Patients with worry: presentation of concerns and expectations for response

Diversity of Parent Emotions and Physician Responses During End-of-Life Conversations

BACKGROUND AND OBJECTIVES

To provide support to parents of critically ill children, it is important that physicians adequately respond to parents' emotions. In this study, we investigated emotions expressed by parents, physicians' responses to these expressions, and parents' emotions after the physicians' responses in conversations in which crucial decisions regarding the child's life-sustaining treatment had to be made.

METHODS

Forty-nine audio-recorded conversations between parents of 12 critically ill children and physicians working in the neonatal and pediatric intensive care units of 3 Dutch university medical centers were coded and analyzed by using a qualitative inductive approach.

RESULTS

Forty-six physicians and 22 parents of 12 children participated. In all 49 conversations, parents expressed a broad range of emotions, often intertwining, including anxiety, anger, devotion, grief, relief, hope, and guilt. Both implicit and explicit expressions of anxiety were prevalent. Physicians predominantly responded to parental emotions with cognition-oriented approaches, thereby limiting opportunities for parents. This appeared to intensify parents' expressions of anger and protectiveness, although their anxiety remained under the surface. In response to more tangible emotional expressions, for instance, grief when the child's death was imminent, physicians provided parents helpful support in both affect- and cognition-oriented ways.

CONCLUSIONS

Our findings illustrate the diversity of emotions expressed by parents during end-of-life conversations. Moreover, they offer insight into the more and less helpful ways in which physicians may respond to these emotions. More training is needed to help physicians in recognizing parents' emotions, particularly implicit expressions of anxiety, and to choose helpful combinations of responses.

How doctors recognise that their patients are worried: A qualitative study of patient cues

OBJECTIVES

Recognising patient cues indicating worry is essential for successful reassurance. To obtain more insight into the variety and nature of patient cues that may arise in practice, this study explores doctors' reflections on patient cues they recognise during consultations.

METHODS

We performed a qualitative study during which GPs participated in stimulated recall interviews, using their own video-recorded consultations to enhance reflection. First, we reanalysed an existing dataset of 15 interviews during which GPs elaborated on the doctor-patient interaction. Additionally, 12 GPs were interviewed specifically about recognising patients' cues.

RESULTS

GPs described four categories of patient cues that indicate worry. GPs recognised worry based on non-verbal cues such as visible bodily reactions, and verbal cues that can be further categorised by type of worry (e.g. about serious disease). Moreover, GPs described behavioural cues, e.g. the patient bringing a list of symptoms. Lastly, GPs recognise worry based on prior knowledge about the patient.

CONCLUSIONS

GPs reflections have given insight into a wide variety of non-verbal -, verbal -, behavioural- and foreknowledge-based cues.

PRACTICE IMPLICATIONS

The identified cues can guide other clinicians in recognising worries and inform medical communication training and future research on the effectiveness of recognising cues and patient reassurance.

'I'd like to report a suspicious looking tree': Public concern, public attention and the nature of reporting about ash dieback in the United Kingdom

'Public concern', a ubiquitous notion used in descriptive and explanatory modes by policy makers, academics and the media, is often presented as axiomatic. However, the variability with which it is deployed in different contexts, for example, as justification for policy attention or having equivalence with what is considered 'newsworthy', belies this status. This article presents an empirical analysis of emails and phone calls from the UK public to UK government agencies, reporting suspected cases of ash dieback disease - a tree health issue which attracted intense media and policy attention in the United Kingdom in 2012. We challenge the view that public attentiveness is necessarily indicative of public concern, or that media attention can be taken as its proxy. Examination of concern at macro and micro levels reveals heterogeneous processes with multiple dimensions. Understanding the nature of public concern is crucial in enabling more effective policy development and operational responses to risk-related issues.

Exploring what patients think when answering the Interpersonal Skills Questionnaire (ISQ): A 'think aloud' study

BACKGROUND

The Interpersonal Skills Questionnaire (ISQ) was developed to collect patient feedback on consultation skills of practitioners. However, it has not yet been evaluated with pharmacists.

