The many "Disguises" of patient-centered communication: Problems of conceptualization and measurement.

Abstract

To critically examine different approaches to the measurement of patient-centered communication. Provides a critique of 7 different measures of patient-centered communication with respect to differences in their assumptions about what constitutes patient-centeredness and in their approaches to measurement. The measures differed significantly with regard to whether the measure captured behavior (what the interactants did) or judgment (how well the behavior was performed), focused on the individual clinician or on the interaction as a whole, and on who makes the assessment (participant or observer). A multidimensional framework for developing patient-centered communication measures is presented that encompasses the patient's perspective and participation, the biopsychosocial context of the patient's health, the clinician-patient relationship, quality of information-exchange, shared understanding, and shared, evidence-based decision-making. The state of measurement of the patient-centered communication construct lacks coherence, in part because current measures were developed either void of a conceptual framework or from very different theoretical perspectives. Assessment of patients' experiences with quality of communication in medical encounters should drill down into specific domains of patient-centeredness.