Patient-centered communication scoring method report on nine coded interviews

Based on the patient-centered clinical method (Brown, Weston, & Stewart, 19 89; Levenstein, McCracken, McWhinney, Stewart, & Brown, 1986; Stewart, 1995 ; Weston, Brown, & Stewart, 1989), a method of scoring patient-doctor encou nters that were either audiotaped or videotaped was developed. This scoring procedure has several advantages over the commonly used methods (Bales, 19 50; Kaplan, Greenfield, & Ware, 1989; Roter, 1977; Roter, Cole, Kern, Barke r, & Grayson, 1990; Stewart, 1984): (a) It does not require that the taped interview between the patient and the doctor be transcribed; and (b) it is theory based, that is, it was developed specifically to assess the behavior s of patients and doctors ascribed by the patient-centered clinical method (Stewart, 1995). The scoring procedure was described fully in a working paper titled "Assess ing Communication Between Patients and Doctors: A Manual for Scoring Patien t-Centered Communication" (Brown, Stewart, & Tessier, 1995). Interrater rel iability of an earlier version of the scoring was established among three r aters at r = .687, .835, and .803 (Brown, Stewart, McCracken, McWhinney, & Levenstein, 1986). A more recent study (Stewart et al., 2000), using the cu rrent version, established an interrater reliability of .83 and an intrarat er reliability of .73. The validity of the scoring procedure was establishe d by a high correlation (.85) with global scores of experienced communicati on researchers (Stewart et al., 2000). The measure allows scores to range theoretically from 0 (not at all patient -centered) to 100 (very patient-centered) communication and includes three main components. The first component, exploring both the disease and illnes s experience, involves physicians' understanding two conceptualizations of ill health that need to be explored with patients-disease and illness. The second component, understanding the whole person, involves physicians explo ring the context of a patient's life setting (e.g., family, work, social su pports) and stage of personal development (e.g., life cycle). The third com ponent of the model deals with finding common ground. An effective manageme nt plan requires that physicians and patients reach a mutual understanding and mutual agreement in three key areas: the nature of the problems and pri orities, the goals of treatment and management, and the roles of the doctor and patient.