OBJECTIVE: To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes. DATA SOURCES: The MEDLINE database was searched for articles published from 1983 to 1993 using "physician-patient relations" as the primary medical subject heading. Several bibliographies and conference proceedings were also reviewed. STUDY SELECTION: Randomized controlled trials (RCTs) and analytic studies of physician-patient communication in which patient health was an outcome variable. DATA EXTRACTION: The following information was recorded about each study: sample size, patient characteristics, clinical setting, elements of communication assessed, patient outcomes measured, and direction and significance of any association found between aspects of communication and patient outcomes. DATA SYNTHESIS: Of the 21 studies that met the final criteria for review, 16 reported positive results, 4 reported negative (i.e., nonsignificant) results, and 1 was inconclusive. The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. The outcomes affected were, in descending order of frequency, emotional health, symptom resolution, function, physiologic measures (i.e., blood pressure and blood sugar level) and pain control. CONCLUSIONS: Most of the studies reviewed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes. The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs. Future research should focus on evaluating such educational programs.

Effective physician-patient communication and health outcomes: a review

Research on gaze and eye contact was organized within the framework of Patterson's (1982) sequential functional model of nonverbal exchange. Studies were reviewed showing how gaze functions to (a) provide information, (b) regulate interaction, (c) express intimacy, (d) exercise social control, and (

Gaze and eye contact: A research review.

From Communication to Language--A Psychological Perspective.

Use of the Rotterdam Symptom Checklist (RSCL) to measure psychological and physical distress as experienced by cancer patients, is discussed in this paper. The stability of the structure of the RSCL was assessed in principal component analyses in three studies: one concerning cancer patients during either chemotherapy or follow-up (n = 86), one done in patients undergoing chemotherapy for advanced ovarian cancer (n = 56), and the third dealing with cancer patients under treatment, disease-free 'patients', and 'normal' controls (n = 611). The psychological dimension proved to be stable across populations. A scale based on this factor was highly reliable (Cronbach's alpha 0.88-0.94). The physical distress is reflected by several dimensions in a homogeneous population (pain, fatigue, gastrointestinal complaints) and undimensionally in a heterogeneous population. Reliability of the physical distress scales is good (0.71-0.88). The current components of the RSCL and the use of individual and disease specific symptoms are discussed.

Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist.

https://www.who.int/reproductivehealth/publications/general/lancet_2.pdf

Sexual behaviour in context: a global perspective.

Context: despite the growing body of knowledge about teenager's sexual and contraceptive behavior in the United Kingdom, much quantitative work has failed to consider the broader social contexts in which this behavior occurs. Methods: a 1999 survey of 963 full-time students aged 16-18 gathered information on individual, contextual and background factors. Logistic regression analyses were conducted to investigate how these factors determine use of a modern method at first sex and whether such use is discussed beforehand. Results: three factors were significantly associated with the odds of contraceptive use at first sex among young men—discussing contraception beforehand (odds ratios, 5.7-13.8), giving an intimate reason for having sex the first time (6.4) and having parents who portrayed sexuality positively during childhood and the early teenage years (1.2). For young women, five factors significantly predicted use—communication (odds ratios, 6.2-15.0), age at first sex (1.8), not having visited a service provider (5.0), feeling comfortable interacting with teenage males (1.2) and "sort of" or not expecting to have sex (0.2 and 0.4, respectively). Among young men, the factors significantly associated with the odds of having discussed contraception were the level of social deprivation, the length of the relationship and parents' openness to talking about sex; among young women, the factors were the number of intimate reasons given for having sex and the warmth and availability of parents. Conclusions: efforts to increase young people's ability to negotiate sexual and contraceptive decision-making should be multifaceted. It is essential that parents provide a supportive climate throughout childhood and adolescence, where discussions of sexual issues are acceptable and where families feel comfortable talking openly.

Factors affecting British teenagers' contraceptive use at first intercourse: the importance of partner communication.

