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HFO Announcements
Ongoing Alliance with Penn Medicine
HFO is co-sponsoring The Foundation Stress Management Programs offered by The Penn Program for Mindfulness (PPM). These 8-week programs are taught by professional instructors and present simple and effective stress reduction techniques, based on the practice of mindfulness meditation, designed to enhance overall health and quality of life. The Foundation Stress Management Programs are conducted three times per year (fall, winter and spring) in 8 convenient locations and are a thorough introduction to mindfulness meditation for personal and clinical application.
In addition, HFO co-sponsors PPM’s advanced classes for those who already have a foundation in mindfulness practice, as well as classed devoted to healthcare professionals. Click here for more information about these additional classes.
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Call for Authors
HFO is seeking competent and qualified academics/healthcare professionals to provide CE courses on topics relevant to behavioral medicine and health psychology. In particular, courses on Asthma, Autism, cultural competence, ethics, Fibromyalgia, healthcare disparities, and organ transplant are desired.
Click here for more information about authorship opportunities and how to grow with HFO. |
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Common Factors Influencing Healthcare Communication
 Effective provider-patient communication benefits both in important ways. Healthcare providers with good communication skills are able to more accurately identify patients’ problems and concerns. These patients, in turn, often have better psychological adjustment and greater satisfaction with their health care. Providers also benefit by showing greater job satisfaction and reduced work stress.1
A clear health communication link among providers-patients-families often serves multiple purposes. For example, it can help the patient and family make optimal health care decisions; enhance disease adjustment through a more realistic understanding of illness demands, treatment side effects and prognosis; clarify medical recommendations and procedures and the role of each provider involved in the patient’s care; and deal with insurance, financial and legal issues.2
Mental health providers are often in a pivotal position to mediate and positively influence communication between patients, their families and the interdisciplinary team that treats them. Here’s a brief overview of several common factors shown to impact provider-patient-family communication to be mindful of.
| Language |
- Patients and family members may have difficulty understanding medical staff when English is a second language for them and/or medical jargon is used frequently by staff.3
- Divergent doctor-patient styles contribute, at times, to frustration on the part of the provider and misunderstandings and distress for patients.4Cultural factors may exacerbate this. For example, in some countries, patient questioning is often done in an indirect way, using metaphors to replace potentially disturbing technical terms, while in others, communication is more clear and direct.
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| Age, Education, Gender & Socioeconomic Status |
- Older patients receive more information, ask more questions and focus on more medical topics. However, they are also more likely to perceive the healthcare provider as the expert and final authority and display a more passive attitude in their care.5
- Family members, on the other hand, who are older and more educated, appear to have greater contact with staff and fewer fears about communicating.5
- Gender dyads influence patient agendas elicited, talk content, communication style, non-verbal communication, the exhibition of power, and consultation length.6
- Specifically, female/female dyads are the most patient-centered, and have longer consultations containing the most talk.
- Patients of female doctors are more satisfied with the overall encounter, even after adjusting for patient characteristics and provider practice style.7
- Female patients ask more questions which may result in their receiving more information and providers provide more affective responses, engage in more psychosocial talk, and use less medical jargon with female patients.8
- Providers impart less information to lower SES patients, despite the lack of correlation between SES level and the amount of information desired.8
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| Ethnicity/Culture |
- Anglo patients and families generally prefer full disclosure of diagnosis, prognosis and associated issues, whereas Asians and many Western Europeans value ‘protection of patient from negative information’ thus preferring less disclosure to patients, if at all.9
- Mistrust of the healthcare system is more prevalent among African Americans and, secondarily, Latinas, in comparison to Caucasians. Medical mistrust is in turn associated with less effective coping, and lower patient quality of life.10
- Health encounters often don’t fully account for ethnic and cultural variations in the related expectations of providers (e.g., visit length, topics/information to be reviewed; illness attributions) and/or patients/family (e.g., issues they’d like addressed; scheduling procedures; how the healthcare provider should treat them, including nonverbal behavior such as eye contact; office decor; the role of support staff).4,11
- Provider-patient differences in illness perspectives are more prevalent when psychological diagnoses are involved, with a psychological interpretation of physical symptoms interpreted by many immigrant patients as disbelief and rejection on the part of the provider. This may lead to shame, self-blame and stigmatization; and subsequent rejection of the diagnosis and noncompliance with recommendations.11
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| Previous Experience with Illness & the Health Care System |
- Multigenerational history with illness and the health care system, and the meanings attributed to illness, influence how each entity responds, interacts and communicates with one another and their health care providers.
