Modern medicine encompasses spectacular advances in understanding the pathogenic mechanisms of the diseases, the deciphering of genetic mysteries, and the development of new means of diagnosis and treatment. Beyond the scientific progress, communication between health professionals contributes substantially to the quality of medical services and increases patients’ adherence to treatment, among other benefits. In addition to professional training and scientific approach, the doctor has the social role of the healer. In this position, some communication skills play a crucial role: displaying respect, understanding, and interest for the patient and his suffering, exercising patience, compassion and interest in patients’ ideas and concerns related to own health[1 2]. Empathy mediates effective communication around health and contributes to increasing the quality and effectiveness of the medical act. The doctor-patient relationship dynamic has changed once the concept of “shared decision” between the doctor and the patient has become widespread.
There is a consistent body of works demonstrating that the quality of doctor-patient communication influences the observable health outcomes and the patient-reported outcomes. An analysis of the therapeutic values of doctor-patient communication indicated two paths of influence over the patient’s health. The direct path is through conversation, expression of empathy, nonverbal behavior, gestures, facial expressions, voice, which can reduce anxiety and negative emotions, increasing hope, confidence, and mental comfort of the patient. The indirect path acts through increasing confidence in the doctor and the medical system, improving adherence to treatment, self-management skills, and social support.
There are differences between patients’ satisfaction with the communication skills of health professionals and the medical personnel’s assessment of the same issues, the latter tending to overestimate their abilities. Healthcare professionals’ attitudes are also affected when there is a divergence between them and patients or their relatives. The negative impact of conflicts can be diminished or even avoided if the patient is well informed, is involved in making choices about his health, and can explain why he disagrees with the doctor. Besides, the increase in patient satisfaction is associated with a decrease in rates of malpractice complaints or claims.
The communication skills of physicians are recognized as vital for the quality of the medical act. Several institutions have included training and assessment of physicians’ communication skills as one of the mandatory skills and competencies for physicians. However, defining and evaluating communication skills is not easy. The Can MEDS Framework defines communication skills as a combination of the following behaviors:
Establishing professional therapeutic relationships with patients and their families
Eliciting and synthesizing accurate and relevant information, incorporating the perspectives of patients and their families
Sharing health care information and plans with patients and their families
Engaging patients and their families in developing plans that reflect the patient’s health care needs and goals
Documenting and sharing written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy.
For the above reasons, many training programs for health professionals focus on communication with patients.
The SEGUE Framework is one of the most popular, well-known, and sophisticated tools for learning and evaluating communication skills. The acronym comes from Stage set, Elicit information, Give information, and Understand the patient’s perspective, End the encounter. It contains a list of 32 items of patient-doctor communication tasks, whose acceptance, validity, and reliability have been confirmed in numerous scientific papers or clinical practice, in medical or academic units, and various specialties. A limitation of this tool is that it is a checklist (the answer for each item is YES or NO) and is less useful in measuring the increase in communication skills compared to a ranking scale. Another example is a program for dermatologists structured upon generally valid principles, such as: organizing the agenda for the current visit, ensuring reflective listening, using the NURS approach (Name, Understanding, Respect, aSsistance), using various and easy-to-understand methods to provide information to patients, checking if the patient has understood (using the teach-back technique). Other communication principles included by the above program are: using teaching tools such as written worksheets, audio-visual aids, and internet materials, and combining them with verbal instructions, making sure to resolve all issues and questions before making a shared decision with the patient[12 13]. These programs are not homogeneous, and there is no consensus on tools for assessing physicians’ ability to communicate.
A systematic review of the literature on existing tools for assessing physicians’ communication skills, which looked at 45 instruments in 57 studies, found an extensive heterogeneity between the tools used, highlighting the lack of consensus. This analysis concluded that it is necessary to develop unitary training methods for health professionals and to use assessment tools that are easy to manage, simple, time-sparing, standardized, validated, easy to reproduce, and generally accepted by users.
Many instruments mix the communication elements with aspects related to patients’ satisfaction with medical activity, the duration of the evaluation period is different (last consultation or longer periods), the evaluation is done in various conditions (outpatient or hospitalization). For example, there is a validated tool designed exclusively to assess how satisfied patients are with the information they receive about the prescribed medications: the “Satisfaction with Information about Medicines Scale” (SIMS).
Patients’ ability to understand and communicate is influenced by many factors: their disease status, genetic predisposition, personality, education, medical knowledge, anxiety, overestimated expectations, and coping style.
A study conducted in 31 European countries, which used a patient-generated questionnaire (PCVq) and also analyzed aspects related to the cultural and socio-economic dimensions, showed that patients most appreciate being treated as partners and continuity in medical care. At the same time, most disliked was the need to obtain additional information and to prepare before a visit.
One of the essential factors in establishing excellent communication with patients is time. The duration of the visit can influence the establishment of a deeper and more complex relationship with the patient. Duration depends on many factors, including the complexity of the patient’s pathology, age, and psycho-intellectual condition. However, more time does not guarantee better communication, the proper use of time being essential in this regard. An analysis of published data on the efficacy of communication in the doctor-patient relationship indicated three areas of improvement for the effective use of communication: developing a friendly relationship with patients, establishing a consultation plan, and acknowledging social or emotional clues with empathy.
The Communication Skills Assessment (CAT) was developed to assess interpersonal communication skills between physicians and patients. This tool’s development process has been complex, and its reliability, validity, and feasibility confirmed in several studies. Since 2009, the Accreditation Council for Graduate Medical Education (ACGME) has recommended this tool for evaluating young physicians in the USA. The original CAT article describes all the details related to development procedures and psychometric parameters. This tool assesses patients’ opinions shortly after hospitalization or outpatient visit regardless of the clinical specialties. It is a reliable and valid questionnaire for measuring patients’ opinions in connection with the doctor’s ability to communicate[20–22]. CAT consists of 15 items measured on a 5-point response scale (1 = poor; 2 = fair; 3 = good; 4 = very good; 5 = excellent). The application alternatives are several: on paper, over the telephone, or on the internet.
Furthermore, it can be self-administered or administered by an interviewer, since its completion does not take long, and there are no restrictions related to patients’ age, sex, race, or education level. Both doctors and patients can use it, and it is useful in daily practice (on the first visit or subsequent visits), and for research purposes. Interpreting and analyzing the results is simple, and there is a section where the patients can rate global care and another one designated to patients’ comments.
Currently, there are no validated instruments to assess patient - healthcare professionals’ communication (HCP) ability in the Romanian healthcare system. This study uses a controlled and methodical process to translate and cross-culturally adapt a Romanian version of the Communication Assessment Tool (CAT_Ro).