A Feasibility Study of a Method of Quantifying Dentist- Patient Communication A. Koerber,* 1 S....
1
A Feasibility Study of a Method of Quantifying Dentist-Patient Communication A. Koerber,* 1 S. Gajendra, 2 R. Fulford, 1 E. BeGole, 1 I. Punwani, 1 C.A. Evans 1 1 University of Illinois College of Dentistry, 2 University of Illinois at Springfield Abstract Roter (1995) devised and validated a method of quantifying physician- patient communication (Roter's Interaction Analysis System/RIAS) which improves physician skills and patient satisfaction. Objectives: We sought to determine whether a modified version was valid and feasible for measuring dentist-patient communication. Method: In a pilot study, a version was used to code audio-tapes of sessions between orthodontic residents and adolescent patients. Roter's 40 categories of utterances were combined into 20. Three RAs coded the utterances into categories, and rated the dentist for Warmth on a 5-point scale. To establish reliability, ten tapes were coded by all raters. Validation of the modified method was tested in two ways: were the two kinds of dental sessions characterized by different types of utterances (Sondell, 1998), and did certain types of utterances correlate appropriately with Warmth of the dentist? Results: 57 Records sessions and 25 Treatment-Plan-Presentation sessions were recorded and coded. Only the dentists' statements were recorded. Inter-rater reliability of the modified method was .80 (Cohen's kappa), but it added an unnecessary step to Roter's method. The patterns of communication differed significantly between the two types of sessions (MANOVA, p<.000). Using a Bonferroni correction (=.005), the Records sessions were characterized by significantly longer time and more approval, orientation, checks for understanding, and open- and close-ended questions. Treatment-Plan-Presentation sessions contained more giving of information and more instructions. Warmth of the dentist correlated significantly with personal, laughter, approving, empathy, and encouragement utterances (Spearman's rho, =.005). Conclusions: Roter's original method is easier than our modified method for coding Objective To determine the validity and feasibility of the Roter Interaction Analysis System (RIAS) for quantifying dentists’ communication. Background The Roter Interaction Analysis System (RIAS) has been used to quantify medical communication (Roter, 1995). It is a valid and reliable method of measuring and evaluating medical communication (Levinson, Roter, & Mullooly,1997). •The RIAS has been used to improve physicians’ communication (Roter, et al., 1998) and to increase patient satisfaction (Hall, et al., 1994). •This method has been validated in a prosthodontic setting (Sondell, et al., 1998). Method 1. RIAS modification 2. Data Collection a. 57 Records Sessions audio- taped. c. 25 Treatment Planning Sessions. d. 70 adolescent patients. e. 16 orthodontic residents. f. 3 Raters coded 10 tapes for an inter-rater reliability of .80 (Cohen’s Kappa). 3. Measures a. Raters scored dentists on Warmth on a 5 point Likert Scale. b. 20 types of utterances. V ariable R ecords Session M edian Score Treatm entPlan Session M edian Score Sig. Tim e (m inutes) 522 432 .004 Tim e SpentTalking to O thers 13 6 .009 W armth 3 3 .366 Personal 8 8 .675 Laughs 5 7 .440 A pproves 27 6 .000 A grees 9 11 .778 Em pathic 1 0 .095 C oncern,W orry 3 3 .870 Encouragem ent 3 4 .029 Partnership 0 2 .005 Self-D isclosure 0 0 .388 D isapproving 0 0 .831 C riticalofO thers 0 0 .708 O rient 114 30 .000 A dm onishm ent 0 0 .934 C heck for U nderstanding 5 2 .000 A sksforO pinion 8 7 .984 C losed-Ended M edicalQuestion 22 2 .000 O pen-Ended M edical Q uestion 2 0 .000 Exchange ofN on-M edicalInfo. 2 5 .029 GivesInform ation 5 91 .000 G ivesInstructions 0 10 .000 Variable Spearma n R Sig . Laughs .487 .00 0 Personal .381 .00 0 Empathic .365 .00 0 Approval .352 .00 1 Encourag es .305 .00 5 Asks for .274 .01 Results Validity: Appropriate Utterances Correlate with Ratings of Warmth Validity: Utterance Differences by Session Conclusions 1. RIAS scoring differentiates between types of sessions. 2. The appropriate RIAS utterances correlate with ratings of warmth. 