2. MAAS-MI / Instrumental Utility

2.2Measuring Patient Satisfaction

Consultations can be impaired by disruptions in the communication between the patient and the practitioner.

For a good interview, patients consider these three factors to be of prime importance:

  • Expressing their concerns and emotions
  • Receiving information about their complaints, causes and prognosis
  • Complying with the advice and medical regimen prescribed for them.

The Patient Satisfaction with Communication Checklist enhances your understanding of what makes a good medical interview. Feedback from simulated patients is the next best thing to a critique by a real patient, giving you extra insights.

In This Chapter

Crijnen, A. A. M., & Kraan, H. F. (1987). Measuring patient satisfaction with the communication. In H. F. Kraan & A. A. M. Crijnen (Eds.), The Maastricht History-taking and Advice Checklist – studies of instrumental utility (pp. 145–171). Lundbeck, Amsterdam.

Measuring Patient Satisfaction

In patient satisfaction, which reflects the patient’s perception of the quality of the delivered care, three dimensions are generally discerned: namely, an affective dimension, a cognitive dimension and the intention to comply, although the quantity and diversity of scientific communications on this issue lead one to believe that much differentiation is observed (Korsch et al, 1972; Wolf et al, 1978; Pendleton, 1983).

Research regarding patient satisfaction is, unfortunately, often characterised by a lack of sound methodology, because the dimensions within the patient’s satisfaction with health care are ill defined and because many studies pay insufficient attention to the psychometric quality of measurement (Ware et al, 1978; Locker et al, 1978; Lebow, 1982; Lebow, 1983). 

Patient Satisfaction

Affective Satisfaction  Affective satisfaction refers to the patient’s feelings of trust and confidence in the physician and his perception of the physician’s positive regard and willingness to listen to the patient’s concerns. Affective satisfaction is likely to be increased when the physician deals with the patient’s concerns and expectations and when the physician enables the patient to express thoughts and emotions.

Satisfaction is enhanced when the physician enables the patient to express thoughts and emotions, and listens to their concerns, emotions and expectations

Cognitive Satisfaction  Cognitive satisfaction points to explanations and information given by the physician and to the patient’s understanding of diagnosis, etiology, prognosis and (side-)effects of treatment. Cognitive satisfaction is increased when the physician volunteers a lot of information and explains the patient’s condition comprehensively. 

Intention to Comply  The intention to comply refers to the patient’s determination to follow-up the proposed treatment plan. Compliance is affected by the quality of information-exchange from physician to patient and by the patient’s participation in the negotiation on the request for help. The patient’s opinion of the quality of the communication is usually evaluated in terms of these three dimensions. 

Shortcomings in research on patient satisfaction

Furthermore, research on patient satisfaction is characterized by two shortcomings: measurements of satisfaction are often ill-defined and insufficient attention is given to the psychometric properties of the scales.

The first shortcoming is due to the fact that the term ‘patient satisfaction’ points to the patient’s opinion of the provided care in general and covers a wide array of dimensions, ranging from a global impression of satisfaction immediately after a consultation to opinions on more specific topics such as the physician’s technical qualities or interpersonal manner, etc. Moreover, researchers appear to be very creative in the development of instruments, each with a specific content (Lebow, 1983). As a result, confusion arises over the constituents of satisfaction and it is difficult to compare different studies and to determine what patients actually value in physician-patient communication. 

The second shortcoming pertains to the quality of measurement, because the process of scale construction is often insufficiently guided by sound psychometric procedures and statistics (Ware et al, 1978; Locker et al, 1978; Thorndike, 1982). Evidence of reliability, such as coefficients of internal consistency used to support item selection, is usually not provided. Many studies fail to achieve variability in scores due to social desirability or halo effects (Ware et al, 1978; Lebow, 1982). Ultimately, differences between patients with regard to the studied dimensions are inadequately measured and it remains unclear to which degree the scales are measuring the concepts validly. 

To Overcome Shortcomings  Ware et al (1983) suggested the construction of multi-item scales based on factored homogeneous item dimensions: groups of items which have a similar content theoretically and which share a substantial amount of variance empirically.

