Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia

McCabe, Rosemarie, Healey, Patrick G T, Priebe, Stefan, Lavelle, Mary, Dodwell, David, Laugharne, Richard, Snell, Amelia and Bremner, Stephen (2013) Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counseling, 93 (1). pp. 73-79. ISSN 0738-3991

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Abstract

OBJECTIVE: Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia. METHODS: Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke.
RESULTS: 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02).
CONCLUSION: The quality of doctor-patient communication also appears to influence adherence in schizophrenia. PRACTICE IMPLICATIONS: Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication.

Item Type: Article
Keywords: Adherence, Antipsychotics, Doctor–patient communication, Repair, Schizophrenia
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine > RC Internal medicine > RC0321 Neurosciences. Biological psychiatry. Neuropsychiatry > RC0438 Psychiatry
Depositing User: Jane Hale
Date Deposited: 01 May 2015 15:39
Last Modified: 01 May 2015 15:39
URI: http://sro.sussex.ac.uk/id/eprint/53852
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Project NameSussex Project NumberFunderFunder Ref
UnsetUnsetMedical Research CouncilG0401323