Optimising communication between consumers and clinicians

Effective communication between health care consumers and professionals is fundamental for evidence-based clinical practice.1 Clinicians and consumers recognise how difficult it is to exchange even apparently simple information with each other, while difficulties with more complex information are usually obvious to either or both. With increasing expectations of health care consumers that they will share more in decision making, and with greater access to information of variable quality outside of consultations, including the media and Internet, effective communication during consultations becomes even more necessary than before.

One consequence of poor communication between consumers and clinicians is limited understanding by consumers of the benefits and risks of tests and treatments. This can result in decisions that might have been different with better understanding. For example, fewer men are interested in prostate-specific antigen (PSA) testing, and fewer women in adjuvant therapy for breast cancer after receiving more detailed or applicable information about these interventions.2,3 Other strategies that enhance communication have been shown to lead to improvements in understanding. A systematic review found that communication tools in most formats (eg, verbal, written, illustrative diagrams, cartoons and graphs, video, provider-delivered, computer-based) can increase patients’ understanding, especially if they are structured, tailored and/or interactive.4 The style in which data are presented also influences comprehension: “framing” numerical data about benefits and risks of interventions in either negative or positive and relative or absolute ways influences how data are perceived, not only by consumers but by clinicians as well. Addressing these issues has been shown to increase both consumer satisfaction and involvement in decision making, to result in more realistic expectations of outcomes, and to reduce decisional conflicts.4

Better communication contributes to consumer satisfaction in other ways, and with better outcomes. For example, agreement between physicians and patients about diagnosis and management of back pain is not only associated with higher patient satisfaction, but with better health status outcomes as well,5 suggesting that communication which promotes clinician–patient agreement leads to better outcomes. However, the extent to which poor communication contributes to clinician dissatisfaction, and also to other unfavourable outcomes, such as inappropriate underuse and overuse of investigations and treatments, and to health care costs, is unclear at present.

There are many barriers to effective communication between health care consumers and professionals. They include physical impairments such as hearing and vision loss; learning disabilities; differences in languages spoken, and in cultural, educational, religious and socioeconomic backgrounds of the clinician and consumer; anxiety; and problems associated with illness and poor literacy. As consumers become more able to access information from an increasing array of sources, the skills of reading, writing and numeracy assume even greater importance. Patients with lower literacy skills are more likely to have problems communicating with health care professionals and to have less understanding about their medical conditions and choices.6

Not all clinicians have the skills to communicate well with a broad range of consumers with differing needs, or to involve consumers in making decisions when consumers want this. In addition, many consumers are not accustomed to having their views heard, or sharing in decisions about their care.7 Implementing better communication also requires negotiation and agreement about the particular arrangements for decision making within specific consumer–professional partnerships.8

The National Health and Medical Research Council has extended and applied the recommendations from two earlier publications to develop a toolkit, based on the best available evidence, to help consumers and clinicians learn the principles for better communication.9 The toolkit highlights common communication problems and provides practical strategies, from both consumer and provider perspectives, for recognising, exploring and solving these problems. The toolkit aims to help both health care consumers and professionals expand their communication skills and use them more effectively in a variety of clinical encounters.

The toolkit recognises five principles for effective communication (Box). Each principle is presented in an identical and structured format: background; what the principle means for both health care consumers and professionals; and examples, with tools to put the principles into practice. To apply these five principles, illustrative scenarios, with questions for health care consumers and professionals, and sources of relevant additional information are included.

Communicating benefits and risks of interventions between health care consumers and professionals is complex, to say the least. While there is a growing body of research evaluating ways to improve communication between health care consumers and professionals,10,11 we have only just begun to integrate this information into routine clinical practice. Improved communication tools and more effective techniques to overcome the barriers to better communication are likely to result in greater mutual understanding, better decisions and better health outcomes. However, as there is often a long period between communication during consultations and tangible health outcomes, and as the effects on health outcomes may also reflect other interventions and changes, it is easier to establish the effectiveness of communication strategies on shorter-term processes like knowledge, understanding and satisfaction. More research is needed, not only to prove whether communication strategies lead to better health outcomes, but also whether such strategies can be effectively taught and learned.