They constructed the Patient Satisfaction Questionnaire, which measures six different characteristics of providers of medical care services that are considered in general as influencing patient satisfaction. These dimensions are: interpersonal manner, technical quality, accessibility/convenience, finances, efficacy/outcomes, continuity, physical environment, availability. The dimensions: technical quality and interpersonal skills appeared to be most influential in determining patient satisfaction, but these dimensions were more difficult to measure when compared with the other dimensions. To enhance the quality of measurement, both scales had more items added.

In addition to the scale construction procedure, the multitrait-multimethod validation procedure was applied to these measurements (see also Instrumental Utility Assessed). Difficulties were experienced with regard to divergent validity which suggests that characteristics of the method of measurement interfered with the assessment of the dimension under study.

The conclusion can therefore be drawn that even the application of solid scale construction procedures does not guarantee the quality of measurement, especially with regard to the evaluation of the patient’s perception of the physician’s competence. 

This Study

In the study presented here, the construction of the Patient Satisfaction with Communication Checklist is described. To overcome the shortcomings mentioned above, the dimensions contributing to patient satisfaction were determined both theoretically and empirically and, secondly, the quality of measurement of the scales was enhanced by applying demanding psychometric statistics, such as the Rasch-model, in the process of scale construction. 

Method

The method section comprises the construction of the original Patient Satisfaction with Communication Checklist, a justification for the choice of the scaling model, a description of the subjects and, finally, the analyses with results. 

Construction

Formulation of the 54 statements which constituted the original PSCC was based on empirical evidence reported in the literature and theoretical reflections on the impact of physician-patient communication on the patient.

Nine dimensions were selected to provide a framework for item formulation.

More

Brief definitions of the dimensions are presented below:

  1. Facilitation: The patient’s opinion of the physician’s interview behavior that encouraged them to voice their concerns and to ask any questions;
  2. Understanding: The patient’s perception of whether the physician understood their concerns and complaint(s);
  3. Directivity: The patient’s opinion on the degree to which the physician controlled the content and course of the consultation;
  4. Disrupted communication: The physician’s behavior generally considered as hampering the communication;
  5. Providing information: The quality and amount of information provided by the physician;
  6. Insight: The patient’s judgment of whether their comprehension of his complaint(s) and problems has been increased by the end of the consultation;
  7. Intention to comply: The patient’s intention to comply with the proposed advice and treatment;
  8. Empathy: The patient’s perception of the physician’s understanding of their inner world;
  9. Satisfaction: The patient’s opinion on the degree to which the consultation was satisfactory. 

Within each dimension, several statements have been formulated pertaining to either the quality of the physician’s communicative behavior with regard to this dimension or to the impact of the physician’s behavior on the patient. All statements referred to a specific, well-described topic. Moreover, they were worded in brief sentences in easy to understand Dutch. During the formulation of items, a methodological suggestion made by Locker and Dunt (1978) was adopted to measure patient satisfaction with items referring to specific topics.

Patients were requested to recall what they had experienced during the foregoing consultation and to indicate on Likert-type, 5-point scales whether they agreed or disagreed with the statements.

Choice of the scaling model

The central issue during scale construction is the assembly of a set of items which measure the dimension of interest to a satisfactory degree and which collectively reflect different levels of achievement on this dimension. The process of scale construction is supported scientifically by scaling models that formalize the relationship between subjects’ responses on items and indices which represent the level of achievement. 

Two well-known scaling models are based on either classical test theory or latent trait models.

More

Classical test theory  Classical test theory has been criticized because of its use of a linear model for the ‘number of items correct’-score, and because of the restricted generalizability of the test conclusion. Critics state that the discrete character of each item and its score is neglected by using the sums of zero and one scores to position a subject on the dimension of interest. Moreover, test parameters, such as internal consistency, item difficulties and item-test correlations, depend heavily on the sample of persons and the group of items tested. Arbitrary elements impinge strongly on the final conclusions about persons. 