OBJECTIVE

To explore the thinking process of patients as they completed the ISQ following a consultation with a pharmacist.

METHODS

A qualitative think aloud (TA) methodology was used to explore patients' thinking while completing the ISQ following a consultation with a pharmacist. The study was conducted in secondary care with outpatients ≥18 years old. Interviews were carried out in rounds and were informally analysed (i.e., by writing notes while listening to recordings) to identify any associated major problem(s). Discussions were held between researchers to determine whether changes were needed based on patients' comments.

RESULTS

Eight patients in total (50% females) participated in this study (mean age: 48 years). Three rounds of TA were conducted. Most items of the ISQ were interpreted similarly by all participants with no major problems necessitating refining the ISQ.

CONCLUSIONS

Modification of the ISQ was unnecessary as interviews demonstrated no major problems with its use. The ISQ is thus a potentially suitable tool to collect patient feedback on pharmacists' consultations.

Managing chest pain patients in general practice: an interview-based study

Background

Assessment of chest pain in general practice is challenging. General practitioners (GPs) often feel uncertainty when dealing with chest pain. The role of new diagnostic tools is yet unclear.

Therefore, we aimed to learn: (1) whether or not GPs experience a change in incidence and presentation of chest pain, (2) how GPs deal with uncertainty, and (3) which thoughts, demands and doubts concerning new diagnostic tools occur.

Methods

Semi-structured, face to face interview based study, aiming at six main subjects: experienced changes in prevalence of chest pain, the management of chest pain patients, dealing with uncertainty, the GPs’ approach in referring chest pain patients, GPs’ attitude towards ‘unnecessary’ referrals, and the GPs’ suggestions for improving the management of chest pain patients.

Results

145 GPs in Belgium and the Netherlands were invited to participate, 27 (15 Flemish and 12 Dutch) GPs were interviewed. Data saturation was reached. The number of patients having an acute coronary syndrome among chest pain patients is decreasing, whereas the presentation of atypical complaints increases, together leading to more uncertainty. GPs rely on their own judgment above all, and desire new diagnostic tools only when these tools are of proven added value.

Conclusion

The incidence of chest pain in general practice is not decreasing according to the GPs. However, the presentation of chest pain is changing. GPs feel relatively comfortable with referring a considerable number of chest pain patients without ACS, as over-referral is safe. Uncertainty is regarded as a substantial element of their profession. New diagnostic tools are awaited with cautiousness.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0771-0) contains supplementary material, which is available to authorized users.

"Doctor, please tell me it's nothing serious": an exploration of patients' worrying and reassuring cognitions using stimulated recall interviews

Background

Many patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients’ worries, cognitions underlying reassurance and factors supporting patients’ reassuring cognitions.

Methods

In a qualitative study, we conducted stimulated recall interviews with 21 patients of 12 different GPs shortly after their consultation. We selected consultations in which the GPs aimed to reassure worried patients and used their videotaped consultation as a stimulus for the interview. The interviews were analysed with thematic coding and by writing interpretive summaries.

Results

Patients expressed four different core cognitions underlying their concerns: ‘I have a serious illness’, ‘my health problem will have adverse physical effects’, ‘my treatment will have adverse effects’ and ‘my health problem will negatively impact my life’. Patients mentioned a range of person-specific and context-specific cognitions as reasons for these core cognitions. Patients described five core reassuring cognitions: ‘I trust my doctor’s expertise’, ‘I have a trusting and supporting relationship with my doctor’, ‘I do not have a serious disease’, ‘my health problem is harmless’ and ‘my health problem will disappear.’ Factors expressed as reasons for these reassuring cognitions were GPs’ actions during the consultation as well as patients’ pre-existing cognitions about their GP, the doctor-patient relationship and previous events. Patients’ worrying cognitions were counterbalanced by specific reassuring cognitions, i.e. worrying and reassuring cognitions seemed to be interrelated.

Conclusions

Patients described a wide range of worrying cognitions, some of which were not expressed during the consultation. Gaining a thorough understanding of the specific cognitions and tailoring reassuring strategies to them should be an effective way of achieving reassurance. The identified reassuring cognitions can guide doctors in applying these strategies in their daily practice.

