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Assessing Communication Between Patients and Physicians: A Manual for Scoring Patient-Centred Communication #95-2

J.B. Brown, M. Stewart, S. Tessier
August 1995

EXECUTIVE SUMMARY

For over a decade the Patient-Doctor Communication Group at the Centre for Studies in Family Medicine, The University of Western Ontario has concentrated on the development, research and dissemination of the Patient-Centred Clinical Model (PCCM). Since our initial publications in 1986, the model has evolved considerably. The clinical method currently consists of six interactive Components that integrate the conventional medical model with an approach that endeavours to understand the patient's unique illness experience. The first Component is the exploration of two conceptualizations of ill health - disease and illness. In addition to assessing the disease process, by history and physical examination, the physician actively seeks to enter the patient' s world - to understand their unique illness experience. The second interactive Component of the patient-centred method is the integration of these concepts of disease and illness with an understanding of the whole person. This includes an awareness of the patient's position in the life cycle and the context in which they live (i.e. family, work, culture). Finding common ground between the doctor and the patient is the third Component of the method and consists of three key areas: the patient and physician mutually defining the problem; establishing the goals of treatment and/or management; and identifying the roles to be assumed by both. The fourth Component emphasizes the importance of using each encounter as an opportunity for prevention and health promotion. The fifth Component takes into consideration that each contact with the patient should be used to build on the patient-doctor relationship as a basis of their continuing work together. The sixth Component requires that, throughout the process, the doctor is realistic about time, availability and accessibility of resources, and amount of emotional and physical energy needed.

With the evolution of the theoretical model the scoring method previously developed to measure patient-centredness during the early 1980's is no longer adequate. This paper describes the development of a new procedure for assessing patient-centred communication which reflects the first three Components of the PCCM. The document provides an overview of the PCCM definitions for each component to be measured, examples, and coding and scoring procedures.