Resources
Bibiliography and Abstracts of RIAS Studies through 2014

Following are abstracts of RIAS studies, listed in alphabetical order by first author. Just click on a letter below to view the abstracts by the author's last name. Monographs and doctoral theses have their own page.

A     B     C     D     E     F     G     H     I     J     K     L     M     N     O     P     Q     R     S

T     U     V     W     X     Y     Z     Monographs & Theses

T

Tates K, Meeuwesen L, Bensing J, Elbers E. Joking or decision-making? Affective and instrumental behaviour in doctor-patient-child communication. Psychology and Health 2004, 17(3): 281-295.
(Primary Care, Netherlands)
Advocating active child participation in medical encounters is in line with demands for shared decision-making and informed consent. The sparse literature on doctor-child communication, however, conceptualizes children as passive participants and depicts the stereotype of a ‘joking’ relationship, which is limited mainly to affective behaviour. This descriptive study explores the nature of communication in the doctor-parent-child triad at the general practitioner’s surgery. Video-taped observations of 106 medical interviews were analyzed in terms of affective and instrumental behaviour. An adjusted version of the Roter Interaction Analysis System (RIAS) was used to analyze the doctor-parent-child triad. The videos, taken over a period of over almost twenty years, made it possible to look for the presence of effects over time. The results show that the stereotype of doctor-child interaction as a joking relationship doe not hold true. In fact, besides affective behaviour, there was more exchange of instrumental behavior. The age if the child was positively related to child participation. Time appears to have had a rather limited effect on the child’s participation. Whereas GPs accommodated their behaviour to the child’s age by displaying more instrumental behaviour towards older children the nature of parental behavior appeared to be almost constant. The results are discussed in terms of the relevance for shared decision-making in medical consultations regarding children, and recommendations are given for medical practice and health education.

Theadom A, de Lusignan S, Wilson E, Chan T. Using three-channel video to evaluate the impact of the use of the computer on the patient-centredness of the general practice consultation. Inform Prim Care. 2003;11(3):149-56.
(Primary Care, Computer Use, United Kingdom)
The aim of this study was to assess the feasibility of using three-channel video to explore the impact of the computer on general practitioner (GP) consultations. A previous study had highlighted the limitations of using single-channel video: firstly, there was a lack of information about exactly how the computer was being used, and secondly difficulty in interpreting the body language of the consulting clinician. More information was needed to understand the impact of the computer on the consultation, and in this pilot three-channel video was used to overcome these constraints. Four doctors consulted, with the patient's role played by an actor with a preset script and preloaded personal and family history record programmed into the computer. The output was analysed using the Roter Interaction Analysis System (RIAS) and observational methods were used to explore the effect of computers on aspects of verbal and non-verbal behaviour and the completeness of the computer data record. Three-channel video proved to be a feasible and valuable technique for the analysis of primary care GP consultations, with advantages over single-channel video. Interesting differences in non-verbal and verbal behaviour became apparent with different types of computer use during the consultation. Implications for the three-channel video technique for training, monitoring GP competence and providing feedback are discussed.

Thornton RL, Powe NR, Roter D, Cooper LA. Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality. Patient Educ Couns. 2011 Dec;85(3):e201-8. Epub 2011 Aug 12.
(Race/Cross-Culture, Patient Satisfaction, United States)
Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians. OBJECTIVE: To determine whether social concordance predicts differences in medical visit communication and patients' perceptions of care. METHODS: Regression analyses were used to determine the association of patient-provider social concordance with medical visit communication and patients' perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area. RESULTS: Lower patient-physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient-physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR=0.64 vs. OR=1.37, p=0.036) and were less likely to recommend their physician to a friend (OR=0.61 vs. OR=1.37, p=0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care. CONCLUSION: Patient-physician concordance across multiple social characteristics may have cumulative effects on patient-physician communication and perceptions of care. PRACTICE IMPLICATIONS: Research should move beyond one-dimensional measures of patient-physician concordance to understand how multiple social characteristics influence health care quality.