Peer-assessment of medical communication skills: the impact of students' personality, academic and social reputation on behavioural assessment

OBJECTIVE

Peer-assessment of communication skills may contribute to mastery of assessment criteria. When students develop the capacity to judge their peers' performance, they might improve their capacity to examine their own clinical performance. In this study peer-assessment ratings are compared to teacher-assessment ratings. The aim of this paper is to explore the impact of personality and social reputation as source of bias in assessment of communication skills.

METHODS

Second year students were trained and assessed history taking communication skills. Peers rated the students' personality and academic and social reputation.

RESULTS

Peer-assessment ratings were significantly correlated with teacher-ratings in a summative assessment of medical communication. Peers did not provide negative ratings on final scales but did provide negative ratings on subcategories. Peer- and teacher-assessments were both related to the students' personality and academic reputation.

CONCLUSION

Peer-assessment cannot replace teacher-assessment if the assessment should result in high-stake decisions about students. Our data do not confirm the hypothesis that peers are overly biased by personality and reputation characteristics in peer-assessment of performance.

PRACTICE IMPLICATIONS

Early introduction of peer-assessment in medical education would facilitate early acceptance of this mode of evaluation and would promote early on the habit of critical evaluation of professional clinical performance and acceptance of being evaluated critically by peers.

Emotional communication in medical consultations with native and non-native patients applying two different methodological approaches

OBJECTIVE

To explore the potential agreement between two different methods to investigate emotional communication of native and non-native patients in medical consultations.

METHODS

The data consisted of 12 videotaped hospital consultations with six native and six non-native patients. The consultations were coded according to coding rules of the Verona Coding definitions of Emotional Sequences (VR-CoDES) and afterwards analyzed by discourse analysis (DA) by two co-workers who were blind to the results from VR-CoDES.

RESULTS

The agreement between VR-CoDES and DA was high in consultations with many cues and concerns, both with native and non-native patients. In consultations with no (or one cue) according to VR-CoDES criteria the DA still indicated the presence of emotionally salient expressions and themes.

CONCLUSION

In some consultations cues to underlying emotions are communicated so vaguely or veiled by language barriers that standard VR-CoDES coding may miss subtle cues. Many of these sub-threshold cues could potentially be coded as cues according to VR-CoDES main coding categories, if criteria for coding vague or ambiguous cues had been better specified.

PRACTICE IMPLICATIONS

Combining different analytical frameworks on the same dataset provide us new insights on emotional communication.

Primary health-care patients' reasons for complaint-related worry and relief

AIM

Primary care patients are commonly worried about their complaints when consulting their doctor. Knowing the reasons behind patients' worries would enhance consultation practices. The aim of this study was to find out the reasons patients themselves give for their worries before a consultation and for possible relief or persistent worry after the consultation.

BACKGROUND

Our previous study using quantitative methods suggested that worried patients were uncertain about what was wrong with them and they perceived their complaints as serious. These results left some aspects unanswered; for instance, why did the patients consider their complaints severe.

METHODS

We conducted semi-structured interviews of patients, aged 18-39 years, with somatic complaints other than a common cold (n = 40), both before and after a consultation, and the patients described their reasons for worry in their own words. These qualitative data were analysed using thematic content analysis.

FINDINGS

The patients gave as reasons for their worries uncertainty, consequences of their complaints (eg, inability to work), insufficient control (eg, inadequate treatment) and prognosis. The patients were relieved when their uncertainty was diminished by getting an explanation for their complaint or when they achieved more control by getting treatment for their complaint. After a consultation, their reasons for worry, except for concern about the ability to function, tended to be replaced by other reasons. Psychological consequences and mistrust in health care also played a role in persistent worry. Our findings offer support to the patient-centred clinical method in primary care. To address the patients' worries properly, the GP should bring them up for discussion. Special attention should be given to worries about the ability to function, as they tend to persist even after a consultation.

Patients' negative emotional cues and concerns in hospital consultations: a video-based observational study

OBJECTIVE

Little is known about the frequency and occurrence of patients' negative emotional cues and concerns (NECC) across specialties in hospital departments.

