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Coding patient-centred behaviour in the medical encounter

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  • Zandbelt, Linda C.
  • Smets, Ellen M.A.
  • Oort, Frans J.
  • de Haes, Hanneke C.J.M.

Abstract

A patient-centred approach is increasingly advocated and incorporated in medical education. Due to its multi-dimensionality, however, the concept of patient-centredness appears to be hard to measure and, consequently, to evaluate. The objective of this study was to develop an instrument to measure patient-centredness in line with one central dimension, i.e. physicians' explorative communication skills: the tendency to encourage (or discourage) patients to express their perspective on illness and treatment, by displaying facilitating and inhibiting behaviours. The paper describes the development of the patient-centred behaviour coding instrument (PBCI), and first results of validity and reliability of the instrument. The study was conducted in the outpatient division of an academic teaching hospital in The Netherlands, where follow-up encounters were videotaped and coded. Participants were 30 residents and specialists in general internal medicine, rheumatology and gastro-enterology, and 323 patients having a (video-taped) follow-up appointment with one of these physicians. All recorded consultations were coded using the PBCI. Statistical analyses verified the existence of two dimensions of the PBCI: facilitating and inhibiting behaviours. Interestingly, open and closed questions generally appeared to be indicative of both the facilitating and the inhibiting dimension; only open and closed questions with a psycho-social content were unambiguously classified as facilitating behaviours. Reliability of the facilitating behaviours was high, while reliability of the inhibiting behaviours was moderate. Besides infrequent observations of the inhibiting behaviours, low reliability was partly due to individual inter-rater variability. A global rating of patient-centredness appeared to correlate with the two dimensions in the expected direction: positively with the facilitating and negatively with the inhibiting dimension, indicating the convergent validity of the instrument.

Suggested Citation

  • Zandbelt, Linda C. & Smets, Ellen M.A. & Oort, Frans J. & de Haes, Hanneke C.J.M., 2005. "Coding patient-centred behaviour in the medical encounter," Social Science & Medicine, Elsevier, vol. 61(3), pages 661-671, August.
    • Handle: RePEc:eee:socmed:v:61:y:2005:i:3:p:661-671
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    References listed on IDEAS

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    1. Zandbelt, Linda C. & Smets, Ellen M.A. & Oort, Frans J. & Godfried, Mieke H. & de Haes, Hanneke C.J.M., 2006. "Determinants of physicians' patient-centred behaviour in the medical specialist encounter," Social Science & Medicine, Elsevier, vol. 63(4), pages 899-910, August.
    2. Del Piccolo, Lidia & Mazzi, Maria Angela & Dunn, Graham & Sandri, Marco & Zimmermann, Christa, 2007. "Sequence analysis in multilevel models. A study on different sources of patient cues in medical consultations," Social Science & Medicine, Elsevier, vol. 65(11), pages 2357-2370, December.
    3. Pavani Rangachari & Kathleen R. May & Lara M. Stepleman & Martha S. Tingen & Stephen Looney & Yan Liang & Nicole Rockich-Winston & R. Karl Rethemeyer, 2019. "Measurement of Key Constructs in a Holistic Framework for Assessing Self-Management Effectiveness of Pediatric Asthma," IJERPH, MDPI, vol. 16(17), pages 1-25, August.
    4. Arpita Gantayet-Mathur & Karenn Chan & Meena Kalluri, 2022. "Patient-centered care and interprofessional collaboration in medical resident education: Where we stand and where we need to go," Palgrave Communications, Palgrave Macmillan, vol. 9(1), pages 1-24, December.

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