How does communication heal? Pathways linking clinician-patient communication to health outcomes.

During the last 30 years, researchers have shown greatinterestinthephenomenonofsocialsupport,particularlyin the context of health. Prior work has found that thosewith high quantity or quality of social networks have adecreased risk of mortality in comparison with thosewho have low quantity or quality of social relationships,even after statistically controlling for baseline healthstatus [1]. In fact, social isolation itself was identiﬁedasanindependentmajorriskfactorforall-causemortality[2]. Current research has focused on expanding severalareas of knowledge in this ﬁeld. These include social-support inﬂuences on morbidity, mortality, and qualityof life in chronic disease populations, understandingthe mechanisms responsible for such associations, andhow we might apply such ﬁndings to design relevantinterventions.It is important to note that social support in these studiesisoperationalizedinseveraldifferentways.Mostbroadly,support can be conceptualized in terms of the structuralcomponents(e.g.socialintegration:being apartofdiffer-ent networks and participating socially [3 ]) and thefunctional components (e.g. different types of trans-actions between individuals, such as emotional supportor favors [4 ]). How the functional components aremeasured often varies between studies; transactionsmay be summarized by actual support received (oftenascertained by asking the support providers [5 ]),perceived support received or available [6 ], or thediscrepancy between perceived support and receivedsupport [7 ]. Support is often further broken down intodifferent types—for instance, instrumental support andemotional support—as people often have preferences fordifferent types of aid depending on the circumstances.This diversity of ways in which support is deﬁned isimportant and can provide greater speciﬁcity (context) toresearch ﬁndings.

Social and emotional support and its implication for health.

Patient-centred communication is associated with positive therapeutic alliance: a systematic review

Background. Pain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties.

Objective.  The objective of the study was to elicit providers' perspectives on their experiences in caring for patients with chronic pain.

Design.  The design used was a qualitative study using open-ended, in-depth interviews.

Participants.  Twenty providers (10 men, 10 women) from five different clinics were interviewed at the Roudebush Veterans Affairs Medical Center.

Results.  Three broad themes emerged from the analysis: 1) providers emphasized the importance of the patient–provider relationship, asserting that productive relationships with patients are essential for good pain care; 2) providers detailed difficulties they encounter when caring for patients with chronic pain, including feeling pressured to treat with opioids, believability of patients' reports of pain, worries about secondary gain/diversion, and “abusive” or “difficult” patients; and 3) providers described the emotional toll they sometimes felt with chronic pain care, including feeling frustrated, ungratified, and guilty.

Findings.  Findings were interpreted within a model of patient-centered care.

Conclusions.  The clinical implications of these findings are two-fold. First, PCPs' needs cannot be ignored when considering pain care. PCPs need support, both instrumental and emotional, as they care for patients with chronic pain. Second, improving PCPs' patient-centered communication skills—including demonstrating empathy and encouraging shared decision-making—holds promise for alleviating some of the strain and burden reported by providers, ultimately leading to improved patient care.

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The Patient–Provider Relationship in Chronic Pain Care: Providers' Perspectives

PURPOSE Participatory decision making (PDM) is associated with improved dia- betes control. We examine a causal model linking PDM to improved clinical out- comes that included patient activation and medication adherence. METHODS This observational study was conducted in 5 family physician offi ces. Diabetic patients were recruited by mail and by completing a study interest card at the conclusion of their offi ce visit. Two survey questionnaires, administered 12 months apart, elicited patients' ratings of their physician's PDM style at baseline and their level of activation and medication adherence both at baseline and at follow-up. Measures of glycated hemoglobin (hemoglobin A1c), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol were abstracted from the medical record starting 12 months before the baseline survey to 12 months after the follow-up survey. A path analysis using a structural equation model was used to test hypotheses. RESULTS We mailed questionnaires to 236 participants; 166 (70%) returned the baseline questionnaire, and 141 (80%) returned the follow-up questionnaire. Hemoglobin A1c levels, systolic blood pressure, and LDL cholesterol values all declined signifi cantly, and patient activation and medication adherence improved. PDM at baseline was associated with patient activation at follow-up. Patient acti- vation at follow-up was associated with medication adherence at follow-up, and medication adherence at follow-up was associated with change in hemoglobin A1c levels and LDL cholesterol values but not with systolic blood pressure. CONCLUSIONS Participatory decision making during primary care encounters by patients with type 2 diabetes resulted in improvements in hemoglobin A1c levels and LDL cholesterol values by improving patient activation, which in turn improved medication adherence.

https://www.annfammed.org/content/annalsfm/8/5/410.full.pdf

Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study

The physician–patient working alliance

This paper reports a meta-analysis of the empirical literature on the effects of speakers’ accents on interpersonal evaluations. Our review of the published literature uncovered 20 studies that have compared the effects of standard accents (i.e., the accepted accent of the majority population) versus non-standard accents (i.e., accents that are considered foreign or spoken by minorities) on evaluations about the speakers. These 20 studies yielded 116 independent effect sizes on an array of characteristics that were selected by the original researchers. We classified each of the characteristics as belonging to one of three domains that have been traditionally discussed in this area, namely status (e.g., intelligence, social class), solidarity (trustworthiness, in-group–out-group member), and dynamism (level of activity and liveliness). The effect was particularly strong when American Network accented speakers were compared with non–standard-accented speakers. These results underscore prior research showing that speakers’ accents have powerful effects on how others perceive them. These and other results are discussed in the context of the literature along with implications for future research in this area. Copyright © 2011 John Wiley & Sons, Ltd.

A meta-analysis of the effects of speakers' accents on interpersonal evaluations

Through semistructured interviews, the authors investigated the relationships between the definition of a "true" American, the impact of 9/11, and the war in Iraq and their impact on experiences of fitting into and being excluded from the American identity with a sample of 10 2nd-generation young adults. Using consensual qualitative research methods (C. E. Hill et al., 2005; C. E. Hill, B. Thompson, & E. N. Williams, 1997) the authors identified 6 major domains that described participants' experiences, including physical characteristics of true Americans, behavioral characteristics of true Americans, beliefs and values of true Americans, the impact of 9/11 on definitions of true Americans, participants' American identity, and experiences as 2nd-generation Americans.

Tracey C. Gilbert

Papers

The physician–patient working alliance

A meta-analysis of the effects of speakers' accents on interpersonal evaluations

What it means to be and feel like a "true" American: perceptions and experiences of second-generation Americans.