METHODS

Ninety-six consultations were videotaped in a general hospital. The VR-CoDES (Verona Coding Definitions of Emotional Sequences) were used to code the patients' NECC. Cohen's kappa was used to establish reliability between coders.

RESULTS

Cohen's kappa was above 0.60. NECC were observed in more than half of the consultations. The number of NECC in the consultations was 163, with 109 negative emotional cues and 54 concerns. The mean number of NECC in the consultations was 1.69, with a median of 1. The first NECC in consultations were stated after a median duration of 5min 21s. We could not find significant differences related to the gender and age of the patient or the physician, or the specialty of the physician.

CONCLUSIONS

More than half of the concerns were not preceded by a negative emotional cue. Few consultations contained more than 3 NECC, and NECC tended to be expressed relatively early.

PRACTICE IMPLICATIONS

Patients' expressions of emotional issues are few, and most of them are subtle. Physicians should be thoroughly trained to identify and respond to them.

Language, culture and emotions: exploring ethnic minority patients' emotional expressions in primary healthcare consultations

OBJECTIVE

This study explores ethnic minority patients' expression of emotional cues and concerns in primary healthcare, and examines relationships with patient, provider and consultation attributes.

METHODS

191 video-recorded consultations were analyzed using the VR-CoDES. Patients were interviewed before the consultation. Generalized Estimating Equations models (GEE) were used to test for associations.

RESULTS

Psychosocial versus bio-medically oriented encounters contained significantly more cues (p≤0.05). Patients with poor versus good language proficiency expressed significantly less cues (p≤0.001). No significant correlations were found with patients' cultural values, patients' or physicians' gender or the presence of an interpreter. Female patients express more concerns (p≤0.05), female physicians have a higher number of concerns expressed by patients (p≤0.02).

CONCLUSION

This study shows that independent of physician and diagnosis, patients' language proficiency has a more important impact on the number of cues expressed by the patient than cultural difference.

PRACTICE IMPLICATIONS

Medical schools and Continuing Medical Education should focus on training programs for recognizing and handling linguistic barriers between physicians and patients. Patient education programs should encourage patients who experience language barriers to open up to physicians. In situations where language is a barrier, physicians and patients should be encouraged to use interpreters to enhance the expression of emotions.

Ways of providing the patient with a prognosis: a terminology of employed strategies based on qualitative data

OBJECTIVE

To identify, denote, and structure strategies applied by physicians and patients when communicating information about prognosis.

METHODS

A descriptive qualitative study based on audiotaped physician-patient encounters between 23 haematologists and rheumatologists, and 89 patients in Oslo. Classification of identified prognostic sequences was based on consensus.

RESULTS

Physicians seldom initiated communication with patients explicitly to find out their overall preferences for prognostic information (metacommunication). Instead, they used sounding and implicit strategies such as invitations, implicatures, and non-specific information that might result in further disclosure of information if requested by the patients. In order to balance the obligation to promote hope and provide (true) information, they used strategies such as bad news/good news spirals, authentications, safeguardings, and softenings. Identified strategies applied by the patients to adjust the physician-initiated prognostic information to their needs were requests for specification, requests for optimism, and emotional warnings.

PRACTICE IMPLICATIONS

The study presents an empirically derived terminology so that clinicians and educators involved in medical communication can increase their awareness of prognostic communication. Based on qualitative data obtained from communication excerpts, we suggest that individual clinicians and researchers evaluate the possible benefits of more frequent use of metacommunication and explicit prognostic information.

Measuring providers' verbal and nonverbal emotion recognition ability: reliability and validity of the Patient Emotion Cue Test (PECT)

OBJECTIVE

To describe the development and validation of the Patient Emotion Cue Test (PECT) as a tool to measure providers' emotion cue recognition ability.

METHODS

The PECT consists of 47 video clips depicting emotion cues that systematically vary in intensity of both verbal and nonverbal contents. The PECT assesses the provider's ability to detect and identify patients' emotion cues accurately. A multi-stage development process produced the PECT. Reliability and validity were assessed in three studies.

