Improving Care through Better Clinician Communication

As part of our mission, PCORI funds research that addresses how clinicians can help patients make the best decisions about their health and healthcare. To provide useful support to patients as they make important choices, clinicians need to communicate effectively with them. However, establishing communication practices that achieve this goal can be a challenge.

A recent article in the New York Times highlighted the difficulty of using workshops or classes to improve communication skills of clinicians. A 2013 study published in JAMA, reported that clinicians who had completed communication skills training were not rated by patients as better communicators than doctors and nurses who had not participated in the training. And there are many examples in the literature of the work that still needs to be done to facilitate open and effective communication between patients and clinicians.

Addressing the Communication Challenge

The good news is that national organizations such as the Joint Commission and the Institute of Medicine (IOM), as well as PCORI, have recognized this need.

The Joint Commission has created a roadmap that provides guidance to healthcare systems on integrating patient and family-centered communication into care delivery. In addition, the IOM recently highlighted basic principles for effective patient-clinician communication. These include having a common understanding of treatment goals, establishing a supportive environment, and ensuring that both patients and clinicians have the best information available for making treatment decisions. To understand how to improve communication between patients and clinicians, we need more information about what patients expect and value when they are communicating with their healthcare team.

Collecting Evidence

At PCORI, we are committed to engaging patients, physicians, nurses, and other healthcare providers in developing ways to promote more effective communication. One North Carolina study that we fund aims to improve patient-reported measures of communication success. The research team, in conjunction with patients, clinicians, and patient advocates, will develop a survey designed to evaluate clinician’s communication with patients and their caregivers.

Another PCORI-funded study focuses on adding the voice of families to the daily communication between clinicians when they transfer responsibility for a patient’s care. The goal of this study is to include families in the exchange of information during morning rounds. Incorporating family preferences could lead to better shared information between clinicians, patients, and their caregivers and may reduce medical errors when compared to current communication practices.

We fund additional projects that focus on improving communication between clinicians and patients and those who care for them, including:

• Among parents of children in a pediatric intensive care unit, researchers will compare the experiences of those who receive an educational brochure and of others assigned to a navigator who aims to improve their communication with healthcare providers. The researchers will assess each parent’s satisfaction with decision making and parent-clinician communication during the hospitalization, as well as the parent’s psychological state and health-related quality of life several weeks after patient discharge.
• Researchers at the University of Rochester are evaluating a method intended to foster communication about concerns among patients aged 70 and older who have advanced cancer. One group of patients, along with their physicians, will receive a summary and recommendations from a geriatric assessment that captures age-related health concerns. The researchers will compare that group with patients who receive only information on clinically significant depression or cognitive issues. The study will measure patients’ success at communicating concerns to their clinicians, and also their quality of life, decision-making preferences, and satisfaction with care.
• In another project, researchers at the Cambridge (Massachusetts) Health Alliance are examining whether a combination of coaching interventions provided to both patients and clinicians improve the quality of shared decision making, as compared to usual care. The study will also look for the underlying mechanisms that improve shared decision making.

Projects such as these will help to advance our understanding of successful approaches for promoting patient-centered clinician communication, which will ultimately help patients and their caregivers make the best decisions about their health care.