Argyle and Dean (1965) found that there was more eye-contact between members of a dyad the further apart they were. This result was predicted from a theory to the effect that there is an equilibrium for intimacy, and that distance and eye contact can substitute for one another as signals for intimacy. In the present paper two experiments are reported which explore further the relations between distance, gaze and mutual gaze, and enable us to decide between alternative explanations of it. In the Argyle and Dean experiments, there was a continuously staring stooge, so the S's gaze and the amount of eye-contact were identical. The two sat at 90° to each other. For MF pairs the level of EC (eye-contact) was 30.5 % at 2', 50 % at 6', and 58 % at 10'; length of glance followed a similar pattern. The effect was less strong for MM and FF pairs. Goldberg, Kiesler and Collins (1969) carried out a similar experiment, using stooges who did not stare all the time, but adopted a more natural pattern of gaze; the subject and stooge sat directly facing, and MM pairs were used. Eye-contact was not recorded, but Ss gazed at the stooge for 35 % of the time at 2i/2', and 60 % of the time at 6'. Stephenson and Rutter (1970) suggested that these results could be due to observers recording more of S's non-eye-directed gazes as eyedirected when he is at a greater distance from the stooge. They carried out an experiment in which a stooge looked systematically at his partner's ear and shoulders, and found that more of these gazes were recorded as

Gaze, Mutual Gaze, and Proximity

This paper considers the common criteria by which school‐based sex and relationship programmes are evaluated, and argues that the domination of public health outcomes serves to make invisible other aspects of courses that warrant attention. In particular, the role of pleasure in sexual development and relations is normally not acknowledged. While it may be unacceptable in most cultures to suggest that teaching young people how to achieve sexual pleasure is valuable, there are increasing indications—from developing as well as developed countries—that public health outcomes may benefit from a greater acceptance of positive sexual experiences. It is suggested that greater comfort with one's own body will enable greater ability to communicate wishes to others, and to be less ‘pressured’ into unwanted sexual relationships.

‘We didn't cover that at school’: education against pleasure or education for pleasure?

Looking while talking (Li) may be used to obtain immediate feedback on the reactions of listeners; looking while listening (LL) may be used to supplement auditory information, by observing eye-movements and changes of facial expression. This function of gaze can be isolated in the situation where a subject interacts across a one-way screen, so that he can see and not be seen; he is unable to send any signals, so must look to collect information. Part of this information is about the other's timing of utterances and is used for synchronizing. This can be eliminated if the S delivers a monologue to his partner.

The Different Functions of Gaze

18 sample surveys conducted in 1989-1993 of male and female respondents aged 15-49 years reporting sex with a nonregular partner in the preceding year were analyzed The proportion of men ranged from 4% to 47% and women from 1% to 19% In the five Asian sites 10-20 times more men than women reported nonregular sex Among the 18 surveys the proportion of men reporting five or more partners in the last 12 months varied from 0% in Sri Lanka and Hong Kong to 11% in Thailand; for women the level never exceeded 3% The proportion of male respondents with more than five nonmarital partners was consistently highest among those aged 25-34 years A significant relationship was found between the prevalence of premarital sex among 15-24 year old youths and the prevalence of nonregular sex among adults for both men and women (R2 = 043 for men; R2 = 057 for women) Prevalence of all men aged 15-49 years reporting commercial sex ranged from 1% to 25% with a median of 97% Among women the corresponding figures were <1% in nine countries but ranged up to 11% in Tanzania with a median of 13% In 1989-93 the proportion of men who never used a condom on these occasions in the last year varied from approximately 25% in Singapore to 80% in Togo Tanzania Manila and Rio In Lusaka and Burundi two areas where the HIV epidemic and the awareness of AIDS were already high more than 50% of men reported regular or occasional use of condoms Youthful age and unmarried status emerged as net predictors of risk behavior in eight of the 12 sex-specific study groups by multivariate analysis Among men significant positive associations between educational level and risk behavior were found in three of the six sites and among women in two of the four sites Regular alcohol drinking was also strongly correlated with risk behavior in most surveys but perceived vulnerability to HIV was not

Roger Ingham

Papers

Factors affecting British teenagers' contraceptive use at first intercourse: the importance of partner communication.

Gaze, Mutual Gaze, and Proximity

‘We didn't cover that at school’: education against pleasure or education for pleasure?

The Different Functions of Gaze

Sexual behaviour in developing countries: implications for HIV control.