RESULTS

Scores on the PECT are normally distributed with significantly above chance responding. Across three studies, the PECT demonstrates convergent validity through significant correlations with standardized tests representing multiple channels of emotion recognition, including the face, body, and voice. The PECT shows adequate inter-item and split-half reliability.

CONCLUSION

The PECT is an easily administered, reliable, and valid test of emotion cue recognition.

PRACTICE IMPLICATIONS

The PECT can be used in future research on providers' emotion recognition ability, for evaluating self-assessment of ability, and as a teaching tool in medical schools.

Development of the Verona coding definitions of emotional sequences to code health providers' responses (VR-CoDES-P) to patient cues and concerns

OBJECTIVE

To present a method to classify health provider responses to patient cues and concerns according to the VR-CoDES-CC (Del Piccolo et al. (2009) [2] and Zimmermann et al. (submitted for publication) [3]). The system permits sequence analysis and a detailed description of how providers handle patient's expressions of emotion.

METHODS

The Verona-CoDES-P system has been developed based on consensus views within the "Verona Network of Sequence Analysis". The different phases of the creation process are described in detail. A reliability study has been conducted on 20 interviews from a convenience sample of 104 psychiatric consultations.

RESULTS

The VR-CoDES-P has two main classes of provider responses, corresponding to the degree of explicitness (yes/no) and space (yes/no) that is given by the health provider to each cue/concern expressed by the patient. The system can be further subdivided into 17 individual categories. Statistical analyses showed that the VR-CoDES-P is reliable (agreement 92.86%, Cohen's kappa 0.90 (±0.04) p<0.0001).

CONCLUSION

Once validity and reliability are tested in different settings, the system should be applied to investigate the relationship between provider responses to patients' expression of emotions and outcome variables.

PRACTICE IMPLICATIONS

Research employing the VR-CoDES-P should be applied to develop research-based approaches to maximize appropriate responses to patients' indirect and overt expressions of emotional needs.

Shifting goals in medical communication. Determinants of goal detection and response formation

OBJECTIVES

Research and education of medical communication different perspective, making the extraction of clear recommendations from research that can be applied in education not always possible. In education, medical communication is encountered from a goal-oriented perspective, which is often lacking in quantitative research where the relationship between process variables and the content of medical practice is often ignored. The aim of this paper is to bring the worlds of research and education together by presenting a comprehensive model of determinants explaining the behavior of physicians in daily practice. A basic notion in this model is that medical communication is goal-oriented, problem-solving behavior. Goals in communication are not fixed, but permanently changing over time. Hence, communication abilities do not rely on behavioral skills only but also on perceptual skills in identifying goals. A number of determinants affect the cognitive processes of goal appraisal and response formation: knowledge, attitudes, social norms, self-efficacy, stressors and interfering goals.

CONCLUSION

Modeling medical communication as goal-oriented problem-solving behavior, and recognizing the complexity of goal appraisal and other key determinants of response formation may provide a common focus for both research and education in measuring, explaining and improving the HCP's behavior.

PRACTICE IMPLICATIONS

In education not only skill practicing but also reflection on the process and outcomes is important to understand how one acts in practice situations and should act in future situations. In research measurements should be expanded to take contextual and goal-oriented dimensions of the process of communication into account to make findings more relevant for education and practice.

General practitioners' responses to the initial presentation of medically unexplained symptoms: a quantitative analysis

BACKGROUND

Physicians in primary and secondary care are frequently confronted with patients with medically unexplained symptoms (MUS). In order to solve their patients' problems and out of a fear of overlooking a serious disease, many physicians give their patients full physical examinations and interventions, thereby incorrectly confirming the somatic nature of their condition. Preventing somatization could be achieved by examining the patient's symptom presentation for clues to underlying psychosocial issues and by an appropriate physician response.

METHODS

Ninety-seven videotaped medical visits from primary care patients presenting MUS for the first time were analyzed. Patients' presentations were categorized in: (1) symptoms only; (2) symptoms with a clue to an underlying concern; or (3) symptoms with an explicit concern. General practitioners' (GPs') responses to patients' presentation were classified into ignoring or more or less exploring responses. Exploring responses were further subdivided in non-directional explorations, clue explorations and medical explorations.

