Making doctor‐patient communication more effective from a patient’s perspective A European mixed‐method study in general medicine settings

The thesis investigated what in the eye of European citizens and primary care patients matters in doctor-patient communication. To include the public’s perspective in evaluating the communication quality of doctors is fundamental as patients often report quality problems in the area of communication and can have different goals and priorities from health care providers. To know patients’ preferences, expectations and needs makes the consultation successful from a patient perspective. The research started with a multicentre study (Guliver-I), involving 259 citizen from Ghent (BE), Utrecht (NL), Liverpool (UK) and Verona (IT). A standardized protocol, based on mixed methods of data gathering (focus group, questionnaires and rating scales), explored the complexity of the communication process between patients and doctors. The second study (GUliVer-II) payed attention on the building of a questionnaire, ‘Patient Consultation Values questionnaire’ (PCVq), composed by the tips which had been suggested by the focus group participants (Guliver-I) to “potential” patients and doctors. The PCVq measures patients’ views on ‘how doctors, as well as patients, might make the medical consultation more effective’. The survey investigated the opinions of a sample of 7270 primary care patients from 31 European countries. The main qualitative findings show that the doctor should listen attentively, take the patient seriously, treat the patient as a person and grant enough time and give clear information on what to do when something goes wrong. On the other hand, patients should be assertive, contribute actively by keeping appointments, speaking openly about health history, symptoms and, when appropriate, psychosocial issues. They should adhere to the agreed treatment plan, give the doctor feedback on treatment outcome and inform about self-medication or alternative medicine use. The importance of these behaviours were confirmed by the external validity and generalizability analyses based on the survey data. The core functions of the consultation, i.e. treating patients as persons, involving them in the communication, giving clear information, assessing the need for referral and continuity of care were shared as “universal” values by European populations. An examination of the distributions of patients’ preferences among groups, distinguished by personal characteristics and contextual backgrounds, showed that characteristics of patients affected their quality assessments of communication. Such findings highlighted the critical communication aspects to which clinicians should pay attention in tailoring their approach to the patient by identifying and considering his/her specific needs and preferences. Again, the leader role for an effective consultation was attributed to doctors, and less importance to patients’ active participation. The participants assigned a higher values to doctors’ behaviours than those of patients, specifically regarding the course and content of the meeting and the checking of patient’s understanding. In conclusion, many of the findings match the recommendations of communication guidelines and are certainly not new for clinicians and trainers, but many components of patient-centred communication such as active listening, treating patient as a person, partnership, support and empathic handling are now supported by strong evidence from the patient point of view and appear as universal values shared in European countries.