard Deviation 0.8 |
| Standard of Care - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Warmth | 3.5 score on a scale | Standard Deviation 0.9 |
| Standard of Care - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Attentiveness | 3.8 score on a scale | Standard Deviation 0.9 |
| Communication Intervention - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Warmth | 3.6 score on a scale | Standard Deviation 0.8 |
| Communication Intervention - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Attentiveness | 3.8 score on a scale | Standard Deviation 0.9 |
| Communication Intervention - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Flow | 3.3 score on a scale | Standard Deviation 1 |
| Communication Intervention - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Concern | 4.2 score on a scale | Standard Deviation 0.7 |
| Communication Intervention - Patients | Global Ratings of Communication as Measured by WISER (Writing, Immersive Experiences, Speaking, Ethical Communication, and Research) Assessment | Respect | 4.0 score on a scale | Standard Deviation 0.9 |