The objective of this project is to analyze moment-by-moment the verbal and non-verbal communication that occurs between physician and patient during a medical encounter, as well as patients' perceptions of this communication. In our analysis, we intend to uncover recurring patterns of moment-by-moment verbal and non-verbal acts that trigger patients' overall perceptions of their physician and the medical encounter. To date, """"""""conventional"""""""" physician-patient communication research has been limited to comparison of patients' overall perceptions with overall totals of communication acts tallied from an entire medical encounter (up to 25-30 minutes in length). We will shift the focus of analysis to a micro level of detail by employing postencounter stimulated recall, an adaptation of a measurement technique used for many years in other fields of research. The general conceptual model of physician-patient communication, that is, effective communication leading to improved patient perceptions, to better patient self-monitoring behaviors and ultimately to improved patient health outcomes, has come to be accepted as working theory in the medical and communication sciences. Therefore, physicians and patients stand to increase desirable patient physiological outcomes by understanding what drives the moment-by-moment evolution of patients' perceptions and by recognizing the specific verbal and non-verbal acts that are most often associated with the emergence of those perceptions. We posit that the application of post-encounter stimulated recall to physician-patient communication research will provide researchers new information that may help them identify in physician-patient encounters """"""""moments that make a difference"""""""" in patient outcomes. We propose to execute this project in three phases, corresponding to the following specific aims:
Specific Aim 1) To test a computer-based technique for administering post-encounter stimulated recall, ensuring that patients are able to use the system as intended;
Specific Aim 2) To develop and test the reliability of a communication coding system for non-verbal acts that focuses on the same constructs of physician-patient communication as an existing system for verbal acts;
Specific Aim 3) To demonstrate that verbal and non-verbal acts specifically identified by patients as driving their perceptions of physician and medical encounter predict patients' overall post-encounter perceptions better than """"""""conventional"""""""" overall totals of acts do. ? ? ? ?