- Variables that constitute “meaning” include personal experience, cultural values and customs, stage of the family life-cycle, and the sources of knowledge (health providers, relatives, friends, Internet) used to better cope.12
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| Individual Considerations: Personal Beliefs/Values/Coping Style |
- Values, attitudes, beliefs and coping styles play a major role in the communication process between providers, patients and families. For example, providers attitudes toward family involvement determine whether family members are informed about a patient’s health status. Patient and family attitudes (e.g., provider is too busy to speak with me) also influence the health communication process).13-14
- Individuals generally differ in the amount of health information desired as a means of coping with the health-related threat at hand.15 However, evidence suggests that patients and families’ informational needs and level of contact desired are greater during the diagnostic, terminal and acute period of an illness.13
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| Environmental Factors |
- Noise level, multi-tasking demands, lack of privacy, the physical layout of the room/office, and continuity of care issues, can all compromise the quality of doctor-patient-family communication.16
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Featured Course
Enhancing Provider-Patient-Family Communication: Theoretical, Ethical, Clinical and Sociocultural Considerations
(4 CEs) Dana Gionta, PhD
 There’s been an increasing awareness regarding the importance of clear and effective communication between patients, families and health care providers in the context of illness and medical ethics. A central focus has been provider-patient communication, with the patient as the primary unit of care. Historically, the role of the family in provider-patient communication research has often been overlooked. However, increasing evidence demonstrates that the family is not only affected by a loved one’s illness, but that it often plays a central role in a family member’s health care (e.g., risk for breast cancer)17, and more specifically, in their health communication encounters with health providers.18-19 Illness in one family member, the patient, often affects multiple systems (e.g. family, friends, and medical staff) which are consistent with the biopsychosocial systems theory first introduced by George Engel.20 According to this theory, an illness will impact multiple systems on a biological, psychological and social level. At a biological level, the illness may cause cellular, tissue and organ damage. Declining physical health may affect the patient’s psychological well-being. The psychological and physical impact will have direct implications for the family. The family’s response, in turn, will have implications for the patient. The patient and family system response will also influence another system in the biopsychosocial hierarchy, the health care community, of which both the patient and family are a part. The provider response, in turn, will affect the patient and family subsystems.
The family’s role in their loved one’s health care often serves numerous functions. Family members help the patient obtain information and identify available resources, accompany the patient to appointments and advocate on their behalf. They also provide important emotional support, reinforce health providers’ treatment recommendations and patients’ subsequent lifestyle changes, and provide a second source of information regarding patient history, current health status, adjustment and compliance.21-22
These feedback loops between patients, families and medical professionals illustrate the interdependency in the relationships between systems that has important implications for patient care in general, and provider-patient-family health communication in particular. Health professionals must be mindful that, patient, caregiver, and provider expectations about health-related communications may not match and that these expectations may vary over the course of an illness, especially as a patient’s health declines.23
This course will discuss what is meant by the term 'health communication', examine the role of communication in patient care and review the relevant theories and existing empirical evidence related to provider-patient-family communication. Evidence-based clinical guidelines for mental health providers and allied healthcare professionals will be offered to facilitate more effective and satisfactory provider-patient-family communication and collaborative care. |
About the Author
 Dana Gionta, PhD –Adjunct Professor, Fairfield University, CT; Psychologist and personal coach specializing in health and wellness. Dr. Gionta has a broad educational foundation in psychology, systems theory, and business, which provides her with unique conceptual, interpersonal and organizational assessment, and intervention skills. She has worked as a clinician, educator, researcher, and consultant to individuals, families and organizations of diverse cultural backgrounds with varied stages of change and goals. Dr. Gionta also serves on the APA's "Business of Practice Network" committee to contribute to the further development of healthy psychological workplaces. |
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References
- Maguire, P. & Pitceathly, C. (2006). Key communication skills and how to acquire them. British Medical Journal, 325, 697-700.