3. Information was lost by not coding the patient utterances. 4. The original RIAS is easier to use than our modified system. 5. Even with the modifications, RIAS is a reliable and valid method for measuring communication in a dental setting. 6. The RIAS method shows promise for training and research purposes in dentistry. Mann-Whitney U Tests. Bonferroni Correction, =.002 Discussion Strengths of RIAS: 1. Good inter-rater reliability is obtainable with training. 2. RIAS shows validity: it distinguishes between types of sessions. 3. Appropriate utterances correlate with Warmth. 4. Objective method of assessing communication skills. Limitations of RIAS & of study: 1. Statistical analysis is difficult-- data are not normally distributed. 2. Collapsing the variables made coding more difficult. 3. Requires rater training. 4. Small provider sample. References 1. Hall, J.A., Irish, J.T., Roter, D.L., Ehrlich, C.M., Miller, L.H. (1994b). Satisfaction, gender, and communication in medical visits. Medical Care, 32 (12), 1216- 1231. 2. Levinson, W., Roter, D., Mullooly, J.P. (1997). The relationship with malpractice claims among primary care physicians and surgeons. Journal of American Medical Association. 277 (7), 553-559. 3. Roter D. (1995). The Roter Method of Interaction Process Analysis, (3 rd ed.) Baltimore, MD: Johns Hopkins University School of Hygiene and Public Health. 4. Roter D; Rosenbaum J; De Negri B; Renaud D; Diprete-Brown L; Hernadez O. (1998)The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Medical Education , 32(2): 181-9 5. Sondell, K., Soderfeldt, B., Palmquist. (1998). A method for communication analysis in prosthodontics. Acta Odontololica Scandinavica.56 (1), 48-56.
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Transcript of A Feasibility Study of a Method of Quantifying Dentist- Patient Communication A. Koerber,* 1 S....
A Feasibility Study of a Method of Quantifying Dentist-Patient Communication
A. Koerber,*1 S. Gajendra,2 R. Fulford,1 E. BeGole, 1 I. Punwani, 1 C.A. Evans 1 1University of Illinois College of Dentistry, 2University of Illinois at Springfield
AbstractRoter (1995) devised and validated a method of
quantifying physician-patient communication (Roter's Interaction Analysis System/RIAS) which improves physician skills and patient satisfaction. Objectives: We sought to determine whether a modified version was valid and feasible for measuring dentist-patient communication. Method: In a pilot study, a version was used to code audio-tapes of sessions between orthodontic residents and adolescent patients. Roter's 40 categories of utterances were combined into 20. Three RAs coded the utterances into categories, and rated the dentist for Warmth on a 5-point scale. To establish reliability, ten tapes were coded by all raters. Validation of the modified method was tested in two ways: were the two kinds of dental sessions characterized by different types of utterances (Sondell, 1998), and did certain types of utterances correlate appropriately with Warmth of the dentist? Results: 57 Records sessions and 25 Treatment-Plan-Presentation sessions were recorded and coded. Only the dentists' statements were recorded. Inter-rater reliability of the modified method was .80 (Cohen's kappa), but it added an unnecessary step to Roter's method. The patterns of communication differed significantly between the two types of sessions (MANOVA, p<.000). Using a Bonferroni correction (=.005), the Records sessions were characterized by significantly longer time and more approval, orientation, checks for understanding, and open- and close-ended questions. Treatment-Plan-Presentation sessions contained more giving of information and more instructions. Warmth of the dentist correlated significantly with personal, laughter, approving, empathy, and encouragement utterances (Spearman's rho, =.005). Conclusions: Roter's original method is easier than our modified method for coding dental communication. Patient utterances are an important part of the RIAS, so we must overcome the difficulties of recording patients. Even with the modifications, RIAS is a reliable and valid method for measuring communication in dental settings. The RIAS shows promise for training and research purposes in dentistry.
