Since the 1990s, the paradigm of medical care has shifted from physician-centered care to patient-centered care. Patient-centered care, by definition, revolves around patients. The Institute of Medicine (IOM) defines patient-centered care as follows:
“Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”
“It is well established now that one can in fact improve the quality of health care and reduce the costs at the same time.”
Communication is key
Communication is a key aspect of patient-centered care. Effective doctor-patient communication recognizes both the doctor’s need to know and understand his/her patients and the patients’ need to be known and understood by doctors. Good two-way communication is fundamental to patient-centered care.
As outlined by Tongue and colleagues in the Journal of Bone and Joint Surgery, the 3 main goals of doctor-patient communication in patient-centered care are,
- Creating a good interpersonal relationship,
- Facilitating exchange of information, and
- Including patients in decision making
Patient centered care is high-quality healthcare
Patient-centered care leads to high-quality healthcare. This is because patients are experts in the experience of their symptoms. And, physicians are dependent on patients for this expertise.
It is via good two-way communication, a basic clinical skill in the practice of medicine, that doctors gather information from patients. This is the basis of disease identification and problem-solving, as well as building therapeutic relationships. Without a cooperative and informative patient, doctors cannot do their job properly. Since non-patients participants can not know exactly how patients feel and what they really need, active patient engagement is critical to achieve patient-centered care.
What we learn about doctor-patient communication from clinical trials
It is hard to measure the degree of patient engagement in general medical care, however, we believe that participation data from clinical trials, which is much easier to gather and study, may serve as proxy for patient engagement in other settings. If we accept this premise, there is reason for concern.
Cancer clinical trials, for example, have a very low rate of subject accrual. In the United States, only about 3% of cancer patients enroll in a trial. If individuals who are not fully eligible for a trial for various reasons are excluded, the rate increases to 20%, which is still not high.
Why are clinical trial accrual rates so low?
- There is only a small pool of eligible patients, or
- There are factors that inhibit patients from participating
Looking at just one cancer, colorectal, we find that there are 165,700 new cases in the U.S. and over 1 million new cases worldwide each year. Clearly, the “small pool of patients” argument doesn’t hold. There must be other reasons why patients are not participating in clinical trials.
What else is going on?
To find out what factors inhibit eligible patients from participating, we need to focus on the clinical trials process. Researchers often point the inconvenience of the data collection process as one of the main obstacles to patients’ participation in clinical trials.
But is this true? To examine this question, we must remember that participation in trials is not a decision patients make in isolation. Most often, it is the result of the interaction between patients, their families, and physicians. Since this is the case, it follows that doctor-patient communication should be one of the key factors influencing patients’ decision to engage in clinical trials or not.
Studies of doctor-patient communication and clinical trials
Studies of doctor-patient communication have documented that communication styles impact patient satisfaction and compliance. Good communication increases patient satisfaction and compliance, which in turn increases clinical trials participation. Another study demonstrated that patients who agreed to clinical trials perceived their doctors as being significantly friendlier and as being a better communicator than patients who declined clinical trials.
A disconnect between patients’ and doctors’ perceptions
As reported in the proceedings of the American Academy on Physician and Patient’s Conference on Education and Evaluation of Competence in Communication and Interpersonal Skills, the American Academy of Orthopedic Surgeons (AAOS) conducted a national survey of communication skills; 807 patients and 700 orthopedic surgeons responded.
The results were surprising: 75% of the orthopedic surgeons believed that they communicated satisfactorily with their patients, but only 21% of the orthopedic patients reported having satisfactory communication with their physicians. This communication gap was most evident in categories such as listening and caring and time spent with the patient.
What can be done?
To improve clinical trial participation and patient engagement in general, we clearly need to improve the quality of communication between the doctors and patients, keeping in mind the following:
- There is no single communication model that can be applied to all patients, even if patients has the same clinical conditions
- Different patients have different preferences in health care
- Patient’s needs must always be the priority.
Robert Smith and colleagues outline the steps inherent in all successful physician-patient communications: establish an information base, motivate the patient, obtain a commitment, and negotiate a specific plan. They note that patience and good communication skills are required in every step and remind us that attitudes of patients and doctors interplay with each other.
The bottom line
Achieving truly patient-centered care requires effective doctor-patient communication.