Latent trait models  Latent trait models have recently gained in popularity (Hambleton et al, 1977; Wright, 1977; Meerling,1981). These models specify the relation between observable test performance and the unobservable traits by means of a mathematical function. The Rasch-model is the most demanding, but also the most attractive latent trait model. In the Rasch-model, all items are assumed to have equal discriminating power and to vary only in terms of their difficulty. The advantages of the Rasch-model are that item-parameters are invariant across samples of subjects chosen from the population of interest and that a subject’s ability can be estimated from any subset of items that appeared to fit in the model.

The Rasch-model therefore allows the construction of scales independent of the specific sample of subjects on which the data for scale construction were obtained and independent of the specific items that are used. 

In the present study, the Rasch-model was applied to secure optimal measurement properties of the scales in the Patient Satisfaction with Communication Checklist.

Subjects

Since the PSCC is intended to be employed as an outcome measurement of physician-patient communication in general practice care and as an outcome measurement of the physician/student-simulated patient communication in medical education, the sample of subjects was drawn from both populations (see Table 1).

Real patients and simulated patients were included in the study.

More

Real Patients  The PSCC was filled out by 117 consecutive patients during consultation hours of seven general practitioners. After leaving the consultation-room, the physician’s secretary or a research-assistant asked the patients to fill in the checklist. Approximately 30 patients did not take part in the study, mostly because they were in a hurry or because they had left the physician’s office before they were asked to participate. After reading the checklist, no patient refused to answer it.

Simulated Patients  In addition, 160 checklists were filled in by 9 different simulated patients who were interviewed by 40 residents in primary care as part of the validity study of the Maastricht History-taking and Advice Checklist, a measurement of physicians’ medical interviewing skills (Crijnen et al, 1985; see Tools). During simulated consultation-hours, residents were asked to behave as if they were taking charge of a colleague’s practice and to interview 4 simulated patients for 15 minutes. Simulated patients presented complaints accompanying myocardial infarction, inception of diabetes mellitus, panic disorder or major depression. At the end of each interview, they were asked to give their personal opinion on the quality of the communication on each of the 54 PSCC items. The participating simulated patients were recruited from a larger pool of lay-people trained by the Skills Laboratory at Maastricht Medical School to simulate complaints in the undergraduate medical curriculum. Simulated patients are able to offer feedback on a physician’s performance and to provide suggestions for the improvement of interviewing skills (Stillman et al, 1983). 

Due to missing values on one or more of the 54 items of the original checklist, only 95 of the 117 checklists filled in by real patients and 151 of the 160 checklists filled in by simulated patients were available for computations.

Table 1 -- Participating Subjects
Schermafbeelding 2021-02-18 om 16.02.39

Analyses & Results

A sequence of analyses was carried out to explore the dimensions in the checklist and to construct the scales.

  • Factor-analyses followed by Rasch-analyses: Table 2;
  • Rasch-analyses at scale-level: Table 3;
  • Rasch-analyses regarding measurement-properties of items per scale: Tables 4.1 – 4.5;
  • Rasch-analyses to establish scale-dimensionality: Table 5;
  • Rasch-analyses comparing simulated and real patients: Table 6.

More

To facilitate statistical analyses, data were prepared in several ways. Eighteen negatively-formulated items were recoded and the 5-point scale was split into one and zero scores because Rasch analysis requires dichotomized data. One is a positive answer e.g. strongly agree and agree, whereas zero is a negative answer e.g. no opinion, disagree and strongly disagree.

Factor-analyses

The PSCC was first factor-analyzed by means of a Varimax rotation for 9 factors followed by an analysis for 4 factors since 9 resp. 4 theoretical dimensions were considered to underlie the construction of the original checklist (SPSS – Nie et al, 1975). The sequence of these analyses is depicted in Table 2.

Procedure  Items with a factorloading greater than .50 for the first five and .35 for the remaining factors were selected to constitute the dimensions. Responses on these items formed input for Rasch analyses. Since the theoretical considerations and empirical evidence with regard to the dimensions in patient satisfaction appeared to be only partly in accordance and because the number of dimensions was considered to be too large, additional analyses were carried out. A second Varimax-rotated factor analysis for 4 factors, followed by Rasch analyses, was applied. Results were still unsatisfactory because the disagreement between theory and empirical evidence continued. In the final step, items stemming from both 9 and 4 factor factor analyses which pertained to identical dimensions formeel input for Rasch analyses. 

