Research was conducted to evaluate conversations about epilepsy between community-based neurologists and patients. Adverse effects of antiepileptic drugs and mood/behavioral issues were infrequently discussed, and neurologists and patients disagreed about these issues postvisit. Follow-up research was conducted to assess the impact of a previsit assessment tool on discussions of epilepsy. Twenty neurologists reviewed a tool incorporating questions from validated instruments (Adverse Events Profile [AEP] and Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]). Naturally occurring interactions between neurologists and 60 patients were recorded. Neurologists and patients were interviewed separately. All components were transcribed and analyzed using sociolinguistics. Using the previsit assessment tool increased the number of discussions about adverse effects and mood/behavioral issues and increased neurologist–patient agreement about issues postvisit. Visit length did not increase significantly when the tool was used. Ten months after follow-up research, 50% of neurologists reported continuing to use the tool in everyday practice with patients with epilepsy.

Psoriasis is a chronic inflammatory disease that can significantly affect quality of life. Effective communication between health care providers and patients is important for managing psoriasis, and sociolinguistic analysis is a validated method for researching physician–patient interactions. To characterize current in-office communication patterns and to identify potential ways in which such interactions may be improved regarding quality of life, we studied the in-office discussions between 24 patients with psoriasis and their physicians using audio and video recordings. Although many physicians acknowledged the effect of psoriasis on quality of life, few discussed this aspect of the disease with patients. This study offers a foundation for additional research examining communication strategies between patients with psoriasis and their health care providers.

Abstract Introduction An in-office linguistic study was conducted to help improve understanding of how to better evaluate and treat attention-deficit/hyperactivity disorder (ADHD). Methods Naturally occurring interactions were recorded among 7 psychiatrists and 23 patients and 8 pediatricians along with 22 patients and their parents. Participants were interviewed separately post-visit. Transcripts of interactions and interviews were analyzed using sociolinguistic techniques. Results Visits were variable in length and lacked concrete treatment plans. In the pediatric setting, children were typically excluded from dialogues, accounting for only 8% of words spoken. School was the primary metric used to evaluate symptoms. Pediatricians allayed parents' concerns about stimulant therapy by promising to prescribe the lowest possible dose, rather than discussing titrating to an optimal dose. Adults were evaluated idiosyncratically without the use of scales or tools. Stimulants were positioned as short-term “trials” without strong physician recommendations. Discussion Conversations about stimulant therapy lacked goal- and expectation-setting. Also missing from conversations was a definitive treatment plan based on the core symptoms of ADHD. Incorporating open-ended questions and tools or rating scales may result in a more effective and efficient in-office dialogue. Conclusion Further research is warranted to assess the efficacy of communication strategies to enhance in-office discussions of ADHD and stimulant therapy.

PURPOSE:To assess communication about adherence and to determine the impact of communication skills training on physicians' approach to nonadherence. DESIGN:Sociolinguistic analysis of videotaped community ophthalmologists' encounters with patients with glaucoma before and after training. Patients in both phases and physicians in phase I knew communication was being studied but not what the focus of the study was. In phase II, physicians knew the targeted communication behaviors. PARTICIPANTS:Twenty-three ophthalmologists and 100 regularly scheduled patients with glaucoma (50 per phase). METHODS:An educational program with videotaped vignettes of simulated patient encounters using audience response and role play to teach patient-centered communication skills, including a 4-step adherence assessment and the use of open-ended questions in ask-tell-ask sequences. MAIN OUTCOME MEASURES:Physician eliciting an acknowledgment of nonadherence during a clinical encounter compared with acknowledgment of nonadherence during a postvisit research interview (primary outcome), and performance of targeted communication and substantive discussion of adherence. RESULTS:After intervention, physicians increased the proportion of open-ended questions (15% vs 6%; P = 0.001) and specifically about medication taking (82% compared with 18% of encounters; P<0.001). Compared with the absence of ask-tell-ask communication, 32% of phase II encounters included a complete ask-tell-ask sequence, 78% included an ask-tell sequence, and 32% a tell-ask sequence (P<0.001). Three of 4 steps for assessment of adherence were more common in phase II, and substantial discussions of adherence occurred in 86% versus 30% of encounters (P<0.001). In phase II, physicians elicited acknowledgment of nonadherence in 78% (7/9) of those who acknowledged nonadherence in the postvisit interview compared with 25% in phase I (3/12; P = 0.03). CONCLUSIONS:This study demonstrates that experienced community physicians significantly improved their communication strategies and ability to detect and address nonadherence after a 3-hour educational program. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found after the references.

