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      The patient satisfaction in primary care consultation—Questionnaire (PiC): An instrument to assess the impact of patient-centred communication on patient satisfaction

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          Abstract

          Background

          Primary care consultation is significantly influenced by communication between the General Practitioner (GP) and their patients. Hypothesising that patient satisfaction can be tested based on an expectation-experience comparison, the aim of this article is to discuss the influence of communication on patient satisfaction.

          Methods

          A standardised questionnaire was developed striving for a universal primary care survey tool that focuses on patient satisfaction in the context of patient-centred-communication. The sample consisted of 14 German GPs with 80 patients each (n = 1120). Due to the inclusion in an overarching cluster-randomised-study (CRT), the medical practices to be examined were divided into intervention and control groups. The intervention was developed as a reflective training on patient-centred communication.

          Results

          The results in the present sample show no correlation between patient-centred-communication and patient satisfaction. There are also no significant differences between the intervention and control group.

          Discussion

          The results raise the question to what extent patient satisfaction can be shaped significantly through patient-centred-communication. The presented project represents part of the basic research in general medical care research and contributes to the transparent processing of theoretical assumptions. With the results described here, communication models with a focus on patient centredness can be evaluated with regard to their practical relevance and transferability.

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          Most cited references23

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          An Integrative Model of Patient-Centeredness – A Systematic Review and Concept Analysis

          Background Existing models of patient-centeredness reveal a lack of conceptual clarity. This results in a heterogeneous use of the term, unclear measurement dimensions, inconsistent results regarding the effectiveness of patient-centered interventions, and finally in difficulties in implementing patient-centered care. The aim of this systematic review was to identify the different dimensions of patient-centeredness described in the literature and to propose an integrative model of patient-centeredness based on these results. Methods Protocol driven search in five databases, combined with a comprehensive secondary search strategy. All articles that include a definition of patient-centeredness were eligible for inclusion in the review and subject to subsequent content analysis. Two researchers independently first screened titles and abstracts, then assessed full texts for eligibility. In each article the given definition of patient-centeredness was coded independently by two researchers. We discussed codes within the research team and condensed them into an integrative model of patient-centeredness. Results 4707 records were identified through primary and secondary search, of which 706 were retained after screening of titles and abstracts. 417 articles (59%) contained a definition of patient-centeredness and were coded. 15 dimensions of patient-centeredness were identified: essential characteristics of clinician, clinician-patient relationship, clinician-patient communication, patient as unique person, biopsychosocial perspective, patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical support, emotional support, integration of medical and non-medical care, teamwork and teambuilding, access to care, coordination and continuity of care. In the resulting integrative model the dimensions were mapped onto different levels of care. Conclusions The proposed integrative model of patient-centeredness allows different stakeholders to speak the same language. It provides a foundation for creating better measures and interventions. It can also be used to inform the development of clinical guidance documents and health policy directives, and through this support the shift towards patient-centered health care.
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            Pretesting survey instruments: an overview of cognitive methods.

            This article puts forward the case that survey questionnaires, which are a type of measuring instrument, can and should be tested to ensure they meet their purpose. Traditionally survey researchers have been pre-occupied with 'standardising' data collection instruments and procedures such as question wording and have assumed that experience in questionnaire design, coupled with pilot testing of questionnaires, will then ensure valid and reliable results. However, implicit in the notion of standardisation are the assumptions that respondents are able to understand the questions being asked, that questions are understood in the same way by all respondents, and that respondents are willing and able to answer such questions. The development of cognitive question testing methods has provided social researchers with a number of theories and tools to test these assumptions, and to develop better survey instruments and questionnaires. This paper describes some of these theories and tools, and argues that cognitive testing should be a standard part of the development process of any survey instrument.
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              Assessing patient-centered communication in a family practice setting: how do we measure it, and whose opinion matters?

              This study evaluated variables thought to influence patient's perceptions of patient-centeredness. We also compared results from two coding schemes that purport to evaluate patient-centeredness, the Measure of Patient-Centered Communication (MPCC) and the 4 Habits Coding Scheme (4HCS). 174 videotaped family practice office visits, and patient self-report measures were analyzed. Patient factors contributing to positive perceptions of patient-centeredness were successful negotiation of decision-making roles and lower post-visit uncertainty. MPCC coding found visits were on average 59% patient-centered (range 12-85%). 4HCS coding showed an average of 83 points (maximum possible 115). However, patients felt their visits were highly patient-centered (mean 3.7, range 1.9-4; maximum possible 4). There was a weak correlation between coding schemes, but no association between coding results and patient variables (number of pre-visit concerns, attainment of desired decision-making role, post-visit uncertainty, patients' perception of patient-centeredness). Coder inter-rater reliability was lower than expected; convergent and divergent validity were not supported. The 4HCS and MPCC operationalize patient-centeredness differently, illustrating a lack of conceptual clarity. The patient's perspective is important. Family practice providers can facilitate a more positive patient perception of patient-centeredness by addressing patient concerns to help reduce patient uncertainty, and by negotiating decision-making roles. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Contributors
                Role: MethodologyRole: ValidationRole: Writing – original draft
                Role: Formal analysis
                Role: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 July 2021
                2021
                : 16
                : 7
                : e0254644
                Affiliations
                [001]Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
                University of Bologna, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-5349-7984
                https://orcid.org/0000-0003-1596-5908
                Article
                PONE-D-20-37750
                10.1371/journal.pone.0254644
                8284638
                34270615
                05d86bf2-68d5-4591-8461-2bac12328388
                © 2021 Stark et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 December 2020
                : 30 June 2021
                Page count
                Figures: 3, Tables: 6, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;
                Award ID: 01GY1605
                This survey was part of a project that was funded by the German Federal Ministry of Education and Research (Bundesministerium fuer Bildung und Forschung, BMBF), grant number 01GY1605. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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