Why it matters
Communication is integral to the doctor–patient relationship. However, it can be challenging to study due to its multi-faceted nature and the variety of outcome measures that can be applied.
The use of different methodological approaches has resulted in variable quality of evidence and difficulty in comparing results.
We reviewed the literature and analysed a selection of methodologies which have been used to study doctor-patient communication. We considered the logistical advantages and disadvantages, along with the scientific merits and limitations, of the different approaches, and set out a range of illustrative examples.
We aimed to provide researchers with an objective view of the toolkit that is available to them when investigating this important area.
What we found
Communication can be broadly considered in terms of content (what information is given) and style (how the information is given); patients are influenced by both in a way that can be difficult to separate.
Tools for measuring content are often checklists or other quantitative methods, for example checklists used for examining transcripts of consultations. Style of communication is more difficult to measure because it is more difficult to define, and both verbal and non-verbal elements must be considered. Approaches to studying communication style include behavioural-coding and ratings scales. Complex constructs, which consist of elements relating to both style and content, can also be examined. The most widely studied example of a complex construct is ‘patient-centredness’, a type of communication which places greater importance on patient perspectives and involves them more in interactions.
Many researchers are interested in measuring not only the different communication variables, but also their effects, by examining associations between certain aspects of communication and potential consequences. This can include use of subjective measures (how patients feel about communication) and objective measures (exploring more concrete health outcomes or behaviours).
We found a range of study instruments and designs that have been used for gathering data on patient or doctor perspectives, including questionnaires, interviews, vignette studies, observation and analysis of interactions, simulated patient studies, and observations of real consultations. We suggest that using a combination of two or more different study designs can facilitate a more nuanced understanding of doctor–patient communication.
The importance of communication is emphasised in medical education, but the extent to which communications skills taught in training environments are transferred to clinical environments has been questioned; it is still not always clear whether this training has a real-world impact on patient-focused outcomes. Many have emphasised the importance of promoting patient-centredness in doctor–patient communication, with some considering it a means to an end, and others maintaining that patient-centredness is an end in itself with intrinsic value regardless of outcomes.
It is important for researchers to decide which aspects of communication they intend to focus on and to choose a methodology or combination of methodologies that can assess this appropriately. Using combinations of methodologies more creatively can produce evidence that is richer, more robust, and more relevant to both training and clinical practice.
The results of our review of the different tools can help researchers mitigate any problems associated with them and lead to higher quality research.