Item Details

A method to assess the organizing behaviors used in physicians’ counseling of standardized parents after newborn genetic screening

Issue: Vol 9 No. 2 (2012)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.v9i2.101


Well-organized conversation can improve people’s ability to comprehend and retain information. As part of a long-term effort to adapt Quality Improvement techniques for communication, we developed an explicit criteria method to assess usage of three organizing behaviors (OBs): ‘opening behaviors’ to establish goals; ‘structuring behaviors’ to guide patients through conversation; and ‘emphasizing behaviors’ that signal a need for attention. Pairs of abstractors independently reviewed transcripts in a demonstration sample of conversations between physicians and standardized parents after newborn screening identifies carrier status for sickle cell disease. Criteria for at least one OB were identified in 50/84 transcripts (60%), including 27 with at least one opening behavior (32%), 5 with at least one structuring behavior (6%), and 38 with at least one emphasizing behavior (45%). The limited number of OBs raises concern about communication after newborn screening. Assessment and improvement of OB usage may improve understanding and allow parents to more actively participate in health care.

Author: Stephanie A. Christopher, Nadia Y. Ahmad, Lisa Bradford, Jenelle L. Collins, Kerry Eskra, Alison La Pean Kirschner, Faith O. O'Tool, Sara J. Roedl, Michael H. Farrell

View Original Web Page

References :

