Further validation of the Patient-Practitioner Orientation Scale (PPOS) from recorded visits for back pain

doi:10.1016/j.pec.2012.07.017

Patient Education and Counseling

Volume 89, Issue 2, November 2012, Pages 288-291

https://doi.org/10.1016/j.pec.2012.07.017 Get rights and content

Abstract

Objective

More patient-centered communication is associated with improved patient satisfaction and health status, fewer malpractice complaints, and increased adherence. In a study of medical encounters for acute low back pain (LBP), we conducted a secondary analysis to assess the validity of the Patient Practitioner Orientation Scale (PPOS), a measure of patient-centeredness.

Methods

Fourteen clinicians and 89 of their patients with acute LBP completed the PPOS and agreed to have verbal exchanges recorded and coded using the Roter Interaction Analysis System (RIAS). We examined correlations between the PPOS and counts of patient and provider utterances within 8 RIAS verbal exchange categories.

Results

Providers with a more patient-centered orientation asked fewer biomedical questions, posed more lifestyle questions, gave more lifestyle advice, and did more rapport-building. Their patients shared more lifestyle information and made more attempts at rapport building and provider engagement. In contrast, the patient-centered orientation of patients showed no effect on communication.

Conclusion

The PPOS scores of providers, but not patients, predicted significant and meaningful differences in the verbal exchanges of patients and providers.

Practice implications

The results support the validity of the PPOS measure and provide further evidence of the extent to which provider orientation influences patient communication and exchange.

Introduction

Patient-centered communication, cultural sensitivity, and shared decision-making have become core values in medicine, and considerable research has been focused on improving communication between healthcare providers and their patients [1]. More patient-centered communication is associated with improved patient satisfaction, fewer malpractice complaints, increased adherence, and improved health status [2], [3], [4]. Few studies of communication, however, have focused on pain, which occupies a substantial proportion of time during primary care visits [5], [6]. More patient-centered strategies might elucidate lifestyle factors, pain beliefs, and treatment preferences shown to influence pain outcomes [7]. When pain is of an occupational origin, open communication may be further compromised by the provider's medico-legal role in assessing work-relatedness and certifying sick leave [8], [9]. Previous findings have shown that workers’ compensation patients are unlikely to mention workplace or psychosocial concerns to their providers, even after endorsing numerous worries in a confidential, pre-visit questionnaire [10], [11].

Much of the existing research on patient-centered communication involves questionnaires designed to assess patient and physician preferences and their correlations with patient outcomes. One such scale is the 18-item Patient-Practitioner Orientation Scale (PPOS) [12], [13], [14], that was developed to assess the extent to which respondents (either patients or providers) believe providers should share equal power and control with patients. While the PPOS shows good psychometric properties and has been validated widely against a range of other attitudinal measures and relevant patient outcomes, the ultimate criterion against which any self-report/attitudinal scale is measured is the actual behavior of patients and providers. In this study we have assessed the relationship between PPOS scores and objectively measured frequency counts of verbal exchange using one of the most widely respected and well-validated measures of its kind, the Roter Interaction Analysis System (RIAS) [15]. This paper therefore provides a further test of the PPOS against an instrument that quantifies actual provider and patient behavior, with physicians as well as non-physicians, and extending its range into pain-related communication.

Section snippets

Providers

Fourteen (9 male, 5 female) clinicians (7 physicians, 4 nurses practitioners, 2 physician assistants, and 1 chiropractor) were recruited from 10 private occupational medicine clinics in the northeastern USA (age range 28–63 years, clinical experience 2–35 years). For most cases of LBP in this setting, providers would be expected to conduct a routine history and physical, with minimal need for pharmacologic intervention and advanced diagnostics [16].

Patients

Ninety-seven patients (62 male, 35 female)

Results

Eighty-nine participants (91.8%) had both complete audiotapes and questionnaire data (the recording device was not properly activated in 3 cases, and 5 participants had incomplete questionnaires). Visit duration was from 3.2 to 31.0 min (M = 15.4, SD = 7.0). The mean number of clinician statements was 256.7 (SD = 99.0) compared with 154.3 by patients (SD = 70.7). Thirty-two percent of provider questions were open-ended, and patients asked a median of 2 questions (range 0–17). Clinician utterances (Table

Discussion and conclusion

In this study, coded verbal exchanges between patients and providers were used to assess the validity of the PPOS self-report measure. The results showed that providers with more patient-centered views did exhibit significant differences in their verbal interactions, including more attention to lifestyle issues, less biomedical focus, and more efforts to establish rapport. This more open-ended and psychosocial approach was also reflected in greater rapport and openness among their patients

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AssessmentFurther validation of the Patient-Practitioner Orientation Scale (PPOS) from recorded visits for back pain

Abstract

Objective

Methods

Results

Conclusion

Practice implications

Introduction

Section snippets

Providers

Patients

Results

Discussion and conclusion

Patient Educ Couns

Patient Educ Couns

Patient Educ Couns

J Spine

Patient Educ Couns

Patient Educ Couns

Provider and patient communication skills training

Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations

Brit Med J

Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons

J Amer Med Assoc

Nurse practitioners’ communication styles and their impact on patient outcomes: an integrated literature review

J Am Acad Nurse Pract

Assessment
Further validation of the Patient-Practitioner Orientation Scale (PPOS) from recorded visits for back pain