Timmermans LM, van der Maazen RW, van Spaendonck KP, Leer JW, Kraaimaat FW. Enhancing patient participation by training radiation oncologists. Patient Educ Couns. 2006 Oct;63(1-2):55-63.
(Radiotherapy, The Netherlands)
OBJECTIVE: Several studies have shown that patients' active participation to their medical interaction is beneficial for their information processing and their quality of life. Unfortunately, cancer patients often act rather passively in contact with their oncologists. We investigated whether cancer patients' participation in radiation therapy consultations could be enhanced by specific communicative behaviours of the radiation oncologists (ROs). METHODS: Eight ROs and 160 patients participated; 80 patients in the pre training group and 80 patients in the post training group. The ROs were trained to use specific communicative behaviours that are supposed to encourage patient participation. In the training special attention was paid to communicative requirements in the first minutes of the consultation. The communicative behaviours of the ROs and the cancer patients were measured by the Roter Interaction Analysis System, and compared before and after the RO training. RESULTS: From the start throughout the entire consultation, patients in the post training group participated more in interactions than patients in the pre training group: they discussed more psychosocial issues, expressed more concerns and contributed more to decision-making. CONCLUSION: Cancer patients' participation in the initial radiation oncology consultations can be increased by training of ROs. PRACTICE IMPLICATIONS: The results suggest that doctors working with cancer patients should receive communication training and feedback on a regular base.

Timmermans LM, van der Maazen RW, Leer JW, Kraaimaat FW. Palliative or curative treatment intent affects communication in radiation therapy consultations. Psychooncology. 2006 Aug;15(8):713-25.
(Radiotherapy, Palliative Care, The Netherlands)
Objective: To assess whether communication in radiotherapy consultations is affected by palliative or curative treatment intent. Subjects and methods: The study involved 160 patients and 8 radiation oncologists. Eighty patients visited the radiation oncologist (RO) for palliative treatment and 80 for curative treatment. The consultation prior to radiation treatment was analyzed with the Roter Interaction Analysis System (RIAS). Within three days, patients completed a quality of life questionnaire (EORTC-QLQ-C30).Results: In palliative radiotherapy (PRT) consultations, ROs asked more (closed-ended) biomedical and psychosocial questions and provided more information on prognosis than in consultations for curative radiotherapy (CRT). Patients in both groups provided a great deal of psychosocial information but asked few questions. The ROs expressed more concerns in the PRT consultations, while patients did not. PRT patients received fewer supportive remarks than CRT patients. In both groups, explicit decision-making received little attention. Proxies who accompanied the patients took a more active role in PRT than in CRT consultations.Conclusion: Communication in radiotherapy is affected by treatment intent with respect to the main contents of the consultation.

Timmermans LM, van der Maazen RW, Verhaak CM, van Roosmalen MS, van Daal WA, Kraaimaat FW. Patient participation in discussing palliative radiotherapy. Patient Educ. Couns. 2005 Apr; 57(1):53-61.
(Palliative Care, Netherlands)
Cancer patients' participation in doctor-patient interactions has been shown to be an important factor in the emotional processing of their condition, particularly when only palliative treatments can be offered. In this study, we assessed incurable cancer patients' participation in initial consultations with their radiation oncologists (ROs). RO stimulation of patient participation and discussions about treatment decisions were also measured. The entire consultation was videotaped and analyzed using the Roter Interaction Analysis System (RIAS). Patients' participation proved to be low on medical information, but high on discussing their experiences and life circumstances. The ROs stimulated patient participation mainly by providing medical information and giving patients opportunities to tell their stories. Decisions about radiation treatment had previously taken place and were rarely discussed in the consultations studied. The results suggest that patient participation in palliative treatment consultations might be improved for facilitating patients' emotional processing of the incurable nature of their cancer.

Timmermans LM, van Zuuren FJ, van der Maazen RW, Leer JW, Kraaimaat FW. Monitoring and blunting in palliative and curative radiotherapy consultations. Psychooncology. 2007 Dec;16(12):1111-20.
(Palliative Care, Netherlands)
Objective: The present research paper investigates how cancer patients' monitoring and blunting coping styles are reflected in their communications during their initial radiotherapy consultations and in their evaluations of the consultation. Additionally, it is explored how a patient's disease status (curative versus palliative) influences the effects of his or her cognitive styles.Methods: The study included 116 oncology patients receiving treatment from eight radiation oncologists. For 56 patients treatment intent was palliative and for the remaining 60 curative. The patients' communicative behaviors were assessed using the Roter Interaction Analysis System (RIAS). Within three days the patients completed a monitoring and blunting inventory and after another six weeks they evaluated the treatment decision and treatment information by postal questionnaire.Results: Monitoring was positively and blunting negatively related to the patient's expression of questions, emotions and decision-making issues. After six weeks 'high monitors' as opposed to 'low monitors' reported having more doubts about the treatment decision and being less satisfied with the information received while 'high blunters' expressed fewer doubts and more satisfaction than 'low blunters' did. Significant associations were all attributable to the palliative treatment group.Conclusion: Cancer patients' communicative behaviors vis-à-vis their oncologist hinge on their cognitive styles and an unfavorable disease status enhances the effects. Copyright (c) 2007 John Wiley & Sons

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