Allen, D. B. and Farrell, P. M. (1996) Newborn screening: Principles and practice. Advances in Pediatrics 43: 231–270.
Allison, J., Wall, T., Spettell, C., Calhoun, J., Fargason, C. J., Kobylinski, R., Farmer, R. and Kiefe, C. (2000) The art and science of chart review. Joint Commission Journal on Quality Improvement 26 (3): 115–136.
Ashton, C. M., Kuykendall, D. H., Johnson, M. L. and Wray, N. P. (1999) An empirical assessment of the validity of explicit and implicit process-of-care criteria for quality assessment. Medical Care 37 (8): 798–808.
Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A. and Kudelka, A. P. (2000) SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist 5 (4): 302–311.
Bower, G. M., Clark, M. C., Lesgold, A. M. and Winzenz, D. (1969) Hierarchial retrieval schemes in recall of categorized word lists. Journal of Verbal Learning and Verbal Behavior 8 (3): 323–342.
Cegala, D. J., Marinelli, T. and Post, D. (2000) The effects of patient communication skills training on compliance. Arch Fam Med 9 (1): 57–64.
Chesebro, J. J. and McCroskey, J. C. (2001) The relationship of teacher clarity and immediacy with student state receiver apprehension, affect, and cognitive learning. Communication Education 50 (1): 59–68.
Ciske, D., Haavisto, A., Laxova, A., Rock, L. and Farrell, P. (2001) Genetic counseling and neonatal screening for cystic fibrosis: An assessment of the communication process. Pediatrics 107 (4): 699–705.
Clever, S. L., Jin, L., Levinson, W. and Meltzer, D. O. (2008) Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrument variable. HSR: Health Services Research 43 (5): 1505–1519.
Coulehan, J. L. and Block, M. R. (2006) The Medical Interview: Mastering Skills for Clinical Practice (5th ed.). Philadelphia: F.A. Davis Co.
Deuster, L., Christopher, S. A., Donovan, J. and Farrell, M. H. (2008) A method to quantify residents’ jargon use during counseling of standardized patients about cancer screening. Journal of General Internal Medicine 23 (12): 1947–1952.
DiMatteo, M. R., Hays, R. D. and Prince, L. M. (1986) Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychology 5 (6): 581–594.
DuBois, N. F., Alverson, G. F. and Staley, R. K. (1979) Educational Psychology and Instructional Decisions. Homewood, Illinois: The Dorsey Press.
Elwyn, G., Gray, J. and Clarke, A. (2000) Shared decision making and non-directiveness in genetic counselling. Journal of Medical Genetics 37 (2): 135–138.
Farrell, M. H., Deuster, L., Donovan, J. and Christopher, S. (2008) Pediatric residents’ use of jargon during counseling about newborn genetic screening results. Pediatrics 122 (2): 243–249.
Farrell, M. H., Certain, L. and Farrell, P. M. (2001) Genetic counseling and risk communication services of newborn screening programs. Archives of Pediatrics and Adolescent Medicine 155 (2): 120-126.
Farrell, M. H., Chan, E. C. Y., Ladouceur, L. and Stein, J. M. (2009a) A structured implicit abstraction method to evaluate whether content of counseling before prostate cancer screening is consistent with recommendations by experts. Patient Education and Counseling 77 (3): 322–327.
Farrell, M. H., Christopher, S. A., Tluczek, A., Kennedy-Parker, K., La Pean, A., Eskra, K. L., Collins, J., Hoffman, G., Panepinto, J. and Farrell, P. M. (2011) Early experience of the Wisconsin Project on improvement of communication process and outcomes after newborn screening. Wisconsin Medical Journal 110 (5): 221–227.
Farrell, M. H. and Farrell, P. M. (2003) Newborn screening for cystic fibrosis: Ensuring more good than harm. Journal of Pediatrics 143 (6): 707–712.
Farrell, M. H. and Kuruvilla, P. (2008) Assessment of parental understanding by pediatric residents during counseling after newborn genetic screening. Archives of Pediatrics and Adolescent Medicine 162 (3): 199–204.
Farrell, M. H., Kuruvilla, P., Eskra, K. L., Christopher, S. A. and Brienza, R. S. (2009b) A method to quantify and compare clinicians’ assessments of patient understanding during counseling of standardized patients. Patient Education and Counseling 77: 128–135.
Farrell, M. H., La Pean, A. and Ladouceur, L. (2005) Content of communication by pediatric residents after newborn genetic screening. Pediatrics 116 (6): 1492–1498.
Farrell, M. H., Speiser, J., Deuster, L. and Christopher, S. A. (2012) Child health providers’ precautionary discussion of emotions during communication about results of newborn genetic screening. Archives of Pediatrics and Adolescent Medicine 166 (1): 62–67.
Feinstein, A. (1985) Clinical Epidemiology: The Architecture of Clinical Research. Philadelphia: WB Saunders.
Fujishin, R. (2008) The Natural Speaker (6th edn). New York: Allyn & Bacon.
Glanzer, M. and Cunitz, A. R. (1966) Two storage mechanisms in Free Recall. Journal of Verbal Learning and Verbal Behaviour 5 (4): 351–360.
Greene, M. G., Adelman, R. D., Friedmann, E. and Charon, R. (1994) Older patient satisfaction with communication during an initial medical encounter. Social Science and Medicine 38 (9): 1279–1288.
