Background
Theoretical framework: communication functions of effective medical encounters
Methods
Study design and setting
Participants
Data collection
Data analysis
Results
Hospital study site | Number of study participants |
---|---|
Hospital 1 | 6 |
Hospital 2 | 3 |
Hospital 3 | 2 |
Hospital 4 | 3 |
Hospital 5 | 1 |
Speciality | Number of study participants |
---|---|
Acute internal medicine | 4 |
Cardiology | 3 |
Emergency medicine | 2 |
Gastroenterology | 3 |
Paediatric acute care | 3 |
Core functions of medical encounter communication (de Haes & Bensing, 2009) [27] | Fostering the relationship(s) | Gathering information | Decision making | Responding to emotions |
---|---|---|---|---|
Providing information | Enabling disease & treatment related behaviour | |||
Study themes
|
Feeling trust and confidence in the relationship
|
Sharing relevant and meaningful information
|
Sharing discussion on illness management & treatment
|
Experiencing emotional care and support
|
PA conveying expertise:
“It was her demeanour. It was the way she explained things … She was very calm.” (Participant 3) “A good, professional manner... the way she was presented.” (Participant 6)
PA giving direct answer to questions:
“She was efficient and she knew, she wasn’t sort of telling you bull. She didn’t have to think before she gave an answer.” (Participant 10)
Personable approach of PA:
“She was friendly. It didn’t feel too official, which frightens mums a bit.” (Participant 1) “So we spoke a bit ‘Oh where did you go on holiday?’ a bit personal-like, it was just nice.” (Participant 2)
PA conveying respect:
“Treating patients like people...You can be efficient and still be pleasant and approachable.” (Participant 11) |
PA encouraging information sharing:
“She was finding out more about what’s wrong with him and help us understand what’s wrong with him.” (Participant 9) “She was very nice so I was happy to talk to her. She was very easy to talk to.” (Participant 2)
Participants feeling informed:
“She shared everything with us...I mean the problem.” (Participant 7) “She said ‘I found those kind of things and I’m going to go and see the senior doctor to talk about what we’re going to do’.” (Participant 8) “I was informed a bit more as well of what was happening. Just trying to get me a bed and trying to get the reduction in the blood pressure reading.” (Participant 4)
Participants understanding information provided:
“The person that we saw today, she was really nice and friendly and she even made it easier for us to understand what’s wrong with him.” (Participant 9) |
Participants understanding possible options:
“The score says what the risk factor is for me to have a heart problem … she went through that process and explained what my score is and what could be the next actions.” (Participant 12) “She looked through all my medical records, my previous records, and she tried to suggest the future course of action.” (Participant 14)
Shared discussion of management/ treatment options:
“I think she pulled out what was the important way ahead. Because patients have the choice and I think she helped me make the right choice.” (Participant 3) “We’ve decided not to look too deeply into whether there’s anything... that would cause mum distress to have a procedure done. And we’d just maintain her bloods and iron.” (Participant 1) |
PA communication of emotional support:
“It makes you feel more relaxed … it’s nice to have someone more informal.” (Participant 6)
PA demonstrating care:
“The way she approached us was kind, loving, and the way she treated my son, she was like someone that cared.” (Participant 8) “She is so lovely, she is so caring, she told me which will help me … Because she talks so politely, she make me understand everything.” (Participant 13)
PA enabling question asking:
“If someone is smiling at you and is very open to you, you can communicate.” (Participant 4)
PA listening skills
“She showed an interest in her patient, she listened, she was a listener.” (Participant 3) |
Theme 1. Feeling trust and confidence in the relationship
Perceived expertise
“She was polite, professional, to the point. She asked all the pertinent questions relating to my symptoms...She was familiar with all the medical terms.” (Participant 14, male, outpatient clinic)
“She knew what she was doing or she put the impression she knew what she was doing which amounts to the same.” (Participant 10, female, emergency department)
“She knew what she was talking about and what she said to me is when she spoke to the doctor he agreed so she was quite confident. So she’s confident, I am.” (Participant 3, female, outpatient clinic)
“It seemed I got dealt with. We’d been in that room a long time, me and my friend. Left to the point where you get frustrated...Once I’d seen her it seemed I was more prioritised.” (Participant 4, male, acute medical unit)
Perceived approachability
“The way she cared about my son, was totally different … My son is sick. He was vomiting for the last five days, he doesn’t have any energy to sit, and she was the one who helped him to sit.” (Participant 7, female, paediatric ward)
“I was just wondering...maybe I liked her because she was a lady. So maybe men would prefer the men one. I’m wondering if it’s a gender issue with me.” (Participant 3, female, outpatient clinic)
PA perceived to be a doctor
“I’ve never heard of it before so I suppose I’m not quite sure what it involves.” (Participant 6, male, acute medical unit).
