Improving Physicians’ Interviewing Skills and Reducing Patients’ Emotional Distress: A Randomized Clinical Trial

Debra Roter, Judith A. Hall, David E Kern, Lee Randol Barker, Karan A. Cole, Robert P. Roca

Research output: Contribution to journalArticle

Abstract

Background: Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters. Objective: To explore the effect of communication-skills training on the process and outcome of care associated with patients’ emotional distress. Methods: A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients’ emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits. Results: Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months. Conclusions: Important changes in physicians’ communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.

Original languageEnglish (US)
Pages (from-to)1877-1884
Number of pages8
JournalArchives of Internal Medicine
Volume155
Issue number17
DOIs
StatePublished - Sep 25 1995

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Randomized Controlled Trials
Physicians
Communication
Office Visits
Emotions
Tape Recording
Physiologic Monitoring
Primary Care Physicians
Telephone
Health Services
Primary Health Care
Control Groups
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Improving Physicians’ Interviewing Skills and Reducing Patients’ Emotional Distress: A Randomized Clinical Trial",
abstract = "Background: Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters. Objective: To explore the effect of communication-skills training on the process and outcome of care associated with patients’ emotional distress. Methods: A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients’ emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits. Results: Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months. Conclusions: Important changes in physicians’ communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.",
author = "Debra Roter and Hall, {Judith A.} and Kern, {David E} and Barker, {Lee Randol} and Cole, {Karan A.} and Roca, {Robert P.}",
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