Hall, J. A., Roter, D. L. and Katz, N. R. (1988). Meta-analysis of correlates of provider behavior in medical encounters. Medical Care 26 (7): 657–675.
Heritage, J. and Robinson, J. D. (2006) The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication 19(2): 89–102.
Inui, T. S., Yourtee, E. L. and Williamson, J. W. (1976) Improved outcomes in hypertension after physician tutorials: A controlled trial. Annals of Internal Medicine 84 (6): 646–651.
Jencks, S. F., Huff, E. D. and Cuerdon, T. (2003) Change in the quality of care delivered to medicare beneficiaries, 1998–1999 to 2000–2001. Journal of the American Medical Association 289 (3): 305–312.
Kaplan, S. H., Greenfield, S. and Ware, J. E., Jr. (1989) Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care 27 (3 Suppl): S110–127.
Kurtz, S., Silverman, J. and Draper, J. (1998) Teaching and Learning Communication Skills in Medicine. Abingdon, Oxon, UK: Radcliffe Medical Press.
La Pean, A. and Farrell, M. H. (2005) Initially misleading communication of carrier results after newborn genetic screening. Pediatrics 116 (6): 1499–1505.
Levinson, W. and Roter, D. (1993) The effects of two continuing medical education programs on communication skills of practicing primary care physicians. Journal of General Internal Medicine 8 (6): 318–324.
Ley, P. (1988) Communicating with Patients: Improving Communication, Satisfaction and Compliance. London: Croom Helm.
Ley, P., Bradshaw, P. W., Eaves, D. and Walker, C. M. (1973) A method for increasing patients’ recall of information presented by doctors. Psychological Medicine 3 (2): 217–220.
Lipkin, M., Putnam, S. and Lazare, A. (1995) The Medical Interview: Clinical Care, Education, and Research. New York: Springer.
Lucas, S. (2001) The Art of Public Speaking (8th edn). Boston: McGraw Hill.
Mainz, J. (2003) Defining and classifying clinical indicators for quality improvement. International Journal for Quality Health Care 15 (6): 523–530.
Makoul, G. (2001) Essential elements of communication in medical encounters: The Kalamazoo consensus statement. Academic Medicine 76 (4): 390–393.
Marvel, M. K., Epstein, R. M., Flowers, K. and Beckman, H. B. (1999) Soliciting the patient’s agenda: Have we improved? Journal of the American Medical Associaiton 281 (3): 283–287.
Maynard, D. W. (1996) On ‘realization’ in everyday life: The forecasting of bad news as a social relation. American Sociological Review 61 (1): 109–131.
Miller, G. E. (1990) The assessment of clinical skills/competence/performance. Academic Medicine 65 (9 Suppl): S63–67.
Morgan, M., Fischhoff, B., Bostrom, A. and Atman, C. (eds) (2001) Risk Communication: A Mental Models Approach. Cambridge: Cambridge University Press.
Ong, L. M., de Haes, J. C., Hoos, A. M. and Lammes, F. B. (1995) Doctor-patient communication: A review of the literature. Social Science Medicine 40 (7): 903–918.
Orth, J. E., Stiles, W. B., Scherwitz, L., Hennrikus, D. and Vallbona, C. (1987) Patient exposition and provider explanation in routine interviews and hypertensive patients’ blood pressure control. Health Psychology 6(1): 29–42.
Rhoades, D. R., McFarland, K. F., Finch, W. H. and Johnson, A. O. (2001) Speaking and interruptions during primary care office visits. Family Medicine 33 (7): 528–532.
Robbins, J. A., Bertakis, K. D., Helms, L. J., Azari, R., Callahan, E. J. and Creten, D. A. (1993) The influence of physician practice behaviors on patient satisfaction. Family Medicine 25 (1): 17–20.
Rost, K. M., Flavin, K. S., Cole, K. and McGill, J. B. (1991) Change in metabolic control and functional status after hospitalization. Impact of patient activation intervention in diabetic patients. Diabetes Care 14 (10): 881–889.
Roter, D. L. and Hall, J. A. (eds) (1992) Doctors Talking with Patients, Patients Talking with Doctors: Improving Communication in Medical Visits. Westport, Connecticut: Auburn House.
Seel, N. (2006) Mental models in learning situations. Advances in Psychology 138: 85–110.
Sharp Jr., H. and McClung, T. (1966) Effects of organization on the speaker’s ethos. Speech Monographs 33: 182–183.
Silverman, J., Kurtz, S. and Draper, J. (eds) (1998) Skills for Communicating with Patients. Abingdon, Oxon, UK: Radcliffe Medical Press.
Smith, R. C. (ed) (2002) Patient-Centered Interviewing: An Evidence-Based Method (2nd edn). Philadelphia: Lippincott, Williams and Wilkins.
Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W. and Jordan, J. (2000) The impact of patient-centered care on outcomes. Journal of Family Practice 49 (9): 796–804.
Street Jr, R. L. (1991) Physicians’ communication and parents’ evaluations of pediatric consultations. Medical Care 29 (11): 1146–1152.
Thompson, E. C. (1960) An experimental investigation of the relative effectiveness of organizational structure in oral communication. Southern Speech Journal 26: 59–69.
Titsworth, B. S. (2001) The effects teacher immediacy, use of organizational lecture cues, and students’ notetaking on cognitive learning. Communication Education 50 (4): 283–297.