Patient-centered communication in digital medical encounters.
Jordan M Alpert, Karen E Dyer, Jennifer Elston Lafata
PMID 28522229WHAT IT FOUND
In patient portal messages, 46.6% of patient-initiated threads received a patient-centered provider response, but many replies were brief and did not address patients’ emotional cues.
Physicians used patient-centered replies more often than nurses.
Key findings
01Patient messages mainly sought solutions, clarification or next steps, and made administrative requests.
0246.6% of patient-initiated message threads contained a patient-centered provider response.
03Physicians used patient-centered responses in 58.1% of message threads versus 23.5% for nurses.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis covered only 58 patient-initiated message threads collected over one week in one health system, so it may not represent other clinics, providers or times of year. Patient-centered communication codes were developed for face-to-face visits, so they may miss behaviors that matter in written portal messages. The study did not know whether patients preferred brief replies or wanted supportive talk and partnership building language. Messages sent after the one-week period, phone calls, or follow-up appointments were not captured, so some provider patient-centered responses may be underestimated. Threads without a provider response were excluded, and four patients had missing demographic data while six providers had missing department information.
The easy way to misread this
Do not conclude that portal messaging is harmful to patient-centered care or that nurses are worse communicators. This was a one-week analysis of 58 threads, and the physician versus nurse difference may reflect how messages were initially routed to doctors and the small sample. The study did not test patient satisfaction, trust or health outcomes.