Table 1 Overview of the selected articles
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. |