S24 Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41

munication variables. Variables seldom examined by this study, satisfaction data is used to generate feedbackresearchers, for example, were considered to be highly for doctors and evaluate changes in communication skillsvalued by patients. Furthermore examination of the following training interventions.degree of patient evaluation meant that the most positive

How do patients influence surgeons to operate in theor negative aspects of a specific variable could be

absence of physical pathology?identified. The present research clearly indicated that inorder to reflect a true measurement of patient satisfaction, Peter Salmon (a), Susan Marchant-Haycox. (a) Depart-future research would benefit from inclusion of items ment of Clinical Psychology, University of Liverpool,obtained from the patients perspective. Whelan Building, Brownlow Hill, Liverpool L69 3GB,

UK.Patient satisfaction with communication: a new in-

Introduction. Physical treatment is frequently provided instrumentresponse to subjective symptoms with no confirmedphysical basis. In this way, many patients receive expen-Denise Ratcliffe (a), Anna Souhami, Sarah Ford, Lesleysive and invasive treatment which is inappropriate andFallowfield. (a) CRC Psychosocial Oncology Group,may even be harmful. It is important to understand howDepartment of Oncology, University College Londonsuch treatment decisions are made. Previous work hasMedical School, 3rd Floor, Bland Sutton Institute, 48emphasized the influence exerted by the doctor. In aRiding House Street, London, W1P 7PL, England.programme of research we are studying the influence

Introduction. Patients are manifestly unhappy with much exerted by the patient. Using qualitative methods weof the communication that takes place between them- have identified ways in which patients who presentselves and their doctors. Satisfaction with communication subjective physical symptoms influence surgeons tohas been shown to improve compliance, reduce anxiety, administer major surgery in the absence of pathology.improve recall and increase overall satisfaction with These patients did not emphasize the intensity or naturemedical care. Currently the standardised measures of of symptoms but, instead, emphasized psychosocialpatient satisfaction are not visit specific nor relevant to distress and pressed medical explanations for their symp-British hospitals, and tend to focus on the general toms upon the surgeons.hospital experience rather than satisfaction with the Methods. These studies have enabled us to devize adoctor-patient interaction. report the development of a method of coding surgeons’ and patients’ speech so as topatient satisfaction instrument for use when evaluating quantify their use of strategies to influence the treatmentinterventions aimed at improving communications. decision. We have used this to test a theory of patient andMethod. The original Patient Satisfaction Questionnaire surgeon strategies that influence the decision for hy-developed by Ware et al (1976) contains 51 items. Items sterectomy for subjective menstrual symptoms in theinappropriate for use in British National Health Service absence of physical pathology. We audiotape-recordedhospitals were omitted or Anglicised where possible. The consultations of 88 patients with gynaecologists in 5remaining 28 items were made visit-specific, and related English hospitals. Patients (i) complained of menstrualto the patient’s experience of the interaction. Patients pain and bleeding (ii) had been investigated with nega-were asked to agree or disagree on a five-item Likert tive results. Interviews were coded according to thescale to statements of opinion about the consultation just previously devized scheme. We contrasted the 15 con-attended. The items were refined over 3 pilot studies. sultations in which the decision was made for hysterec-Results. Following factor analysis, 17 questions were tomy with the 73 at which conservative treatment wasretained which appear to tap 3 separate dimensions of instituted.patient satisfaction: confidence in doctor, doctor’s man- Results. Interrater reliability of coding was high. Therener /approach and information giving. Psychometric was no difference between groups receiving hysterec-properties of the questionnaire will be discussed along tomy and conservative treatment in the way symptomswith data from 629 cancer patients collected from major were described. Instead, patients receiving hysterectomyUK cancer centres. The instrument effectively discrimi- were characterized by their complaints of psychosocialnates between satisfied and dissatisfied patients. Waiting distress. They ‘catastrophized’ their symptoms, criticisedtime in clinic, level of distress and the patient’s age have previous medical treatment and requested hysterectomy,a powerful influence on the overall satisfaction score citing other doctors or friends in support of this.obtained. Conclusions. The results are consistent with our develop-Conclusion. The PSCQ is a reliable and valid instrument ing theory that, in the absence of physical pathology,which is capable of measuring subtle differences in surgeon-patient interaction can become an activity ofpatients’ evaluations. The use of the instrument as an opponents: the patient aiming to give responsibility to theoutcome measure will be demonstrated with examples surgeon for her distress, the surgeon aiming to resist thatfrom the CRC Psychosocial Oncology Group randomised responsibility. The results and theory have important impli-trial of communication skills training for oncologists. In cations for the teaching of communication to doctors.