He Ritenga Whakaaro - New Zealand Doctor

Tātaritanga ā Rangahau Hāngai - Literature Review 2
Little et al (2001) also reported that a positive, patient-centred approach results in greater patient satisfaction,
greater enablement, a lesser burden of symptoms, and lower rates of referral. Most of the ‘patient-centred’
approach relied upon good communications skills and relationship development.
Crow et al (2002) in a major review of literature for an NHS Health Technology Assessment of measurement of
satisfaction, reported on studies that investigated the patient-clinician relationship and the importance of that
bond to patient ratings of satisfaction.. The eight studies reviewed by Crow confirm that patient satisfaction is
more closely related to provider communication skills (and attitudes) than to issues of service access or availability.
Crow also reported on 43 studies that examined the features of patient-clinician relationships, noting that the key
elements that predict satisfaction are:
1. Affective behaviours, such as those demonstrating:
• worth and respect (Kenny 1995)
• friendliness (Korsch et al 1968; Stewart 1989; Bertakis et al 1991; Greene et al 1994; Gross et al 1998; Hall
et al 1998)
• trust (Ben-Sira 1990; De La Cuesta 1997)
• courtesy and empathy (Comstock et al 1982)
• supportiveness (Greene et al 1994)
• sensitivity (Holloway et al 1989)
• understanding (Treadway 1983)
2. Clear explanations and information sharing (Korsch et al 1968; Stiles et al 1979; Kent Smith et al 1981;
Comstock et al 1982; Brody et al 1989; Stewart 1989; Robbins et al 1993; Kenny 1995; De La Cuesta 1997;
Kvamme & Hjortdahl 1997; Gross et al 1998; Hall et al 1998; Krupat et al 2000; Jackson et al 2001)
By contrast Crow et al noted that patient satisfaction decreased in studies that reported:
• overly technical discussions, (Kent Smith et al 1981; Wartman et al 1983; Bartlett et al 1984; Robbins et al
1993)or
• clinician-dominated discussions (Bertakis et al 1991; Buller & Buller 1987).
Furthermore Crow et al (2002) reported that the consistent finding from all parts of the health sector was that, ‘
… the most important factor affecting satisfaction is the patient-practitioner relationship, including information
giving’. The importance of this relationship has been suggested to underlie the public’s interest in alternative and
complementary therapies.
‘Patients find these practitioners speak a language that is more easily understood than what they
perceive as the unintelligible gobbledygook of the scientifically trained doctor… Alternative
health practitioners are often better at communication because they use a more patient friendly
and simplistic model; doctors’ scientific training often leaves them wrestling with how to
communicate the complexity of clinical uncertainties’. (Persaud 2005)
Steinberg (2002) refined this further, concluding that good communication between the patient and clinician (as
perceived by the patient) is perhaps the most important predictor of patient experiences, satisfaction, and trust, as
well as being associated with improved clinical outcomes. The establishment of rapport is not only key to making
the correct diagnosis, but it is also how patients (and their families) are convinced of the value of the recommended
treatment plan (Cram et al 2003; Persaud 2005).
As mentioned above, doctors often lack good communication skills (Beckman & Frankel 1984; Buetow et al 1996;
Falvo & Tippy 1998; Marvel et al 1999; Lamont & Christakis 2001), in spite of self-belief to the contrary (Ford et al
1996). International research clearly shows that these difficulties are exacerbated when communication crosses
cultural boundaries, such as between white doctors and non-white patients (Schouten et al 2007). For example,
non-white patients with advanced AIDS rated the quality of communication with white physicians about their
end-of-life care lower than did white patients with advanced AIDS (Curtis et al 1999). In another study, Johnson et
He Ritenga Whakaaro: Māori experiences of health services | 29