Results  The 9 factor factor analysis produced 7 factors related to 8 hypothesized dimensions (see Table 2). One new dimension emerged called “physician’s expertise”. One factor could not be interpreted. Six factors fitted in the Rasch-model, although the content of the factors was not always clearly related to the theoretical dimensions. Facilitation and satisfaction clustered in one factor. Two factors contained items of both the dimensions providing information and insight. Disrupted communication, directivity and intention to comply pertained clearly to their hypothesized dimensions.

In the 4 factor factor analysis, satisfaction and facilitation formed the first factor, providing information and insight the second, disrupted communication the third, and the intention to comply with the fourth. All item-groups fitted well in the Rasch model.

Finally, after Rasch-analyzing items stemming from a combination of the 9 and 4 factor solutions, the dimension Satisfaction disappeared from the dimension Facilitation. Insight and Providing Information formed a second dimension, whereas Disrupted Communication and the Intention to Comply formed two further dimensions.

Since Directivity emerged in the first analyses as a Rasch homogeneous scale, and because it formed a theoretically well-defined dimension, it became part of the final PSCC together with Facilitation, Insight, Intention to Comply and Disrupted Communication.

Rasch-Analyses

Rasch analyses were carried out by means of the PML-program (Gustaffson, 1977; Molenaar, 1981).

Procedures  By applying the Binomial test and Allerup’s Graphical test, items were selected to fit in the Rasch- model. Subsequently, the scalability of item groups was analyzed by means of the Martin Löf chi-square test which determines the fit between the observed proportion positive answers for a pertinent item on each ability level and the estimated probability of a positive answer according to the assumptions of the Rasch-model. Items which diminished the fit were eliminated. In addition, the uni-dimensionality of the ultimate scales was tested by a second Martin Löf test which determines differences of estimated person parameters between pairs of scales. Finally, item parameters and confidence intervals were computed separately for the sample of simulated patients and for the sample of real patients to determine the occurrence of item-bias. 

Results  Statistics of the Martin Löf-test presented in Table 3, indicate a good fit of the item-groups to the assumptions of the Rasch-model. The hypothesis that the item-groups form Rasch-homogeneous scales cannot be rejected according to the goodness of fit-test used, as is evidenced by the high probabilities (Löf, 1973). Directivity fits least well.

The measurement properties of each item per scale are presented in more detail in Tables 4.1 – 4.5:

  • Estimates of a subject’s ability on the dimensions of interest are indicated by raw scores and ability scores. The item parameter estimates, which reflect the strength of an item in measuring the dimension of interest, are indicated by the item difficulties. Low item difficulties require only low ability scores to answer an item positively.
  • Moreover, the observed proportion of positive answers is compared to the estimated probability of a positive answer according to the Rasch-model. Strong similarities between observed and estimated proportions positive answers can be seen. Sometimes violations of the Rasch-model occur when the range of item difficulties is relatively narrow, e.g. disrupted communication.

The uni-dimensionality of the scales was tested by Martin-Löf chi-square tests for pairs of scales. The low probability levels presented in Table 5 indicate that each scale measures only one dimension which forms additional evidence of divergent validity.

Finally, item-bias was examined by separately comparing the confidence intervals of the item parameters estimated over both samples of real and simulated patients. The results, displayed in Table 6, reveal that only items 9 and 12 and none of the other items are influenced by item-bias.

Table 2 -- Sequence of Analyses During the Construction of the PSCC
Schermafbeelding 2021-03-03 om 09.46.29
Table 3 -- Rasch Homogeneous Scales in PSCC
Schermafbeelding 2021-03-03 om 09.41.55
Table 4.1 -- Facilitation: Measurement Properties of Items in PSCC
Schermafbeelding 2021-02-26 om 15.46.59
Table 4.2 -- Insight: Measurement Properties of Items in PSCC
Schermafbeelding 2021-03-01 om 12.46.42
Table 4.3 -- Intention to Comply: Measurement Properties of Items in PSCC
Schermafbeelding 2021-03-01 om 14.32.08
Table 4.4 -- Disruption of Communication: Measurement Properties of Items in PSCC
Schermafbeelding 2021-03-01 om 14.46.08
Table 4.5 -- Directivity: Measurement Properties of Items in PSCC
Schermafbeelding 2021-03-04 om 09.05.00
Table 5 -- Results of Martin Löf Test for Dimensionality of Scales in PSCC
Schermafbeelding 2021-03-03 om 08.45.44
Table 6 -- Estimates of item Parameters and Confidence Intervals for Real and Simulated Patients of the PSCC
Schermafbeelding 2021-03-01 om 17.01.38