Objective: To study the tone, content, and structure of in-office discussions between psychiatrists and adults with depression and possible comorbid attention-deficitlhyperactivity disorder (ADHD). Methods: Patients with a pre-existing diagnosis of depression, but not ADHD, and screening results indicating the possible presence of ADHD, were selected. Office visits were videotaped and analyzed for tone, content, and structure, using sociolinguistic techniques. Separate post-visit interviews were conducted with patients and psychiatrists. Results: The study sample comprised 14 patients and eight psychiatrists, although data on the possibility of ADHD were available for only 13 patients. The possibility of an ADHD diagnosis was not discussed in any office visit. Psychiatrist- or patient-driven language suggesting possible ADHD symptoms occurred during five (36%) visits. In post-visit interviews of 13 patients, nine (69%) felt they had or might ha ve ADHD. In contrast, psychiatrists felt that 12 patients (92%) did not have ADHD. Nine psychiatrist-patient pairs (69%) disagreed about the possibility of ADHD. Conclusion: Psychiatrists and their patients diagnosed with depression showed low levels of agreement regarding the possibility of comorbid ADHD. Psychiatrists frequently missed or misinterpreted patient cues regarding potential ADHD symptoms, suggesting psychiatrists may need to be more vigilant in screening for ADHD in this at-risk population.

An in-office linguistic study was conducted to assess physician patient discussions of mixed dyslipidemia. Naturally occurring interactions among 12 cardiologists, 12 primary care physicians, and 45 of their patients diagnosed with low levels of high-density lipoprotein cholesterol and being treated with prescription niacin extended-release were recorded. The participants were interviewed separately after the visit. The transcripts were analyzed using sociolinguistic techniques. Determined from the time at talk and the number of questions asked, the patients were moderately engaged in the visit conversations; however, most communication was physician-driven. Only 6% of the average visit was dedicated to disease education. Conversations about dyslipidemia were characterized by numerous laboratory values but rarely contained clear benchmarking or goal setting. In the postvisit interviews, the patients demonstrated a lack of understanding about their lipid levels and the next steps they should take. Both "HDL" [high-density lipoprotein] and "good cholesterol" were the most frequently mentioned aspects of dyslipidemia in these conversations; however, most physicians did not contextualize these components such that the patients were able to understand and retain the information after the visit. Although the conversations about treatment with niacin extended-release contained detailed information about how to manage the side effect of flushing, they lacked a clear description of this side effect. Also, missing from the dialogue was a balanced discussion of risks and benefits. Communication gaps were observed in the discussions regarding mixed dyslipidemia and its treatment with niacin extended-release. In conclusion, additional research is warranted to assess the efficacy of communication strategies to educate both physicians and patients about this condition and its treatment. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:51-55)

On page 1, the first line of the first paragraph in the right column should read "Prior to study initiation, a working group consisting of epilepsy experts (F.G., P.P., J.S., G.H., D.L., and J.C.) and linguistic specialists (C.E., M.O. and E.M.) convened to discuss study objectives, methodology, and analyses, with the goal of studying communication surrounding epilepsy in real-world office visits," instead of "Prior to study initiation, a working group consisting of epilepsy experts (F.G., P.P., D.L., G.H., and J.C.) and linguistic specialists (C.E., M.O., and E.M.) convened to discuss study objectives, methodology, and analyses, with the goal of studying communication surrounding epilepsy in real-world office visits." On page 1, the first line of the first paragraph in the right column should read "Prior to study initiation, a working group consisting of epilepsy experts (F.G., P.P., J.S., G.H., D.L., and J.C.) and linguistic specialists (C.E., M.O. and E.M.) convened to discuss study objectives, methodology, and analyses, with the goal of studying communication surrounding epilepsy in real-world office visits," instead of "Prior to study initiation, a working group consisting of epilepsy experts (F.G., P.P., D.L., G.H., and J.C.) and linguistic specialists (C.E., M.O., and E.M.) convened to discuss study objectives, methodology, and analyses, with the goal of studying communication surrounding epilepsy in real-world office visits." Conversations between community-based neurologists and patients with epilepsy: Results of an observational linguistic studyEpilepsy & BehaviorVol. 16Issue 2PreviewAn in-office linguistic study was conducted to assess neurologist–patient discussions of epilepsy. Naturally occurring interactions among 20 neurologists and 60 of their patients with epilepsy were recorded. Participants were interviewed separately postvisit. Transcripts were analyzed using sociolinguistic techniques. Of 59 patients taking antiepileptic drugs previsit, 44 (75%) discussed side effects with their neurologist. Side effect discussions were most often neurologist initiated. Postvisit, patients and neurologists often disagreed about which side effects were experienced. Full-Text PDF

