How to value patients with psychosis: An inductive study of psychiatrists’ behaviour in routine consultations

Authors

  • Paula John Queen Mary University of London Wolfson Institute of Preventive Medicine
  • Husnara Khanom East London NHS Foundation Trust
  • Michela Cameli Queen Mary University of London Wolfson Institute of Preventive Medicine
  • Rose McCabe University of Exeter Medical School
  • Stefan Priebe Queen Mary University of London Wolfson Institute of Preventive Medicine

DOI:

https://doi.org/10.1558/cam.v12i1.26363

Keywords:

communication, patient satisfaction, psychiatrist behaviour, psychiatric treatment, psychosis, routine care, valuing

Abstract

Valuing patients underlies good communication in psychiatry and mediates positive outcomes. The aim of this study was to (1) identify and reliably assess valuing and devaluing communicative behaviour of psychiatrists in routine consultations, and (2) explore whether valuing behaviour is associated with patient satisfaction. In an inductive study, psychiatrists’ valuing and devaluing behaviours were operationalized and identified in 100 video-recorded consultations with patients with psychosis. Inter-rater reliability of identifying these behaviours was assessed. Associations with patients’ satisfaction were explored using a mixed linear regression model. We identified 18 different valuing behaviours – e.g. seeking patient’s views and supportive statements – and four devaluing behaviours – e.g. talking over the patient and poor responding to concerns – that could be assessed with good reliability. The inter-rater reliability was high (ICC=.89). More valuing behaviour was linked to higher patient satisfaction with the communication (?=.45, CI .14 to.77, p<.01). It was found that psychiatrists value and devalue patients through a wide range of different behaviours, on which there is agreement among different observers. The inductively developed list of valuing behaviours may be validated through the association with higher patient satisfaction. The behaviours may be used in training and supervision to enhance the valuing of patients in consultations.

Author Biographies

Paula John, Queen Mary University of London Wolfson Institute of Preventive Medicine

Paula John is research assistant at the Centre for Psychiatry at Queen Mary University of London, working on the VOLUME (Volunteering in mental health Care for People with Psychosis) project. She is also conducting a part-time PhD on interactions in helpful relationships for patients with psychosis, and previously at the unit for Social and Community Psychiatry she project managed a pilot RCT on developing and piloting a new intervention to improve communication with patients with psychosis.

Husnara Khanom, East London NHS Foundation Trust

Husnara Khanom is a researcher at the unit of Social and Community Psychiatry at Queen Mary University of London, working on patient preferences for different styles of consultant communication and shared decision-making in ongoing outpatient psychiatric treatment. address for correspondence:

Michela Cameli, Queen Mary University of London Wolfson Institute of Preventive Medicine

Michela Cameli studied medicine and psychiatry at the University of Modena, Italy. Since may 2010, she has undertaken clinical and research activities at the Department of Psychiatry, University of Modena e Reggio Emilia, as a psychiatric trainee. from September 2013 to march 2014 she was a visiting honorary research assistant at the academic unit of the Newham Centre for mental health and unit for Social and Community Psychiatry of the Queen Mary University of London. her research interests include psychosomatic disorders, liaison psychiatry, psychotherapy sessions and psychoeducational interventions in patients with eating disorders, psychiatric rehabilitation, and psycho-pharmacology interventions in elderly with psychiatric disorders.

Rose McCabe, University of Exeter Medical School

Rose McCabe trained as psychologist and worked in the unit for Social and Community Psychiatry as research fellow up until 2013 when she left to take up her post as Professor of Clinical Communication at the university of Exeter medical School. her work focuses on analysing treatment processes, in particular clinical consultations, to identify challenges along with effective communication. She uses multiple methods to analyse communication, including conversation analysis, 3D motion capture, and computational linguistic techniques.

Stefan Priebe, Queen Mary University of London Wolfson Institute of Preventive Medicine

Stefan Priebe qualified as a psychiatrist and psychotherapist at the Free University Berlin. he has been Chair for Social and Community Psychiatry at Queen Mary, University of London since 1997, and is currently Director of a research unit focusing on psychosocial processes and outcomes of mental health care. he is also the principal investigator on a number of national and international studies, and he has produced more than 400 peer-reviewed publications. understanding therapeutic relationships and patient-clinician communication is core to his research activities.

Published

2016-06-07

How to Cite

John, P., Khanom, H., Cameli, M., McCabe, R., & Priebe, S. (2016). How to value patients with psychosis: An inductive study of psychiatrists’ behaviour in routine consultations. Communication and Medicine, 12(1), 55–69. https://doi.org/10.1558/cam.v12i1.26363

Issue

Section

Articles