Discussion

For patient satisfaction with the medical consultation, the quality of physician-patient communication appears to be of paramount importance. Notwithstanding a considerable amount of research, the dimensions in satisfaction distinguished by patients are not clearly defined. Moreover, shortcomings in the quality of measurement are often observed.

In the present study, the construction of the Patient Satisfaction with Communication Checklist is described. The study attempts to obviate the shortcomings by careful examination of the dimensions discerned in patient satisfaction and by the application of adequate psychometric statistics in the process of scale construction.

Ultimately, five dimensions are distinguished in patient satisfaction with communication; these are measured by Rasch homogeneous scales. For final scales see Patient Satisfaction with Communication.

Dimensions in Patient Satisfaction

Facilitation

The scale Facilitation measures the patient’s opinion of the opportunity provided for talking about his complaint(s), for voicing concerns and for asking any questions. Facilitation is important since many patients strongly desire to mention their greatest concerns to the physician, but either do not often have the opportunity to mention them or they are not encouraged to do so (Korsch et al, 1972). The influence of facilitation on the patient is considerable since the physician’s willingness to listen to the patient is related to feelings of trust and acceptance, and it enhances compliance with the prescribed regimen. Moreover, a strong relation between facilitation and satisfaction is observed which emphasizes the importance of a patient-centered phase during the medical consultation (Byrne et al, 1976; Wolf et al, 1978; Misteler, 1984). 

Insight

The scale Insight measures the impact of the exchange of information on the patient’s comprehension of his condition and treatment. The original theoretical dimensions of providing information and insight collapsed into one dimension because patients do not make a distinction between them. This is understandable since the dimensions are theoretically related, although the findings are in conflict with Tuckett’s observations (1985) that information which is conveyed effectively does not automatically entail comprehension by the patient.

With regard to the content of the exchanged information, patients expect to receive a comprehensive explanation of the nature, the course and the prognosis of their complaint(s) or disease (Korsch et al, 1972). Moreover, they expect to be informed about the ins and outs of the proposed treatment. Explanations of the patient’s psychological functioning represent the upper part of the scale.

In general, insight seems to be a legitimate outcome of the consultation, because the provision of information:

  • Can change attributions;
  • Is able to resolve unfounded fears;
  • And enhances the patient’s sense of mastery of his situation.

Especially in ambulatory care, information appears to be of importance, because patients are expected to deal with their complaint(s) themselves after they have left the consultation room (Vuori et al, 1972). Both the content of exchanged information and the quality of the physician’s interviewing skills during the presentation of solutions are involved in increasing the patient’s insight (Stiles et al, 1979; Tuckett et al, 1985).

Intention to comply

The scale Intention to Comply measures the patient’s determination to cooperate with the proposed advice and treatment. The pioneer of research into the medical interview, Davis, observed the relation between the quality of physicians’ interviewing skills and patients’ adherence to the medical regimen (Davis, 1966; Davis, 1968). This finding was later supported by other studies (Korsch et al, 1972; Ley, 1980; Ley, 1983).

The scale Intention to Comply is composed of three statements pertaining to variables which can be influenced by communication: namely, recall, understanding and responsibility, and one statement measuring the patient’s commitment to compliance. Ley (1983) elaborated the positive relation between recall and comprehension to compliance, while Eisenthal and Lazare (1976) described the confirmative impact of responsibility when patients are given the opportunity to negotiate about their request for help. 

