A systematic review 1 including 36 studies was abstracted in DARE. 21 trials reported on various communication behaviours of physicians and residents/registrars involving a total of 594 practising physicians and 758 residents/registrars. The interventions used were classified as information (instructions to change behaviour, e.g. written instructions, leaflets, readings, case reviews, lectures), feedback, modelling (demonstration of the behaviour in written models, in person or as videotapes) and practice (rehearsal of the behaviour as coaching sessions and role play). Multiple type interventions were more common with physicians, whereas single type interventions (mostly information) were more commonly directed at patients. Most of the studies reported significant effects on one or more outcomes. Physicians who received high-intensity interventions were more likely to elicit patient concerns (significant effect in 3 out of 4 studies) and exhibit a patient-centred style (significant effect in 5 out of 6 studies). They were also more likely to express empathy (5 studies), although in one study the initial effect was not sustained after 12 months. Significant improvement in information giving was shown in 6 out of 7 studies of high-intensity interventions. In 4 out 5 studies there was a significant effect on physician behaviour to verify patient understanding of the information given. 18 studies reported on various communication behaviours of patients (n=2339). The findings were mixed. High- or moderate-intensity interventions showed significant effects on patient participation, whereas no effect was observed in 2 studies of low-intensity interventions. Two out of 3 studies reported a significant effect on information verifying behaviour.
Comment: The quality of evidence is downgraded by study quality (methodological aspects of the included studies were assessed but the findings were not used in the interpretation of the results) and by potential reporting bias.
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