Purpose: To evaluate current discussions of Crohn's disease and its treatment, an observational study was conducted using accepted sociolinguistic methodologies. Methods: 1161 community-based gastroenterologists were invited to participate; the first 18 who responded and met screening criteria were enrolled in the sample. Regularly scheduled office visits were recorded with patients with Crohn's disease who were candidates for and likely to discuss biologic therapy. Separate post-visit interviews were recorded with physicians and patients, and demographic questionnaires were completed. Recordings were transcribed and analyzed using sociolinguistic techniques, including quantification of topics discussed and time spent on each, quantification and qualification of questions asked and answered, and identification of requests for information and making of recommendations. Results: Interactions between 14 physicians and 23 patients were analyzed. Physicians were 77% male; patients were 48% female, had a mean age 38 and a mean duration of Crohn's disease of 13 years. Mean duration of visits was 10.46 minutes (range 2.42 -26.33 minutes). Discussions of Crohn's disease, including side effects, medication efficacy, and all other medication conversation (e.g., confirming current regimen, dosing, refills), made up 45% of visits. Conversations about symptoms and complications of the disease comprised 18% of visits. Quality of life dialogues made up less than 3% of visits. Visits were physician-driven and characterized by rapid-fire, closed-ended symptom questions. Patients' quality of life (QOL) was rarely addressed; however, 96% of patients revealed information post-visit about how their QOL was negatively impacted by Crohn's disease. Additionally, 39% of patients reported deliberately withholding information about their QOL from their physician. Biologic therapy was discussed but not initiated in 11 of 23 visits. Both risks and benefits of biologics were mentioned, but risks were typically serious (e.g., lymphoma) while benefits were typically general (e.g., a biologic “might help you”). All 11 patients stated post-visit that they would be interested in learning more about new forms of treatment for Crohn's disease. Conclusion: In-office dialogue is marked by rapid-fire, closed-ended symptom questions, a lack of attention to QOL, and an unbalanced presentation of biologic therapy. This may account for 11 of 23 visits in which biologic therapy was discussed as an option but not prescribed. Further research is needed to evaluate strategies to improve in-office communication, such as incorporating a validated tool into office visits focused on the management of Crohn's disease. Disclosure: Dr Persley - Consultant: Centocor Ortho Biotech.

An in-office linguistic study was conducted to assess neurologist–patient discussions of epilepsy. Naturally occurring interactions among 20 neurologists and 60 of their patients with epilepsy were recorded. Participants were interviewed separately postvisit. Transcripts were analyzed using sociolinguistic techniques. Of 59 patients taking antiepileptic drugs previsit, 44 (75%) discussed side effects with their neurologist. Side effect discussions were most often neurologist initiated. Postvisit, patients and neurologists often disagreed about which side effects were experienced. The presence of a caregiver (e.g., spouse) usually resulted in lengthier, more detailed discussions of side effects, without drastically increasing overall visit length. Discussions of mood- and behavior-related comorbidities occurred infrequently (14 of 60 visits); postvisit, neurologists stated that they felt that management of these conditions was outside their area of expertise. Communication gaps observed in discussions of epilepsy and its treatment warrant further exploration. Additional research is currently underway to assess the efficacy of a previsit assessment tool.

Objective: The aim was to evaluate in-office discussions of ADHD and psychiatric comorbidities. Method: Naturally occurring interactions among 11 psychiatrists, 32 patients and their parents were recorded, with a focus on “complicated” patients (i.e., having or suspected to have ≥ 1 psychiatric comorbidities and/or learning disabilities in addition to ADHD). Participants were interviewed separately post visit. Transcripts were analyzed using validated sociolinguistic methodologies. Results: Some 62% of patients were male, with an average age of 12.5 years, and 79% had a family history of ADHD. Visits were psychiatrist-driven, focusing on medication management and school performance, leaving management of comorbidities largely unaddressed. Post visit, 78% of parents and psychiatrists disagreed on patients' “most concerning behavior.” Parents most often reported concern about aggression and oppositionality. Psychiatrists and parents emphasized different aspects of patients' personality, using deficit- and strength-based models, respectively. Conclusion: Psychiatrists and parents interpreted the relationship between ADHD and comorbidities differently. The significant incidence of misalignment regarding worrisome behaviors warrants further exploration.