Disrupted Communication

The scale Disrupted Communication measures the patient’s opinion of the occurrence of interview behavior that is generally considered to impair communication and to enhance feelings of confusion and anxiety. Medical jargon, hurried interviews and the lack of verbal tracking (the changing rapidly from one subject to another by the physician) are well-known examples (DiMatteo et al, 1983; Ivey, 1983; Mishler, 1984). 

Directivity

The scale Directivity was originally constructed to measure a specific quality of individual psychotherapeutic relations. It refers to an authoritarian communication style in which the physician acts from his own frame of reference. The dimension was operationalized as: paying no respect to the patient’s initiative or pace in acknowledging problems or solutions (Lietaer, 1976). Moreover, attempts to change the patient’s emotions or behavior were considered to form expressions of directivity. Unfortunately, the significance of high or low levels of directivity for the quality of physician-patient communication has not yet been established. 

Several hypothesized dimensions were not retraced after the subsequent factor analyses and Rasch analyses. These dimensions were obviously not distinguished by patients or not well measured by the items in the checklist. Although the original checklist contained several items pertaining to satisfaction, no distinct dimension Satisfaction came forth. Items referring to satisfaction emerged in the factor solution facilitation, but after Rasch analysis, they were eliminated from the scale Facilitation. Apparently, a strong connotation of facilitation with satisfaction exists. This finding calls into question the validity of global satisfaction measurements, because patients do not seem to evaluate the quality of the communication in terms of satisfaction.

Moreover, the hypothesized dimension Physicians Understanding, was not retraced in the analyses. In retrospect, it is clear that the dimension ‘physician’s understanding of the patient’s situation’ should be put rather to the physician than to the patient. In close relation to the previous observation is the notable absence of the theoretical dimension Empathy. Although the items in this checklist were chosen from the scales of Truax and Carkhuff (1967) and carefully adapted to the Dutch situation by Lietaer (1976), our subjects failed to distinguish empathy as an important dimension in the communication. The finding supports Hogan’s (1969) assertions about the lack of validity in measurements of empathy. 

Considerations

This study reveals that within patient satisfaction with communication, several dimensions can be discerned. Patient satisfaction on its own is not recognized as a separate dimension. We therefore recommend the use in future studies of these measurements of the patient’s opinion as they enhance our understanding of the relation between process and well-defined outcomes of a medical interview. Furthermore, we consider it to be a shortcoming of our study that no items on anxiety-reduction and reassurance were included in the original checklist. Additional research into these dimensions seams to be necessary. 

Notwithstanding the limited number of items, the measurement properties of the PSCC scales are very attractive

The measurement properties of the scales in the PSCC are very attractive notwithstanding the dramatic loss of items:

  • Firstly, each scale measures only one dimension: this is an important achievement as it increases our understanding of the impact of the medical interview on the patient.
  • Secondly, all item groups but one fit in well with the assumptions of the Rasch-model; directivity fits only marginally. The results of the Rasch analyses enable researchers to determine the patient’s opinion of a pertinent dimension with considerable precision. All items show a strong similarity between the observed proportion positive answers and the probability of a positive answer according to the estimations of the Rasch-model.
  • Moreover, the observed proportion of positive answers on an item increases considerably when patients’ ability scores exceed the item difficulties.

One of the problems encountered during the operationalization of several dimensions is the formulation of items with very low or very high item difficulties. In the present study, this problem arose with regard to the dimension Directivity and, to some degree, with Insight and Disruption of Communication. As a result, violations of the Rasch-model may take place. 

Simulated Patients vs Real Patients

A feature of the Rasch-model is that conclusions on the measurement properties of the scales are dependent on the population studied but independent of the specific sample of subjects. The construction of the Patient Satisfaction with Communication Checklist was based on a combined sample of subjects from two populations: namely, real patients who visited their own general practitioners and simulated patients who were interviewed by residents in general practice.

Real patients and simulated patients approach the dimensions in a similar way

Since many researchers may question this procedure, we studied the influence of group membership on item responses, generally known as item-bias (Mellenbergh, 1985). Item-bias was assessed by computing the confidence intervals of the estimates of item parameters over both samples and by comparing the overlap of the intervals. The results show that groep membership is not associated with the responses on the items with the exception of items 9 and 12. Real patients and simulated patients approach the dimensions similarly.