- Chesler, M. & Barbarin, O. (1984). Relating to the medical staff: How parents of children with cancer see the issues. Health and Social Work, 9, 49-65.
- Thompson, T. L.(1994). Interpersonal communicationandhealth care. In M. L. Knapp & G. R. Miller(Eds.),Handbook of interpersonal communication (2nd ed., pp. 696-725).
- Hudelson, P. (2005). Improving patient-provider communication: insights from interpreters. Family Practice, 22, 311-316.
- Miller, E.A. (2002). Telemedicine and doctor-patient communication: a theoretical framework for evaluation. Journal of Telemedicine and Telecare, 8, 311-318.
- Sandhu, H., Adams, A., Singleton, L., Clark-Carter, D., & Kidd, J. (2009). The impact of gender dyads on doctor-patient communication: a systematic review. Patient Education Counseling, 76(3), 348-355.
- Bertakis, K.D. (2009). The influence of gender on the doctor-patient interaction. Patient Education Counseling, 76(3), 356-360.
- Waitzkin, H. (1985). Information giving in medical care. Journal of Health and Social Behavior, 26, 81-101.
- Shahidi, J. (2010) Not telling the truth: circumstances leading to concealment of diagnosis and prognosis from cancer patients. European Journal of Cancer Care. Epub ahead of print.
- Maly, R.C., Stein, J.A., Umezawa, Y., Leake, B., & Anglin, M.D. (2008). Racial/Ethnic Differences in Breast Cancer Outcomes Among Older Patients: Effects of Physician Communication and Patient Empowerment. Health Psychology, 27, 728-736.
- Perloff, R.M., Bonder, B., Ray, G.B., & Ray, E.B. (2006). Doctor-Patient Communication, Cultural Competence and Minority Health. American Behavioral Scientist, 49, 835-852.
- Rolland. John S. (1994). Families, Illness, and Disability: A Biopyschosocial Treatment Model. New York. Basic Books. pp. 165-195, 233-267.
- Bond, S (1982). Communicating with families of cancer patients: 1. The relatives and doctors. Nursing Times, 78, 962-965.
- Gionta, D. A. (2003). A proposed model of medical staff-family communication in the context of cancer: Psychometric, model and mediational testing. Dissertation Abstracts International, Section B, 63, 4417.
- Miller, S.M., Rodoletz, M., Schroeder, C. M. Mangan, C. E., & Sedlacek, T. V. (1996). Applications of the monitoring process model to coping with severe long-term medical threats. Health Psychology, 15, 216-225.
- Bushinski, R. L., & Cummings, K. (2007). Practices of Effective End-of-Life Communication between Nurses and Patients/Families in Two Care Settings. Creative Nursing, 13 (3), 1-12.
- Tunin, R., Uziely, B., & Woloski-Wruble, A.C. (2009). First degree relatives of women with breast cancer: who’s providing information and support and who’d they prefer. Psychooncology, July 14, epub ahead of print.
- Ballard-Reisch, D.S., & Letner, J.A. (2003). Centering families in cancer communication research: acknowledging the impact of support, culture and process on client/provider communication in cancer management. Patient Education and Counseling, 50(1), 61-66.
- Northouse, P., & Northouse, L. (1992). Health Communication: Strategies for health professionals. Norwalk, CT: Appleton & Lange.
- Engel, G. (1977). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535-544.
- Chesler, M. & Barbarin, O. (1984). Relating to the medical staff: How parents of children with cancer see the issues. Health and Social Work, 9, 49-65.
- Kahana, E., & Kahana, B. (2003). Patient proactivity enhancing doctor-patient-family communication in cancer prevention and care among the aged. Patient Education and Counseling, 50 (1), 67-73.
- Gold, M., Philip, J., McIver, S., & Konesaroff, P.A. (2009). Between a rock and a hard place: exploring the conflict between respecting the privacy of patients and informing their carers. Internal Medicine Journal, 39(9), 582-587.
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