PURPOSE:To assess doctor-patient communication in patients with glaucoma.DESIGN:Observational cohort study.PARTICIPANTS:Twenty-three ophthalmologists and 50 patients with glaucoma.METHODS:Doctor-patient encounters were audio- and videotaped and analyzed using validated sociolinguistic approaches. After the visit, the doctor and the patient completed questionnaires, and patients were interviewed using a semistructured, patient-centered protocol.MAIN OUTCOME MEASURES:Summary statistics about doctor-patient encounters, assessment of alignment of attitudes between patients and doctors, and patient admission to missing doses.RESULTS:Physicians spent an average of 8.0 (standard deviation [SD], 3.1; median, 7.8) minutes in the room with the patient and an average of 5.8 (SD, 2.4; median, 7.5) minutes talking with the patient, delivering 70% of all spoken words and asking two thirds of all questions. Glaucoma-related discussion occupied 50% of talk time and was focused primarily on examinations and treatment (25%). One third of discussions addressed ocular issues other than glaucoma. Virtually all physician questions (94%) were closed ended. Most patient questions were about intraocular pressure (20% of visits), details of the medication regimen (20%), disease status (14%), and testing (12%). Although physicians and patients were aligned in believing that the physician should control the visit agenda, physicians tended to support greater physician control of decision making than did patients. Physicians failed to identify most patients who admitted to missing doses, a surrogate for nonadherence, stating that 10 of 13 in this category were taking drops "all" or "most" of the time. Physician interviews detected 3 of the 11 patients whose postvisit questionnaire indicated missing a dose in the last week compared with 11 of the 11 detected by the postvisit research interview. Patients who stated they had missed doses recently reported being less satisfied with the doctor-patient encounter than those who did not.CONCLUSIONS:Doctor-patient dialogue was universally physician centered; physicians spoke 70% of the words and asked closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses. A minority of physicians ever asked patients if they had questions. In contrast with the patient-centered research interview, doctors' physician-centered communication failed to identify most patients who had missed doses.

1064 Background: The majority of research in office-based breast cancer communication has focused on the adjuvant setting; however, an unmet need exists for insight into dialogue with metastatic breast cancer (MBC) patients. An observational in-office linguistic study was conducted to analyze how oncologists and MBC patients discuss MBC and its treatment, in order to identify gaps in communication and develop recommendations to improve patient-provider dialogue. Methods: 1,000+ community-based oncologists were sent invitation letters; of these, 20 met screening criteria and agreed to participate. Signed consent was obtained from all providers and MBC patients (n=45). Patient-provider discussions were recorded during regularly-scheduled visits. Both parties were interviewed separately post-visit to capture provider intent and patient comprehension. All components were transcribed, analyzed and correlated using validated sociolinguistic models. Results: In-office discussions of MBC treatment have the following characteristics: Oncologists primarily use closed-ended questioning to evaluate symptoms and side effects. Neither party links side effects to patients’ quality of life (QOL). In contrast, post-visit, patients focus on how side effects affect their QOL. Oncologists and patients are often misaligned regarding side effects post-visit, with both parties often referencing side effects not mentioned during the visit. Oncologists’ language surrounding prognosis and treatment goals is largely positive. Although patients are actively engaged in visits through asking questions about MBC and treatment, they are often not aligned with the oncologist on prognosis and treatment goals post-visit. Conclusions: Analysis of in-office dialogue demonstrates that oncologists and patients may be misaligned on multiple facets of treatment decision-making and objectives. New interactional frameworks may help meet the specific needs of oncologists engaging in dialogue with MBC patients, resulting in improved patient care. No significant financial relationships to disclose.

Objective: The American Migraine Communication Study I (AMCS 1) revealed communication deficits illustrated by differing healthcare professional (HCP) and patient reports about issues such as impairment and frequency. AMCS II was designed to assess an intervention using open-ended questions about impairment and 'ask-tell-ask' sequences to confirm headache frequency in days versus attacks.Research design and methods: HCPs who participated in AMCS I completed an internet-based intervention. Researchers were sent to HCPs' offices, and patients likely to discuss migraine were recruited immediately prior to normally-scheduled appointments. Post-consent, visits were recorded without a researcher present. Separate post-visit interviews were conducted with all parties. All interactions were transcribed.Main outcome measures: Transcripts were analyzed using validated sociolinguistic techniques, and study results were compared to AMCS I.Results: HCPs assessed impairment in 90% of interactions compared to 10% in AMCS I (p < 0.0001) and used open-ended questions to assess impairment in 55% of visits (95% CI: 0.4261-0.6598). Impairment between attacks was discussed in 37% of visits vs. 0% in AMCS I (p < 0.0001). HCPs completed full ask-tell-ask sequences in 29% of visits (95% CI: 0.1921-0.4070). AMCS II contained more discussions of migraine preventive therapy with appropriate candidates compared to AMCS I (74 vs. 50%; p = 0.069) without statistically increasing median visit length (9:36 vs. 11:00; p = 0.668). Post-visit, HCPs and patients were often aligned about impairment and frequency and reported high levels of satisfaction.Conclusions: Although further research with a larger sample is needed, a brief, internet-based intervention appears to promote positive communication changes not associated with increased visit length.