Author: Mollie Alyssa RubenPublisher:
ISBN:
Category : Communication in medicine
Languages : en
Pages : 198
Book Description
Patient centered care is a healthcare movement that supports patients' active involvement in their health through building a quality relationship with physicians and sharing in decision making. The provider can foster patient centered care through their own verbal and nonverbal behavior. Patient centered care has been associated with many positive outcomes for patients including increased satisfaction, adherence, and less shopping around for physicians. But less research has focused on the direct impact of patient centered care on health outcomes. The present research aimed to first validate skin conductance as a measure of pain intensity in Study 1. Study 2 examined the effect and impact of physician patient centered vs. clinician centered nonverbal and verbal behavior on participants' pain experience. Finally, Study 3 examined the impact of physician communication style from Study 2, on new onlookers' assessments of pain. In Study 1, participants underwent a standardized laboratory pain procedure called the tourniquet task. Their skin conductance was monitored throughout the pain task and they made pain ratings every 30s on a scale from no pain at all (0) to the most intense pain imaginable (10). Results showed that skin conductance level and response increased from baseline to pain task. Skin conductance level was also validated as a measure of pain intensity as the correlation between participants' mean tonic SCL every 30s and their self-reported pain intensity every 30s was highly and positively correlated. Study 1 findings suggested that skin conductance is a valid and sensitive objective indicator of participants' pain intensity. In Study 2, trained and professional actors (one male and one female) were videotaped playing the part of a physician either giving patient centered nonverbal, patient centered verbal, clinician centered nonverbal or clinician centered verbal instructions on a pain task, in a fully crossed design. Participants came into the laboratory and were randomly assigned to have a one-way interaction with one of the 8 physician videos. The one-way interaction allowed for the physicians' behavior to remain constant while participants responded to the physician (when the physician asked questions or when participants had questions) as if they were talking to the physician in real life. An experimenter monitored the participant and answered any questions that the physician did not address in the videotape. Participants then underwent the same pain task as in Study 1 (the tourniquet task), their skin conductance was monitored, and they gave oral ratings of their pain intensity on the same scale as in Study 1. After participants completed the pain task and answered questions about how the pain felt led by the physician, participants completed post task questionnaires to understand the pain experience and also their satisfaction and impressions of the physician. Participants' laboratory session was video recorded in order to code the pain experience and reflection of pain. Results showed that patient centered nonverbal behaviors displayed by the physicians (more gaze, smiling, nodding, and a warm tone of voice) tended to reduce the experience of pain for participants--in their reports of pain at the time and two weeks later (for males only), and for all participants in their expressions of pain and in how long they tolerated the task. Verbal patient centeredness did not have an impact on participants' pain experience; however, verbal patient centeredness did impact the way participants talked about their pain (using more affective and emotional words and appearing less anxious and more engaged when talking about pain). Neither verbal nor nonverbal behavior of the physician impacted skin conductance level, though skin conductance level was positively correlated with pain intensity ratings. Finally, Study 3 utilized the videotaped pain experience from Study 2 to ask new participants or judges to infer how much pain each of the Study 2 participants were experiencing. Judges were more accurate at judging Study 2 participants who had initially been assigned to the nonverbally patient centered physicians compared to the nonverbally clinician centered physicians. Results of these three studies suggest that patient centered nonverbal behavior has an impact on objective and subjective indicators of pain--with a tendency to alleviate the pain experience--while patient centered verbal behavior has a direct impact on how people talk about their pain. These results can be used to train medical providers to display nonverbal and verbal expressions of patient centeredness when patients are undergoing painful procedures or reflecting on a pain experience in order to possibly reduce the pain intensity experienced and to get patients to disclose more emotional information after a pain experience.