With regard to items 9 and 12, simulated patients report earlier that they are able to recall the provided information and they agree less easily that they had responsibility for the choice of their treatment. The former is easily understood because simulated patients were informed approximately 20 times about the treatment of ‘their’ disease; this enhances recall of information. The latter is explained by the fact that simulated patients are not really in need of treatment, because they are making no real request for help. This makes them less involved in decision-taking.

Simulated patients provide detailed feedback to medical students on real life dimensions in the communication

In Conclusion 

We observe that the Patient Satisfaction with Communication Checklist can be applied to both populations, because real patients and simulated patients discern the same dimensions in their satisfaction with the communication and approach the dimensions similarly. 

The advantage of this scale construction procedure is that identical checklists can be given to subjects of both populations which allows comparisons between and additional studies of the validity of simulated patients. Moreover, checklists filled in by simulated patients provide detailed feedback to medical students on dimensions which are also valued by real patients. Medical education can thus be attuned to the reality of daily practice. 

In summary

Facilitation, insight, intention to comply, disrupted communication and directivity are dimensions in physician-patient communication which are discerned and evaluated by patients.

The formulation of theoretical dimensions and the application of adequate procedures in the process of scale construction form important tools for the development of scales that measure only one well-defined dimension.

Real patients and simulated patients discern the same dimensions in their satisfaction with the communication and approach the dimensions similarly. The PSCC can therefore be used in daily practice with real patients and in medical education in simulated situations for feedback and assessment.

Hopefully, when they are applied in future research, the scales will enhance our understanding of the impact of physician-patient communication on the patient. For an application of Patient Satisfaction with Communication in research see Construct Validity.

References

Selected Reading

DiMatteo MR, DiNicola DD. Achieving patient compliance: the psychology of the medical practitioner’s role. Pergamon Press, New York, 1982. 

Gustafsson JE. The Rasch-model for dichotomous items: theory, applications and a computer program. Reports from the institute of Education, No. 64, University of Göteborg, Sweden, 1977. 

Korsch BM, Negrete VF. Doctor-patient communication. Scientific American, 1972; 227: 66-74. 

Lebow J. Consumer satisfaction with mental health treatment. Psychological Bulletin, 1982; 91: 244-259. 

Tuckett D, Williams A. An approach to the measurement of explanation and information giving in medical consultations: a review of empirical studies. Social Science and Medicine, 1984; 18: 571-580. 

All references

More

Byrne PS, Long BEL. Doctors talking to patients: a study of the verbal behavior of general practitioners consulting in their surgeries. HSMO, London, 1976. 

Crijnen AAM, Dalen J van, Kraan HF, Zuidweg J. Medische interviewvaardigheden gemeten: de Maastrichtse Anamnese en Advies Scoringslijst (Measuring medical interviewing skills: the Maastricht History-taking and Advice Checklist). Medisch Contact, 1986; 41: 114- 116. 

Davis MS. Variations in patients’ compliance with doctor’s orders: analysis of congruence between survey responses and results of empirical investigations. Journal of Medical Education, 1966; 41: 1037- 1048. 

Davis MS. Variations in patient’s compliance with doctor’s advice: an empirical analysis of patterns of communication. American Journal of Public Health, 1968; 58: 274-288. 

DiMatteo MR, DiNicola DD. Achieving patient compliance: the psychology of the medical practitioner’s role. Pergamon Press, New York, 1982. 

Eisenthal S, Lazare A. Expression of patient’s request in the initial interview. Psychological Reports, 1977; 40: 131-138. 

Eisenthal S, Koopman C, Lazare A. Process analysis of two dimensions of the negotiated approach in relation to satisfaction in the initial interview. Journal of Nervous and Mental Disease, 1983; 171: 

Gustafsson JE. The Rasch-model for dichotomous items: theory, applications and a computer program. Reports from the institute of Education, No. 64, University of Göteborg, Sweden, 1977. 

Hambleton RK, Cook LL. Latent trait models and their use in the analysis of educational test data. Journal of Educational Measurement, 1977; 14: 75-96. 

