Improving Patient-Doc Communications

By Leslie Feldman

Last updated on: May 25, 2010 | Posted on: May 21, 2010

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Asking physicians important questions, and getting all the right answers, is vital to patients managing chronic ailments. Yet so often, patient-doctor communication is hindered by a lack of ease. Patients may feel uncomfortable if their doctor is a different age, gender or race than they are.
Recognizing this predicament, the Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OH, is leading an interdisciplinary research team in a 2-year, $1.3 million National Center on Minority Health and Health Disparities study: Electronic Self-Management Resource Training to Reduce Health Disparities (e-SMART-HD).
The goal of the project is to effect long-term improvements in healthcare outcomes for those with chronic illnesses by providing an interactive, culturally relevant, accessible and easy to use computer-based simulation system.
"In the busy world of clinics and hospitals, patients may not always see their regular doctor. Learning how to communicate with an unfamiliar doctor or healthcare provider of another race, gender or age group can impact whether people get the information they need," said John Clochesy, PhD, RN, FAAN, FCCM, Independence Foundation professor of nursing education. He is also director of the e-SMART-HD study, funded by the National Institute of Nursing Research of the NIH. As such, Clochesy directs researchers from the schools of nursing, medicine and engineering, the Mt. Sinai Skills and Simulation Center and participants from a software company, in developing technologies using "avatar" doctors. Similar to avatars found in computer games, these cyber physicians help patients hone communications skills. The university has hired a research associate and three research nurses to assist with the project.

Improving Communication Gap
According to Clochesy, about 80 percent of a patient's healthcare is self-managed or overseen by family caregivers.
"Millions of Americans are impacted by chronic illnesses, but in particular, minority groups have disproportionately higher rates of almost all the major illnesses," Clochesy explained. "eSMART-HD might close the health disparity gap by teaching patients skills needed to be successful in managing their health through better communications with doctors.
"We hope eventually to have technology available in hospitals and clinics to help patients when they receive a diagnosis," said Clochesy, who envisions patients stopping by a kiosk before a doctor's visit and practicing how to ask the important questions. "Patients might normally feel uncomfortable asking questions to an unfamiliar doctor. But the exposure to avatars of different races and genders might bridge those differences."

John Clochesy, PhD, RN, FAAN, FCCM, Independence Foundation Professor of Nursing Education and director of the e-SMART-HD study at the Fances Payne Bolton School of Nursing at Case Western University.

State-of-the-Art Virtual Technology
During the first phase of the project, 67 men and women from the African-American, Hispanic, Russian-immigrant and lesbian, gay, bisexual and transgender communities participated in focus groups designed to identify common themes in their experiences with healthcare providers. These themes are the basis for the scripts currently being tested by community members interacting with actors from the Mt. Sinai Skills and Simulation Center. Eventually, a refined script will be used in the avatar-based virtual coaching of approximately 160 people with chronic disorders.
According to Clochesy, eSMART-HD will allow participants to "experience" interaction with a variety of virtual healthcare providers and to practice self-management skills, including negotiating for what they want and need.
"As subjects reflect on their 'experience', we expect they will increase their confidence and self-efficacy," noted Clochesy. "In turn, this should increase the productivity of their interactions during regular clinic visits with their providers.
"This is particularly an issue for those with chronic disorders such as diabetes and chronic lung conditions," Clochesy continued. "Only 20 percent of care for chronic illness is provided by healthcare professionals while most care is managed by patients themselves."
"The chronic care model suggests improvements in healthcare outcomes will occur when patients are informed and activated and have productive interactions with a prepared, proactive healthcare team."
At the end of the e-SMART-HD project, Clochesy hopes to have evidence patient communication has improved with healthcare workers by interacting with this technology, and that it makes a difference in their health. "It is important for both the school and the university to build on our expertise while working on unmet needs of patients and their families."

Leslie Feldman is a frequent contributor to ADVANCE.

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