Assessing patient-centred communication in teaching: a systematic review of instruments

Abstract

ContextPatient‐centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient‐centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments.ObjectivesThe aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor–patient communication and can be used to provide direct feedback.MethodsA systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor–patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist.ResultsThirteen articles describing 14 instruments measuring patient centredness in doctor–patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity.ConclusionsThis review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor–patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient‐centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and enhancement of existing instruments in terms of validity and reliability, along with enhancement of their generalisability, responsiveness and aspects of interpretability in different contexts (real patients, simulated patients, doctors in different specialties, etc.). Comprehensibility and feasibility should also be taken into account.

Developing measures for assessment of patient-centred communication: a case of the tail wagging the dog?

“…For many, patient‐centredness reflects the zeitgeist of contemporary medicine; it democratises doctor–patient relationships and challenges the enduring dominance of paternalistic culture. In this issue, ‘Assessing patient–centred communication in teaching: a systematic review of instruments’, provides a useful starting point for considering the different ways in which the complex and arguably nebulous dimensions of patient‐centredness may (or may not) find expression in current educational tools, and how these might therefore be advanced.…”

“…But, in heralding innovation of technical matters and rushing to test instruments before establishing clarity of purpose, are we in danger of creating a situation where the tail is inadvertently wagging the dog? Although, for example, Brouwer et al’s application of Stewart's five dimensions of patient‐centredness to communication makes sense, several of these are lost in translation because of a preoccupation with measurement scales and the inexorable drive to establish statistical validity and reliability.…”

“…The question raised by Brouwers et al . of how educators should approach ‘further research and enhancement of existing measurements on different aspects of validity and reliability’ is therefore crucial.…”

“…At the very least, patient narratives could helpfully inform the preliminary stages of concept development, principal component analysis, content ordering and establishing feasibility, bringing a more inductive, but also transparently abductive, patient base to instrument development. Brouwers and colleagues rightly assert that the ‘comprehensibility and feasibility of instruments should be taken into account’ . The benefit and familiarity of formal and systematic feedback to clinicians and educators is well rehearsed.…”

“…Although useful for standardisation and comparative purposes, a predominant focus on quantitative measurement results in the application of numerical values and binary categories to what are essentially subjective, complex and situationally contingent human responses to medical professionalism and care. Brouwers et al 1 for example, address the assertion that 'adequate patient centred communication and its assessment is necessary' with a 'call for adequate measurement instruments'. In philosophical terms this statement could be viewed as a non-sequitur, in as much as assessment does not automatically equal 'measurement'.…”