Methods and theory for improving medical communication

Healthy reasoning’: using heuristics in medical decision making

Sarah Bigi

According to the WHO, chronic conditions cause 63% of deaths globally. Especially in Western countries, the increasing aging of the population and stronger impact of comorbility and chronic conditions are seriously challenging the sustainability of health care systems.

In this scenario, prevention becomes a fundamental goal: prevention of chronic diseases, but also of the complications connected to them, which are caused by a bad management of the disease itself. In a situation of chronicity and comorbility, prevention is achieved by considering patients as active agents in the process of care, by motivating and helping them make long-term commitments to healthier lifestyles. These have become therapeutic goals in their own right, which can only be achieved through an effective use of communication during the consultation.

The research project “Healthy reasoning. Strategies and mechanisms of persuasion in chronic care” aims at testing the usability and effectiveness of heuristic strategies – or ‘irrational’ reasoning – in the decision making process within the medical consultation with chronic patients. Decision making comes into play during the crucial phase of the consultation in which doctors and patients discuss treatment or behavior change. In particular with regard to behavior change, it is extremely important that patients are involved, not only for ethical reasons, but also because involvement has been shown to be strongly linked to commitment and, eventually, to adherence. However, existing literature on ‘shared decision making’ in the consultation and on the ‘motivational interview’ recommends avoiding ‘argumentation’, which seems to be considered only in its more rational form.  This would seem to allow no space for insights coming from the field of Argumentation Theory, but what emerges from the aforementioned studies can be easily integrated in an approach to decision making in the consultation in which argumentation is considered as a macro-category encompassing ‘rational’ and ‘irrational’ uses of argument.

Based on a strong theoretical foundation, the experimental phases of the project involve the operationalization of heuristic strategies and their use within the decision making phases of real life consultations with diabetes patients. To this end, a sample of doctors from different regions of Italy are being recruited to participate in the experimental phase.

The presentation will outline the theoretical and methodological design of the project, highlighting the similarities and differences of the approach taken in comparison with the literature on ‘shared decision making’ and on the ‘motivational interview’.

Information on Patients’ Medical Knowledge in Health Counselling: How Can Communication Become More Patient-Centred?

Elisabeth Mayweg-Paus, Regina Jucks, Rainer Bromme

The success of health communication is not solely determined by a well-considered selection of the information introduced into the counselling process but also by the communicative skills of physicians and other health care providers. Here, one central challenge is to communicate health information in a way that it is intelligible to the patient. In this talk, I will report two studies examining how physicians use information about a patient’s background knowledge when both anticipating what a patient knows and producing actual answers in an email counseling setting.

A fictitious patient used a (high vs. low) level of technical jargon in an email inquiry about diabetes and provided explicit information on prior knowledge (high vs. low) through self-report. Final-year medical students (semi-experts) were asked to gauge the patient’s knowledge level (Experiment 1) and to produce an answer to the inquiry (Experiment 2). A total of N = 150 participated in one of the two experiments. The finding shed light on how semi-experts use different hints on the patient’s knowledge level: Whereas knowledge anticipation is influenced mainly by direct information on the patient’s knowledge level as provided in self-reports, the way responses are formulated also depends to some extent on lexical aspects, like word use, of the patient’s inquiry. More specifically, the answers were more technical when the inquiry used technical jargon instead of everyday language.

Knowledge anticipation and communication behavior in email health care seem to be guided by different hints regarding the patient, suggesting the existence of two separate mechanisms. Beyond merely teaching physicians or health care providers to be aware of the patient’s knowledge level when formulating a patient-centered response, on-task methods should support health care providers during the actual communication phase by providing, for instance, metacognitive prompts.