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Table 1 Overview of the selected articles

From: The social gradient in doctor-patient communication

First author (Ref. nb.) Setting Method Nb of patients Variable SES Variable communication doctor Variable communication patient Information on validity and reliability Conclusion of the study
Hall professional health care providers meta-analysis 157 (mean) social class indices, education or income information giving, question asking, task and interpersonal competence, partnership building and socio-emotional behaviour   Correlation and standard norm deviate was extracted for each study if possible Higher social class: more overall communication and more information.
Street primary care audiovisual analysis 41 education information giving (diagnostic, treatment, procedural) communicative style: affective expressiveness Unitizing reliability for utterances: Cohen's kappa = 0.84
Reliability categorizing:
Higher educated patients: more diagnostic and health information.
        Physician information giving: 0.82
Partnership building: 0.87
Patient's opinion giving:0.82
More question asking by patient leads to more information giving.
        Patient affective expressiveness: 0.75
Patient's question asking: 0.96
No relation between educational level and question asking
Street multipurpose clinic, pediatric consultation audiotapes 115 educational level partnership building parent's question asking and opinion giving Reliability:
- physician response (0.72-0.95)
- patient response (0.68-0.91)
Higher education: more expressive, higher level of opinionated and asking more questions.
         Personal characteristics less influence on physician response than own communication behavior?
Martin primary care questionnaires 1972 occupation listening, explaining, advice giving, examination listening, explaining, advice giving, examination m No information available Patient perception of consulation: emphasis on prescribing, reassuring and referring
         Physician's perception of consultation: emphasis on active listening, supporting and giving advice.
         Higher social class: more examination, listening and explaining.
         Patients perceive no difference
Fiscella primary care direct observation, chart audits, patiënt reports 2538 education time use, preventive tasks, satisfaction, attributes of primary care Interpersonal communication, patient satifaction Time use: Davis Observation Code Attributes of Primary care:
Components of Primary Care Instrument Patient satisfaction: items from the Medical Outcomes Survey
Lower education more physical examination and nutritional counseling, less time on questions, assessing health knowledge, negotiation and counseling, chatting and screening tests.
        Reliability: doctor satisfaction = 0.90, nurse satisfaction 0.72 Same satisfaction as higher educated.
Taira Employees questionnaires 6549 income discussion of health risk health risk behaviours No information available High income: more diet and exercise discussion.
         Lower income: more smoking discussion
Pendleton primary care videotaped consultations 79 social class amount of information given to the patiënt   No information available High SES: more explanations
Street primary care videotaped consultations 41 education nonverbal behaviour consistency and adaptations   Cohen's kappa: 0.82 for speaking turns and response latencies
0.71 for interruptive speakovers
0.92 for physicians' taks touch
0.85 for illustrators
0.71 for adaptors
0.79 for procimity
0.93 for body orientation
0.90 for turn duration
0.81 for response latency
0.83 for pausing within speaking
0.75 for patient's anxiety
Physicians talking with higher educated patients used more body orientated talk then they did with lower educated.
Kaplan solo & multispecialty practices questionnaires 8316 education PDM (Participatory Decision-Making) style: involve them in treatment decisions, give them a sense of control over medical care and ask them to take some responsibility for care   Data from the Medical Outcomes Survey (MOS)
Reliability Participatory decision making style: 0.74
Lower educated patients: less mutual decision making, less sense of control and given less responsibility.
McKinstry primary care structured interview, video vignettes 410 social class indices shared decision making style   No information available Lower educated patients: lower preference for shared decision making.
Roter primary care audiotape RIAS; questionnaires 537 income narrowly biomedical, expanded biomedical, biopsychosocial, psychosocial, consumerist pattern idem Reliability physician: 0.76
Reliability patient: 0.81
Lower SES patients prefer narrowly biomedical pattern.
Stewart primary care audiotapes 140 educational level information giving; patiënt centredness   Statement made by doctor: Bales Interaction Process Analysis Communication on drugs: scheme developed by Svarstad and refined by Scherwitz and Evans Higer education: more explanation on drug prescription
         Low education: more emotional support
Maly breast cancer treatment program survey, PEPPI 327 education, income interactive information-giving patient-perceived self- efficacy Self-efficacy: validated Perceived
Efficacy in Patient-Physician Interactions (PEPPI) questionnaire Language: Marin Acculturation Scale with reliability of 0.99
Higher education: more interactive information giving by physician and greater perceived self-efficacy.
Piette & Schillinger [39] department of Veterans Affairs (VA),university- based and county health care system telephone interview 752 education Interpersonal Processes of Care (IPC) questionnaire: general clarity; explanations; elicitation of patient's preferences, emotional support   Revised scale of the Interpersonal Processes of Care (IPC) questionnaire with reliability of 0.91 Low SES: better general and diabetes-specific communication than high SES
Jensen primary care survey, interview 131 education, income explain things; listen carefully to what the patient has to say; show respect; spend enough time with the patient idem Questions coming from the Medical Expenditures Panel Survey Patients with high literacy skills are more critical on their physician.
         Low income perceive some areas of tension in communication with their health care provider.
Street primary care patients, lung cancer patients, patients with systemic lupus erythematosus audiotapes 279 education partnership-building; encourage patient involvement; supportive talk asking questions; assertive responses, expressions of concern or other negative emotions Coding system developed by Street and colleagues with reliability ranging from 0.61 to 0.97 depending on the behavior and the study Higher educated patients are more active communicators, ask more questions and are more assertive, but they do not express more concerns
         Patients are more active communicators when physicians use partnership- building.
Siminoff oncology practices audiotapes, RIAS 405 education, income educating and counseling the patient concerning biomedical and psychosocial issues-ask patients for information to indicate understanding, opinion or permission-attempting to built a relationship with the patient-engagement in conversation about the patients emotional status-gathering relevant data and information patient communicates biomedical and psychosocial information; asking questions; building relationship with the physician, engaging in discussion; expression of feelings; Doctor-patient communication: Roter Interaction Analysis System (RIAS) High income patients: receive more biomedical talk, emotional talk, psychosocial counseling and education, ask more question and receive less questions about their disease than low income patients.
Murray american households computer- assisted telephone interview 3209 education, income giving information; decision-making style preferred style of decision-making; experienced style of decision-making; No information available High SES patients prefer shared decision making
         Lowe SES patients prefer consumerism and paternalism
         High SES patients are more likely to experience the preferred style
Bao primary care patient and physician surveys 5978 Income, education self-assessment of communication; performance of communication behaviours when discussing cancer screening   Questionnaire from the Communication in Medical Care (CMC) Research Program series. Low SES patients are more likely to discuss cancer screening then high SES patients.
         Between-physicians differences by income
         Within-physicians differences by education.
Devoe [24] primary care secondary analysis of data from Medical Expenditure Panel Survey (MEPS) (face-to-face interview) 16 700 educational attainment, family income listen carefully; explain things; show respect; spend enough time with the patient   Questionnaires coming from the Medical Expenditure Panel Survey (MEPS) Poor patients: receiving less explanations in a way they understand.