A Feasibility Study of a Method of Quantifying Dentist-Patient Communication

1. A Feasibility Study of a Method of Quantifying Dentist-Patient Communication A. Koerber,*1 S. Gajendra,2 R. Fulford,1 E. BeGole, 1 I. Punwani, 1 C.A. Evans 1 1University of Illinois College of Dentistry, 2University of Illinois at Springfield Abstract Roter (1995) devised and validated a method of quantifying physician-patient communication (Roter's Interaction Analysis System/RIAS) which improves physician skills and patient satisfaction. Objectives: We sought to determine whether a modified version was valid and feasible for measuring dentist-patient communication. Method: In a pilot study, a version was used to code audio-tapes of sessions between orthodontic residents and adolescent patients. Roter's 40 categories of utterances were combined into 20. Three RAs coded the utterances into categories, and rated the dentist for Warmth on a 5-point scale. To establish reliability, ten tapes were coded by all raters. Validation of the modified method was tested in two ways: were the two kinds of dental sessions characterized by different types of utterances (Sondell, 1998), and did certain types of utterances correlate appropriately with Warmth of the dentist? Results: 57 Records sessions and 25 Treatment-Plan-Presentation sessions were recorded and coded. Only the dentists' statements were recorded. Inter-rater reliability of the modified method was .80 (Cohen's kappa), but it added an unnecessary step to Roter's method. The patterns of communication differed significantly between the two types of sessions (MANOVA, p<.000). Using a Bonferroni correction (a=.005), the Records sessions were characterized by significantly longer time and more approval, orientation, checks for understanding, and open- and close-ended questions. Treatment-Plan-Presentation sessions contained more giving of information and more instructions. Warmth of the dentist correlated significantly with personal, laughter, approving, empathy, and encouragement utterances (Spearman's rho, a =.005). Conclusions: Roter's original method is easier than our modified method for coding dental communication. Patient utterances are an important part of the RIAS, so we must overcome the difficulties of recording patients. Even with the modifications, RIAS is a reliable and valid method for measuring communication in dental settings. The RIAS shows promise for training and research purposes in dentistry. Objective To determine the validity and feasibility of the Roter Interaction Analysis System (RIAS) for quantifying dentists’ communication. Method 1. RIAS modification 2. Data Collection a. 57 Records Sessions audio-taped. c. 25 Treatment Planning Sessions. d. 70 adolescent patients. e. 16 orthodontic residents. f. 3 Raters coded 10 tapes for an inter-rater reliability of .80 (Cohen’s Kappa). 3. Measures a. Raters scored dentists on Warmth on a 5 point Likert Scale. b. 20 types of utterances. Discussion Strengths of RIAS: 1. Good inter-rater reliability is obtainable with training. 2. RIAS shows validity: it distinguishes between types of sessions. 3. Appropriate utterances correlate with Warmth. 4. Objective method of assessing communication skills. Limitations of RIAS & of study: 1. Statistical analysis is difficult-- data are not normally distributed. 2. Collapsing the variables made coding more difficult. 3. Requires rater training. 4. Small provider sample. Validity: Utterance Differences by Session • Background • The Roter Interaction Analysis System (RIAS) has been used to quantify medical communication (Roter, 1995). • It is a valid and reliable method of measuring and evaluating medical communication (Levinson, Roter, & Mullooly,1997). • The RIAS has been used to improve physicians’ communication (Roter, et al., 1998) and to increase patient satisfaction (Hall, et al., 1994). • This method has been validated in a prosthodontic setting (Sondell, et al., 1998). Results Validity: Appropriate Utterances Correlate with Ratings of Warmth Conclusions 1. RIAS scoring differentiates between types of sessions. 2. The appropriate RIAS utterances correlate with ratings of warmth. 3. Information was lost by not coding the patient utterances. 4. The original RIAS is easier to use than our modified system. 5. Even with the modifications, RIAS is a reliable and valid method for measuring communication in a dental setting. 6. The RIAS method shows promise for training and research purposes in dentistry. References 1. Hall, J.A., Irish, J.T., Roter, D.L., Ehrlich, C.M., Miller, L.H. (1994b). Satisfaction, gender, and communication in medical visits. Medical Care, 32(12), 1216-1231. 2. Levinson, W., Roter, D., Mullooly, J.P. (1997). The relationship with malpractice claims among primary care physicians and surgeons. Journal of American Medical Association. 277(7), 553-559. 3. Roter D. (1995). The Roter Method of Interaction Process Analysis, (3rd ed.) Baltimore, MD: Johns Hopkins University School of Hygiene and Public Health. 4. Roter D; Rosenbaum J; De Negri B; Renaud D; Diprete-Brown L; Hernadez O. (1998)The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Medical Education , 32(2): 181-9 5. Sondell, K., Soderfeldt, B., Palmquist. (1998). A method for communication analysis in prosthodontics. Acta Odontololica Scandinavica.56(1), 48-56. Mann-Whitney U Tests. Bonferroni Correction, a=.002