A microanalysis of the clarity of information in physicians' and patients' discussions of treatment plans with and without language barriers.

Abstract

OBJECTIVE: Physicians and patients discuss treatment plans. If tasks within plans are not described adequately, patients cannot adhere. We evaluated task descriptions, testing whether patient engagement and language barriers affected task clarity. METHOD: We sampled 12 videotaped hospital interactions from a corpus of 497: two encounters each from six hospital physicians, interacting with one native-speaking and one non-native-speaking patient. We used microanalysis of face-to-face dialogue to assess whether the physicians and patients achieved a complete, clear description of each task's three core information elements (who should do what and when). RESULTS: We conducted detailed analysis on 78 of the 90 tasks. Core information elements were complete in 62 (0.79) and clear in 37 (0.47). Language barriers had no effect on task clarity. When native-speaking patients were engaged, tasks were clearer (p<0.05). Although non-native-speaking patients were significantly more engaged (p<0.01), their engagement had no effect. CONCLUSION: Physicians may be pursuing patients' agreement, motivation, and commitment at the expense of working with the patient to be clear about what needs to be done. PRACTICE IMPLICATIONS: Physicians need to improve how clearly they present basic task information. Previous research demonstrated that even a short course can significantly improve the clarity of instructions.