Communicating with older patients: a challenge for researchers and clinicians

Expectations for Care: Older Adults' Satisfaction With and Trust in Health Care Providers

This study sought to determine whether community-dwelling older adults' expectations for care were met by identifying factors that influence trust in and satisfaction with health care providers. Data were collected using a demographic questionnaire and focus group methodology. A total of 39 older adults participated in 8 focus groups. Three categories of themes were identified: a sense of personal touch, technical proficiency, and environmental factors. These categories related to individual providers or practice environments. When providers and practice settings met expectations for care, then the elderly individual was satisfied. Trust was more complex, as the older adults indicated they could be satisfied but not trust providers or they could trust providers but not be satisfied. Implications for practice include spending quality time with older adults and treating them as individuals.

Healthcare providers' sun-protection promotion and at-risk clients' skin-cancer-prevention outcomes

BACKGROUND

This study aims to determine whether healthcare providers' (HCPs') communication dealing with sun-protection (i.e., counseling) is associated with clients' skin-cancer-related prevention practices, detection self-efficacy, and knowledge.

METHODS

Secondary analysis of two surveys of 1,469 randomly sampled farmers and soccer participants from southeast and coastal Georgia.

RESULTS

Farmers and soccer participants who report ever having been counseled by a HCP about how to protect their skin from the sun report being more likely to wear sunscreen (P < 0.05), get clinical exams of their skin (P < 0.001), be certain that they can recognize unhealthy changes in their skin (P < 0.001), be certain that they know how to perform a skin exam (P < 0.001), and be knowledgeable about skin cancer prevention (P < 0.05 and P < 0.001, respectively); soccer participants are additionally more likely to wear protective headgear (P < 0.05) and perform monthly self-exams of their skin (P < 0.001). All analyses incorporated three control variables: participants' prior history of skin cancer, age, and non-HCP-derived skin-cancer awareness.

CONCLUSIONS

Findings suggest that HCPs' counseling can positively shape skin-cancer-related prevention practices, detection self-efficacy, and knowledge. Additional research is needed on HCPs' actual communication about skin cancer and sun protection and its influence on client outcomes.

Correspondence among patients' self-reports, chart records, and audio/videotapes of medical visits

This pilot study examined the covariation of patients' self-reports of instrumental and affective aspects of communication during physician-patient visits with 2 other sources of data: medical chart records and audio/videotapes. Participants were 17 community-based (nonuniversity) primary-care physicians and 77 of their patients, ages 50 to 80. Patients were interviewed by telephone within 1 week after their medical visits. Thirty-five of these visits were audio- and videotaped. Patients were asked to report on their receipt of specific cancer screening in the previous 2 years, the occurrence of instrumental communication events during the visit (e.g., recommendations), their affect, and their visit experiences and communication with their physicians. Results showed (a) noteworthy disagreements between patients' self-reports and medical charts regarding cancer screening; (b) better agreement of patients' self-reports with videotape records than with chart records regarding physicians' recommendations; (c) accurate recognition of patients' self-reported affect, communication, and visit experiences by third-party raters of both audiotapes and videotapes; and (d) similar correlations of audio- and videotape ratings with patients' self-reports as well as substantial correlations between audio and video ratings. The implications of these findings are discussed, and recommendations are made for future research.

The influence of patient age on primary care resident physician-patient interaction

OBJECTIVES

To explore resident physician-patient interaction in primary care to address issues relevant to quality of care for older people.

DESIGN

A sample of 509 new, adult, nonpregnant patients was assigned to the care of second- and third-year residents in primary care clinics. Care was compared for three subgroups of patients: older patients (65 years or older; n = 45), those aged 18 to 44 years (n = 320), and those aged 45 to 64 years (n = 144).

SETTING

Observations were made at the family medicine and general internal medicine clinics at the University of California, Davis.

MEASUREMENTS

Self-report by means of the Medical Outcomes Study Short Form-36 (MOS SF-36) was used to determine patient demographics and patient health status. Two measures of satisfaction were obtained gauging reaction to medical care in general and to the videotaped visit specifically. Videotapes were coded for content using the Davis Observation Code.

RESULTS

Self-reported health status of older persons was poorer than that of younger groups as measured by the MOS SF-36. Differences in demographics were explored and then controlled, along with physical health status in subsequent analyses. Supporting prior studies, this study found that older patients had more return visits and reported higher levels of satisfaction than did younger comparison groups. Contrary to prior literature, older patients were found to have longer visits than did younger cohorts. The physician-patient interaction was significantly different in many areas between these three groups. Whereas older patients experienced more chatting in their visits, they were given less counseling, asked fewer questions, had less discussion about their families and their use of substances, were asked to change their health behavior habits less often, and were given less health education. For older patients, more of each visit was spent checking on compliance with earlier treatment and developing treatment plans.

CONCLUSIONS

These results provide a new and more detailed view of how resident physician-patient interaction differs between older and younger groups and raise important issues on whether quality of care needs for this population are being adequately addressed, particularly regarding mental health issues.