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

journal contribution
posted on 2023-06-08, 20:40 authored by Rosemarie McCabe, Patrick G T Healey, Stefan Priebe, Mary Lavelle, David Dodwell, Richard Laugharne, Amelia Snell, Stephen BremnerStephen Bremner
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.

Funding

Medical Research Council; G0401323

History

Publication status

  • Published

Journal

Patient Education and Counseling

ISSN

0738-3991

Publisher

Elsevier

Issue

1

Volume

93

Page range

73-79

Department affiliated with

  • BSMS Publications

Full text available

  • No

Peer reviewed?

  • Yes

Legacy Posted Date

2015-05-01

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