IMPROVING PHYSICIANS INTERVIEWING SKILLS AND REDUCING PATIENTS EMOTIONAL DISTRESS - A RANDOMIZED CLINICAL-TRIAL

Background: Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounter s. Objective: To explore the effect of communication-skills training o n the process and outcome of care associated with patients' emotional distress. Methods: A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communica tion-skills training courses designed to help physicians address patie nts' emotional distress. The two training courses addressed communicat ion through problem-defining skills or emotion-handling skills. All of fice visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on pat ient response to the General Health Questionnaire. Physicians were als o audiotaped interviewing a simulated patient to evaluate clinical pro ficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conduc ted 2 weeks, 3 months, and 6 months after their audiotaped office visi ts. Results: Audiotape analysis of actual and simulated patients showe d that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increa sing the length of the visit. Trained physicians also reported more ps ychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficie ncy with simulated patients. Patients of trained physicians reported r eduction in emotional distress for as long as 6 months. Conclusions: I mportant changes in physicians' communication skills were evident afte r an 8-hour program. The training improved the process and outcome of care without lengthening the visits.