“Well it’s the first time I’ve heard it today and I didn’t really know it. If I had to guess, a trainee physician, that’s the first thing which comes to mind.” (Participant 10, female, emergency department).
“I just thought I was going to see a doctor for consultation.” (Participant 2, female outpatient clinic).
Nevertheless, all but one of the participants said they would recommend receiving medical care from a PA. One participant thought it more appropriate patients see a “proper physician.”“[The PA]‘s not a physician really … just not a medical doctor. How do we know [the PA] knows about anything or anything?” (Participant 5, female, emergency unit)
Theme 2. Sharing relevant and meaningful information
Motivated to engage
“I felt that I could tell her how we’ve been coping and everything. I was quite happy to talk to her. I felt quite comfortable talking to her.” (Participant 1, female, outpatient clinic).
“Not a lot to be honest … I don’t remember answering.” (Participant 15, male, acute medical unit).
Personalised explanation of health status
“Explained what was happening going forward, the tests that would be taken and that sort of thing. She made it quite clear what was going to happen.” (Participant 6, male, acute medical unit).
“I feel quite comfortable to her. I couldn’t speak proper English, she – nicely explaining, understanding everything, and quite friendly.” (Participant 9, female, paediatric unit).
“More of the human touch, not quite as formal … Hospitals can be quite unpleasant places so it’s nice to see someone with a more friendly face. Whereas doctors give you the nitty gritty, the associate tend to be more down to earth.” (Participant 6, male, acute medical unit)
Wanting to know about the PA role
“The letter didn't explain that... maybe that needs to be explained there is a new role. I mean it's not to bother any people, it's just to give some more understanding.” (Participant 12, male, outpatient clinic)
“There was no doubt in my mind that she isn't professionally trained, right. So as such as a patient, I don't particularly see any reason why I want to know any more about her role.” (Participant 14, male, outpatient clinic)
Theme 3. Experiencing emotional care and support
“I'm sure it makes all the patients feel comfortable and I'm sure that's what you need when you come into a strange hospital for a consultation. I think some patients might be quite terrified at the thought of consultations, but there was nothing terrifying about [PA].” (Participant 3, female, outpatient clinic)
“She was just approachable. I could speak to her and go really personal, because it is kind of a personal thing that I’m here for...I could really talk to her.” (Participant 2, female, outpatient clinic)
“Because she talks so politely, she make me understand everything, what happened to me....She just tell me everything and that’s why I think she is very caring.” (Participant 13, female, outpatient clinic).
“She put a pleasant face on [things] which I suppose is useful but I don’t know what care she gave.” (Participant 15, male, acute medical unit)
Theme 4. Sharing discussion on illness management and treatment
“I felt I could ask questions which you don’t always feel comfortable with asking nursing staff.” (Participant, 4, male, acute medical unit)
“If you do this thing, it is better for me because I have diabetes in low age because I am now only 38 so I have diabetes type 2. So it’s a little bit risky for me.” (Participant 13, female, outpatient clinic)
“She explained things to me regarding iron that I didn't [previously] understand.” (Participant 1, female, outpatient clinic)
“She went through the details explaining where I am. She was not pushing me to accept anything, was leaving me to decide … So she was engaging in that respect you know. Not taking action or pushing anything on me that you should do.” (Participant 12, male, outpatient clinic)