Hogan R. Development of an empathy scale. Journal of Consulting Clinical Psychology, 1969; 33: 307-316. 

Ivey AE. Intentional interviewing and counseling. Wadsworth, Belmont, California, 1983. 

Korsch BM, Negrete VF. Doctor-patient communication. Scientific American, 1972; 227: 66-74. 

Lebow J. Consumer satisfaction with mental health treatment. Psychological Bulletin, 1982; 91: 244-259. 

Lebow J. Research assessing consumer satisfaction with mental health treatment. Evaluation and Program Planning, 1983; 6: 211-236. 

Ley P. Giving information to patients. In: Eisser JR (Ed.). Social psychology and behavioral medicine. Wiley, London, 1980. 

Ley P. Patients’ understanding and recall in clinical communication failure. In: Pendleton D, Hasler J (Eds.). Doctor-patient communication. Academic Press, London, 1983. 

Lietaer G. Nederlandstalige revisie van Barrett-Lennard’s Relationship Inventory voor individueel-therapeutische relaties (The relationship inventory of Barrett-Lennard: Dutch revision for therapeutic relationships). Psychologica Belgica, 1976; 15: 73-94. 

Locker D, Dunt D. Theoretical and methodological issues in sociological studies of consumer satisfaction with medical care. Social Science and Medicine, 1978; 12: 283-292. 

Martin Löf P. Statistical models. Notes from seminars, 1969-1970, by Rolf Sunberg (2nd ed.). Institute fCir feirslcrings matanatika och matematik statistik vid Stockholms Universitet, Stockholm, 1973. 

Meerling. Methoden en technieken van psychologisch onderzoek (Methods and techniques of psychological research – part 1 and part 2). Boom, Meppel, 1981. 

Mellenbergh GJ. Vraag-onzuiverheid: definitie en onderzoek (Item bias: definition and research). Nederlands Tijdschrift voor de Psychologie, 1985; 40: 425-435. 

Mishler EG. The discourse of medicine: dialectics of medical interviews. Ablex, Norwood, 1982. 

Molenaar IW. Programma beschrijving van PML voor het Rasch-model (Description of the PML-program for the Rasch-model, version 3.1). Heymans Bulletin, vakgroep Statistiek en Meettheorie, Universiteit van Groningen, Groningen, 1981. 

Nie N, H1111 CH, Jenkins JG, Steinbrenner K, Bent DH. Statistical package for the social sciences. McGraw-Hill, New York, 1975. 

Pendleton D. Doctor-patient communication: a review. In: Pendleton D, Hasler J (Eds.). Doctor-patient communication. Academic Press, London, 1983. 

Stiles WB, Putnam SM, Wolf MH, James SA. Interaction exchange structure and patient satisfaction with medical interviews. Medical Care, 1979; 17: 667-679. 

Stillman PL, Barpeau-Di Gregorio MY, Nicholson GI, Sabers DL, Stillman AE. Six years of experience using patient instructors to teach interviewing skills. Journal of Medical Education, 1983; 58: 941-946. 

Thorndike RL. Applied psychometrics. Houghton Mifflin Company, Boston, 1982. 

Truax CB, Carkhuff RR. Toward effective counseling and psychotherapy. Aldine, Chicago, 1967. 

Tuckett D, Williams A. An approach to the measurement of explanation and information giving in medical consultations: a review of empirical studies. Social Science and Medicine, 1984; 18: 571-580. 

Vuori H, Aako T, Aine E, Erkko R, Johansso R. The doctor-patient relationship in the light of patients’ experiences. Social Science and Medicine, 1972; 6 (6): 723-730. 

Ware JE, Davies-Yvery, A, Stewart AL. The measurement and meaning of patient satisfaction. Health and Medical Care Services Review, 1978; 1: 1-15. Ware JE, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Evaluation and Program Planning, 1983; 6: 247-263. 

Wolf MH, Putnam SM, James SA, Stiles WB. The medical interview satisfaction scale: development of a scale to measure patient perceptions of physician behavior. Journal of Behavioral Medicine, 1978; 1: 391-401.

MAAS Medical Interview
Menu
Index
Languages
Contact
Index