Chapter 4 Health Communications PDF

PSY 307: Health Psychology Chapter 4 Health Communication  A Simple Relation Effective doctor-patient communication is central to satisfaction with treatment The role of the therapeutic alliance in psychotherapy Why do people seek medical help?  Perceiving Symptoms...

PSY 307: Health Psychology Chapter 4 Health Communication  A Simple Relation Effective doctor-patient communication is central to satisfaction with treatment The role of the therapeutic alliance in psychotherapy Why do people seek medical help?  Perceiving Symptoms Notice something is wrong We Aren’t the Best at This  Perceiving Symptoms Variability in perception stems from different factors – Personality – hypochondriacs – Situation –mood & affect – Demographics – women, elderly, high SES  Interpreting Symptoms How symptoms are interpreted – Experience New symptoms are worse – Familiarity Unfamiliar symptoms are worse Culture – E.g., boys don’t cry  In General The faster you seek treatment, the better the outcome will be What motivates people to seek treatment?  Seeking Medical Care Most seek help when symptoms are – New (best predictor) – Painful – Disruptive – Highly visible – Affect valued body parts  In General Delays from identifying symptoms to receiving medical treatment take up valuable time – E.g., average time between heart attack and medical treatment is 3.5 hours  Szasz & Hollender (1956) Theoretical model of patient-doctor communication 1. Active-Passive = patients unable to participate due to severity of DII  Szasz & Hollender (1956) 2. Guidance-Cooperation = patients seek help, they answer doctor’s questions 3. Mutual-Participation = patient and doctor make joint decisions  Talking to Your Doctor Roter (1997) taped and analyzed over 500 patient-doctor interactions in a variety of HC settings Empirical model of patient-doctor communication  1. Narrowly Biomedical 32% Mostly biomedical talk, closed ended questions (e.g., “does it hurt when I do…?”) Patient as subject  2. Expanded Biomedical 33% Moderate levels of biomedical talk, some talk of patient concerns, feeling Patient as subject with feelings  3. Biopsychosocial 20% Even mix of biomedical talk and patient concerns Patient as partner  4. Psychosocial 8% Dominated by concerns about psychosocial well-being of patients Doctors give life advice (“get a hobby, think positive”)  5. Consumerist 8% Doctor as consultant Patient as boss  National Study “What people want from their family physician?” Top 10 attributes of patient satisfaction are mostly about communication, not outcomes Top 10 Attributes  Benefits For Patients For Doctors – Satisfaction with care – Fewer patient complaints & lawsuits – Sharing of information for accurate diagnosis – Greater work satisfaction, less work- – Efficacy related stress, & reduced burnout – Adherence – Recovery Adhering to Medical Advice  Adherence Following the advice of your doctor Non-adherence – not following advice of health care professionals Creative Non-adherence – intentional modification of recommended treatment  Measuring Adherence Ask health professional Ask patient Ask other people Watch for appointment non-attendance Count pills Watch for treatment non-response Examine biochemical evidence  Rates of Adherence DiMatteo (2004) meta-analysis of 500 studies – Average 25% non-adherence Highest in HIV, arthritis, gastrointestinal disorders, & cancer Lowest in pulmonary disease, diabetes, & sleep – Both doctors & patients overestimate adherence  Cost of Non-adherence Medical costs from excessive hospital expenditures to treat non-adherent patients – E.g., 20% of hospital admissions Lost productivity, industry Personal costs (e.g., pain, suffering)  Improving Adherence Communication skills training Educational strategies – E.g., package inserts, lectures, etc. Behavioral strategies – Prompts & reminders Practical social support  Technology E.g., Ware et al. (2019) Patient adherence to a mobile phone– based heart failure telemonitoring program Improved adherence rate, but same decline in adherence over time END  Stress  Health Robert Sapolsky Stress: Portrait of a Killer (56 min)