Objective
To determine the validity and feasibility of the Roter Interaction Analysis System (RIAS) for quantifying dentists’ communication.
Background
The Roter Interaction Analysis System (RIAS) has been used to quantify medical communication (Roter, 1995). It is a valid and reliable method of measuring and evaluating medical communication (Levinson, Roter, & Mullooly,1997). •The RIAS has been used to improve physicians’ communication (Roter, et al., 1998) and to increase patient satisfaction (Hall, et al., 1994). •This method has been validated in a prosthodontic setting (Sondell, et al., 1998).
Method
1. RIAS modification2. Data Collection a. 57 Records Sessions audio-taped. c. 25 Treatment Planning Sessions. d. 70 adolescent patients. e. 16 orthodontic residents. f. 3 Raters coded 10 tapes for an inter-rater
reliability of .80 (Cohen’s Kappa).3. Measures a. Raters scored dentists on Warmth on a 5
point Likert Scale. b. 20 types of utterances.
Variable Records Session
Median Score
Treatment Plan Session
Median Score
Sig.
Time (minutes) 522 432 .004
Time Spent Talking to Others 13 6 .009
Warmth 3 3 .366
Personal 8 8 .675 Laughs 5 7 .440
Approves 27 6 .000 Agrees 9 11 .778
Empathic 1 0 .095 Concern, Worry 3 3 .870
Encouragement 3 4 .029 Partnership 0 2 .005
Self-Disclosure 0 0 .388
Disapproving 0 0 .831 Critical of Others 0 0 .708
Orient 114 30 .000 Admonishment 0 0 .934
Check for Understanding 5 2 .000
Asks for Opinion 8 7 .984
Closed-Ended Medical Question 22 2 .000
Open-Ended Medical Question 2 0 .000
Exchange of Non-Medical Info. 2 5 .029
Gives Information 5 91 .000 Gives Instructions 0 10 .000
Variable Spearman R
Sig.
Laughs .487 .000
Personal .381 .000
Empathic .365 .000
Approval .352 .001
Encourages .305 .005
Asks for Opinion
.274 .013
Results
Validity: Appropriate Utterances Correlate with Ratings of Warmth
Validity: Utterance Differences by Session
Conclusions1. RIAS scoring differentiates between types of sessions.2. The appropriate RIAS utterances correlate with ratings of
warmth.3. Information was lost by not coding the patient utterances.4. The original RIAS is easier to use than our modified
system.5. Even with the modifications, RIAS is a reliable and valid
method for measuring communication in a dental setting.
6. The RIAS method shows promise for training and research purposes in dentistry.
Mann-Whitney U Tests. Bonferroni Correction, =.002
DiscussionStrengths of RIAS: 1. Good inter-rater reliability is obtainable with training.2. RIAS shows validity: it distinguishes between types of
sessions.3. Appropriate utterances correlate with Warmth.4. Objective method of assessing communication skills.
Limitations of RIAS & of study:1. Statistical analysis is difficult-- data are not normally distributed.2. Collapsing the variables made coding more difficult.3. Requires rater training.4. Small provider sample.
References1. Hall, J.A., Irish, J.T., Roter, D.L., Ehrlich, C.M., Miller, L.H. (1994b). Satisfaction, gender, and communication in medical visits. Medical Care, 32(12), 1216-1231. 2. Levinson, W., Roter, D., Mullooly, J.P. (1997). The relationship with malpractice claims among primary care physicians and surgeons. Journal of American Medical Association. 277(7), 553-559.3. Roter D. (1995). The Roter Method of Interaction Process Analysis, (3rd ed.) Baltimore, MD: Johns Hopkins University School of Hygiene and Public Health. 4. Roter D; Rosenbaum J; De Negri B; Renaud D; Diprete-Brown L; Hernadez O. (1998)The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Medical Education , 32(2): 181-95. Sondell, K., Soderfeldt, B., Palmquist. (1998). A method for communication analysis in prosthodontics. Acta Odontololica Scandinavica.56(1), 48-56.