RESULTS

Results show that most patients presented their symptoms together with a reference to an underlying concern. Yet, most of them did so in an implicit way. GPs usually explored the concern presented by the patients, but most often in a medical way only.

CONCLUSION

To address the potential psychological basis of patients' medically unexplained symptoms, GPs should pay more attention to the specific clues patients present to them. Likewise, in order to receive full attention, patients should try to present their concerns more explicitly.

"Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry

BACKGROUND

Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care.

OBJECTIVE

To describe physicians' responses to patients' worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients' ratings of interpersonal aspects of care.

DESIGN

Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about "something serious" in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS.

PARTICIPANTS

One hundred primary care physicians and 4,746 patients.

MEASUREMENTS

Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses.

RESULTS

Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence.

CONCLUSIONS

Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.

Content Development of the Optometric Patient Anxiety Scale

PURPOSE

Patient anxiety has been shown to be detrimental to many aspects of healthcare outcomes. To date, there is no method of evaluating anxiety in optometric practice. Therefore, the purpose of this study was the content development of a questionnaire to measure optometric patient anxiety. Such a tool will have both clinical and research application; allowing the identification of anxious patients in practice and as a method to establish the success of anxiety reducing interventions.

METHODS

Selection of initial items was based on patient interviews, literature review, and focus group feedback. The initial 30-item Optometric Patient Anxiety Scale was piloted on 148 patients in optometric practice. Rasch analysis was used to analyze response category operation and to facilitate item removal to ensure a valid and unidimensional scale. Test-retest reliability (test-retest time, 2 weeks) was measured on 59 young adults to test the stability of the measure with time.

RESULTS

Rasch analysis identified disordering of category thresholds and underutilization of the end-response category. Therefore, categories were merged to a three response solution. Item reduction was principally driven by infit and outfit statistics. The items in the final 10-item scale all had good infit and outfit values (infit: 0.80-1.20, outfit: 0.7-1.3), good person separation (>2) and high person and item reliability coefficients, 0.84 and 0.88, respectively. Test-retest reliability also demonstrated good stability of the measure with time (intraclass correlation; ICC = 0.85).

CONCLUSIONS

The Optometric Patient Anxiety Scale is the first questionnaire to measure patient anxiety specific to optometric practice. The scale was developed using Rasch analysis to ensure that all the items work together to form a valid unidimensional interval scale.

The development of a scale to discover outpatients' perceptions of the relative desirability of different elements of doctors' communication behaviours

OBJECTIVE

The objective of the study was to discover which aspects of doctor communication behaviours are more or less desirable to patients who are attending medical outpatients clinics.

METHODS

Two hundred and twenty patients took part in the study, which was undertaken in four phases. In phase one, patients completed a 10-item questionnaire where they indicated, by means of a five-point scale, their preferences for doctor communication behaviours. In phases two and three patients qualitatively expressed the meaning that they ascribed to terminology that is used by some researchers to define doctor communication behaviours. In the final phase of the study a 12-item questionnaire was developed by integrating the phase one questionnaire and patients' report from phases two and three. Patients indicated, by means of a five-point scale, their preferences for different communication behaviours that might be used by doctors. Patient's preferences were ranked in terms of the most to the least preferred behaviours.

RESULTS

The findings suggest that patients most prefer consultations where doctors give information spontaneously and display affective behaviours. They least preferred consultations where medical matters are discussed and where information is not forthcoming. Furthermore, the finding suggests that the use of blanket terms by researches in defining doctor communication can lead to differences in interpretation by patients.

CONCLUSIONS

The methods developed in the study appear to provide a useful tool to discover patients' desires in terms of doctor communication.

PRACTICE IMPLICATIONS

The rank scale developed in the study could prove useful to medical practice. It could, for example, provide a straightforward method whereby doctors could readily access researcher's recommendations about communication. Furthermore, the scale could be used in various healthcare settings in order to discover if different patient groups vary in terms of the doctor communication they desire.