Interdisciplinary research on patient-provider communication: a cross-method comparison

Patient-provider communication, a key aspect of healthcare delivery, has been assessed through multiple methods for purposes of research, education, and quality control. Common techniques include satisfaction ratings and quantitatively- and qualitatively-oriented direct observations. Identifying the strengths and weaknesses of different approaches is critically important in determining the appropriate assessment method for a specific research or practical goal. Analyzing ten videotaped simulated encounters between medical students and Standardized Patients (SPs), this study compared three existing assessment methods through the same data set. Methods included: (1) dichotomized SP ratings on students' communication skills; (2) Roter Interaction Analysis System (RIAS) analysis; and (3) inductive discourse analysis informed by sociolinguistic theories. The large dichotomous contrast between good and poor ratings in (1) was not evidenced in any of the other methods. Following a discussion of strengths and weaknesses of each approach, we pilot-tested a combined assessment done by coders blinded to results of (1)-(3). This type of integrative approach has the potential of adding a quantifiable dimension to qualitative, discourse-based observations. Subjecting the same data set to separate analytic methods provides an excellent opportunity for methodological comparisons with the goal of informing future assessment of clinical encounters.